Grand Lake Health System
Grand Lake Health System in Saint Marys, OH publishes cash prices for 350 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 Ohio median for 264 of 346 procedures and below it for 80. By typical cash price it ranks #120 of 137 Ohio hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
200 Saint Clair Street, Saint Marys, OH 45885 Collected Sep 28, 2026 Source price file (419) 394-3335
Acute care hospital Emergency department CMS star rating 4 of 5 CCN 360032 · CMS hospital register NPI 1639133002
CMS price transparency record
The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 3 actions for a hospital named Grand Lake Health System in Saint Marys, OH:
- Oct 7, 2024 Warning notice
- Jan 14, 2025 Case closed
- Jun 17, 2026 Warning notice
Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems.
A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Ohio | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT ABD W/WO CONTRAST | $2,994.30 | $3,327.00 | — | 127% above | 10% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABD W/WO CONTRAST | $2,994.30 | $3,327.00 | — | — | 10% |
| Abdominal X-ray, 2 views CPT 74019 ABDOMEN-2 VIEWS | $371.70 | $413.00 | — | 8% above | 10% |
| Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN-2 VIEWS | $371.70 | $413.00 | — | — | 10% |
| Ankle X-ray, complete, 3 or more views CPT 73610 LT ANKLE COMPLE W/STRESS VIEWS | $415.80 | $462.00 | — | 29% above | 10% |
| Ankle X-ray, complete, 3 or more views CPT 73610 RT ANKLE COMPLE W/STRESS VIEWS | $415.80 | $462.00 | — | 29% above | 10% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 LEFT ANKLE COMPLETE | $347.40 | $386.00 | — | 7% above | 10% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 RIGHT ANKLE COMPLETE | $347.40 | $386.00 | — | 7% above | 10% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 LT ANKLE COMPLE W/STRESS VIEWS | $415.80 | $462.00 | — | — | 10% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RT ANKLE COMPLE W/STRESS VIEWS | $415.80 | $462.00 | — | — | 10% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 RIGHT ANKLE COMPLETE | $347.40 | $386.00 | — | — | 10% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 LEFT ANKLE COMPLETE | $347.40 | $386.00 | — | — | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 WC-US EXT SINGLE-BILAT PHYSIOL | $208.80 | $232.00 | — | — | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US LOWER EXT ART 1LEVEL PHYSIO | $620.10 | $689.00 | — | 29% above | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 WC-US EXT SINGLE-BILAT PHYSIOL | $208.80 | $232.00 | — | — | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US LOWER EXT ART 1LEVEL PHYSIO | $620.10 | $689.00 | — | — | 10% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT RT UPPER EXTREM WO CONTRAS | $1,847.70 | $2,053.00 | — | 96% above | 10% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT LT UPPER EXTREM WO CONTRAST | $1,847.70 | $2,053.00 | — | 96% above | 10% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT RT UPPER EXTREM WO CONTRAS | $1,847.70 | $2,053.00 | — | — | 10% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT LT UPPER EXTREM WO CONTRAST | $1,847.70 | $2,053.00 | — | — | 10% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS | $667.80 | $742.00 | — | 52% above | 10% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGUS | $667.80 | $742.00 | — | — | 10% |
| Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE SCAN WHOLE BODY | $1,738.80 | $1,932.00 | — | 13% above | 10% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE SCAN WHOLE BODY | $1,738.80 | $1,932.00 | — | — | 10% |
| Breast ultrasound, complete, one breast one side CPT 76641 US RT BREAST COMPLETE | $1,069.20 | $1,188.00 | — | 124% above | 10% |
| Breast ultrasound, complete, one breast one side CPT 76641 US LT BREAST COMPLETE | $1,069.20 | $1,188.00 | — | 124% above | 10% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US LT BREAST COMPLETE | $1,069.20 | $1,188.00 | — | — | 10% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US RT BREAST COMPLETE | $1,069.20 | $1,188.00 | — | — | 10% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US RT BREAST LIMITED | $574.20 | $638.00 | — | 40% above | 10% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US LT BREAST LIMITED | $574.20 | $638.00 | — | 40% above | 10% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US LT BREAST LIMITED | $574.20 | $638.00 | — | — | 10% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US RT BREAST LIMITED | $574.20 | $638.00 | — | — | 10% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABD & PELVIS | $4,364.10 | $4,849.00 | — | 106% above | 10% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ANGIO ABD & PELVIS | $4,364.10 | $4,849.00 | — | — | 10% |
| CT angiography (CTA) of the head CPT 70496 CT ANGIO HEAD | $2,544.30 | $2,827.00 | — | 91% above | 10% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIO HEAD | $2,544.30 | $2,827.00 | — | — | 10% |
| CT angiography (CTA) of the neck CPT 70498 CT ANGIO NECK | $3,249.00 | $3,610.00 | — | 149% above | 10% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIO NECK | $3,249.00 | $3,610.00 | — | — | 10% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST | $3,093.30 | $3,437.00 | — | 118% above | 10% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST | $3,093.30 | $3,437.00 | — | — | 10% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT KID STONE ABD & PELVIS WO C | $3,282.30 | $3,647.00 | — | 109% above | 10% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST | $3,282.30 | $3,647.00 | — | 109% above | 10% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CONTRAST | $3,282.30 | $3,647.00 | — | — | 10% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT KID STONE ABD & PELVIS WO C | $3,282.30 | $3,647.00 | — | — | 10% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CONTRAST | $3,305.70 | $3,673.00 | — | 70% above | 10% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CONTRAST | $3,305.70 | $3,673.00 | — | — | 10% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD & PELVIS W/WO CONTRAST | $4,146.30 | $4,607.00 | — | 78% above | 10% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD & PELVIS W/WO CONTRAST | $4,146.30 | $4,607.00 | — | — | 10% |
| CT scan of the abdomen with contrast CPT 74160 CT ABD W/CONTRAST | $2,202.30 | $2,447.00 | — | 89% above | 10% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABD W/CONTRAST | $2,202.30 | $2,447.00 | — | — | 10% |
| CT scan of the abdomen without contrast CPT 74150 CT ABD WO CONTRAST | $2,186.10 | $2,429.00 | — | 108% above | 10% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD WO CONTRAST | $2,186.10 | $2,429.00 | — | — | 10% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT LIMITED SINUSES W/O CONTRAS | $993.60 | $1,104.00 | — | 13% above | 10% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT FACIAL BONES | $1,990.80 | $2,212.00 | — | 127% above | 10% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS-MAX/FACIAL WO CONTRAS | $1,990.80 | $2,212.00 | — | 127% above | 10% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT LIMITED SINUSES W/O CONTRAS | $993.60 | $1,104.00 | — | — | 10% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT FACIAL BONES | $1,990.80 | $2,212.00 | — | — | 10% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS-MAX/FACIAL WO CONTRAS | $1,990.80 | $2,212.00 | — | — | 10% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CONTRAST | $1,740.60 | $1,934.00 | — | 108% above | 10% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CONTRAST | $1,740.60 | $1,934.00 | — | — | 10% |
| CT scan of the head with contrast CPT 70460 CT HEAD W/CONTRAST | $1,756.80 | $1,952.00 | — | 75% above | 10% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/CONTRAST | $1,756.80 | $1,952.00 | — | — | 10% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD W/WO CONTRAST | $2,244.60 | $2,494.00 | — | 94% above | 10% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/WO CONTRAST | $2,244.60 | $2,494.00 | — | — | 10% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE WO CONTRAST | $2,420.10 | $2,689.00 | — | 121% above | 10% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE WO CONTRAST | $2,420.10 | $2,689.00 | — | — | 10% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O CONTRAST | $2,205.90 | $2,451.00 | — | 106% above | 10% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O CONTRAST | $2,205.90 | $2,451.00 | — | — | 10% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST | $2,202.30 | $2,447.00 | — | 80% above | 10% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST | $2,202.30 | $2,447.00 | — | — | 10% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US CAROTID ARTERY COMPLETE | $1,123.20 | $1,248.00 | — | 55% above | 10% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US CAROTID ARTERY COMPLETE | $1,123.20 | $1,248.00 | — | — | 10% |
| Chest CT scan without and with contrast CPT 71270 CT CHEST W/WO CONTRAST | $2,562.30 | $2,847.00 | — | 74% above | 10% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST W/WO CONTRAST | $2,562.30 | $2,847.00 | — | — | 10% |
| Chest X-ray, 2 views CPT 71046 LT. LAT. DECUBITUS CHEST 2 VIEWS | $350.10 | $389.00 | — | 28% above | 10% |
| Chest X-ray, 2 views CPT 71046 RT. LAT. DECUBITUS CHEST 2 VIEWS | $350.10 | $389.00 | — | 28% above | 10% |
| Chest X-ray, 2 views CPT 71046 CHEST INSPIRATION & EXPIRATION | $422.10 | $469.00 | — | 55% above | 10% |
| Chest X-ray, 2 views CPT 71046 CHEST PA & LATERAL | $422.10 | $469.00 | — | 55% above | 10% |
| Chest X-ray, 2 views CPT 71046 CHEST W/FLUORO | $491.40 | $546.00 | — | 80% above | 10% |
| Chest X-ray, 2 views inpatient CPT 71046 RT. LAT. DECUBITUS CHEST 2 VIEWS | $350.10 | $389.00 | — | — | 10% |
| Chest X-ray, 2 views inpatient CPT 71046 LT. LAT. DECUBITUS CHEST 2 VIEWS | $350.10 | $389.00 | — | — | 10% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST INSPIRATION & EXPIRATION | $422.10 | $469.00 | — | — | 10% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST PA & LATERAL | $422.10 | $469.00 | — | — | 10% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST W/FLUORO | $491.40 | $546.00 | — | — | 10% |
| Chest X-ray, single view CPT 71045 CHEST PA ONLY | $339.30 | $377.00 | — | 46% above | 10% |
| Chest X-ray, single view CPT 71045 CHEST-PA-PORTABLE | $369.90 | $411.00 | — | 59% above | 10% |
| Chest X-ray, single view inpatient CPT 71045 CHEST PA ONLY | $339.30 | $377.00 | — | — | 10% |
| Chest X-ray, single view inpatient CPT 71045 CHEST-PA-PORTABLE | $369.90 | $411.00 | — | — | 10% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 RIGHT CLAVICLE | $274.50 | $305.00 | — | at median | 10% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 LEFT CLAVICLE | $274.50 | $305.00 | — | at median | 10% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 LEFT CLAVICLE | $274.50 | $305.00 | — | — | 10% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 RIGHT CLAVICLE | $274.50 | $305.00 | — | — | 10% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US KIDNEY/RENAL COMPLETE W/BLADDER | $959.40 | $1,066.00 | — | 35% above | 10% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US KIDNEY/RENAL COMPLETE W/BLADDER | $959.40 | $1,066.00 | — | — | 10% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA SCAN SPINE/HIP | $738.00 | $820.00 | — | 63% above | 10% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 CMS DXA SCAN SPINE/HIP | $738.00 | $820.00 | — | 63% above | 10% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA SCAN SPINE/HIP | $738.00 | $820.00 | — | — | 10% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 CMS DXA SCAN SPINE/HIP | $738.00 | $820.00 | — | — | 10% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA SCAN FOREARM | $315.90 | $351.00 | — | 23% above | 10% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA SCAN FOREARM | $315.90 | $351.00 | — | — | 10% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO CONTRAST | $2,375.10 | $2,639.00 | — | 153% above | 10% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST HIGH RES. LOCAL STUDY | $2,375.10 | $2,639.00 | — | 153% above | 10% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST HIGH RES. LOCAL STUDY | $2,375.10 | $2,639.00 | — | — | 10% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST WO CONTRAST | $2,375.10 | $2,639.00 | — | — | 10% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CONTRAST | $2,389.50 | $2,655.00 | — | 109% above | 10% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CONTRAST | $2,389.50 | $2,655.00 | — | — | 10% |
| Diagnostic mammogram, both breasts CPT 77066 MAMMOGRAPHY DIAGNOSTIC DIGITAL W CAD | $390.60 | $434.00 | — | at median | 10% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMOGRAPHY DIAGNOSTIC DIGITAL W CAD | $390.60 | $434.00 | — | — | 10% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAPHY RT BREAST DIGITAL W CAD | $337.50 | $375.00 | — | 5% below | 10% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAPHY LEFT BREAST DIGITAL W CAD | $337.50 | $375.00 | — | 5% below | 10% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAPHY LEFT BREAST DIGITAL W CAD | $337.50 | $375.00 | — | — | 10% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAPHY RT BREAST DIGITAL W CAD | $337.50 | $375.00 | — | — | 10% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US BILATERAL LOWER EXT ARTERIAL DUPLEX IMAGING | $1,062.00 | $1,180.00 | — | — | 10% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US BILATERAL LOWER EXT ARTERIAL DUPLEX IMAGING | $1,062.00 | $1,180.00 | — | — | 10% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VENOUS INSUFFICIENCY BILATERAL | $1,536.30 | $1,707.00 | — | — | 10% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US BILAT UPPER VENOUS DUPLEX | $1,536.30 | $1,707.00 | — | — | 10% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US BILAT LOWER VENOUS DUPLEX | $1,536.30 | $1,707.00 | — | — | 10% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US BILAT LOWER VENOUS DUPLEX | $1,536.30 | $1,707.00 | — | — | 10% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VENOUS INSUFFICIENCY BILATERAL | $1,536.30 | $1,707.00 | — | — | 10% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US BILAT UPPER VENOUS DUPLEX | $1,536.30 | $1,707.00 | — | — | 10% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHOCARDIOGRAM - COMPLETE | $2,241.90 | $2,491.00 | — | 33% above | 10% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHOCARDIOGRAM - COMPLETE | $2,241.90 | $2,491.00 | — | — | 10% |
| Elbow X-ray, 2 views one side CPT 73070 RIGHT ELBOW - AP/LATERAL | $317.70 | $353.00 | — | 19% above | 10% |
| Elbow X-ray, 2 views one side CPT 73070 LEFT ELBOW - AP/LATERAL | $317.70 | $353.00 | — | 19% above | 10% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 RIGHT ELBOW - AP/LATERAL | $317.70 | $353.00 | — | — | 10% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 LEFT ELBOW - AP/LATERAL | $317.70 | $353.00 | — | — | 10% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 RIGHT ELBOW W/OBLIQUES | $375.30 | $417.00 | — | 18% above | 10% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 LEFT ELBOW W/OBLIQUES | $375.30 | $417.00 | — | 18% above | 10% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 RIGHT ELBOW W/OBLIQUES | $375.30 | $417.00 | — | — | 10% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 LEFT ELBOW W/OBLIQUES | $375.30 | $417.00 | — | — | 10% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT SELLA/POST FOSSA W/O CONTRA | $1,865.70 | $2,073.00 | — | 116% above | 10% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBITS WO CONTRAST | $1,865.70 | $2,073.00 | — | 116% above | 10% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT IAC'S WO CONTRAST | $1,865.70 | $2,073.00 | — | 116% above | 10% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT SELLA/POST FOSSA W/O CONTRA | $1,865.70 | $2,073.00 | — | — | 10% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBITS WO CONTRAST | $1,865.70 | $2,073.00 | — | — | 10% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT IAC'S WO CONTRAST | $1,865.70 | $2,073.00 | — | — | 10% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES | $377.10 | $419.00 | — | 3% below | 10% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES | $377.10 | $419.00 | — | — | 10% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 RIGHT FOREARM | $347.40 | $386.00 | — | 27% above | 10% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 LEFT FOREARM | $347.40 | $386.00 | — | 27% above | 10% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 RIGHT FOREARM | $347.40 | $386.00 | — | — | 10% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 LEFT FOREARM | $347.40 | $386.00 | — | — | 10% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM BILIARY SCAN | $1,638.90 | $1,821.00 | — | 3% above | 10% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM BILIARY SCAN | $1,638.90 | $1,821.00 | — | — | 10% |
| Hand X-ray, 2 views one side CPT 73120 LEFT HAND 2 VIEWS | $317.70 | $353.00 | — | 19% above | 10% |
| Hand X-ray, 2 views one side CPT 73120 RIGHT HAND 2 VIEWS | $317.70 | $353.00 | — | 19% above | 10% |
| Hand X-ray, 2 views inpatient one side CPT 73120 LEFT HAND 2 VIEWS | $317.70 | $353.00 | — | — | 10% |
| Hand X-ray, 2 views inpatient one side CPT 73120 RIGHT HAND 2 VIEWS | $317.70 | $353.00 | — | — | 10% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 LEFT HEEL/CALCANEUS | $317.70 | $353.00 | — | 16% above | 10% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 RIGHT HEEL/CALCANEUS | $317.70 | $353.00 | — | 16% above | 10% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 LEFT HEEL/CALCANEUS | $317.70 | $353.00 | — | — | 10% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 RIGHT HEEL/CALCANEUS | $317.70 | $353.00 | — | — | 10% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SC DR-HOME SLEEP MONITORING | $105.30 | $117.00 | — | 85% below | 10% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SC HOME SLEEP MONITORING | $815.40 | $906.00 | — | 16% above | 10% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SC DR-HOME SLEEP MONITORING | $105.30 | $117.00 | — | — | 10% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SC HOME SLEEP MONITORING | $815.40 | $906.00 | — | — | 10% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SC DR-CPAP 4/ MORE PARAMETERS | $348.30 | $387.00 | — | 91% below | 10% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SC-CPAP 4 OR MORE PARAMETERS | $4,167.90 | $4,631.00 | — | 9% above | 10% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SC DR-CPAP 4/ MORE PARAMETERS | $348.30 | $387.00 | — | — | 10% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SC-CPAP 4 OR MORE PARAMETERS | $4,167.90 | $4,631.00 | — | — | 10% |
| Knee X-ray, 3 views one side CPT 73562 LEFT KNEE - 3 VIEWS | $361.80 | $402.00 | — | 2% above | 10% |
| Knee X-ray, 3 views one side CPT 73562 RIGHT KNEE - 3 VIEWS | $361.80 | $402.00 | — | 2% above | 10% |
| Knee X-ray, 3 views inpatient one side CPT 73562 LEFT KNEE - 3 VIEWS | $361.80 | $402.00 | — | — | 10% |
| Knee X-ray, 3 views inpatient one side CPT 73562 RIGHT KNEE - 3 VIEWS | $361.80 | $402.00 | — | — | 10% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 LEFT KNEE W/OBLIQUES | $409.50 | $455.00 | — | 4% above | 10% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 RIGHT KNEE - 4 VIEWS | $409.50 | $455.00 | — | 4% above | 10% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 RIGHT KNEE W/ OBLIQUES | $409.50 | $455.00 | — | 4% above | 10% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 LEFT KNEE - 4 VIEWS | $409.50 | $455.00 | — | 4% above | 10% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 LEFT KNEE - 4 VIEWS | $409.50 | $455.00 | — | — | 10% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 RIGHT KNEE W/ OBLIQUES | $409.50 | $455.00 | — | — | 10% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 RIGHT KNEE - 4 VIEWS | $409.50 | $455.00 | — | — | 10% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 LEFT KNEE W/OBLIQUES | $409.50 | $455.00 | — | — | 10% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LT LOWER EXTREM WO CONTRAST | $1,847.70 | $2,053.00 | — | 96% above | 10% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT RT LOWER EXTREM WO CONTRAST | $1,847.70 | $2,053.00 | — | 96% above | 10% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LT LOWER EXTREM WO CONTRAST | $1,847.70 | $2,053.00 | — | — | 10% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT RT LOWER EXTREM WO CONTRAST | $1,847.70 | $2,053.00 | — | — | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED | $140.40 | $156.00 | — | 75% below | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED US ABDOMEN LIMITED | $856.80 | $952.00 | — | 55% above | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED / FOLLOW-UP | $856.80 | $952.00 | — | 55% above | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED US BILIARY TRACT LIMITED | $856.80 | $952.00 | — | 55% above | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED | $140.40 | $156.00 | — | — | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ED US ABDOMEN LIMITED | $856.80 | $952.00 | — | — | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ED US BILIARY TRACT LIMITED | $856.80 | $952.00 | — | — | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LIMITED / FOLLOW-UP | $856.80 | $952.00 | — | — | 10% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 ED DR US JOINT OR NV EXTREMITY | $32.40 | $36.00 | — | 93% below | 10% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 UC DR US LIMITED JOINT OR FOCAL | $75.60 | $84.00 | — | 84% below | 10% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 UC US LIMITED JOINT OR FOCAL | $396.00 | $440.00 | — | 17% below | 10% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 ED US JOINT OR NV EXTREMITY | $757.80 | $842.00 | — | 59% above | 10% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US LT EXTREMITY LIMITED ANATOM | $757.80 | $842.00 | — | 59% above | 10% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US RT EXTREMITY LIMITED ANATOM | $757.80 | $842.00 | — | 59% above | 10% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 ED DR US JOINT OR NV EXTREMITY | $32.40 | $36.00 | — | — | 10% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 UC DR US LIMITED JOINT OR FOCAL | $75.60 | $84.00 | — | — | 10% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 UC US LIMITED JOINT OR FOCAL | $396.00 | $440.00 | — | — | 10% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 ED US JOINT OR NV EXTREMITY | $757.80 | $842.00 | — | — | 10% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US LT EXTREMITY LIMITED ANATOM | $757.80 | $842.00 | — | — | 10% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US RT EXTREMITY LIMITED ANATOM | $757.80 | $842.00 | — | — | 10% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LDCT CHEST LUNG CA SCRN W/O | $397.80 | $442.00 | — | 39% above | 10% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LDCT CHEST LUNG CA SCRN W/O | $397.80 | $442.00 | — | — | 10% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LEFT LOWER LEG | $347.40 | $386.00 | — | 26% above | 10% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 RIGHT LOWER LEG | $347.40 | $386.00 | — | 26% above | 10% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 RIGHT LOWER LEG | $347.40 | $386.00 | — | — | 10% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LEFT LOWER LEG | $347.40 | $386.00 | — | — | 10% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA BRAIN W/O CONTRAST | $2,622.60 | $2,914.00 | — | 83% above | 10% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA BRAIN W/O CONTRAST | $2,622.60 | $2,914.00 | — | — | 10% |
| MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST BILATERAL W & W/O CONTRAST | $3,396.60 | $3,774.00 | — | — | 10% |
| MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI BREAST BILATERAL W & W/O CONTRAST | $3,396.60 | $3,774.00 | — | — | 10% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI RIGHT KNEE W/O CONTRAST | $2,931.30 | $3,257.00 | — | 72% above | 10% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI RIGHT ANKLE W/O CONTRAST | $2,931.30 | $3,257.00 | — | 72% above | 10% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LEFT ANKLE W/O CONTRAST | $2,931.30 | $3,257.00 | — | 72% above | 10% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LEFT HIP W/O CONTRAST | $2,931.30 | $3,257.00 | — | 72% above | 10% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI RIGHT HIP W/O CONTRAST | $2,931.30 | $3,257.00 | — | 72% above | 10% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LEFT KNEE W/O CONTRAST | $2,931.30 | $3,257.00 | — | 72% above | 10% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI RIGHT KNEE W/O CONTRAST | $2,931.30 | $3,257.00 | — | — | 10% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LEFT ANKLE W/O CONTRAST | $2,931.30 | $3,257.00 | — | — | 10% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LEFT KNEE W/O CONTRAST | $2,931.30 | $3,257.00 | — | — | 10% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI RIGHT ANKLE W/O CONTRAST | $2,931.30 | $3,257.00 | — | — | 10% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI RIGHT HIP W/O CONTRAST | $2,931.30 | $3,257.00 | — | — | 10% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LEFT HIP W/O CONTRAST | $2,931.30 | $3,257.00 | — | — | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI RIGHT KNEE W/WO CONTRAST | $3,434.40 | $3,816.00 | — | 45% above | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LEFT ANKLE W/WO CONTRAST | $3,434.40 | $3,816.00 | — | 45% above | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LEFT HIP W/WO CONTRAST | $3,434.40 | $3,816.00 | — | 45% above | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LEFT KNEE W/WO CONTRAST | $3,434.40 | $3,816.00 | — | 45% above | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI RIGHT ANKLE W/WO CONTRAST | $3,434.40 | $3,816.00 | — | 45% above | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI RIGHT HIP W/WO CONTRAST | $3,434.40 | $3,816.00 | — | 45% above | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI RIGHT KNEE W/WO CONTRAST | $3,434.40 | $3,816.00 | — | — | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LEFT ANKLE W/WO CONTRAST | $3,434.40 | $3,816.00 | — | — | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LEFT HIP W/WO CONTRAST | $3,434.40 | $3,816.00 | — | — | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LEFT KNEE W/WO CONTRAST | $3,434.40 | $3,816.00 | — | — | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI RIGHT ANKLE W/WO CONTRAST | $3,434.40 | $3,816.00 | — | — | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI RIGHT HIP W/WO CONTRAST | $3,434.40 | $3,816.00 | — | — | 10% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST | $3,141.90 | $3,491.00 | — | 71% above | 10% |
| MRI of the abdomen without contrast CPT 74181 MRI MRCP | $3,141.90 | $3,491.00 | — | 71% above | 10% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP | $3,141.90 | $3,491.00 | — | — | 10% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST | $3,141.90 | $3,491.00 | — | — | 10% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/ & W/O CONTRAST | $3,630.60 | $4,034.00 | — | 60% above | 10% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/ & W/O CONTRAST | $3,630.60 | $4,034.00 | — | — | 10% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST | $3,036.60 | $3,374.00 | — | 91% above | 10% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST | $3,036.60 | $3,374.00 | — | — | 10% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/IAC S W/WO CONTRAS | $3,932.10 | $4,369.00 | — | 80% above | 10% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO CONTRAST | $4,128.30 | $4,587.00 | — | 89% above | 10% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/IAC S W/WO CONTRAS | $3,932.10 | $4,369.00 | — | — | 10% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO CONTRAST | $4,128.30 | $4,587.00 | — | — | 10% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONTRAST | $3,294.90 | $3,661.00 | — | 100% above | 10% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CONTRAST | $3,294.90 | $3,661.00 | — | — | 10% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/WO CONTRAST | $4,128.30 | $4,587.00 | — | 77% above | 10% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/WO CONTRAST | $4,128.30 | $4,587.00 | — | — | 10% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O CONTRAS | $3,191.40 | $3,546.00 | — | 96% above | 10% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE W/O CONTRAS | $3,191.40 | $3,546.00 | — | — | 10% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W/WO CONTRA | $4,128.30 | $4,587.00 | — | 83% above | 10% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE W/WO CONTRA | $4,128.30 | $4,587.00 | — | — | 10% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE W/O CONTRAS | $3,191.40 | $3,546.00 | — | 98% above | 10% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE W/O CONTRAS | $3,191.40 | $3,546.00 | — | — | 10% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PROSTATE W/WO CONTRAST | $3,630.60 | $4,034.00 | — | 83% above | 10% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/WO CONTRAST | $3,630.60 | $4,034.00 | — | 83% above | 10% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PROSTATE W/WO CONTRAST | $3,630.60 | $4,034.00 | — | — | 10% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/WO CONTRAST | $3,630.60 | $4,034.00 | — | — | 10% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PROSTATE W/O CONTRAST | $2,992.50 | $3,325.00 | — | 97% above | 10% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST | $2,992.50 | $3,325.00 | — | 97% above | 10% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PROSTATE W/O CONTRAST | $2,992.50 | $3,325.00 | — | — | 10% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST | $2,992.50 | $3,325.00 | — | — | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI LEFT SHOULDER W/O CONTRAST | $2,791.80 | $3,102.00 | — | 92% above | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI RT SHOULDER W/O CONTRAST | $2,791.80 | $3,102.00 | — | 92% above | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI LEFT ELBOW W/O CONTRAST | $2,791.80 | $3,102.00 | — | 92% above | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI RIGHT ELBOW W/O CONTRAST | $2,791.80 | $3,102.00 | — | 92% above | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI RIGHT WRIST W/O CONTRAST | $2,931.30 | $3,257.00 | — | 102% above | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI LEFT WRIST W/O CONTRAST | $2,931.30 | $3,257.00 | — | 102% above | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI RIGHT ELBOW W/O CONTRAST | $2,791.80 | $3,102.00 | — | — | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI LEFT ELBOW W/O CONTRAST | $2,791.80 | $3,102.00 | — | — | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI LEFT SHOULDER W/O CONTRAST | $2,791.80 | $3,102.00 | — | — | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI RT SHOULDER W/O CONTRAST | $2,791.80 | $3,102.00 | — | — | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI LEFT WRIST W/O CONTRAST | $2,931.30 | $3,257.00 | — | — | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI RIGHT WRIST W/O CONTRAST | $2,931.30 | $3,257.00 | — | — | 10% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERV SPINE AP- LAT- FLEX- EXT | $564.30 | $627.00 | — | 25% above | 10% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERVICAL SPINE W/OBLIQUES | $564.30 | $627.00 | — | 25% above | 10% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERVICAL SPINE W/OBLIQUES | $564.30 | $627.00 | — | — | 10% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERV SPINE AP- LAT- FLEX- EXT | $564.30 | $627.00 | — | — | 10% |
| Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W/CONTRAS | $2,042.10 | $2,269.00 | — | 75% above | 10% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W/CONTRAS | $2,042.10 | $2,269.00 | — | — | 10% |
| Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK WO/CONTRA | $1,976.40 | $2,196.00 | — | 115% above | 10% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK WO/CONTRA | $1,976.40 | $2,196.00 | — | — | 10% |
| Neck soft tissue X-ray CPT 70360 SOFT TISSUE NECK - 2 VIEWS | $291.60 | $324.00 | — | 12% above | 10% |
| Neck soft tissue X-ray inpatient CPT 70360 SOFT TISSUE NECK - 2 VIEWS | $291.60 | $324.00 | — | — | 10% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM CARD TREAD S&R W/ W.M & EF | $4,482.00 | $4,980.00 | — | 12% above | 10% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM CARD PHARM S&R W/ W.M & EF | $4,655.70 | $5,173.00 | — | 16% above | 10% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM CARD TREAD S&R W/ W.M & EF | $4,482.00 | $4,980.00 | — | — | 10% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM CARD PHARM S&R W/ W.M & EF | $4,655.70 | $5,173.00 | — | — | 10% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET CT SKULLBASE TO MIDTHIGH | $7,322.40 | $8,136.00 | — | 51% above | 10% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET CT SKULLBASE TO MIDTHIGH | $7,322.40 | $8,136.00 | — | — | 10% |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS WO CONTRAST | $2,186.10 | $2,429.00 | — | 117% above | 10% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS WO CONTRAST | $2,186.10 | $2,429.00 | — | — | 10% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 ED US PELVIS NON OB LIMITED | $589.50 | $655.00 | — | 34% above | 10% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIMITED-BLADDER | $600.30 | $667.00 | — | 37% above | 10% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIM/FOLLOW-UP NON OB | $600.30 | $667.00 | — | 37% above | 10% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 ED US PELVIS NON OB LIMITED | $589.50 | $655.00 | — | — | 10% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LIMITED-BLADDER | $600.30 | $667.00 | — | — | 10% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LIM/FOLLOW-UP NON OB | $600.30 | $667.00 | — | — | 10% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS | $1,026.00 | $1,140.00 | — | 101% above | 10% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS | $1,026.00 | $1,140.00 | — | — | 10% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB-COMP AFTER 1ST SINGLE | $1,352.70 | $1,503.00 | — | 128% above | 10% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB-COMP AFTER 1ST SINGLE | $1,352.70 | $1,503.00 | — | — | 10% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB-COMP 1ST TRIMES SINGLE | $999.00 | $1,110.00 | — | 82% above | 10% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB-COMP 1ST TRIMES SINGLE | $999.00 | $1,110.00 | — | — | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 UC BEDSIDE US | $140.40 | $156.00 | — | 71% below | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 UC DR BEDSIDE US | $162.00 | $180.00 | — | 66% below | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ULTRASOUND-LIMITED IN OB | $373.50 | $415.00 | — | 22% below | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED/REAL TIME EXAM | $549.90 | $611.00 | — | 15% above | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ED US OB LIMITED W/PREG | $856.80 | $952.00 | — | 80% above | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 UC BEDSIDE US | $140.40 | $156.00 | — | — | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 UC DR BEDSIDE US | $162.00 | $180.00 | — | — | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 ULTRASOUND-LIMITED IN OB | $373.50 | $415.00 | — | — | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED/REAL TIME EXAM | $549.90 | $611.00 | — | — | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 ED US OB LIMITED W/PREG | $856.80 | $952.00 | — | — | 10% |
| Rib X-ray, one side, 2 views one side CPT 71100 LEFT RIBS | $522.00 | $580.00 | — | 69% above | 10% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIGHT RIBS | $522.00 | $580.00 | — | 69% above | 10% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 LEFT RIBS | $522.00 | $580.00 | — | — | 10% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIGHT RIBS | $522.00 | $580.00 | — | — | 10% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 LEFT RIBS W/PA CHEST | $592.20 | $658.00 | — | 51% above | 10% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIGHT RIBS W/PA CHEST | $592.20 | $658.00 | — | 51% above | 10% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 LEFT RIBS W/PA CHEST | $592.20 | $658.00 | — | — | 10% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIGHT RIBS W/PA CHEST | $592.20 | $658.00 | — | — | 10% |
| Screening mammogram, both breasts CPT 77067 MAMMO SCREEN DIG SELF REQUEST W CAD | $294.30 | $327.00 | — | 53% above | 10% |
| Screening mammogram, both breasts CPT 77067 MAMMOGRAPHY SCREENING DIGITAL W CAD | $324.90 | $361.00 | — | 69% above | 10% |
| Screening mammogram, both breasts one side CPT 77067 MAMMO UNILAT SCREENING DIGITAL W CAD | $233.10 | $259.00 | — | 21% above | 10% |
| Screening mammogram, both breasts inpatient CPT 77067 MAMMO SCREEN DIG SELF REQUEST W CAD | $294.30 | $327.00 | — | — | 10% |
| Screening mammogram, both breasts inpatient CPT 77067 MAMMOGRAPHY SCREENING DIGITAL W CAD | $324.90 | $361.00 | — | — | 10% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MAMMO UNILAT SCREENING DIGITAL W CAD | $233.10 | $259.00 | — | — | 10% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 RIGHT SHOULDER COMPLETE | $450.90 | $501.00 | — | 33% above | 10% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 LEFT SHOULDER COMPLETE | $450.90 | $501.00 | — | 33% above | 10% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 RIGHT SHOULDER COMPLETE | $450.90 | $501.00 | — | — | 10% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 LEFT SHOULDER COMPLETE | $450.90 | $501.00 | — | — | 10% |
| Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES - COMPLET | $415.80 | $462.00 | — | 15% above | 10% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES - COMPLET | $415.80 | $462.00 | — | — | 10% |
| Skull X-ray, fewer than 4 views CPT 70250 SKULL LIMITED | $347.40 | $386.00 | — | 20% above | 10% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL LIMITED | $347.40 | $386.00 | — | — | 10% |
| Sleep study in a lab (polysomnography) CPT 95810 SC DR-PSG 4 OR MORE PARAMETERS | $348.30 | $387.00 | — | 90% below | 10% |
| Sleep study in a lab (polysomnography) CPT 95810 SC-PSG 4 OR MORE PARAMETERS | $3,572.10 | $3,969.00 | — | 1% below | 10% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 SC DR-PSG 4 OR MORE PARAMETERS | $348.30 | $387.00 | — | — | 10% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 SC-PSG 4 OR MORE PARAMETERS | $3,572.10 | $3,969.00 | — | — | 10% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 BARIUM SWALLOW MODIFIED | $828.00 | $920.00 | — | 64% above | 10% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 BARIUM SWALLOW MODIFIED | $828.00 | $920.00 | — | — | 10% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 LT FEMUR AP & LAT | $372.60 | $414.00 | — | 37% above | 10% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 RT FEMUR AP & LAT | $372.60 | $414.00 | — | 37% above | 10% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 RT FEMUR AP & LAT | $372.60 | $414.00 | — | — | 10% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 LT FEMUR AP & LAT | $372.60 | $414.00 | — | — | 10% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE W/O CONTRAST | $2,406.60 | $2,674.00 | — | 172% above | 10% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE W/O CONTRAST | $2,406.60 | $2,674.00 | — | — | 10% |
| Toe X-ray, 2 or more views one side CPT 73660 RIGHT GREAT TOE | $286.20 | $318.00 | — | 14% above | 10% |
| Toe X-ray, 2 or more views one side CPT 73660 LEFT TOE FIFTH DIGIT | $286.20 | $318.00 | — | 14% above | 10% |
| Toe X-ray, 2 or more views one side CPT 73660 LEFT TOE FOURTH DIGIT | $286.20 | $318.00 | — | 14% above | 10% |
| Toe X-ray, 2 or more views one side CPT 73660 LEFT TOE THIRD DIGIT | $286.20 | $318.00 | — | 14% above | 10% |
| Toe X-ray, 2 or more views one side CPT 73660 LEFT TOE SECOND DIGIT | $286.20 | $318.00 | — | 14% above | 10% |
| Toe X-ray, 2 or more views one side CPT 73660 RIGHT TOE THIRD DIGIT | $286.20 | $318.00 | — | 14% above | 10% |
| Toe X-ray, 2 or more views one side CPT 73660 LEFT GREAT TOE | $286.20 | $318.00 | — | 14% above | 10% |
| Toe X-ray, 2 or more views one side CPT 73660 RIGHT TOE FOURTH DIGIT | $286.20 | $318.00 | — | 14% above | 10% |
| Toe X-ray, 2 or more views one side CPT 73660 RIGHT TOE SECOND DIGIT | $286.20 | $318.00 | — | 14% above | 10% |
| Toe X-ray, 2 or more views one side CPT 73660 RIGHT TOE FIFTH DIGIT | $286.20 | $318.00 | — | 14% above | 10% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 RIGHT TOE FOURTH DIGIT | $286.20 | $318.00 | — | — | 10% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 LEFT GREAT TOE | $286.20 | $318.00 | — | — | 10% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 LEFT TOE SECOND DIGIT | $286.20 | $318.00 | — | — | 10% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 LEFT TOE THIRD DIGIT | $286.20 | $318.00 | — | — | 10% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 LEFT TOE FOURTH DIGIT | $286.20 | $318.00 | — | — | 10% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 LEFT TOE FIFTH DIGIT | $286.20 | $318.00 | — | — | 10% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 RIGHT GREAT TOE | $286.20 | $318.00 | — | — | 10% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 RIGHT TOE SECOND DIGIT | $286.20 | $318.00 | — | — | 10% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 RIGHT TOE THIRD DIGIT | $286.20 | $318.00 | — | — | 10% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 RIGHT TOE FIFTH DIGIT | $286.20 | $318.00 | — | — | 10% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $547.20 | $608.00 | — | 2% below | 10% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL | $547.20 | $608.00 | — | — | 10% |
| Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL | $675.00 | $750.00 | — | 35% above | 10% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB TRANSVAGINAL | $675.00 | $750.00 | — | — | 10% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN-COMP | $1,206.90 | $1,341.00 | — | 92% above | 10% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN-COMP | $1,206.90 | $1,341.00 | — | — | 10% |
| Ultrasound of the scrotum and testicles CPT 76870 ER US SCROTUM | $649.80 | $722.00 | — | 22% above | 10% |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM | $959.40 | $1,066.00 | — | 79% above | 10% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 ER US SCROTUM | $649.80 | $722.00 | — | — | 10% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM | $959.40 | $1,066.00 | — | — | 10% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TIS NK/HED (IE THYROID | $959.40 | $1,066.00 | — | 69% above | 10% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ED US FOCUSED SOFT TISSUE HEAD & NECK | $959.40 | $1,066.00 | — | 69% above | 10% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TIS NK/HED (IE THYROID | $959.40 | $1,066.00 | — | — | 10% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 ED US FOCUSED SOFT TISSUE HEAD & NECK | $959.40 | $1,066.00 | — | — | 10% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 GI SERIES | $1,147.50 | $1,275.00 | — | 93% above | 10% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 GI SERIES | $1,147.50 | $1,275.00 | — | — | 10% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 RIGHT HUMERUS | $347.40 | $386.00 | — | 24% above | 10% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 LEFT HUMERUS | $347.40 | $386.00 | — | 24% above | 10% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 LEFT HUMERUS | $347.40 | $386.00 | — | — | 10% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 RIGHT HUMERUS | $347.40 | $386.00 | — | — | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US EXTREMITY VEINS LIMITED | $1,008.00 | $1,120.00 | — | 38% above | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 ED US FOCUSED LOW EXT VENOUS LIMITED UNLTRL | $1,008.00 | $1,120.00 | — | 38% above | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US RT LOWER VENOUS DUPLEX EXT | $1,008.00 | $1,120.00 | — | 38% above | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LT UPPER VENOUS DUPLEX EXT | $1,008.00 | $1,120.00 | — | 38% above | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS INSUFFICIENCY UNILATERAL | $1,008.00 | $1,120.00 | — | 38% above | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US RT UPPER VENOUS DUPLEX EXT | $1,008.00 | $1,120.00 | — | 38% above | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LT LOWER VENOUS DUPLEX EXT | $1,008.00 | $1,120.00 | — | 38% above | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 ED US FOCUSED LOW EXT VENOUS LIMITED UNLTRL | $1,008.00 | $1,120.00 | — | — | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US EXTREMITY VEINS LIMITED | $1,008.00 | $1,120.00 | — | — | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US RT LOWER VENOUS DUPLEX EXT | $1,008.00 | $1,120.00 | — | — | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS INSUFFICIENCY UNILATERAL | $1,008.00 | $1,120.00 | — | — | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LT LOWER VENOUS DUPLEX EXT | $1,008.00 | $1,120.00 | — | — | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LT UPPER VENOUS DUPLEX EXT | $1,008.00 | $1,120.00 | — | — | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US RT UPPER VENOUS DUPLEX EXT | $1,008.00 | $1,120.00 | — | — | 10% |
| Wrist X-ray, 2 views one side CPT 73100 RIGHT WRIST AP/LATERAL | $317.70 | $353.00 | — | 22% above | 10% |
| Wrist X-ray, 2 views one side CPT 73100 LEFT WRIST AP/LATERAL | $317.70 | $353.00 | — | 22% above | 10% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 LEFT WRIST AP/LATERAL | $317.70 | $353.00 | — | — | 10% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 RIGHT WRIST AP/LATERAL | $317.70 | $353.00 | — | — | 10% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 LEFT WRIST COMPLETE | $347.40 | $386.00 | — | 1% above | 10% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 RIGHT WRIST COMPLETE | $347.40 | $386.00 | — | 1% above | 10% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 LEFT WRIST COMPLETE | $347.40 | $386.00 | — | — | 10% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 RIGHT WRIST COMPLETE | $347.40 | $386.00 | — | — | 10% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 RT HIP AP & LAT W/ OR WO PELVI | $387.90 | $431.00 | — | 26% above | 10% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 LT HIP AP & LAT W/ OR WO PELVI | $387.90 | $431.00 | — | 26% above | 10% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 LT HIP AP & LAT W/ OR WO PELVI | $387.90 | $431.00 | — | — | 10% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 RT HIP AP & LAT W/ OR WO PELVI | $387.90 | $431.00 | — | — | 10% |
| X-ray of the abdomen, 1 view CPT 74018 ABDOMEN KUB (SINGLE VIEW) | $335.70 | $373.00 | — | 30% above | 10% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN KUB (SINGLE VIEW) | $335.70 | $373.00 | — | — | 10% |
| X-ray of the ankle, 2 views one side CPT 73600 RIGHT ANKLE - AP/LATERAL | $317.70 | $353.00 | — | 21% above | 10% |
| X-ray of the ankle, 2 views one side CPT 73600 LEFT ANKLE - AP/LATERAL | $317.70 | $353.00 | — | 21% above | 10% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 LEFT ANKLE - AP/LATERAL | $317.70 | $353.00 | — | — | 10% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 RIGHT ANKLE - AP/LATERAL | $317.70 | $353.00 | — | — | 10% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 LEFT FINGER 2ND DIGIT (INDEX) | $286.20 | $318.00 | — | 10% above | 10% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 LEFT THUMB | $286.20 | $318.00 | — | 10% above | 10% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 LEFT FIFTH DIGIT (LITTLE) | $286.20 | $318.00 | — | 10% above | 10% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 RIGHT FINGER 4TH DIGIT (RING) | $286.20 | $318.00 | — | 10% above | 10% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 RIGHT THUMB | $286.20 | $318.00 | — | 10% above | 10% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 RIGHT FINGER 2ND DIGIT (INDEX) | $286.20 | $318.00 | — | 10% above | 10% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 RIGHT FINGER 3RD DIGIT (MIDDLE | $286.20 | $318.00 | — | 10% above | 10% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 RIGHT FINGER 5TH DIGIT (LITTLE | $286.20 | $318.00 | — | 10% above | 10% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 LEFT FINGER FOURTH DIGIT (RING | $286.20 | $318.00 | — | 10% above | 10% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 LEFT FINGER 3RD DIGIT (MIDDLE) | $286.20 | $318.00 | — | 10% above | 10% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 LEFT FINGER FOURTH DIGIT (RING | $286.20 | $318.00 | — | — | 10% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 RIGHT FINGER 4TH DIGIT (RING) | $286.20 | $318.00 | — | — | 10% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 RIGHT FINGER 3RD DIGIT (MIDDLE | $286.20 | $318.00 | — | — | 10% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 RIGHT FINGER 2ND DIGIT (INDEX) | $286.20 | $318.00 | — | — | 10% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 LEFT THUMB | $286.20 | $318.00 | — | — | 10% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 LEFT FINGER 2ND DIGIT (INDEX) | $286.20 | $318.00 | — | — | 10% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 LEFT FINGER 3RD DIGIT (MIDDLE) | $286.20 | $318.00 | — | — | 10% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 RIGHT FINGER 5TH DIGIT (LITTLE | $286.20 | $318.00 | — | — | 10% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 LEFT FIFTH DIGIT (LITTLE) | $286.20 | $318.00 | — | — | 10% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 RIGHT THUMB | $286.20 | $318.00 | — | — | 10% |
| X-ray of the foot, 2 views one side CPT 73620 LEFT FOOT AP/LATERAL | $317.70 | $353.00 | — | 35% above | 10% |
| X-ray of the foot, 2 views one side CPT 73620 RIGHT FOOT 2 VIEWS | $317.70 | $353.00 | — | 35% above | 10% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 LEFT FOOT AP/LATERAL | $317.70 | $353.00 | — | — | 10% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 RIGHT FOOT 2 VIEWS | $317.70 | $353.00 | — | — | 10% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 LEFT FOOT 3 OR MORE VIEWS | $347.40 | $386.00 | — | 13% above | 10% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 RIGHT FOOT 3 OR MORE VIEWS | $347.40 | $386.00 | — | 13% above | 10% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 LEFT FOOT 3 OR MORE VIEWS | $347.40 | $386.00 | — | — | 10% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 RIGHT FOOT 3 OR MORE VIEWS | $347.40 | $386.00 | — | — | 10% |
| X-ray of the hand, 3 or more views one side CPT 73130 RIGHT HAND 3 OR MORE VIEWS | $347.40 | $386.00 | — | 5% above | 10% |
| X-ray of the hand, 3 or more views one side CPT 73130 LEFT HAND 3 OR MORE VIEWS | $347.40 | $386.00 | — | 5% above | 10% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 LEFT HAND 3 OR MORE VIEWS | $347.40 | $386.00 | — | — | 10% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 RIGHT HAND 3 OR MORE VIEWS | $347.40 | $386.00 | — | — | 10% |
| X-ray of the knee, 1 or 2 views CPT 73560 LT KNEE STANDING LONG CASSETTE | $361.80 | $402.00 | — | 30% above | 10% |
| X-ray of the knee, 1 or 2 views CPT 73560 RT KNEE STANDING LONG CASSETTE | $361.80 | $402.00 | — | 30% above | 10% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 RIGHT KNEE - ONE VIEW | $320.40 | $356.00 | — | 15% above | 10% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 LEFT KNEE - ONE VIEW | $320.40 | $356.00 | — | 15% above | 10% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 RIGHT KNEE - AP/LATERAL | $347.40 | $386.00 | — | 25% above | 10% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 LEFT KNEE - AP/LATERAL | $347.40 | $386.00 | — | 25% above | 10% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 LT KNEE STANDING LONG CASSETTE | $361.80 | $402.00 | — | — | 10% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 RT KNEE STANDING LONG CASSETTE | $361.80 | $402.00 | — | — | 10% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 LEFT KNEE - ONE VIEW | $320.40 | $356.00 | — | — | 10% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 RIGHT KNEE - ONE VIEW | $320.40 | $356.00 | — | — | 10% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 RIGHT KNEE - AP/LATERAL | $347.40 | $386.00 | — | — | 10% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 LEFT KNEE - AP/LATERAL | $347.40 | $386.00 | — | — | 10% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE AP & LAT | $347.40 | $386.00 | — | 6% above | 10% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR SPINE AP & LAT | $347.40 | $386.00 | — | — | 10% |
| X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE W/OBL | $522.00 | $580.00 | — | 11% above | 10% |
| X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPI AP- LAT- FLEX- EXT. | $522.00 | $580.00 | — | 11% above | 10% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPINE W/OBL | $522.00 | $580.00 | — | — | 10% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPI AP- LAT- FLEX- EXT. | $522.00 | $580.00 | — | — | 10% |
| X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES | $291.60 | $324.00 | — | at median | 10% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES | $291.60 | $324.00 | — | — | 10% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 2 OR 3 VIEWS | $320.40 | $356.00 | — | 6% below | 10% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE 2 OR 3 VIEWS | $320.40 | $356.00 | — | — | 10% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS - A P ONLY | $347.40 | $386.00 | — | 38% above | 10% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS - A P ONLY | $347.40 | $386.00 | — | — | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM | $333.90 | $371.00 | — | 12% above | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 COCCYX | $333.90 | $371.00 | — | 12% above | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM & COCCYX | $389.70 | $433.00 | — | 31% above | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 COCCYX | $333.90 | $371.00 | — | — | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM | $333.90 | $371.00 | — | — | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM & COCCYX | $389.70 | $433.00 | — | — | 10% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Ohio | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ACTH | $199.80 | $222.00 | — | 53% above | 10% |
| ACTH blood test inpatient CPT 82024 ACTH | $199.80 | $222.00 | — | — | 10% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (SGPT) | $37.80 | $42.00 | — | 31% above | 10% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT FIBROMETER | $52.20 | $58.00 | — | 80% above | 10% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT (SGPT) | $37.80 | $42.00 | — | — | 10% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT FIBROMETER | $52.20 | $58.00 | — | — | 10% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 AST (SGOT) | $37.80 | $42.00 | — | 50% above | 10% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 AST FIBROMETER | $52.20 | $58.00 | — | 107% above | 10% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST (SGOT) | $37.80 | $42.00 | — | — | 10% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST FIBROMETER | $52.20 | $58.00 | — | — | 10% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL ACUTE | $117.90 | $131.00 | — | 45% below | 10% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL ACUTE | $117.90 | $131.00 | — | — | 10% |
| Albumin blood test CPT 82040 ALBUMIN BY NEPHELOMETRY | $38.70 | $43.00 | — | 75% above | 10% |
| Albumin blood test CPT 82040 ALBUMIN, SERUM | $38.70 | $43.00 | — | 75% above | 10% |
| Albumin blood test inpatient CPT 82040 ALBUMIN, SERUM | $38.70 | $43.00 | — | — | 10% |
| Albumin blood test inpatient CPT 82040 ALBUMIN BY NEPHELOMETRY | $38.70 | $43.00 | — | — | 10% |
| Aldosterone blood test CPT 82088 ALDOSTERONE | $223.20 | $248.00 | — | 59% above | 10% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE | $223.20 | $248.00 | — | — | 10% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE | $37.80 | $42.00 | — | 58% above | 10% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE | $37.80 | $42.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IGE, EACH | $22.50 | $25.00 | — | 4% below | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN WHITE ASH TREE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN POTATO | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PISTACHIO | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CASEIN | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SESAME SEED | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN LATEX | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN TUNA | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN RYE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ORANGE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN LETTUCE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN HAZELNUT | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PORK | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN GLUTEN | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN EGG YOLK | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CRAB | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CODFISH/WHITEFISH | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CHOCOLATE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN NAVY BEAN | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN GRAPE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CHICKEN | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CHESTNUT | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CASHEW | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN BRAZIL NUT | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CARROT | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN BEEF | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CABBAGE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN BELL PEPPER/PAPRIKA | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN BARLEY | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN BANANA | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ALMOND | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN BIRCH TREE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN RUSSIAN THISTLE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PIGWEED | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN COTTONWOOD TREE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN MOUNTAIN CEDAR TREE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SHEEP SOREL (DOCK) | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN HORSE HAIR / DANDER | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN WHITE MULBERRY TREE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN DOG DANDER | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN WHITEFISH | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN MUCOR RACEMOSUS | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN MOUSE EPITHELIUM | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PENICILLIUM NOTATUM | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SYCAMORE TREE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PECAN | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN H DUST STIER | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CANDIDA ALBICANS | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN WHEAT POLLEN | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN LAMBS QUARTERS | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ASPERGILLUS FUMIGATU | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN H DUST GREER | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ORCHARD GRAS/COCKSFT | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN TIMOTHY GRASS | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PEANUT | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN HORMODENDRUM | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN GIANT RAGWEED | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN WALNUT TREE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PECANTREE/WHITEHICKRY | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN COCKROACH GERMAN | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN JOHNSON GRASS | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN WALNUT/BLACK WALNUT | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN TOMATO | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SHRIMP | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN BOX ELDER/MAPLE TREE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN JUNE GRASS | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN OAK TREE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ENGLISH PLANTAIN | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN D PTERONYSSINUS | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN RICE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN D. FARINAE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ELM TREE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SHORT RAGWEED | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN BERMUDA GRASS | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN OAT | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN WHEAT | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SOYBEAN | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN EGG WHITE | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CAT EPI & DANDER | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CORN | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN MILK (COW) | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ALTERNARIA (TENUIS) | $38.70 | $43.00 | — | 65% above | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IGE, EACH | $22.50 | $25.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CODFISH/WHITEFISH | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CRAB | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN EGG YOLK | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN GLUTEN | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN NAVY BEAN | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ORANGE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN HAZELNUT | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN LETTUCE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PORK | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CASEIN | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CANDIDA ALBICANS | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ENGLISH PLANTAIN | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN RYE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN TUNA | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ASPERGILLUS FUMIGATU | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN WHEAT POLLEN | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN WHEAT | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN LAMBS QUARTERS | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN D PTERONYSSINUS | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CORN | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN H DUST GREER | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN RICE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ORCHARD GRAS/COCKSFT | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SOYBEAN | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN TIMOTHY GRASS | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN LATEX | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PEANUT | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SESAME SEED | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN HORMODENDRUM | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN BEEF | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN D. FARINAE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CABBAGE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN GIANT RAGWEED | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN BANANA | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PENICILLIUM NOTATUM | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN POTATO | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SYCAMORE TREE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN JUNE GRASS | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN OAT | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN H DUST STIER | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN OAK TREE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ALTERNARIA (TENUIS) | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN BELL PEPPER/PAPRIKA | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN WALNUT TREE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN BARLEY | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ELM TREE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN WHITE ASH TREE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PECANTREE/WHITEHICKRY | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ALMOND | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN EGG WHITE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN HORSE HAIR / DANDER | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN BRAZIL NUT | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CASHEW | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CHESTNUT | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CARROT | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN GRAPE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CHICKEN | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CHOCOLATE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN BIRCH TREE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN COCKROACH GERMAN | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN RUSSIAN THISTLE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SHORT RAGWEED | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PIGWEED | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN JOHNSON GRASS | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN COTTONWOOD TREE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN MILK (COW) | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN MOUNTAIN CEDAR TREE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN WALNUT/BLACK WALNUT | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SHEEP SOREL (DOCK) | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN BERMUDA GRASS | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN TOMATO | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN DOG DANDER | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN WHITE MULBERRY TREE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CAT EPI & DANDER | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN MUCOR RACEMOSUS | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SHRIMP | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN WHITEFISH | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PISTACHIO | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PECAN | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN BOX ELDER/MAPLE TREE | $38.70 | $43.00 | — | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN MOUSE EPITHELIUM | $38.70 | $43.00 | — | — | 10% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFP, MARKER | $88.20 | $98.00 | — | 46% above | 10% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFP, MATERNAL SERUM | $88.20 | $98.00 | — | 46% above | 10% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP, MATERNAL SERUM | $88.20 | $98.00 | — | — | 10% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP, MARKER | $88.20 | $98.00 | — | — | 10% |
| Ammonia blood test CPT 82140 AMMONIA | $198.90 | $221.00 | — | 263% above | 10% |
| Ammonia blood test inpatient CPT 82140 AMMONIA | $198.90 | $221.00 | — | — | 10% |
| Amylase blood test CPT 82150 AMYLASE, FLUID | $149.40 | $166.00 | — | 202% above | 10% |
| Amylase blood test CPT 82150 AMYLASE, URINE- 2HR | $149.40 | $166.00 | — | 202% above | 10% |
| Amylase blood test CPT 82150 AMYLASE, URINE | $149.40 | $166.00 | — | 202% above | 10% |
| Amylase blood test CPT 82150 AMYLASE, 24HR | $149.40 | $166.00 | — | 202% above | 10% |
| Amylase blood test CPT 82150 AMYLASE | $149.40 | $166.00 | — | 202% above | 10% |
| Amylase blood test inpatient CPT 82150 AMYLASE, URINE | $149.40 | $166.00 | — | — | 10% |
| Amylase blood test inpatient CPT 82150 AMYLASE | $149.40 | $166.00 | — | — | 10% |
| Amylase blood test inpatient CPT 82150 AMYLASE, FLUID | $149.40 | $166.00 | — | — | 10% |
| Amylase blood test inpatient CPT 82150 AMYLASE, 24HR | $149.40 | $166.00 | — | — | 10% |
| Amylase blood test inpatient CPT 82150 AMYLASE, URINE- 2HR | $149.40 | $166.00 | — | — | 10% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEP IGG | $140.40 | $156.00 | — | 143% above | 10% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEP IGG | $140.40 | $156.00 | — | — | 10% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTI-NUCLEAR AB | $107.10 | $119.00 | — | 94% above | 10% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTI-NUCLEAR AB | $107.10 | $119.00 | — | — | 10% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT PRO-BNP | $309.60 | $344.00 | — | 107% above | 10% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT PRO-BNP | $309.60 | $344.00 | — | — | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE RESPIRATORY | $117.90 | $131.00 | — | 72% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE THROAT | $117.90 | $131.00 | — | 72% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE AEROBIC | $117.90 | $131.00 | — | 72% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE AEROBIC CSF | $117.90 | $131.00 | — | 72% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE ENVIRONMENTAL | $117.90 | $131.00 | — | 72% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE GENITAL | $117.90 | $131.00 | — | 72% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE ENVIRONMENTAL | $117.90 | $131.00 | — | — | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE GENITAL | $117.90 | $131.00 | — | — | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE RESPIRATORY | $117.90 | $131.00 | — | — | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE THROAT | $117.90 | $131.00 | — | — | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE AEROBIC | $117.90 | $131.00 | — | — | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE AEROBIC CSF | $117.90 | $131.00 | — | — | 10% |
| Basic metabolic panel (blood test) CPT 80048 METABOLIC PANEL BASIC | $194.40 | $216.00 | — | 196% above | 10% |
| Basic metabolic panel (blood test) inpatient CPT 80048 METABOLIC PANEL BASIC | $194.40 | $216.00 | — | — | 10% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL | $57.60 | $64.00 | — | 140% above | 10% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN (TOTAL) NEONATAL | $57.60 | $64.00 | — | 140% above | 10% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN (TOTAL) NEONATAL | $57.60 | $64.00 | — | — | 10% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL | $57.60 | $64.00 | — | — | 10% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATH DR CELL BLOCK | $149.40 | $166.00 | — | 27% below | 10% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATH DR GROSS & MICRO C | $276.30 | $307.00 | — | 36% above | 10% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 CELL BLOCK | $334.80 | $372.00 | — | 65% above | 10% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 GROSS & MICRO C | $518.40 | $576.00 | — | 155% above | 10% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PATH DR CELL BLOCK | $149.40 | $166.00 | — | — | 10% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PATH DR GROSS & MICRO C | $276.30 | $307.00 | — | — | 10% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 CELL BLOCK | $334.80 | $372.00 | — | — | 10% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 GROSS & MICRO C | $518.40 | $576.00 | — | — | 10% |
| Blood culture for bacteria CPT 87040 CULTURE BLOOD | $157.50 | $175.00 | — | 68% above | 10% |
| Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD | $157.50 | $175.00 | — | — | 10% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD COLLECTION, VENOUS | $26.10 | $29.00 | — | 64% above | 10% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD ETOH DRAW - LAW ENFORCE | $39.60 | $44.00 | — | 149% above | 10% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD COLLECTION, LEGAL | $41.40 | $46.00 | — | 160% above | 10% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENOUS SPECIMEN COLLECTION | $55.80 | $62.00 | — | 251% above | 10% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD COLLECTION, VENOUS | $26.10 | $29.00 | — | — | 10% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD ETOH DRAW - LAW ENFORCE | $39.60 | $44.00 | — | — | 10% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD COLLECTION, LEGAL | $41.40 | $46.00 | — | — | 10% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENOUS SPECIMEN COLLECTION | $55.80 | $62.00 | — | — | 10% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE LEVEL | $45.00 | $50.00 | — | 91% above | 10% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE POC | $47.70 | $53.00 | — | 102% above | 10% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE FIBROMETER | $52.20 | $58.00 | — | 121% above | 10% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE, 2 HR P.P. | $66.60 | $74.00 | — | 182% above | 10% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE LEVEL | $45.00 | $50.00 | — | — | 10% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE POC | $47.70 | $53.00 | — | — | 10% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE FIBROMETER | $52.20 | $58.00 | — | — | 10% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE, 2 HR P.P. | $66.60 | $74.00 | — | — | 10% |
| Blood lead test CPT 83655 LEAD, BLOOD CAPILLARY | $66.60 | $74.00 | — | 37% above | 10% |
| Blood lead test CPT 83655 LEAD- INDUSTR L EXPOSURE(COMP) | $66.60 | $74.00 | — | 37% above | 10% |
| Blood lead test CPT 83655 LEAD, BLOOD VENOUS | $66.60 | $74.00 | — | 37% above | 10% |
| Blood lead test CPT 83655 LEAD, URINE | $66.60 | $74.00 | — | 37% above | 10% |
| Blood lead test inpatient CPT 83655 LEAD- INDUSTR L EXPOSURE(COMP) | $66.60 | $74.00 | — | — | 10% |
| Blood lead test inpatient CPT 83655 LEAD, URINE | $66.60 | $74.00 | — | — | 10% |
| Blood lead test inpatient CPT 83655 LEAD, BLOOD CAPILLARY | $66.60 | $74.00 | — | — | 10% |
| Blood lead test inpatient CPT 83655 LEAD, BLOOD VENOUS | $66.60 | $74.00 | — | — | 10% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 BHCG, SERUM QUAL | $124.20 | $138.00 | — | 118% above | 10% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 BHCG, SERUM QUAL | $124.20 | $138.00 | — | — | 10% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 TYPE, ABO ONLY | $59.40 | $66.00 | — | 4% above | 10% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 TYPE, ABO ONLY | $59.40 | $66.00 | — | — | 10% |
| Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN POC | $43.20 | $48.00 | — | 85% above | 10% |
| Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN | $43.20 | $48.00 | — | 85% above | 10% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN POC | $43.20 | $48.00 | — | — | 10% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN | $43.20 | $48.00 | — | — | 10% |
| C-peptide blood test CPT 84681 C - PEPTIDE SERUM | $154.80 | $172.00 | — | 101% above | 10% |
| C-peptide blood test inpatient CPT 84681 C - PEPTIDE SERUM | $154.80 | $172.00 | — | — | 10% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $110.70 | $123.00 | — | 115% above | 10% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN | $110.70 | $123.00 | — | — | 10% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFFICILE TOXIN B GENE (TCDB) BY PCR | $219.60 | $244.00 | — | 66% above | 10% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFFICILE TOXIN B GENE (TCDB) BY PCR | $219.60 | $244.00 | — | — | 10% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 | $135.90 | $151.00 | — | 90% above | 10% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 | $135.90 | $151.00 | — | — | 10% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 | $135.90 | $151.00 | — | 45% above | 10% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 | $135.90 | $151.00 | — | — | 10% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 BY PCR LIAT-U0002 | $182.70 | $203.00 | — | 30% above | 10% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 BY PCR LIAT-U0002 | $182.70 | $203.00 | — | — | 10% |
| Calcium blood test, total CPT 82310 CALCIUM LEVEL | $39.60 | $44.00 | — | 25% above | 10% |
| Calcium blood test, total CPT 82310 CALCIUM, URINE | $47.70 | $53.00 | — | 51% above | 10% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM LEVEL | $39.60 | $44.00 | — | — | 10% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM, URINE | $47.70 | $53.00 | — | — | 10% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CEA | $234.90 | $261.00 | — | 176% above | 10% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA | $234.90 | $261.00 | — | — | 10% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB IGM | $94.50 | $105.00 | — | 63% above | 10% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB IGG | $94.50 | $105.00 | — | 63% above | 10% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB IGM | $94.50 | $105.00 | — | — | 10% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB IGG | $94.50 | $105.00 | — | — | 10% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS, AMP | $102.60 | $114.00 | — | 10% above | 10% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS THIN PREP | $102.60 | $114.00 | — | 10% above | 10% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS THIN PREP | $102.60 | $114.00 | — | — | 10% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS, AMP | $102.60 | $114.00 | — | — | 10% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE REFLEX LDL DIRECT | $167.40 | $186.00 | — | 213% above | 10% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE | $167.40 | $186.00 | — | 213% above | 10% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE | $167.40 | $186.00 | — | — | 10% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE REFLEX LDL DIRECT | $167.40 | $186.00 | — | — | 10% |
| Complete blood count (CBC) with differential CPT 85025 CBC MANUAL DIFF IF IND | $94.50 | $105.00 | — | 154% above | 10% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC MANUAL DIFF IF IND | $94.50 | $105.00 | — | — | 10% |
| Complete blood count (CBC), no differential CPT 85027 HEMOGRAM AND PLATELET ONLY | $81.90 | $91.00 | — | 148% above | 10% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM AND PLATELET ONLY | $81.90 | $91.00 | — | — | 10% |
| Comprehensive metabolic panel (blood test) CPT 80053 METABOLIC PANEL COMPREHENSIVE | $268.20 | $298.00 | — | 321% above | 10% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 METABOLIC PANEL COMPREHENSIVE | $268.20 | $298.00 | — | — | 10% |
| Cortisol blood test, total CPT 82533 CORTISOL | $80.10 | $89.00 | — | 11% above | 10% |
| Cortisol blood test, total CPT 82533 CORTISOL SALIVA | $80.10 | $89.00 | — | 11% above | 10% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL SALIVA | $80.10 | $89.00 | — | — | 10% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL | $80.10 | $89.00 | — | — | 10% |
| Creatine kinase (CK) blood test, total CPT 82550 CK | $111.60 | $124.00 | — | 221% above | 10% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CK | $111.60 | $124.00 | — | — | 10% |
| Creatinine blood test CPT 82565 CREATININE W/EGFR ARUP | $10.80 | $12.00 | — | 56% below | 10% |
| Creatinine blood test CPT 82565 CREATININE POC | $43.20 | $48.00 | — | 77% above | 10% |
| Creatinine blood test CPT 82565 CREATININE | $43.20 | $48.00 | — | 77% above | 10% |
| Creatinine blood test inpatient CPT 82565 CREATININE W/EGFR ARUP | $10.80 | $12.00 | — | — | 10% |
| Creatinine blood test inpatient CPT 82565 CREATININE | $43.20 | $48.00 | — | — | 10% |
| Creatinine blood test inpatient CPT 82565 CREATININE POC | $43.20 | $48.00 | — | — | 10% |
| Cytomegalovirus (CMV) antibody test CPT 86644 BLD CMV NEG TESTING OF UNIT | $126.00 | $140.00 | — | 87% above | 10% |
| Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGALOVIRUS AB, IGG | $139.50 | $155.00 | — | 107% above | 10% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 BLD CMV NEG TESTING OF UNIT | $126.00 | $140.00 | — | — | 10% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGALOVIRUS AB, IGG | $139.50 | $155.00 | — | — | 10% |
| D-dimer blood test (blood clot marker) CPT 85379 D-DIMER | $201.60 | $224.00 | — | 180% above | 10% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER | $201.60 | $224.00 | — | — | 10% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-SULFATE | $147.60 | $164.00 | — | 48% above | 10% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-SULFATE | $147.60 | $164.00 | — | — | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCRN PRESUMPTIVE TLC | $60.30 | $67.00 | — | 38% below | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 ETHYL GLUCURONIDE SCREEN | $73.80 | $82.00 | — | 24% below | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 COTININE SCREEN, URINE | $73.80 | $82.00 | — | 24% below | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN CLASS SINGLE | $110.70 | $123.00 | — | 14% above | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN PAIN MGT URINE | $125.10 | $139.00 | — | 29% above | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN- UR LEGAL | $125.10 | $139.00 | — | 29% above | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN MEDICAL UR | $125.10 | $139.00 | — | 29% above | 10% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCRN PRESUMPTIVE TLC | $60.30 | $67.00 | — | — | 10% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 COTININE SCREEN, URINE | $73.80 | $82.00 | — | — | 10% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ETHYL GLUCURONIDE SCREEN | $73.80 | $82.00 | — | — | 10% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN CLASS SINGLE | $110.70 | $123.00 | — | — | 10% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN PAIN MGT URINE | $125.10 | $139.00 | — | — | 10% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN- UR LEGAL | $125.10 | $139.00 | — | — | 10% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN MEDICAL UR | $125.10 | $139.00 | — | — | 10% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTES PANEL | $145.80 | $162.00 | — | 206% above | 10% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTES PANEL | $145.80 | $162.00 | — | — | 10% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EBV-VCA AB, IGG | $117.00 | $130.00 | — | 80% above | 10% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EBV-VCA AB, IGM | $117.00 | $130.00 | — | 80% above | 10% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV-VCA AB, IGM | $117.00 | $130.00 | — | — | 10% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV-VCA AB, IGG | $117.00 | $130.00 | — | — | 10% |
| Estradiol blood test CPT 82670 ESTRADIOL TANDEM MASS SPEC | $107.10 | $119.00 | — | 4% below | 10% |
| Estradiol blood test CPT 82670 ESTRADIOL | $107.10 | $119.00 | — | 4% below | 10% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL | $107.10 | $119.00 | — | — | 10% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL TANDEM MASS SPEC | $107.10 | $119.00 | — | — | 10% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH, SERUM | $132.30 | $147.00 | — | 54% above | 10% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH, SERUM | $132.30 | $147.00 | — | — | 10% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, FECAL | $483.30 | $537.00 | — | 223% above | 10% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, FECAL | $483.30 | $537.00 | — | — | 10% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN FIBROMETER | $52.20 | $58.00 | — | 31% below | 10% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $124.20 | $138.00 | — | 63% above | 10% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN FIBROMETER | $52.20 | $58.00 | — | — | 10% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN | $124.20 | $138.00 | — | — | 10% |
| Fibrinogen blood test CPT 85384 FIBRINOGEN | $147.60 | $164.00 | — | 228% above | 10% |
| Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN | $147.60 | $164.00 | — | — | 10% |
| Folate (folic acid) blood test CPT 82746 FOLATE(FOLIC ACID), SERUM | $124.20 | $138.00 | — | 85% above | 10% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLATE(FOLIC ACID), SERUM | $124.20 | $138.00 | — | — | 10% |
| Free T3 thyroid hormone test CPT 84481 T3, FREE | $126.00 | $140.00 | — | 72% above | 10% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3, FREE | $126.00 | $140.00 | — | — | 10% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE, FREE BY EQUIL DIALY | $149.40 | $166.00 | — | 259% above | 10% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 BY EQUIL DIALYSIS-TMS | $149.40 | $166.00 | — | 259% above | 10% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4, FREE | $149.40 | $166.00 | — | 259% above | 10% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE, FREE BY EQUIL DIALY | $149.40 | $166.00 | — | — | 10% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4 BY EQUIL DIALYSIS-TMS | $149.40 | $166.00 | — | — | 10% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4, FREE | $149.40 | $166.00 | — | — | 10% |
| Free testosterone test CPT 84402 TESTOSTERONE, FREE | $121.50 | $135.00 | — | 28% above | 10% |
| Free testosterone test CPT 84402 TESTOSTERONE FREE BY LC-MS | $257.40 | $286.00 | — | 170% above | 10% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE | $121.50 | $135.00 | — | — | 10% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE BY LC-MS | $257.40 | $286.00 | — | — | 10% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT | $90.90 | $101.00 | — | 113% above | 10% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT | $90.90 | $101.00 | — | — | 10% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE, POST GLUCOLA | $87.30 | $97.00 | — | 148% above | 10% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE, 1 HR POST GLUCOLA | $87.30 | $97.00 | — | 148% above | 10% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE, POST GLUCOLA | $87.30 | $97.00 | — | — | 10% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE, 1 HR POST GLUCOLA | $87.30 | $97.00 | — | — | 10% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 3 SPECIMENS | $145.80 | $162.00 | — | 117% above | 10% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 1 HR | $145.80 | $162.00 | — | 117% above | 10% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 2 HR | $145.80 | $162.00 | — | 117% above | 10% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 3 SPECIMENS | $145.80 | $162.00 | — | — | 10% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 1 HR | $145.80 | $162.00 | — | — | 10% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 2 HR | $145.80 | $162.00 | — | — | 10% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE THIN PREP | $102.60 | $114.00 | — | 10% above | 10% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE, AMP | $102.60 | $114.00 | — | 10% above | 10% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE THIN PREP | $102.60 | $114.00 | — | — | 10% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE, AMP | $102.60 | $114.00 | — | — | 10% |
| H. pylori stool antigen test CPT 87338 HEL PYLORI AG, STOOL | $293.40 | $326.00 | — | 320% above | 10% |
| H. pylori stool antigen test inpatient CPT 87338 HEL PYLORI AG, STOOL | $293.40 | $326.00 | — | — | 10% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA QUANT BY PCR | $464.40 | $516.00 | — | 30% above | 10% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA QUANT BY PCR | $464.40 | $516.00 | — | — | 10% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV1&2 ANTIBOD W/REFLEX TO WB | $136.80 | $152.00 | — | 122% above | 10% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV 1 & 2, RAPID | $144.00 | $160.00 | — | 133% above | 10% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV1&2 ANTIBOD W/REFLEX TO WB | $136.80 | $152.00 | — | — | 10% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1 & 2, RAPID | $144.00 | $160.00 | — | — | 10% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV COMBO AG/AB | $86.40 | $96.00 | — | 17% above | 10% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV COMBO AG/AB | $86.40 | $96.00 | — | — | 10% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH RISK GROUP, CERVIX | $199.80 | $222.00 | — | 69% above | 10% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HIGH RISK GROUP, CERVIX | $199.80 | $222.00 | — | — | 10% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C | $123.30 | $137.00 | — | 170% above | 10% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C | $123.30 | $137.00 | — | — | 10% |
| Hemoglobin blood test CPT 85018 HEMOGLOBIN | $35.10 | $39.00 | — | 117% above | 10% |
| Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN | $35.10 | $39.00 | — | — | 10% |
| Hepatitis B core antibody test (total) CPT 86704 HEP B CORE AB, TOTAL | $130.50 | $145.00 | — | 142% above | 10% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEP B CORE AB, TOTAL | $130.50 | $145.00 | — | — | 10% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE AB | $121.50 | $135.00 | — | 153% above | 10% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE AB | $121.50 | $135.00 | — | — | 10% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP B SURFACE ANTIGEN | $135.90 | $151.00 | — | 193% above | 10% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEP B SURFACE ANTIGEN | $135.90 | $151.00 | — | — | 10% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY | $137.70 | $153.00 | — | 115% above | 10% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY | $137.70 | $153.00 | — | — | 10% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C VIRUS RNA, QUANT | $219.60 | $244.00 | — | 14% above | 10% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C CONFIRM/QUANT | $219.60 | $244.00 | — | 14% above | 10% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C CONFIRM/QUANT | $219.60 | $244.00 | — | — | 10% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C VIRUS RNA, QUANT | $219.60 | $244.00 | — | — | 10% |
| Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IGG AB | $63.00 | $70.00 | — | 7% above | 10% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IGG AB | $63.00 | $70.00 | — | — | 10% |
| Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IGG AB | $63.00 | $70.00 | — | 5% below | 10% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IGG AB | $63.00 | $70.00 | — | — | 10% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HIGH SENS | $110.70 | $123.00 | — | 64% above | 10% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HIGH SENS | $110.70 | $123.00 | — | — | 10% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE, TOTAL | $173.70 | $193.00 | — | 116% above | 10% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE, TOTAL | $173.70 | $193.00 | — | — | 10% |
| Insulin blood test CPT 83525 INSULIN FASTING | $145.80 | $162.00 | — | 184% above | 10% |
| Insulin blood test CPT 83525 INSULIN POST GLUCOLA | $145.80 | $162.00 | — | 184% above | 10% |
| Insulin blood test CPT 83525 INSULIN 2HR POST PRANDIAL | $145.80 | $162.00 | — | 184% above | 10% |
| Insulin blood test inpatient CPT 83525 INSULIN 2HR POST PRANDIAL | $145.80 | $162.00 | — | — | 10% |
| Insulin blood test inpatient CPT 83525 INSULIN FASTING | $145.80 | $162.00 | — | — | 10% |
| Insulin blood test inpatient CPT 83525 INSULIN POST GLUCOLA | $145.80 | $162.00 | — | — | 10% |
| Iron blood test (serum iron) CPT 83540 IRON LEVEL | $121.50 | $135.00 | — | 219% above | 10% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON LEVEL | $121.50 | $135.00 | — | — | 10% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY (UIBC) | $121.50 | $135.00 | — | 212% above | 10% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY (UIBC) | $121.50 | $135.00 | — | — | 10% |
| Kidney function blood test panel CPT 80069 RENAL PANEL | $191.70 | $213.00 | — | 163% above | 10% |
| Kidney function blood test panel inpatient CPT 80069 RENAL PANEL | $191.70 | $213.00 | — | — | 10% |
| LH (luteinizing hormone) test CPT 83002 LUTENIZING HORMONE, SERUM | $111.60 | $124.00 | — | 17% above | 10% |
| LH (luteinizing hormone) test inpatient CPT 83002 LUTENIZING HORMONE, SERUM | $111.60 | $124.00 | — | — | 10% |
| Lactate (lactic acid) blood test CPT 83605 LACTIC ACID | $106.20 | $118.00 | — | 104% above | 10% |
| Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID | $106.20 | $118.00 | — | — | 10% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LD | $110.70 | $123.00 | — | 305% above | 10% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LD FLUID | $110.70 | $123.00 | — | 305% above | 10% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LD FLUID | $110.70 | $123.00 | — | — | 10% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LD | $110.70 | $123.00 | — | — | 10% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE, FLUID | $144.00 | $160.00 | — | 147% above | 10% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $144.00 | $160.00 | — | 147% above | 10% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE, FLUID | $144.00 | $160.00 | — | — | 10% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE | $144.00 | $160.00 | — | — | 10% |
| Liver function blood test panel CPT 80076 LIVER PANEL | $189.00 | $210.00 | — | 203% above | 10% |
| Liver function blood test panel inpatient CPT 80076 LIVER PANEL | $189.00 | $210.00 | — | — | 10% |
| Lyme disease antibody test CPT 86618 LYME EIA IGG & IGM REFLEX CHARGE | $90.90 | $101.00 | — | 19% above | 10% |
| Lyme disease antibody test CPT 86618 LYME DISEASE ABS | $117.90 | $131.00 | — | 54% above | 10% |
| Lyme disease antibody test CPT 86618 BORRELIA BURGDORFERI ABS TOTAL | $117.90 | $131.00 | — | 54% above | 10% |
| Lyme disease antibody test inpatient CPT 86618 LYME EIA IGG & IGM REFLEX CHARGE | $90.90 | $101.00 | — | — | 10% |
| Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ABS | $117.90 | $131.00 | — | — | 10% |
| Lyme disease antibody test inpatient CPT 86618 BORRELIA BURGDORFERI ABS TOTAL | $117.90 | $131.00 | — | — | 10% |
| Magnesium blood test CPT 83735 MAGNESIUM RBC | $95.40 | $106.00 | — | 183% above | 10% |
| Magnesium blood test CPT 83735 MAGNESIUM LEVEL | $102.60 | $114.00 | — | 205% above | 10% |
| Magnesium blood test CPT 83735 MAGNESIUM, URINE- 24HR | $102.60 | $114.00 | — | 205% above | 10% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM RBC | $95.40 | $106.00 | — | — | 10% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM, URINE- 24HR | $102.60 | $114.00 | — | — | 10% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM LEVEL | $102.60 | $114.00 | — | — | 10% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA (MEASLES) AB IGM | $82.80 | $92.00 | — | 45% above | 10% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA (MEASLES) AB, IGG | $82.80 | $92.00 | — | 45% above | 10% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA (MEASLES) AB IGM | $82.80 | $92.00 | — | — | 10% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA (MEASLES) AB, IGG | $82.80 | $92.00 | — | — | 10% |
| Mono test (heterophile antibody, Monospot) CPT 86308 MONO TEST RAPID | $61.20 | $68.00 | — | 18% above | 10% |
| Mono test (heterophile antibody, Monospot) CPT 86308 MONO TEST | $61.20 | $68.00 | — | 18% above | 10% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO TEST | $61.20 | $68.00 | — | — | 10% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO TEST RAPID | $61.20 | $68.00 | — | — | 10% |
| Mumps immunity blood test CPT 86735 MUMPS AB, IGG | $90.00 | $100.00 | — | 54% above | 10% |
| Mumps immunity blood test CPT 86735 MUMPS, AB, IGM | $90.00 | $100.00 | — | 54% above | 10% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS AB, IGG | $90.00 | $100.00 | — | — | 10% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS, AB, IGM | $90.00 | $100.00 | — | — | 10% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $716.40 | $796.00 | — | 241% above | 10% |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL | $716.40 | $796.00 | — | — | 10% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PROSTATIC SPECIFC AG FREE-COMP | $130.50 | $145.00 | — | 58% above | 10% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PROSTATIC SPECIFC AG FREE-COMP | $130.50 | $145.00 | — | — | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPECIFIC ANTIGEN DIAGNOSTIC | $144.00 | $160.00 | — | 82% above | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPECIFIC ANTIGEN | $144.00 | $160.00 | — | 82% above | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPECIFIC AG TTL-COMP | $162.00 | $180.00 | — | 105% above | 10% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SPECIFIC ANTIGEN DIAGNOSTIC | $144.00 | $160.00 | — | — | 10% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SPECIFIC ANTIGEN | $144.00 | $160.00 | — | — | 10% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SPECIFIC AG TTL-COMP | $162.00 | $180.00 | — | — | 10% |
| Pap test (liquid-based, automated screening with review) CPT 88175 PAP THIN PREP | $125.10 | $139.00 | — | 25% above | 10% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP THIN PREP | $125.10 | $139.00 | — | — | 10% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID INTACT | $145.80 | $162.00 | — | 3% above | 10% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID INTACT W/GRAPH | $234.90 | $261.00 | — | 67% above | 10% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID INTACT | $145.80 | $162.00 | — | — | 10% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID INTACT W/GRAPH | $234.90 | $261.00 | — | — | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 APTT | $81.90 | $91.00 | — | 121% above | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT RATIO NEUT TREAT RFLX | $99.00 | $110.00 | — | 167% above | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT-LA RATIO (COMP) | $99.00 | $110.00 | — | 167% above | 10% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APTT | $81.90 | $91.00 | — | — | 10% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT-LA RATIO (COMP) | $99.00 | $110.00 | — | — | 10% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT RATIO NEUT TREAT RFLX | $99.00 | $110.00 | — | — | 10% |
| Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS | $97.20 | $108.00 | — | 172% above | 10% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS | $97.20 | $108.00 | — | — | 10% |
| Potassium blood test CPT 84132 POTASSIUM POC | $53.10 | $59.00 | — | 127% above | 10% |
| Potassium blood test CPT 84132 POTASSIUM LEVEL | $53.10 | $59.00 | — | 127% above | 10% |
| Potassium blood test inpatient CPT 84132 POTASSIUM POC | $53.10 | $59.00 | — | — | 10% |
| Potassium blood test inpatient CPT 84132 POTASSIUM LEVEL | $53.10 | $59.00 | — | — | 10% |
| Progesterone blood test CPT 84144 PROGESTERONE | $116.10 | $129.00 | — | 44% above | 10% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE | $116.10 | $129.00 | — | — | 10% |
| Prolactin blood test CPT 84146 PROLACTIN | $111.60 | $124.00 | — | 28% above | 10% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN | $111.60 | $124.00 | — | — | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 INR RAPID | $51.30 | $57.00 | — | 113% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $51.30 | $57.00 | — | 113% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME - POCT | $51.30 | $57.00 | — | 113% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (COMP) | $51.30 | $57.00 | — | 113% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 INR, WHOLE BLOOD | $51.30 | $57.00 | — | 113% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME 1:1MIX REFLEX | $111.60 | $124.00 | — | 364% above | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (COMP) | $51.30 | $57.00 | — | — | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR RAPID | $51.30 | $57.00 | — | — | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME - POCT | $51.30 | $57.00 | — | — | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR, WHOLE BLOOD | $51.30 | $57.00 | — | — | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $51.30 | $57.00 | — | — | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME 1:1MIX REFLEX | $111.60 | $124.00 | — | — | 10% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN, URINE (JTDMH) | $124.20 | $138.00 | — | 115% above | 10% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN, URINE (JTDMH) | $124.20 | $138.00 | — | — | 10% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A & B AGS, POCT | $61.20 | $68.00 | — | 7% below | 10% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A & B AGS, POCT | $61.20 | $68.00 | — | — | 10% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 RAPID STREP RAPID | $61.20 | $68.00 | — | 7% above | 10% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RAPID STREP RAPID | $61.20 | $68.00 | — | — | 10% |
| Renin blood test CPT 84244 RENIN ACTIVITY | $88.20 | $98.00 | — | 3% above | 10% |
| Renin blood test inpatient CPT 84244 RENIN ACTIVITY | $88.20 | $98.00 | — | — | 10% |
| Rh blood typing CPT 86901 RH ONLY | $57.60 | $64.00 | — | 54% above | 10% |
| Rh blood typing inpatient CPT 86901 RH ONLY | $57.60 | $64.00 | — | — | 10% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR | $215.10 | $239.00 | — | 549% above | 10% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR | $215.10 | $239.00 | — | — | 10% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG | $62.10 | $69.00 | — | 28% above | 10% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM | $62.10 | $69.00 | — | 28% above | 10% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ABS, TOTAL | $110.70 | $123.00 | — | 128% above | 10% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGG | $62.10 | $69.00 | — | — | 10% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGM | $62.10 | $69.00 | — | — | 10% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ABS, TOTAL | $110.70 | $123.00 | — | — | 10% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE | $70.20 | $78.00 | — | 88% above | 10% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE | $70.20 | $78.00 | — | — | 10% |
| Sodium blood test CPT 84295 SODIUM LEVEL | $40.50 | $45.00 | — | 49% above | 10% |
| Sodium blood test CPT 84295 SODIUM POC | $40.50 | $45.00 | — | 49% above | 10% |
| Sodium blood test inpatient CPT 84295 SODIUM LEVEL | $40.50 | $45.00 | — | — | 10% |
| Sodium blood test inpatient CPT 84295 SODIUM POC | $40.50 | $45.00 | — | — | 10% |
| Stool ova and parasites exam CPT 87177 OVA & PARASITES (COMP) | $85.50 | $95.00 | — | 116% above | 10% |
| Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES (COMP) | $85.50 | $95.00 | — | — | 10% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD, STOOL (1-3 SPEC) | $53.10 | $59.00 | — | 1% below | 10% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD, STOOL (1-3 SPEC) | $53.10 | $59.00 | — | — | 10% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMAL ABS BY TP-PA | $73.80 | $82.00 | — | 28% above | 10% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMAL ABS BY TP-PA | $73.80 | $82.00 | — | — | 10% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 TREPONEMA ABS W/REFLEX TTR | $73.80 | $82.00 | — | 206% above | 10% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 TREPONEMA ABS W/REFLEX TTR-CSF | $73.80 | $82.00 | — | 206% above | 10% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR | $90.00 | $100.00 | — | 274% above | 10% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 TREPONEMA ABS W/REFLEX TTR | $73.80 | $82.00 | — | — | 10% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 TREPONEMA ABS W/REFLEX TTR-CSF | $73.80 | $82.00 | — | — | 10% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR | $90.00 | $100.00 | — | — | 10% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON-TB GOLD IN-TUBE | $191.70 | $213.00 | — | 53% above | 10% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON-TB GOLD IN-TUBE | $191.70 | $213.00 | — | — | 10% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL | $99.00 | $110.00 | — | 7% above | 10% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE BY LC-MS | $250.20 | $278.00 | — | 172% above | 10% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL | $99.00 | $110.00 | — | — | 10% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE BY LC-MS | $250.20 | $278.00 | — | — | 10% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB | $144.00 | $160.00 | — | 122% above | 10% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AB | $144.00 | $160.00 | — | — | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH, ULTRASENSITIVE | $180.90 | $201.00 | — | 141% above | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH REFLEX FT4 IF TSH ABNORMAL | $180.90 | $201.00 | — | 141% above | 10% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH REFLEX FT4 IF TSH ABNORMAL | $180.90 | $201.00 | — | — | 10% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH, ULTRASENSITIVE | $180.90 | $201.00 | — | — | 10% |
| Total IgE blood test CPT 82785 IMMUNOGLOBULIN E | $88.20 | $98.00 | — | 37% above | 10% |
| Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN E | $88.20 | $98.00 | — | — | 10% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL | $63.90 | $71.00 | — | 75% above | 10% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL, FLUID | $66.60 | $74.00 | — | 82% above | 10% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL | $63.90 | $71.00 | — | — | 10% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL, FLUID | $66.60 | $74.00 | — | — | 10% |
| Total thyroxine (T4) blood test CPT 84436 THYROXINE, TOTAL | $81.90 | $91.00 | — | 102% above | 10% |
| Total thyroxine (T4) blood test inpatient CPT 84436 THYROXINE, TOTAL | $81.90 | $91.00 | — | — | 10% |
| Total triiodothyronine (T3) blood test CPT 84480 T3, TOTAL | $118.80 | $132.00 | — | 98% above | 10% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3, TOTAL | $118.80 | $132.00 | — | — | 10% |
| Transferrin blood test CPT 84466 TRANSFERRIN | $130.50 | $145.00 | — | 79% above | 10% |
| Transferrin blood test inpatient CPT 84466 TRANSFERRIN | $130.50 | $145.00 | — | — | 10% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMP | $102.60 | $114.00 | — | 19% above | 10% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS BY TMA (COMPONENT) | $106.20 | $118.00 | — | 23% above | 10% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMP | $102.60 | $114.00 | — | — | 10% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS BY TMA (COMPONENT) | $106.20 | $118.00 | — | — | 10% |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES | $51.30 | $57.00 | — | 40% above | 10% |
| Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES | $51.30 | $57.00 | — | — | 10% |
| Troponin test, quantitative CPT 84484 TROPONIN T | $159.30 | $177.00 | — | 90% above | 10% |
| Troponin test, quantitative inpatient CPT 84484 TROPONIN T | $159.30 | $177.00 | — | — | 10% |
| Uric acid blood test CPT 84550 URIC ACID | $102.60 | $114.00 | — | 191% above | 10% |
| Uric acid blood test inpatient CPT 84550 URIC ACID | $102.60 | $114.00 | — | — | 10% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS WITH MICROSCOPIC | $80.10 | $89.00 | — | 197% above | 10% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS WITH MICROSCOPIC | $80.10 | $89.00 | — | — | 10% |
| Urinalysis without microscope exam, automated CPT 81003 U/A CHEM ONLY RAPID | $45.00 | $50.00 | — | 88% above | 10% |
| Urinalysis without microscope exam, automated CPT 81003 U/A-MICRO IF IND | $45.00 | $50.00 | — | 88% above | 10% |
| Urinalysis without microscope exam, automated CPT 81003 W/C URINE DIPSTICK URINALYSIS | $45.00 | $50.00 | — | 88% above | 10% |
| Urinalysis without microscope exam, automated CPT 81003 U/A CHEM ONLY, POCT | $45.00 | $50.00 | — | 88% above | 10% |
| Urinalysis without microscope exam, automated CPT 81003 U/A CHEM ONLY | $45.00 | $50.00 | — | 88% above | 10% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 U/A CHEM ONLY RAPID | $45.00 | $50.00 | — | — | 10% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 W/C URINE DIPSTICK URINALYSIS | $45.00 | $50.00 | — | — | 10% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 U/A CHEM ONLY | $45.00 | $50.00 | — | — | 10% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 U/A CHEM ONLY, POCT | $45.00 | $50.00 | — | — | 10% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 U/A-MICRO IF IND | $45.00 | $50.00 | — | — | 10% |
| Urinalysis without microscope exam, manual CPT 81002 SPECIFIC GRAVITY URINE | $26.10 | $29.00 | — | 58% above | 10% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 SPECIFIC GRAVITY URINE | $26.10 | $29.00 | — | — | 10% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE | $120.60 | $134.00 | — | 111% above | 10% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE | $120.60 | $134.00 | — | — | 10% |
| Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN, 24 HR | $116.10 | $129.00 | — | 129% above | 10% |
| Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN, URINE RANDOM | $116.10 | $129.00 | — | 129% above | 10% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN, URINE RANDOM | $116.10 | $129.00 | — | — | 10% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN, 24 HR | $116.10 | $129.00 | — | — | 10% |
| Urine pregnancy test, read by color change CPT 81025 BHCG, URINE QUAL | $56.70 | $63.00 | — | 17% above | 10% |
| Urine pregnancy test, read by color change CPT 81025 BHCG, URINE (QUAL), POCT | $56.70 | $63.00 | — | 17% above | 10% |
| Urine pregnancy test, read by color change CPT 81025 BHCG-QUAL UR RAPID | $56.70 | $63.00 | — | 17% above | 10% |
| Urine pregnancy test, read by color change inpatient CPT 81025 BHCG, URINE (QUAL), POCT | $56.70 | $63.00 | — | — | 10% |
| Urine pregnancy test, read by color change inpatient CPT 81025 BHCG, URINE QUAL | $56.70 | $63.00 | — | — | 10% |
| Urine pregnancy test, read by color change inpatient CPT 81025 BHCG-QUAL UR RAPID | $56.70 | $63.00 | — | — | 10% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 LEVEL | $135.90 | $151.00 | — | 84% above | 10% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 LEVEL | $135.90 | $151.00 | — | — | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25-HYDROXY | $154.80 | $172.00 | — | 69% above | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VIT D 25-OH D2 & D3 BYMASSSPEC | $181.80 | $202.00 | — | 98% above | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25-HYDROXY | $154.80 | $172.00 | — | — | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VIT D 25-OH D2 & D3 BYMASSSPEC | $181.80 | $202.00 | — | — | 10% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D 1,25-DYHYDROXY | $165.60 | $184.00 | — | 8% above | 10% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D 1,25-DYHYDROXY | $165.60 | $184.00 | — | — | 10% |
| Zinc blood test CPT 84630 ZINC LEVEL | $96.30 | $107.00 | — | 88% above | 10% |
| Zinc blood test inpatient CPT 84630 ZINC LEVEL | $96.30 | $107.00 | — | — | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BHCG MARKER | $144.00 | $160.00 | — | 113% above | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BHCG, QUANT (COMP OF AFP) | $144.00 | $160.00 | — | 113% above | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BHCG, SERUM QUANT | $144.00 | $160.00 | — | 113% above | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BHCG MARKER | $144.00 | $160.00 | — | — | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BHCG, QUANT (COMP OF AFP) | $144.00 | $160.00 | — | — | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BHCG, SERUM QUANT | $144.00 | $160.00 | — | — | 10% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Ohio | Off list |
|---|---|---|---|---|---|
| Botox injections for chronic migraine both sides CPT 64615 CHEMODENERV BILAT CHR MIGRAINE | $922.50 | $1,025.00 | — | — | 10% |
| Botox injections for chronic migraine inpatient both sides CPT 64615 CHEMODENERV BILAT CHR MIGRAINE | $922.50 | $1,025.00 | — | — | 10% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 STEREO/MAM BREAST BX 1ST LESION | $6,020.10 | $6,689.00 | — | 50% above | 10% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 STEREO/MAM BREAST BX 1ST LESION | $6,020.10 | $6,689.00 | — | — | 10% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 ER DR-CARDIOVERSION | $369.90 | $411.00 | — | 82% below | 10% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION W/ MOD SEDATION | $1,538.10 | $1,709.00 | — | 25% below | 10% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION | $1,701.00 | $1,890.00 | — | 17% below | 10% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ER DR-CARDIOVERSION | $369.90 | $411.00 | — | — | 10% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION W/ MOD SEDATION | $1,538.10 | $1,709.00 | — | — | 10% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION | $1,701.00 | $1,890.00 | — | — | 10% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 ER CLSD TX DIST RADIAL FX | $389.70 | $433.00 | — | 3% below | 10% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 ER DR CLSD TX DIST RADIAL FX | $411.30 | $457.00 | — | 2% above | 10% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 ER CLSD TX DIST RADIAL FX | $389.70 | $433.00 | — | — | 10% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 ER DR CLSD TX DIST RADIAL FX | $411.30 | $457.00 | — | — | 10% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 WC-LES-1ST BENIGN/PREMALIG | $334.80 | $372.00 | — | 65% above | 10% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 WC-LES-1ST BENIGN/PREMALIG | $334.80 | $372.00 | — | — | 10% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 UC DR-REMOVAL IMPACTED CERUMEN | $79.20 | $88.00 | — | 49% below | 10% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 UC REMOVAL IMPACTED CERUMEN | $96.30 | $107.00 | — | 38% below | 10% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 ER DR-REMOVAL IMPACTED CERUMEN | $99.00 | $110.00 | — | 36% below | 10% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 ER REMOVAL IMPACTED CERUMEN | $113.40 | $126.00 | — | 27% below | 10% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 UC DR-REMOVAL IMPACTED CERUMEN | $79.20 | $88.00 | — | — | 10% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 UC REMOVAL IMPACTED CERUMEN | $96.30 | $107.00 | — | — | 10% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ER DR-REMOVAL IMPACTED CERUMEN | $99.00 | $110.00 | — | — | 10% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ER REMOVAL IMPACTED CERUMEN | $113.40 | $126.00 | — | — | 10% |
| Earwax removal with instruments, one ear CPT 69210 ER DR REMOVAL IMPACTED CERUMEN W/ INSTRUMENTATION | $64.80 | $72.00 | — | 58% below | 10% |
| Earwax removal with instruments, one ear CPT 69210 UC DR REMOVAL IMPACTED CERUMEN W/ INSTRUMENTATION | $64.80 | $72.00 | — | 58% below | 10% |
| Earwax removal with instruments, one ear CPT 69210 UC REMOVAL IMPACTED CERUMEN W/ INSTRUMENTATION | $96.30 | $107.00 | — | 38% below | 10% |
| Earwax removal with instruments, one ear CPT 69210 ER REMOVAL IMPACTED CERUMEN W/ INSTRUMENTATION | $113.40 | $126.00 | — | 27% below | 10% |
| Earwax removal with instruments, one ear CPT 69210 WC-REM IMPACTED CERUMEN | $233.10 | $259.00 | — | 51% above | 10% |
| Earwax removal with instruments, one ear inpatient CPT 69210 UC DR REMOVAL IMPACTED CERUMEN W/ INSTRUMENTATION | $64.80 | $72.00 | — | — | 10% |
| Earwax removal with instruments, one ear inpatient CPT 69210 ER DR REMOVAL IMPACTED CERUMEN W/ INSTRUMENTATION | $64.80 | $72.00 | — | — | 10% |
| Earwax removal with instruments, one ear inpatient CPT 69210 UC REMOVAL IMPACTED CERUMEN W/ INSTRUMENTATION | $96.30 | $107.00 | — | — | 10% |
| Earwax removal with instruments, one ear inpatient CPT 69210 ER REMOVAL IMPACTED CERUMEN W/ INSTRUMENTATION | $113.40 | $126.00 | — | — | 10% |
| Earwax removal with instruments, one ear inpatient CPT 69210 WC-REM IMPACTED CERUMEN | $233.10 | $259.00 | — | — | 10% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ SPINE EPIDURAL CERV/THOR W/ IMAGING | $1,557.90 | $1,731.00 | — | 30% below | 10% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJ SPINE EPIDURAL CERV/THOR W/ IMAGING | $1,557.90 | $1,731.00 | — | — | 10% |
| Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 PARAVERT FACET L/S BILAT | $2,890.80 | $3,212.00 | — | — | 10% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 PARAVERTEBRAL FACET L/S | $2,046.60 | $2,274.00 | — | 6% below | 10% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 PARAVERT FACET L/S BILAT | $2,890.80 | $3,212.00 | — | — | 10% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 PARAVERTEBRAL FACET L/S | $2,046.60 | $2,274.00 | — | — | 10% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HOSP-FLEXIBLE SIGMOIDOSCOPY | $92.70 | $103.00 | — | 96% below | 10% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HOSP-FLEXIBLE SIGMOIDOSCOPY | $92.70 | $103.00 | — | — | 10% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETERI& INTRO SALINE/CONTRA | $415.80 | $462.00 | — | 9% above | 10% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATHETERI& INTRO SALINE/CONTRA | $415.80 | $462.00 | — | — | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 W/C DR - I&D SIMPLE ABSCESS | $186.30 | $207.00 | — | 52% below | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 URGENT PHYS I&D SIMPLE ABSCESS | $186.30 | $207.00 | — | 52% below | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 ER DR-I&D SIMPLE ABSCESS | $225.90 | $251.00 | — | 41% below | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 URGENT I&D SIMPLE ABSCESS | $328.50 | $365.00 | — | 15% below | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 W/C I&D SIMPLE ABSCESS | $328.50 | $365.00 | — | 15% below | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 WC-I&D SIMPLE ABSCESS | $333.90 | $371.00 | — | 13% below | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 ER I&D-SIMPLE ABSCESS | $345.60 | $384.00 | — | 10% below | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D SIMPLE | $441.00 | $490.00 | — | 14% above | 10% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 W/C DR - I&D SIMPLE ABSCESS | $186.30 | $207.00 | — | — | 10% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 URGENT PHYS I&D SIMPLE ABSCESS | $186.30 | $207.00 | — | — | 10% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ER DR-I&D SIMPLE ABSCESS | $225.90 | $251.00 | — | — | 10% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 W/C I&D SIMPLE ABSCESS | $328.50 | $365.00 | — | — | 10% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 URGENT I&D SIMPLE ABSCESS | $328.50 | $365.00 | — | — | 10% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 WC-I&D SIMPLE ABSCESS | $333.90 | $371.00 | — | — | 10% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ER I&D-SIMPLE ABSCESS | $345.60 | $384.00 | — | — | 10% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D SIMPLE | $441.00 | $490.00 | — | — | 10% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECT TENDON/LIGAMENT/CYST | $661.50 | $735.00 | — | 95% above | 10% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECT TENDON/LIGAMENT/CYST | $661.50 | $735.00 | — | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 DRAIN/INJ JNT/BURSA LG BILAT | $922.50 | $1,025.00 | — | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 UC DR-ARTHROCENT MAJ JT W/O US | $147.60 | $164.00 | — | 79% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ER DR-ARTHROCENT-MAJ JT W/O US | $181.80 | $202.00 | — | 74% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS-INJ JOINT | $344.70 | $383.00 | — | 50% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS (INJ JT) W/O US | $373.50 | $415.00 | — | 46% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 UC ARTHROCENT MAJ JT W/O US | $393.30 | $437.00 | — | 43% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ER ARTHROCENT-MAJOR JNT W/O US | $460.80 | $512.00 | — | 34% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHRO ASP &/OR INJ MAJOR JT | $485.10 | $539.00 | — | 30% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 WC-INJ/ASPIRATION MAJOR JOINT/BURSA | $499.50 | $555.00 | — | 28% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT JOINT/BURSA LG | $661.50 | $735.00 | — | 5% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient both sides CPT 20610 DRAIN/INJ JNT/BURSA LG BILAT | $922.50 | $1,025.00 | — | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 UC DR-ARTHROCENT MAJ JT W/O US | $147.60 | $164.00 | — | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ER DR-ARTHROCENT-MAJ JT W/O US | $181.80 | $202.00 | — | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS-INJ JOINT | $344.70 | $383.00 | — | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS (INJ JT) W/O US | $373.50 | $415.00 | — | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 UC ARTHROCENT MAJ JT W/O US | $393.30 | $437.00 | — | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ER ARTHROCENT-MAJOR JNT W/O US | $460.80 | $512.00 | — | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHRO ASP &/OR INJ MAJOR JT | $485.10 | $539.00 | — | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 WC-INJ/ASPIRATION MAJOR JOINT/BURSA | $499.50 | $555.00 | — | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJECT JOINT/BURSA LG | $661.50 | $735.00 | — | — | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 DRAIN/INJ JNT/BURSA MED BILAT | $922.50 | $1,025.00 | — | — | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 UC DR ARTHROCENTESIS INTERMED JT W/O US GUIDANCE | $74.70 | $83.00 | — | 88% below | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ER DR-ARTHROCENT-INT JT W/O US | $147.60 | $164.00 | — | 76% below | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS ASP/INJ INTERMED JT | $354.60 | $394.00 | — | 43% below | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 UC ARTHROCENTESIS INTERMED JT W/O US GUIDANCE | $393.30 | $437.00 | — | 37% below | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ER ARTHROCENT-INTMD JNT W/O US | $460.80 | $512.00 | — | 26% below | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJECT JOINT/BURSA MED | $661.50 | $735.00 | — | 6% above | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient both sides CPT 20605 DRAIN/INJ JNT/BURSA MED BILAT | $922.50 | $1,025.00 | — | — | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 UC DR ARTHROCENTESIS INTERMED JT W/O US GUIDANCE | $74.70 | $83.00 | — | — | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ER DR-ARTHROCENT-INT JT W/O US | $147.60 | $164.00 | — | — | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS ASP/INJ INTERMED JT | $354.60 | $394.00 | — | — | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 UC ARTHROCENTESIS INTERMED JT W/O US GUIDANCE | $393.30 | $437.00 | — | — | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ER ARTHROCENT-INTMD JNT W/O US | $460.80 | $512.00 | — | — | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJECT JOINT/BURSA MED | $661.50 | $735.00 | — | — | 10% |
| Joint injection or drainage, small joint (fingers, toes) both sides CPT 20600 DRAIN/INJ JNT/BURSA SM BILAT | $922.50 | $1,025.00 | — | — | 10% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 UC DR ARTHROCENTESIS SM JT W/O US GUID | $68.40 | $76.00 | — | 86% below | 10% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ER DR ARTHROCENT SM JT W/O US | $90.00 | $100.00 | — | 82% below | 10% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP/INJ SM JT | $354.60 | $394.00 | — | 28% below | 10% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 UC ARTHROCENTESIS SM JT W/O US GUID | $393.30 | $437.00 | — | 20% below | 10% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ER ARTHROCENTISIS SM JT W/O US | $460.80 | $512.00 | — | 7% below | 10% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJECT JOINT/BURSA SM | $661.50 | $735.00 | — | 34% above | 10% |
| Joint injection or drainage, small joint (fingers, toes) inpatient both sides CPT 20600 DRAIN/INJ JNT/BURSA SM BILAT | $922.50 | $1,025.00 | — | — | 10% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 UC DR ARTHROCENTESIS SM JT W/O US GUID | $68.40 | $76.00 | — | — | 10% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ER DR ARTHROCENT SM JT W/O US | $90.00 | $100.00 | — | — | 10% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP/INJ SM JT | $354.60 | $394.00 | — | — | 10% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 UC ARTHROCENTESIS SM JT W/O US GUID | $393.30 | $437.00 | — | — | 10% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ER ARTHROCENTISIS SM JT W/O US | $460.80 | $512.00 | — | — | 10% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJECT JOINT/BURSA SM | $661.50 | $735.00 | — | — | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 W/C DR INTMD LACER 2.5CM BODY | $320.40 | $356.00 | — | 43% below | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 UC DR-INTMD LACER 2.5CM BODY | $397.80 | $442.00 | — | 29% below | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ER DR-LACER INTMD 0 2.5CM BODY | $397.80 | $442.00 | — | 29% below | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 W/C INTMD LACER 2.5CM BODY | $471.60 | $524.00 | — | 16% below | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 UC INTMD LACER 2.5CM BODY | $490.50 | $545.00 | — | 13% below | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ER LACER-INTMD 2.5 CM BODY | $512.10 | $569.00 | — | 9% below | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 W/C DR INTMD LACER 2.5CM BODY | $320.40 | $356.00 | — | — | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 UC DR-INTMD LACER 2.5CM BODY | $397.80 | $442.00 | — | — | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 ER DR-LACER INTMD 0 2.5CM BODY | $397.80 | $442.00 | — | — | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 W/C INTMD LACER 2.5CM BODY | $471.60 | $524.00 | — | — | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 UC INTMD LACER 2.5CM BODY | $490.50 | $545.00 | — | — | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 ER LACER-INTMD 2.5 CM BODY | $512.10 | $569.00 | — | — | 10% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJECT SPINE EPIDURAL LUMB/SAC W/ IMAGING | $1,557.90 | $1,731.00 | — | 22% below | 10% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJECT SPINE EPIDURAL LUMB/SAC W/ IMAGING | $1,557.90 | $1,731.00 | — | — | 10% |
| Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 TRANSFORAM EPID L/S BILAT | $2,890.80 | $3,212.00 | — | — | 10% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 TRANSFORAM EPID L/S | $2,046.60 | $2,274.00 | — | 1% below | 10% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 TRANSFORAM EPID L/S BILAT | $2,890.80 | $3,212.00 | — | — | 10% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 TRANSFORAM EPID L/S | $2,046.60 | $2,274.00 | — | — | 10% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 UC DR-EXC BNGN LESN 0.5CM/< | $255.60 | $284.00 | — | 81% below | 10% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 UC EXC BNGN LESN 0.5 CM/< | $936.00 | $1,040.00 | — | 32% below | 10% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 WC-EXC BENIGN &MARG 0.5CM/LESS | $1,163.70 | $1,293.00 | — | 15% below | 10% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 UC DR-EXC BNGN LESN 0.5CM/< | $255.60 | $284.00 | — | — | 10% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 UC EXC BNGN LESN 0.5 CM/< | $936.00 | $1,040.00 | — | — | 10% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 WC-EXC BENIGN &MARG 0.5CM/LESS | $1,163.70 | $1,293.00 | — | — | 10% |
| Nail removal (partial or complete), one nail CPT 11730 UC DR-NAIL AVUL SMPL / CMPLT | $184.50 | $205.00 | — | 42% below | 10% |
| Nail removal (partial or complete), one nail CPT 11730 W/C-DR AVULS NAIL-SIMPL EVAC H | $193.50 | $215.00 | — | 39% below | 10% |
| Nail removal (partial or complete), one nail CPT 11730 ER DR-NAIL AVUL SIMPL / CMPLT | $193.50 | $215.00 | — | 39% below | 10% |
| Nail removal (partial or complete), one nail CPT 11730 UC NAIL AVUL SMPL / CMPLT | $328.50 | $365.00 | — | 3% above | 10% |
| Nail removal (partial or complete), one nail CPT 11730 W/C-AVULS NAIL SIMPL EVAC HEMA | $328.50 | $365.00 | — | 3% above | 10% |
| Nail removal (partial or complete), one nail CPT 11730 WC-AVULSION 1 NAIL-SIMPLE | $333.90 | $371.00 | — | 5% above | 10% |
| Nail removal (partial or complete), one nail CPT 11730 ER NAIL AVUL SIMPL / CMPLT | $345.60 | $384.00 | — | 8% above | 10% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 UC DR-NAIL AVUL SMPL / CMPLT | $184.50 | $205.00 | — | — | 10% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 ER DR-NAIL AVUL SIMPL / CMPLT | $193.50 | $215.00 | — | — | 10% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 W/C-DR AVULS NAIL-SIMPL EVAC H | $193.50 | $215.00 | — | — | 10% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 W/C-AVULS NAIL SIMPL EVAC HEMA | $328.50 | $365.00 | — | — | 10% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 UC NAIL AVUL SMPL / CMPLT | $328.50 | $365.00 | — | — | 10% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 WC-AVULSION 1 NAIL-SIMPLE | $333.90 | $371.00 | — | — | 10% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 ER NAIL AVUL SIMPL / CMPLT | $345.60 | $384.00 | — | — | 10% |
| Occipital nerve block (injection for headaches) both sides CPT 64405 NRV BLK OCCIPITAL BILAT | $922.50 | $1,025.00 | — | — | 10% |
| Occipital nerve block (injection for headaches) CPT 64405 OCCIPITAL NERVE BLOCK | $658.80 | $732.00 | — | 30% below | 10% |
| Occipital nerve block (injection for headaches) CPT 64405 NERVE BLOCK INJ OCCIPITAL | $661.50 | $735.00 | — | 30% below | 10% |
| Occipital nerve block (injection for headaches) inpatient both sides CPT 64405 NRV BLK OCCIPITAL BILAT | $922.50 | $1,025.00 | — | — | 10% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 OCCIPITAL NERVE BLOCK | $658.80 | $732.00 | — | — | 10% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 NERVE BLOCK INJ OCCIPITAL | $661.50 | $735.00 | — | — | 10% |
| Paracentesis with imaging guidance CPT 49083 HOSP-SUBSEQ PARACENTESIS | $174.60 | $194.00 | — | 90% below | 10% |
| Paracentesis with imaging guidance CPT 49083 ED MD US GUIDED PARACENTESIS | $195.30 | $217.00 | — | 89% below | 10% |
| Paracentesis with imaging guidance CPT 49083 ED US GUIDED PARACENTESIS | $1,015.20 | $1,128.00 | — | 42% below | 10% |
| Paracentesis with imaging guidance CPT 49083 IMAGE GUIDED PARACENTESIS | $1,706.40 | $1,896.00 | — | 2% below | 10% |
| Paracentesis with imaging guidance inpatient CPT 49083 HOSP-SUBSEQ PARACENTESIS | $174.60 | $194.00 | — | — | 10% |
| Paracentesis with imaging guidance inpatient CPT 49083 ED MD US GUIDED PARACENTESIS | $195.30 | $217.00 | — | — | 10% |
| Paracentesis with imaging guidance inpatient CPT 49083 ED US GUIDED PARACENTESIS | $1,015.20 | $1,128.00 | — | — | 10% |
| Paracentesis with imaging guidance inpatient CPT 49083 IMAGE GUIDED PARACENTESIS | $1,706.40 | $1,896.00 | — | — | 10% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 UC DR-INGROWN NAIL REMOVAL | $348.30 | $387.00 | — | 55% below | 10% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 ER PHYS-INGROWN NAIL REMOVAL | $390.60 | $434.00 | — | 50% below | 10% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 URGENT INGROWN NAIL REMOVAL | $490.50 | $545.00 | — | 37% below | 10% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 ER INGROWN NAIL REMOVAL | $512.10 | $569.00 | — | 34% below | 10% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 WC-EXC NAIL- PARTIAL/COMPLETE | $608.40 | $676.00 | — | 22% below | 10% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 UC DR-INGROWN NAIL REMOVAL | $348.30 | $387.00 | — | — | 10% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 ER PHYS-INGROWN NAIL REMOVAL | $390.60 | $434.00 | — | — | 10% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 URGENT INGROWN NAIL REMOVAL | $490.50 | $545.00 | — | — | 10% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 ER INGROWN NAIL REMOVAL | $512.10 | $569.00 | — | — | 10% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 WC-EXC NAIL- PARTIAL/COMPLETE | $608.40 | $676.00 | — | — | 10% |
| Prostate biopsy CPT 55700 US PERCUT. NEEDLE BX PROSTATE | $2,142.90 | $2,381.00 | — | at median | 10% |
| Prostate biopsy CPT 55700 CT PERCUT. NEEDLE BX PROSTATE | $2,250.00 | $2,500.00 | — | 5% above | 10% |
| Prostate biopsy CPT 55700 URONAV PROSTATE BIOPSY | $4,486.50 | $4,985.00 | — | 109% above | 10% |
| Prostate biopsy inpatient CPT 55700 US PERCUT. NEEDLE BX PROSTATE | $2,142.90 | $2,381.00 | — | — | 10% |
| Prostate biopsy inpatient CPT 55700 CT PERCUT. NEEDLE BX PROSTATE | $2,250.00 | $2,500.00 | — | — | 10% |
| Prostate biopsy inpatient CPT 55700 URONAV PROSTATE BIOPSY | $4,486.50 | $4,985.00 | — | — | 10% |
| Radiofrequency ablation of facet joint nerves, lower back, one level both sides CPT 64635 DESTROY PARAVERT NERVE L/S BILAT | $6,719.40 | $7,466.00 | — | — | 10% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY PARAVERT NERVE L/S | $4,513.50 | $5,015.00 | — | 39% above | 10% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient both sides CPT 64635 DESTROY PARAVERT NERVE L/S BILAT | $6,719.40 | $7,466.00 | — | — | 10% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DESTROY PARAVERT NERVE L/S | $4,513.50 | $5,015.00 | — | — | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 UC DR-I&R FOREIGN BODY-SIMPLE | $191.70 | $213.00 | — | 71% below | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 W/C DR-I&R FOREIGN BODY-SIMPLE | $191.70 | $213.00 | — | 71% below | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 ER DR-I&R FOREIGN BODY-SIMPLE | $233.10 | $259.00 | — | 65% below | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 W/C I&R FOREIGN BODY-SIMPLE | $471.60 | $524.00 | — | 30% below | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 UC I&D FOREIGN BODY-SIMPLE | $490.50 | $545.00 | — | 27% below | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 ER I&R FOREIGN BODY-SIMPLE | $512.10 | $569.00 | — | 24% below | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 WC-INC & REM FB SIMPLE | $608.40 | $676.00 | — | 9% below | 10% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 UC DR-I&R FOREIGN BODY-SIMPLE | $191.70 | $213.00 | — | — | 10% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 W/C DR-I&R FOREIGN BODY-SIMPLE | $191.70 | $213.00 | — | — | 10% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 ER DR-I&R FOREIGN BODY-SIMPLE | $233.10 | $259.00 | — | — | 10% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 W/C I&R FOREIGN BODY-SIMPLE | $471.60 | $524.00 | — | — | 10% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 UC I&D FOREIGN BODY-SIMPLE | $490.50 | $545.00 | — | — | 10% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 ER I&R FOREIGN BODY-SIMPLE | $512.10 | $569.00 | — | — | 10% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 WC-INC & REM FB SIMPLE | $608.40 | $676.00 | — | — | 10% |
| Short arm cast (elbow to hand) CPT 29075 ER APPLY CAST ELBOW TO FINGER | $418.50 | $465.00 | — | 39% above | 10% |
| Short arm cast (elbow to hand) inpatient CPT 29075 ER APPLY CAST ELBOW TO FINGER | $418.50 | $465.00 | — | — | 10% |
| Short arm splint (forearm and hand) CPT 29125 UC DR-APPLY SHORT ARM SPLINT | $120.60 | $134.00 | — | 59% below | 10% |
| Short arm splint (forearm and hand) CPT 29125 UC APPLY SHORT ARM SPLINT | $215.10 | $239.00 | — | 26% below | 10% |
| Short arm splint (forearm and hand) CPT 29125 W/C APPLY OF SHORT ARM SPLINT | $215.10 | $239.00 | — | 26% below | 10% |
| Short arm splint (forearm and hand) CPT 29125 APPLY OF SHORT ARM SPLINT | $243.90 | $271.00 | — | 16% below | 10% |
| Short arm splint (forearm and hand) CPT 29125 OT APP-BIL SHORT ARM SPLT- STATIC | $275.40 | $306.00 | — | 5% below | 10% |
| Short arm splint (forearm and hand) one side CPT 29125 OT APP-RT SHORT ARM SPLT-STATIC | $183.60 | $204.00 | — | 37% below | 10% |
| Short arm splint (forearm and hand) one side CPT 29125 OT APP-LT SHORT ARM SPLT-STATIC | $183.60 | $204.00 | — | 37% below | 10% |
| Short arm splint (forearm and hand) inpatient CPT 29125 UC DR-APPLY SHORT ARM SPLINT | $120.60 | $134.00 | — | — | 10% |
| Short arm splint (forearm and hand) inpatient CPT 29125 W/C APPLY OF SHORT ARM SPLINT | $215.10 | $239.00 | — | — | 10% |
| Short arm splint (forearm and hand) inpatient CPT 29125 UC APPLY SHORT ARM SPLINT | $215.10 | $239.00 | — | — | 10% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APPLY OF SHORT ARM SPLINT | $243.90 | $271.00 | — | — | 10% |
| Short arm splint (forearm and hand) inpatient CPT 29125 OT APP-BIL SHORT ARM SPLT- STATIC | $275.40 | $306.00 | — | — | 10% |
| Short arm splint (forearm and hand) inpatient one side CPT 29125 OT APP-LT SHORT ARM SPLT-STATIC | $183.60 | $204.00 | — | — | 10% |
| Short arm splint (forearm and hand) inpatient one side CPT 29125 OT APP-RT SHORT ARM SPLT-STATIC | $183.60 | $204.00 | — | — | 10% |
| Short leg cast (below the knee) CPT 29405 ER APPLY OF SHORT LEG CAST | $418.50 | $465.00 | — | 5% above | 10% |
| Short leg cast (below the knee) CPT 29405 WC-APP SHORT LEG CAST | $437.40 | $486.00 | — | 10% above | 10% |
| Short leg cast (below the knee) inpatient CPT 29405 ER APPLY OF SHORT LEG CAST | $418.50 | $465.00 | — | — | 10% |
| Short leg cast (below the knee) inpatient CPT 29405 WC-APP SHORT LEG CAST | $437.40 | $486.00 | — | — | 10% |
| Short leg splint (calf to foot) CPT 29515 W/C APPLY OF SHORT LEG SPLINT | $228.60 | $254.00 | — | 25% below | 10% |
| Short leg splint (calf to foot) CPT 29515 UC APPLY SHORT LEG SPLINT | $228.60 | $254.00 | — | 25% below | 10% |
| Short leg splint (calf to foot) CPT 29515 APPLY OF SHORT LEG SPLINT | $294.30 | $327.00 | — | 3% below | 10% |
| Short leg splint (calf to foot) CPT 29515 WC-SPLINT APPLICATION OF LOWER EXTREMITY | $328.50 | $365.00 | — | 8% above | 10% |
| Short leg splint (calf to foot) inpatient CPT 29515 W/C APPLY OF SHORT LEG SPLINT | $228.60 | $254.00 | — | — | 10% |
| Short leg splint (calf to foot) inpatient CPT 29515 UC APPLY SHORT LEG SPLINT | $228.60 | $254.00 | — | — | 10% |
| Short leg splint (calf to foot) inpatient CPT 29515 APPLY OF SHORT LEG SPLINT | $294.30 | $327.00 | — | — | 10% |
| Short leg splint (calf to foot) inpatient CPT 29515 WC-SPLINT APPLICATION OF LOWER EXTREMITY | $328.50 | $365.00 | — | — | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 UC DR-LACER SMPL 0 2.5 CM BODY | $220.50 | $245.00 | — | 33% below | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 W/C DR-LACER SMPL 0 2.5CM BODY | $220.50 | $245.00 | — | 33% below | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ER DR-LACER SMPL 0 2.5CM BODY | $270.90 | $301.00 | — | 18% below | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 UC LACER SMPL 0 2.5 CM BODY | $328.50 | $365.00 | — | at median | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 W/C LACER SMPL 0 2.5CM BODY | $328.50 | $365.00 | — | at median | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WC SIMPLE REP WND <2.5CM | $333.90 | $371.00 | — | 1% above | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ER LACER-SMPL 0 2.5 CM BODY | $345.60 | $384.00 | — | 5% above | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 W/C DR-LACER SMPL 0 2.5CM BODY | $220.50 | $245.00 | — | — | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 UC DR-LACER SMPL 0 2.5 CM BODY | $220.50 | $245.00 | — | — | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 ER DR-LACER SMPL 0 2.5CM BODY | $270.90 | $301.00 | — | — | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 UC LACER SMPL 0 2.5 CM BODY | $328.50 | $365.00 | — | — | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 W/C LACER SMPL 0 2.5CM BODY | $328.50 | $365.00 | — | — | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 WC SIMPLE REP WND <2.5CM | $333.90 | $371.00 | — | — | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 ER LACER-SMPL 0 2.5 CM BODY | $345.60 | $384.00 | — | — | 10% |
| Skin biopsy, punch, one lesion CPT 11104 WC-BIOPSY SKIN 1 (INCL SIMPLE CLOSURE) | $747.90 | $831.00 | — | 67% above | 10% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 WC-BIOPSY SKIN 1 (INCL SIMPLE CLOSURE) | $747.90 | $831.00 | — | — | 10% |
| Skin tag removal, up to 15 tags CPT 11200 UC DR-REMOVAL OF SKIN TAG | $130.50 | $145.00 | — | 55% below | 10% |
| Skin tag removal, up to 15 tags CPT 11200 ED DR-REMOVAL SKIN TAG | $138.60 | $154.00 | — | 53% below | 10% |
| Skin tag removal, up to 15 tags CPT 11200 URGENT REMOVAL OF SKIN TAG | $328.50 | $365.00 | — | 12% above | 10% |
| Skin tag removal, up to 15 tags CPT 11200 WC-REMOVAL SKIN TAGS (MULTIPLE UP TO & INCL 15 LES | $333.90 | $371.00 | — | 14% above | 10% |
| Skin tag removal, up to 15 tags CPT 11200 ED REMOVAL SKIN TAG | $345.60 | $384.00 | — | 18% above | 10% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVE EXTRA DIGIT NEWBORN | $422.10 | $469.00 | — | 44% above | 10% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 UC DR-REMOVAL OF SKIN TAG | $130.50 | $145.00 | — | — | 10% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 ED DR-REMOVAL SKIN TAG | $138.60 | $154.00 | — | — | 10% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 URGENT REMOVAL OF SKIN TAG | $328.50 | $365.00 | — | — | 10% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 WC-REMOVAL SKIN TAGS (MULTIPLE UP TO & INCL 15 LES | $333.90 | $371.00 | — | — | 10% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 ED REMOVAL SKIN TAG | $345.60 | $384.00 | — | — | 10% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVE EXTRA DIGIT NEWBORN | $422.10 | $469.00 | — | — | 10% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HOSP-SPINAL TAP | $105.30 | $117.00 | — | 90% below | 10% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 ER PHYS-SPINAL/LUMBAR PUNCTURE | $305.10 | $339.00 | — | 72% below | 10% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE | $569.70 | $633.00 | — | 48% below | 10% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 ER SPINAL/LUMBAR PUNCTURE | $1,068.30 | $1,187.00 | — | 2% below | 10% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 PRO-SPINAL PUNCT- LUMBAR-DIAG | $1,441.80 | $1,602.00 | — | 32% above | 10% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP DIAGNOSTIC | $1,557.90 | $1,731.00 | — | 43% above | 10% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HOSP-SPINAL TAP | $105.30 | $117.00 | — | — | 10% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ER PHYS-SPINAL/LUMBAR PUNCTURE | $305.10 | $339.00 | — | — | 10% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE | $569.70 | $633.00 | — | — | 10% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ER SPINAL/LUMBAR PUNCTURE | $1,068.30 | $1,187.00 | — | — | 10% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 PRO-SPINAL PUNCT- LUMBAR-DIAG | $1,441.80 | $1,602.00 | — | — | 10% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL FLUID TAP DIAGNOSTIC | $1,557.90 | $1,731.00 | — | — | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 W/C DR LACER SMPL 2.6-7.5 BODY | $246.60 | $274.00 | — | 30% below | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 UC DR-LCR SMPL 2.6-7.5CM BODY | $286.20 | $318.00 | — | 19% below | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ER DR-LCR SMPL 2.6-7.5CM BODY | $303.30 | $337.00 | — | 14% below | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 UC LACER SMPL 2.6 - 7.5CM BODY | $328.50 | $365.00 | — | 7% below | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 W/C LACER-SMPL2.6-7.5 BODY | $328.50 | $365.00 | — | 7% below | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 WC SIMPLE REP SUPERF 2.6-7.5 | $333.90 | $371.00 | — | 5% below | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ER LACER SMPL 2.6-7.5 CM BODY | $345.60 | $384.00 | — | 2% below | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 W/C DR LACER SMPL 2.6-7.5 BODY | $246.60 | $274.00 | — | — | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 UC DR-LCR SMPL 2.6-7.5CM BODY | $286.20 | $318.00 | — | — | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 ER DR-LCR SMPL 2.6-7.5CM BODY | $303.30 | $337.00 | — | — | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 W/C LACER-SMPL2.6-7.5 BODY | $328.50 | $365.00 | — | — | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 UC LACER SMPL 2.6 - 7.5CM BODY | $328.50 | $365.00 | — | — | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 WC SIMPLE REP SUPERF 2.6-7.5 | $333.90 | $371.00 | — | — | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 ER LACER SMPL 2.6-7.5 CM BODY | $345.60 | $384.00 | — | — | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 WC-SIMPLE REP SUPERFICIAL WNDS FACE <2.5CM | $255.60 | $284.00 | — | 19% below | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 UC DR-SMPL LACER 0 2.5 CM FACE | $255.60 | $284.00 | — | 19% below | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 W/C DR LACER SMPL 0 2.5CM FACE | $255.60 | $284.00 | — | 19% below | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ER DR-LCR SMPL 0 2.5 CM FACE | $313.20 | $348.00 | — | 1% below | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 W/C LACER SMPL 2.5CM FACE | $328.50 | $365.00 | — | 4% above | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 UC SMPL LACER 0 2.5 CM FACE | $328.50 | $365.00 | — | 4% above | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ER LACER-SMPL 0 2.5 CM FACE | $345.60 | $384.00 | — | 9% above | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 WC-SIMPLE REP SUPERFICIAL WNDS FACE <2.5CM | $255.60 | $284.00 | — | — | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 UC DR-SMPL LACER 0 2.5 CM FACE | $255.60 | $284.00 | — | — | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 W/C DR LACER SMPL 0 2.5CM FACE | $255.60 | $284.00 | — | — | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 ER DR-LCR SMPL 0 2.5 CM FACE | $313.20 | $348.00 | — | — | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 UC SMPL LACER 0 2.5 CM FACE | $328.50 | $365.00 | — | — | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 W/C LACER SMPL 2.5CM FACE | $328.50 | $365.00 | — | — | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 ER LACER-SMPL 0 2.5 CM FACE | $345.60 | $384.00 | — | — | 10% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 WC-TANGENTIAL BX SKIN, SINGLE LESION | $747.90 | $831.00 | — | 146% above | 10% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 WC-TANGENTIAL BX SKIN, SINGLE LESION | $747.90 | $831.00 | — | — | 10% |
| Thoracentesis with imaging guidance CPT 32555 HOSP-THORACENTESIS W/ TUBE INS | $181.80 | $202.00 | — | 90% below | 10% |
| Thoracentesis with imaging guidance CPT 32555 ED MD US GUIDED THORACENTESIS | $202.50 | $225.00 | — | 89% below | 10% |
| Thoracentesis with imaging guidance CPT 32555 ED US GUIDED THORACENTESIS | $1,015.20 | $1,128.00 | — | 44% below | 10% |
| Thoracentesis with imaging guidance CPT 32555 IMAGE GUID THORACENTESIS PROC | $1,655.10 | $1,839.00 | — | 8% below | 10% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HOSP-THORACENTESIS W/ TUBE INS | $181.80 | $202.00 | — | — | 10% |
| Thoracentesis with imaging guidance inpatient CPT 32555 ED MD US GUIDED THORACENTESIS | $202.50 | $225.00 | — | — | 10% |
| Thoracentesis with imaging guidance inpatient CPT 32555 ED US GUIDED THORACENTESIS | $1,015.20 | $1,128.00 | — | — | 10% |
| Thoracentesis with imaging guidance inpatient CPT 32555 IMAGE GUID THORACENTESIS PROC | $1,655.10 | $1,839.00 | — | — | 10% |
| Trigger point injections, 1 or 2 muscles CPT 20552 ER MD TRIGGER PNT INJ 1/2 MUSCLES | $64.80 | $72.00 | — | 91% below | 10% |
| Trigger point injections, 1 or 2 muscles CPT 20552 ER TRIGGER PNT INJ 1/2 MUSCLES | $460.80 | $512.00 | — | 34% below | 10% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1-2 MUSC GRP | $661.50 | $735.00 | — | 5% below | 10% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ER MD TRIGGER PNT INJ 1/2 MUSCLES | $64.80 | $72.00 | — | — | 10% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ER TRIGGER PNT INJ 1/2 MUSCLES | $460.80 | $512.00 | — | — | 10% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1-2 MUSC GRP | $661.50 | $735.00 | — | — | 10% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US BREAST BX W OR W/O CLIP & SPEC FIRST LESION | $3,518.10 | $3,909.00 | — | 5% above | 10% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 US BREAST BX W OR W/O CLIP & SPEC FIRST LESION | $3,518.10 | $3,909.00 | — | — | 10% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ER DR-UGI ENDO W/BAL DILAT<30M | $397.80 | $442.00 | — | 89% below | 10% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ER UGI ENDO W/BAL DILAT<30MM | $2,546.10 | $2,829.00 | — | 29% below | 10% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 ER DR-UGI ENDO W/BAL DILAT<30M | $397.80 | $442.00 | — | — | 10% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 ER UGI ENDO W/BAL DILAT<30MM | $2,546.10 | $2,829.00 | — | — | 10% |
| Vein ablation, radiofrequency, first vein CPT 36475 VC RFA 1ST VEIN | $10,003.50 | $11,115.00 | — | 53% above | 10% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 VC RFA 1ST VEIN | $10,003.50 | $11,115.00 | — | — | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 ER DR-DEBRID SUBQ 1ST 20SQ CM | $165.60 | $184.00 | — | 79% below | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 ER DEBRID SUBQ 1ST 20SQ CM | $512.10 | $569.00 | — | 34% below | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 WOUND DEBRIDEMENT - SKIN/SUBQ TISSUE | $512.10 | $569.00 | — | 34% below | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 WC-DEBRID SUBQ 1ST 20SQ CM | $784.80 | $872.00 | — | 1% above | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 ER DR-DEBRID SUBQ 1ST 20SQ CM | $165.60 | $184.00 | — | — | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 ER DEBRID SUBQ 1ST 20SQ CM | $512.10 | $569.00 | — | — | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 WOUND DEBRIDEMENT - SKIN/SUBQ TISSUE | $512.10 | $569.00 | — | — | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 WC-DEBRID SUBQ 1ST 20SQ CM | $784.80 | $872.00 | — | — | 10% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Ohio | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD OR BLD COMP | $911.70 | $1,013.00 | — | 18% below | 10% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD OR BLD COMP | $911.70 | $1,013.00 | — | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI / SUBSEQUENT VISIT | $86.40 | $96.00 | — | 51% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 VOLARA SUBSEQ RX | $109.80 | $122.00 | — | 38% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TREATMENT - SUBSEQUENT | $115.20 | $128.00 | — | 35% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TREATMENT - INITIAL | $125.10 | $139.00 | — | 29% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI INITIAL/INSTRUCT | $133.20 | $148.00 | — | 25% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 METANEB SUBSEQUENT RX | $328.50 | $365.00 | — | 86% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 METANEB INITIAL RX | $457.20 | $508.00 | — | 158% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 VOLARA INITIAL RX | $458.10 | $509.00 | — | 159% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI / SUBSEQUENT VISIT | $86.40 | $96.00 | — | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 VOLARA SUBSEQ RX | $109.80 | $122.00 | — | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL TREATMENT - SUBSEQUENT | $115.20 | $128.00 | — | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL TREATMENT - INITIAL | $125.10 | $139.00 | — | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI INITIAL/INSTRUCT | $133.20 | $148.00 | — | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 METANEB SUBSEQUENT RX | $328.50 | $365.00 | — | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 METANEB INITIAL RX | $457.20 | $508.00 | — | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 VOLARA INITIAL RX | $458.10 | $509.00 | — | — | 10% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO ADMIN IV UP TO 1 HR SINGLE OR INITIAL DOSE | $618.30 | $687.00 | — | 19% below | 10% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO ADMIN IV UP TO 1 HR SINGLE OR INITIAL DOSE | $618.30 | $687.00 | — | — | 10% |
| Critical care, first 30 to 74 minutes CPT 99291 HOSP-CRITICAL CARE 1ST HR | $357.30 | $397.00 | — | 88% below | 10% |
| Critical care, first 30 to 74 minutes CPT 99291 ER DR CRIT CARE 30-74 MIN | $1,015.20 | $1,128.00 | — | 65% below | 10% |
| Critical care, first 30 to 74 minutes CPT 99291 AMB/OB/OOS CRITICAL CARE TRANSFER | $1,844.10 | $2,049.00 | — | 37% below | 10% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE | $2,007.00 | $2,230.00 | — | 32% below | 10% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 HOSP-CRITICAL CARE 1ST HR | $357.30 | $397.00 | — | — | 10% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 ER DR CRIT CARE 30-74 MIN | $1,015.20 | $1,128.00 | — | — | 10% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 AMB/OB/OOS CRITICAL CARE TRANSFER | $1,844.10 | $2,049.00 | — | — | 10% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE | $2,007.00 | $2,230.00 | — | — | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD W/O INTERP | $234.00 | $260.00 | — | 26% above | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG PED W/ INTERP DAYTON CMC | $279.00 | $310.00 | — | 51% above | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD W/O INTERP | $234.00 | $260.00 | — | — | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG PED W/ INTERP DAYTON CMC | $279.00 | $310.00 | — | — | 10% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER PHYS LEVEL I | $112.50 | $125.00 | — | 64% below | 10% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY CLASS I | $171.90 | $191.00 | — | 45% below | 10% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER PHYS LEVEL I | $112.50 | $125.00 | — | — | 10% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENCY CLASS I | $171.90 | $191.00 | — | — | 10% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER PHYS LEVEL II | $178.20 | $198.00 | — | 65% below | 10% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY CLASS II | $315.00 | $350.00 | — | 38% below | 10% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER PHYS LEVEL II | $178.20 | $198.00 | — | — | 10% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY CLASS II | $315.00 | $350.00 | — | — | 10% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER PHYS LEVEL III | $256.50 | $285.00 | — | 70% below | 10% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY CLASS III | $539.10 | $599.00 | — | 36% below | 10% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER PHYS LEVEL III | $256.50 | $285.00 | — | — | 10% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY CLASS III | $539.10 | $599.00 | — | — | 10% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER PHYS LEVEL IV | $456.30 | $507.00 | — | 66% below | 10% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY CLASS IV | $947.70 | $1,053.00 | — | 29% below | 10% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER PHYS LEVEL IV | $456.30 | $507.00 | — | — | 10% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY CLASS IV | $947.70 | $1,053.00 | — | — | 10% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER PHYS LEVEL V | $807.30 | $897.00 | — | 53% below | 10% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY CLASS V | $1,404.00 | $1,560.00 | — | 19% below | 10% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER PHYS LEVEL V | $807.30 | $897.00 | — | — | 10% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY CLASS V | $1,404.00 | $1,560.00 | — | — | 10% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 PHARMACEUTICAL STRESS | $1,137.60 | $1,264.00 | — | 27% above | 10% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST | $1,137.60 | $1,264.00 | — | 27% above | 10% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS/RADIONUCLIDE STUDY | $1,137.60 | $1,264.00 | — | 27% above | 10% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 TREADMILL STRESS TEST | $1,137.60 | $1,264.00 | — | 27% above | 10% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS/RADIONUCLIDE STUDY | $1,137.60 | $1,264.00 | — | — | 10% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TREADMILL STRESS TEST | $1,137.60 | $1,264.00 | — | — | 10% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVASCULAR STRESS TEST | $1,137.60 | $1,264.00 | — | — | 10% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 PHARMACEUTICAL STRESS | $1,137.60 | $1,264.00 | — | — | 10% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION, INITIAL HOUR | $379.80 | $422.00 | — | 9% below | 10% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION, INITIAL HOUR | $379.80 | $422.00 | — | — | 10% |
| IV infusion of a medicine, first hour CPT 96365 IV THERAPY INITIAL HOUR | $379.80 | $422.00 | — | 12% below | 10% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY INITIAL HOUR | $379.80 | $422.00 | — | — | 10% |
| IV push of a medicine, first drug CPT 96374 IV PUSH SINGLE OR INITIAL DRUG | $379.80 | $422.00 | — | 56% above | 10% |
| IV push of a medicine, first drug inpatient CPT 96374 IV PUSH SINGLE OR INITIAL DRUG | $379.80 | $422.00 | — | — | 10% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 W/C SQ/IM INJECTION | $111.60 | $124.00 | — | 21% below | 10% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC SQ/IM INJECTION | $169.20 | $188.00 | — | 19% above | 10% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 W/C SQ/IM INJECTION | $111.60 | $124.00 | — | — | 10% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC SQ/IM INJECTION | $169.20 | $188.00 | — | — | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REED - 15 MIN | $75.60 | $84.00 | — | 30% below | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 OTA NEURO RE-ED 15 MIN | $75.60 | $84.00 | — | 30% below | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-ED - 15 MIN | $75.60 | $84.00 | — | 30% below | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 MOR OTA NEURO RE-ED 15 MIN | $75.60 | $84.00 | — | 30% below | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 MOR OT NEUROMUSCULAR RE-ED - 15 MIN | $75.60 | $84.00 | — | 30% below | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 PTA NEURO REED 15 MIN | $75.60 | $84.00 | — | 30% below | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 MOR PTA NEURO REED 15 MIN | $75.60 | $84.00 | — | 30% below | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 MOR PT NEUROMUSCULAR REED - 15 MIN | $75.60 | $84.00 | — | 30% below | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 PEDS PTA NEUROMUSCULAR REED - 15 MIN | $75.60 | $84.00 | — | 30% below | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 PEDS PT NEUROMUSCULAR REED - 15 MIN | $75.60 | $84.00 | — | 30% below | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 PEDS PT NEUROMUSCULAR REED - 15 MIN | $75.60 | $84.00 | — | — | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 MOR OTA NEURO RE-ED 15 MIN | $75.60 | $84.00 | — | — | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR REED - 15 MIN | $75.60 | $84.00 | — | — | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 PTA NEURO REED 15 MIN | $75.60 | $84.00 | — | — | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-ED - 15 MIN | $75.60 | $84.00 | — | — | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 OTA NEURO RE-ED 15 MIN | $75.60 | $84.00 | — | — | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 PEDS PTA NEUROMUSCULAR REED - 15 MIN | $75.60 | $84.00 | — | — | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 MOR PT NEUROMUSCULAR REED - 15 MIN | $75.60 | $84.00 | — | — | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 MOR PTA NEURO REED 15 MIN | $75.60 | $84.00 | — | — | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 MOR OT NEUROMUSCULAR RE-ED - 15 MIN | $75.60 | $84.00 | — | — | 10% |
| New patient office visit, about 30 minutes CPT 99203 SC DR-LEVEL 3 NEW PT | $146.70 | $163.00 | — | 34% above | 10% |
| New patient office visit, about 30 minutes CPT 99203 VC LEVEL 3 E&M NEW PATIENT | $459.90 | $511.00 | — | 319% above | 10% |
| New patient office visit, about 30 minutes CPT 99203 WC LEVEL 3 VISIT - NEW | $459.90 | $511.00 | — | 319% above | 10% |
| New patient office visit, about 30 minutes inpatient CPT 99203 SC DR-LEVEL 3 NEW PT | $146.70 | $163.00 | — | — | 10% |
| New patient office visit, about 30 minutes inpatient CPT 99203 WC LEVEL 3 VISIT - NEW | $459.90 | $511.00 | — | — | 10% |
| New patient office visit, about 30 minutes inpatient CPT 99203 VC LEVEL 3 E&M NEW PATIENT | $459.90 | $511.00 | — | — | 10% |
| New patient office visit, about 45 minutes CPT 99204 SC DR-LEVEL 4 NEW PT | $213.30 | $237.00 | — | 76% above | 10% |
| New patient office visit, about 45 minutes CPT 99204 VC LEVEL 4 E&M NEW PATIENT | $612.00 | $680.00 | — | 405% above | 10% |
| New patient office visit, about 45 minutes CPT 99204 WC LEVEL 4 VISIT - NEW | $612.00 | $680.00 | — | 405% above | 10% |
| New patient office visit, about 45 minutes inpatient CPT 99204 SC DR-LEVEL 4 NEW PT | $213.30 | $237.00 | — | — | 10% |
| New patient office visit, about 45 minutes inpatient CPT 99204 VC LEVEL 4 E&M NEW PATIENT | $612.00 | $680.00 | — | — | 10% |
| New patient office visit, about 45 minutes inpatient CPT 99204 WC LEVEL 4 VISIT - NEW | $612.00 | $680.00 | — | — | 10% |
| New patient office visit, about 60 minutes CPT 99205 SC DR-LEVEL 5 NEW PT | $272.70 | $303.00 | — | 58% above | 10% |
| New patient office visit, about 60 minutes CPT 99205 WC LEVEL 5 VISIT - NEW | $834.30 | $927.00 | — | 383% above | 10% |
| New patient office visit, about 60 minutes CPT 99205 VC LEVEL 5 E&M NEW PATIENT | $834.30 | $927.00 | — | 383% above | 10% |
| New patient office visit, about 60 minutes inpatient CPT 99205 SC DR-LEVEL 5 NEW PT | $272.70 | $303.00 | — | — | 10% |
| New patient office visit, about 60 minutes inpatient CPT 99205 VC LEVEL 5 E&M NEW PATIENT | $834.30 | $927.00 | — | — | 10% |
| New patient office visit, about 60 minutes inpatient CPT 99205 WC LEVEL 5 VISIT - NEW | $834.30 | $927.00 | — | — | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 SC DR-LEVEL 2 NEW PT | $113.40 | $126.00 | — | 16% above | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 WC LEVEL 2 VISIT - NEW | $351.90 | $391.00 | — | 260% above | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 VC LEVEL 2 E&M NEW PATIENT | $351.90 | $391.00 | — | 260% above | 10% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 SC DR-LEVEL 2 NEW PT | $113.40 | $126.00 | — | — | 10% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 VC LEVEL 2 E&M NEW PATIENT | $351.90 | $391.00 | — | — | 10% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 WC LEVEL 2 VISIT - NEW | $351.90 | $391.00 | — | — | 10% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 DIET THERAPY- INT- EACH 15 MIN | $51.30 | $57.00 | — | 21% below | 10% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 DIET THERAPY- INT- EACH 15 MIN | $51.30 | $57.00 | — | — | 10% |
| Occupational therapy evaluation, low complexity CPT 97165 OT EVAL BRIEF | $95.40 | $106.00 | — | 63% below | 10% |
| Occupational therapy evaluation, low complexity CPT 97165 MOR OT EVAL BRIEF | $95.40 | $106.00 | — | 63% below | 10% |
| Occupational therapy evaluation, low complexity CPT 97165 MOR OT EVAL-LOW COMPLEXITY (30 MIN) | $183.60 | $204.00 | — | 30% below | 10% |
| Occupational therapy evaluation, low complexity CPT 97165 PEDS OT EVAL-LOW COMPLEXITY (30MIN) | $183.60 | $204.00 | — | 30% below | 10% |
| Occupational therapy evaluation, low complexity CPT 97165 OT EVAL-LOW COMPLEXITY (30 MIN) | $183.60 | $204.00 | — | 30% below | 10% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 MOR OT EVAL BRIEF | $95.40 | $106.00 | — | — | 10% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL BRIEF | $95.40 | $106.00 | — | — | 10% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 MOR OT EVAL-LOW COMPLEXITY (30 MIN) | $183.60 | $204.00 | — | — | 10% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL-LOW COMPLEXITY (30 MIN) | $183.60 | $204.00 | — | — | 10% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 PEDS OT EVAL-LOW COMPLEXITY (30MIN) | $183.60 | $204.00 | — | — | 10% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 MOR PT EVAL-HIGH COMPLEXITY (45 MIN) | $183.60 | $204.00 | — | 39% below | 10% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL-HIGH COMPLEXITY (45 MIN) | $183.60 | $204.00 | — | 39% below | 10% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PEDS PT EVAL-HIGH COMPLEXITY (45 MIN) | $183.60 | $204.00 | — | 39% below | 10% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL-HIGH COMPLEXITY (45 MIN) | $183.60 | $204.00 | — | — | 10% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PEDS PT EVAL-HIGH COMPLEXITY (45 MIN) | $183.60 | $204.00 | — | — | 10% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 MOR PT EVAL-HIGH COMPLEXITY (45 MIN) | $183.60 | $204.00 | — | — | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 MOR PT EVAL BRIEF | $95.40 | $106.00 | — | 63% below | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL BRIEF | $95.40 | $106.00 | — | 63% below | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 MOR PT EVAL-LOW COMPLEXITY (20 MIN) | $183.60 | $204.00 | — | 30% below | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL-LOW COMPLEXITY (20 MIN) | $183.60 | $204.00 | — | 30% below | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PEDS PT EVAL-LOW COMPLEXITY (20 MIN) | $183.60 | $204.00 | — | 30% below | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL BRIEF | $95.40 | $106.00 | — | — | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 MOR PT EVAL BRIEF | $95.40 | $106.00 | — | — | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PEDS PT EVAL-LOW COMPLEXITY (20 MIN) | $183.60 | $204.00 | — | — | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL-LOW COMPLEXITY (20 MIN) | $183.60 | $204.00 | — | — | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 MOR PT EVAL-LOW COMPLEXITY (20 MIN) | $183.60 | $204.00 | — | — | 10% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL-MEDIUM COMPLEXITY (30 MIN) | $183.60 | $204.00 | — | 34% below | 10% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PEDS PT EVAL-MEDIUM COMPLEXITY (30 MIN) | $183.60 | $204.00 | — | 34% below | 10% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 MOR PT EVAL-MEDIUM COMPLEXITY (30 MIN) | $183.60 | $204.00 | — | 34% below | 10% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 MOR PT EVAL-MEDIUM COMPLEXITY (30 MIN) | $183.60 | $204.00 | — | — | 10% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PEDS PT EVAL-MEDIUM COMPLEXITY (30 MIN) | $183.60 | $204.00 | — | — | 10% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL-MEDIUM COMPLEXITY (30 MIN) | $183.60 | $204.00 | — | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OTA MANUAL THERAPY 15 MIN | $90.00 | $100.00 | — | 16% below | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | 16% below | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PEDS PT MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | 16% below | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PEDS PTA MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | 16% below | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PEDS OT MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | 16% below | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MOR PTA MANUAL THERAPY 15 MIN | $90.00 | $100.00 | — | 16% below | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PEDS OTA MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | 16% below | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MOR OT MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | 16% below | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MOR OTA MANUAL THERAPY 15 MIN | $90.00 | $100.00 | — | 16% below | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PTA MANUAL THERAPY 15 MIN | $90.00 | $100.00 | — | 16% below | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MOR PT MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | 16% below | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MOR PT MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PEDS OT MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MOR PTA MANUAL THERAPY 15 MIN | $90.00 | $100.00 | — | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PEDS PT MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OTA MANUAL THERAPY 15 MIN | $90.00 | $100.00 | — | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MOR OT MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PEDS OTA MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PEDS PTA MANUAL THERAPY - 15 MIN | $90.00 | $100.00 | — | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MOR OTA MANUAL THERAPY 15 MIN | $90.00 | $100.00 | — | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PTA MANUAL THERAPY 15 MIN | $90.00 | $100.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE - 15 MIN | $92.70 | $103.00 | — | 20% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 MOR OTA THERAPEUTIC EX 15 MIN | $92.70 | $103.00 | — | 20% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PEDS OT THERAPEUTIC EXERCISE - 15 MIN | $92.70 | $103.00 | — | 20% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PEDS PTA THERAPEUTICE EXERCISE - 15 MIN | $92.70 | $103.00 | — | 20% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EX-15 MIN | $92.70 | $103.00 | — | 20% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 MOR OT THERAPEUTIC EX-15 MIN | $92.70 | $103.00 | — | 20% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OTA THERAPEUTIC EX 15 MIN | $92.70 | $103.00 | — | 20% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 MOR PTA THERAPEUTIC EX 15 MIN | $92.70 | $103.00 | — | 20% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PEDS PT THERAPEUTIC EXERCISE - 15 MIN | $92.70 | $103.00 | — | 20% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 MOR PT THERAPEUTIC EXERCISE - 15 MIN | $92.70 | $103.00 | — | 20% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PEDS OTA THERAPEUTIC EXERCISE - 15 MIN | $92.70 | $103.00 | — | 20% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PTA THERAPEUTIC EX 15 MIN | $92.70 | $103.00 | — | 20% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PASSIVE LEG EXERCISER (CPM) | $171.00 | $190.00 | — | 48% above | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PTA LEG EXERCISER (CPM) | $171.00 | $190.00 | — | 48% above | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 MOR PT THERAPEUTIC EXERCISE - 15 MIN | $92.70 | $103.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PTA THERAPEUTIC EX 15 MIN | $92.70 | $103.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE - 15 MIN | $92.70 | $103.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 MOR OTA THERAPEUTIC EX 15 MIN | $92.70 | $103.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 MOR OT THERAPEUTIC EX-15 MIN | $92.70 | $103.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 MOR PTA THERAPEUTIC EX 15 MIN | $92.70 | $103.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PEDS OTA THERAPEUTIC EXERCISE - 15 MIN | $92.70 | $103.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PEDS OT THERAPEUTIC EXERCISE - 15 MIN | $92.70 | $103.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PEDS PTA THERAPEUTICE EXERCISE - 15 MIN | $92.70 | $103.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PEDS PT THERAPEUTIC EXERCISE - 15 MIN | $92.70 | $103.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OTA THERAPEUTIC EX 15 MIN | $92.70 | $103.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPEUTIC EX-15 MIN | $92.70 | $103.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PTA LEG EXERCISER (CPM) | $171.00 | $190.00 | — | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PASSIVE LEG EXERCISER (CPM) | $171.00 | $190.00 | — | — | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 SC DR-LEVEL 5 ESTAB PT | $181.80 | $202.00 | — | 8% above | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTAB PT HIGH LEVEL | $244.80 | $272.00 | — | 45% above | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE/OP VISIT EST LEV 5 | $395.10 | $439.00 | — | 134% above | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 W/C DR ESTAB PT HIGH LEVEL | $417.60 | $464.00 | — | 147% above | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 SC LEVEL 5 - ESTAB PT | $435.60 | $484.00 | — | 158% above | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 W/C RN ESTAB PT HIGH LEVEL | $527.40 | $586.00 | — | 213% above | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 VC LEVEL 5 E&M ESTAB PT | $667.80 | $742.00 | — | 296% above | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 WC LEVEL 5 VISIT - ESTAB | $667.80 | $742.00 | — | 296% above | 10% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 SC DR-LEVEL 5 ESTAB PT | $181.80 | $202.00 | — | — | 10% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ESTAB PT HIGH LEVEL | $244.80 | $272.00 | — | — | 10% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE/OP VISIT EST LEV 5 | $395.10 | $439.00 | — | — | 10% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 W/C DR ESTAB PT HIGH LEVEL | $417.60 | $464.00 | — | — | 10% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 SC LEVEL 5 - ESTAB PT | $435.60 | $484.00 | — | — | 10% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 W/C RN ESTAB PT HIGH LEVEL | $527.40 | $586.00 | — | — | 10% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 VC LEVEL 5 E&M ESTAB PT | $667.80 | $742.00 | — | — | 10% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 WC LEVEL 5 VISIT - ESTAB | $667.80 | $742.00 | — | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 UC DR ESTAB PT LOW LEVEL | $70.20 | $78.00 | — | 39% below | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 SC DR-LEVEL 3 ESTAB PT | $100.80 | $112.00 | — | 13% below | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTAB PT LOW LEVEL | $159.30 | $177.00 | — | 38% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 URGE RN ESTAB PT LOW LEVEL | $186.30 | $207.00 | — | 62% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 ACC ESTAB PT FAC FEE LEVEL 3 | $195.30 | $217.00 | — | 69% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OP VISIT EST LEV 3 | $216.90 | $241.00 | — | 88% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 W/C DR ESTAB PT LOW LEVEL | $234.90 | $261.00 | — | 104% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 SC LEVEL 3 - ESTAB PT | $268.20 | $298.00 | — | 133% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 W/C RN ESTAB PT LOW LEVEL | $274.50 | $305.00 | — | 138% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 WC LEVEL 3 VISIT - ESTAB | $369.90 | $411.00 | — | 221% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 VC LEVEL 3 E&M ESTAB PT | $369.90 | $411.00 | — | 221% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 UC DR ESTAB PT LOW LEVEL | $70.20 | $78.00 | — | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 SC DR-LEVEL 3 ESTAB PT | $100.80 | $112.00 | — | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ESTAB PT LOW LEVEL | $159.30 | $177.00 | — | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 URGE RN ESTAB PT LOW LEVEL | $186.30 | $207.00 | — | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ACC ESTAB PT FAC FEE LEVEL 3 | $195.30 | $217.00 | — | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OP VISIT EST LEV 3 | $216.90 | $241.00 | — | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 W/C DR ESTAB PT LOW LEVEL | $234.90 | $261.00 | — | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 SC LEVEL 3 - ESTAB PT | $268.20 | $298.00 | — | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 W/C RN ESTAB PT LOW LEVEL | $274.50 | $305.00 | — | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 WC LEVEL 3 VISIT - ESTAB | $369.90 | $411.00 | — | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 VC LEVEL 3 E&M ESTAB PT | $369.90 | $411.00 | — | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 UC DR ESTAB PT MOD LEVEL | $90.90 | $101.00 | — | 34% below | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 SC DR-LEVEL 4 ESTAB PT | $131.40 | $146.00 | — | 4% below | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTAB PT MOD LEVEL | $193.50 | $215.00 | — | 41% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 URGE RN ESTAB PT MOD LEVEL | $215.10 | $239.00 | — | 57% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ACC ESTAB PT FAC FEE LEVEL 4 | $233.10 | $259.00 | — | 70% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE/OP VISIT EST LEV 4 | $258.30 | $287.00 | — | 89% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 W/C DR ESTAB PT MOD | $334.80 | $372.00 | — | 145% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 SC LEVEL 4 - ESTAB PT | $343.80 | $382.00 | — | 151% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 W/C RN ESTAB PT MOD LEVEL | $453.60 | $504.00 | — | 232% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 VC LEVEL 4 E&M ESTAB PT | $488.70 | $543.00 | — | 257% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 WC LEVEL 4 VISIT - ESTAB | $488.70 | $543.00 | — | 257% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 UC DR ESTAB PT MOD LEVEL | $90.90 | $101.00 | — | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 SC DR-LEVEL 4 ESTAB PT | $131.40 | $146.00 | — | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ESTAB PT MOD LEVEL | $193.50 | $215.00 | — | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 URGE RN ESTAB PT MOD LEVEL | $215.10 | $239.00 | — | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ACC ESTAB PT FAC FEE LEVEL 4 | $233.10 | $259.00 | — | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE/OP VISIT EST LEV 4 | $258.30 | $287.00 | — | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 W/C DR ESTAB PT MOD | $334.80 | $372.00 | — | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 SC LEVEL 4 - ESTAB PT | $343.80 | $382.00 | — | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 W/C RN ESTAB PT MOD LEVEL | $453.60 | $504.00 | — | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 WC LEVEL 4 VISIT - ESTAB | $488.70 | $543.00 | — | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 VC LEVEL 4 E&M ESTAB PT | $488.70 | $543.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 URGENT DR-SPORTS PHYSICAL | $14.40 | $16.00 | — | 85% below | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 UC DR-SCHOOL ADMIT PHYSICAL | $14.40 | $16.00 | — | 85% below | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 UC DR ESTAB PT STRTFWD | $53.10 | $59.00 | — | 46% below | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EMP HLTH MD FLU VISIT ESTABLISHED | $77.40 | $86.00 | — | 21% below | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 SC DR-LEVEL 2 ESTAB PT | $81.90 | $91.00 | — | 16% below | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 URGE SCHOOL ADMIT PHYSICAL | $116.10 | $129.00 | — | 19% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 URGENT SPORTS PHYSICAL | $116.10 | $129.00 | — | 19% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTAB PT STRFWD | $121.50 | $135.00 | — | 24% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 URGE RN ESTAB PT STRTFWD | $136.80 | $152.00 | — | 40% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ACC ESTAB PT FAC FEE LEVEL 2 | $147.60 | $164.00 | — | 51% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 W/C DR ESTAB PT STRTFWD | $171.00 | $190.00 | — | 75% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE/OP VISIT EST LEV 2 | $188.10 | $209.00 | — | 92% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 W/C RN ESTAB PT STRTFWD | $191.70 | $213.00 | — | 96% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 SC LEVEL 2 - ESTAB PT. | $258.30 | $287.00 | — | 164% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 WC LEVEL 2 VISIT - ESTAB | $281.70 | $313.00 | — | 188% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 VC LEVEL 2 E&M ESTAB PT | $281.70 | $313.00 | — | 188% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 URGENT DR-SPORTS PHYSICAL | $14.40 | $16.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 UC DR-SCHOOL ADMIT PHYSICAL | $14.40 | $16.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 UC DR ESTAB PT STRTFWD | $53.10 | $59.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EMP HLTH MD FLU VISIT ESTABLISHED | $77.40 | $86.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 SC DR-LEVEL 2 ESTAB PT | $81.90 | $91.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 URGENT SPORTS PHYSICAL | $116.10 | $129.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 URGE SCHOOL ADMIT PHYSICAL | $116.10 | $129.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ESTAB PT STRFWD | $121.50 | $135.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 URGE RN ESTAB PT STRTFWD | $136.80 | $152.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ACC ESTAB PT FAC FEE LEVEL 2 | $147.60 | $164.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 W/C DR ESTAB PT STRTFWD | $171.00 | $190.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE/OP VISIT EST LEV 2 | $188.10 | $209.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 W/C RN ESTAB PT STRTFWD | $191.70 | $213.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 SC LEVEL 2 - ESTAB PT. | $258.30 | $287.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 WC LEVEL 2 VISIT - ESTAB | $281.70 | $313.00 | — | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 VC LEVEL 2 E&M ESTAB PT | $281.70 | $313.00 | — | — | 10% |
| Speech and language evaluation CPT 92523 EVAL-SOUND PROD W/COMP&EXPRESS | $337.50 | $375.00 | — | 2% above | 10% |
| Speech and language evaluation CPT 92523 PEDS ST EVAL-SOUND PROD W/COMP & EXPRESS | $337.50 | $375.00 | — | 2% above | 10% |
| Speech and language evaluation inpatient CPT 92523 EVAL-SOUND PROD W/COMP&EXPRESS | $337.50 | $375.00 | — | — | 10% |
| Speech and language evaluation inpatient CPT 92523 PEDS ST EVAL-SOUND PROD W/COMP & EXPRESS | $337.50 | $375.00 | — | — | 10% |
| Speech therapy session, individual CPT 92507 SPEECH THERAPY-EXERCISE | $230.40 | $256.00 | — | 5% above | 10% |
| Speech therapy session, individual CPT 92507 PEDS SPEECH THERAPY - EXERCISE | $230.40 | $256.00 | — | 5% above | 10% |
| Speech therapy session, individual inpatient CPT 92507 SPEECH THERAPY-EXERCISE | $230.40 | $256.00 | — | — | 10% |
| Speech therapy session, individual inpatient CPT 92507 PEDS SPEECH THERAPY - EXERCISE | $230.40 | $256.00 | — | — | 10% |
| Spirometry (breathing test) CPT 94010 DR-PFT SCREEN | $36.90 | $41.00 | — | 88% below | 10% |
| Spirometry (breathing test) CPT 94010 PFT SCREEN | $351.00 | $390.00 | — | 13% above | 10% |
| Spirometry (breathing test) CPT 94010 PED PFT SCREEN | $389.70 | $433.00 | — | 26% above | 10% |
| Spirometry (breathing test) inpatient CPT 94010 DR-PFT SCREEN | $36.90 | $41.00 | — | — | 10% |
| Spirometry (breathing test) inpatient CPT 94010 PFT SCREEN | $351.00 | $390.00 | — | — | 10% |
| Spirometry (breathing test) inpatient CPT 94010 PED PFT SCREEN | $389.70 | $433.00 | — | — | 10% |
| Spirometry before and after a bronchodilator CPT 94060 HOSP-PFT INTERPRETATION | $61.20 | $68.00 | — | 89% below | 10% |
| Spirometry before and after a bronchodilator CPT 94060 DR-PFT W/WO | $80.10 | $89.00 | — | 86% below | 10% |
| Spirometry before and after a bronchodilator CPT 94060 PFT W/WO BRONCHODILATOR | $643.50 | $715.00 | — | 12% above | 10% |
| Spirometry before and after a bronchodilator CPT 94060 PED PFT W/WO | $794.70 | $883.00 | — | 39% above | 10% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 HOSP-PFT INTERPRETATION | $61.20 | $68.00 | — | — | 10% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 DR-PFT W/WO | $80.10 | $89.00 | — | — | 10% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 PFT W/WO BRONCHODILATOR | $643.50 | $715.00 | — | — | 10% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 PED PFT W/WO | $794.70 | $883.00 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITY - 15 MIN | $72.00 | $80.00 | — | 39% below | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 MOR PT THERAPEUTIC ACTIVITY - 15 MIN | $72.00 | $80.00 | — | 39% below | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 PEDS OTA THERAPEUTIC ACTIVITY - 15 MIN | $72.00 | $80.00 | — | 39% below | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 PEDS OT THERAPEUTIC ACTIVITY - 15 MIN | $72.00 | $80.00 | — | 39% below | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 PEDS PTA THERAPEUTIC ACTIVITY - 15 MIN | $72.00 | $80.00 | — | 39% below | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 PEDS PT THERAPEUTIC ACTIVITY - 15 MIN | $72.00 | $80.00 | — | 39% below | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 OTA THERAPEUTIC ACT 15 MIN | $72.00 | $80.00 | — | 39% below | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 OT THERAPEUTIC ACT-15 MIN | $72.00 | $80.00 | — | 39% below | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 PTA THERAPEUTIC ACT 15 MIN | $72.00 | $80.00 | — | 39% below | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 MOR OTA THERAPEUTIC ACT 15 MIN | $72.00 | $80.00 | — | 39% below | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 MOR OT THERAPEUTIC ACT-15 MIN | $72.00 | $80.00 | — | 39% below | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 MOR PTA THERAPEUTIC ACT 15 MIN | $72.00 | $80.00 | — | 39% below | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 MOR OTA THERAPEUTIC ACT 15 MIN | $72.00 | $80.00 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PEDS PTA THERAPEUTIC ACTIVITY - 15 MIN | $72.00 | $80.00 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PEDS OT THERAPEUTIC ACTIVITY - 15 MIN | $72.00 | $80.00 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PEDS OTA THERAPEUTIC ACTIVITY - 15 MIN | $72.00 | $80.00 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 MOR PT THERAPEUTIC ACTIVITY - 15 MIN | $72.00 | $80.00 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PEDS PT THERAPEUTIC ACTIVITY - 15 MIN | $72.00 | $80.00 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OTA THERAPEUTIC ACT 15 MIN | $72.00 | $80.00 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT THERAPEUTIC ACT-15 MIN | $72.00 | $80.00 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PTA THERAPEUTIC ACT 15 MIN | $72.00 | $80.00 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 MOR PTA THERAPEUTIC ACT 15 MIN | $72.00 | $80.00 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 MOR OT THERAPEUTIC ACT-15 MIN | $72.00 | $80.00 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITY - 15 MIN | $72.00 | $80.00 | — | — | 10% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY | $238.50 | $265.00 | — | 1% above | 10% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY | $238.50 | $265.00 | — | — | 10% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Ohio | Off list |
|---|---|---|---|---|---|
| Hepatitis A vaccine, adult dose CPT 90632 Vaqta 50units/mL Vaccine | $240.85 | $267.61 | — | 24% above | 10% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 Vaqta 50units/mL Vaccine | $240.85 | $267.61 | — | — | 10% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 M-M-R VACCINE 1 apc (0.5mL) inj. | $4,724.73 | $5,249.70 | — | 2166% above | 10% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 M-M-R VACCINE 1 apc (0.5mL) inj. | $4,724.73 | $5,249.70 | — | — | 10% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Prevnar 13 injection | $234.64 | $260.71 | — | 47% below | 10% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Prevnar 13 injection | $234.64 | $260.71 | — | — | 10% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMONIA VACCINE 1 apc (0.5mL) | $564.93 | $627.70 | — | 105% above | 10% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMONIA VACCINE 1 apc (0.5mL) | $564.93 | $627.70 | — | — | 10% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE 1 apc (2.5units) inj. | $2,075.59 | $2,306.21 | — | 118% above | 10% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE 1 apc (2.5units) inj. | $2,075.59 | $2,306.21 | — | — | 10% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Shingrix 50mcg/0.5mL vaccine | $703.85 | $782.06 | — | 40% above | 10% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Shingrix 50mcg/0.5mL vaccine | $703.85 | $782.06 | — | — | 10% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA Toxoids ADULT 1apc (0.5mL) inj. | $245.60 | $272.89 | — | 174% above | 10% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA Toxoids ADULT 1apc (0.5mL) inj. | $245.60 | $272.89 | — | — | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET-DIPH-PERT (Tdap) 1 apc (0.5mL) inj. | $203.86 | $226.51 | — | 84% above | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET-DIPH-PERT (Tdap) 1 apc (0.5mL) inj. | $203.86 | $226.51 | — | — | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION SQ OR IM | $77.40 | $86.00 | — | 102% above | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 W/C INJ VACCINE/TOXOID | $111.60 | $124.00 | — | 192% above | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION RABIES VACCINE | $169.20 | $188.00 | — | 342% above | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-ONE VACCINE | $169.20 | $188.00 | — | 342% above | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN PNEUMOCOCCAL VACCINE | $169.20 | $188.00 | — | 342% above | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INFLUENZA VIRUS VACCINE | $169.20 | $188.00 | — | 342% above | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION SQ OR IM | $77.40 | $86.00 | — | — | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 W/C INJ VACCINE/TOXOID | $111.60 | $124.00 | — | — | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN INFLUENZA VIRUS VACCINE | $169.20 | $188.00 | — | — | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMINISTRATION RABIES VACCINE | $169.20 | $188.00 | — | — | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN PNEUMOCOCCAL VACCINE | $169.20 | $188.00 | — | — | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN-ONE VACCINE | $169.20 | $188.00 | — | — | 10% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN-EA ADDL | $169.20 | $188.00 | — | 386% above | 10% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN-EA ADDL | $169.20 | $188.00 | — | — | 10% |
Source file: https://grandlakehealth.org/wp-content/uploads/2026/08/34-1623770_grand-lake-health-system_standardcharges.csv