Hospital

Altru Hospital Devils Lake

Altru Hospital Devils Lake in Devils Lake, ND publishes cash prices for 444 common procedures listed here, from its own machine-readable price file updated Mar 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the North Dakota median for 251 of 423 procedures and above it for 93. By typical cash price it ranks #10 of 29 North Dakota hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1031 Seventh Street NE, Devils Lake, ND 58301 Collected Sep 29, 2026 Source price file (701) 662-2131

Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 2 of 5 CCN 351333 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 HC ANKLE MIN 3 VIEWS	$153.72	$252.00	—	19% below	39%
Ankle X-ray, complete, 3 or more views CPT 73610 CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS	$191.54	$314.00	—	1% above	39%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC ANKLE MIN 3 VIEWS	$153.72	$252.00	—	—	39%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS	$191.54	$314.00	—	—	39%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 PR PADNET EXAM LMTD	$51.24	$84.00	—	80% below	39%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC EXTREMITY STUDY VASCULAR	$293.41	$481.00	—	16% above	39%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC PADNET EXAM,LMTD	$293.41	$481.00	—	16% above	39%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$344.65	$565.00	—	37% above	39%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 PR PADNET EXAM LMTD	$51.24	$84.00	—	—	39%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC EXTREMITY STUDY VASCULAR	$293.41	$481.00	—	—	39%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC PADNET EXAM,LMTD	$293.41	$481.00	—	—	39%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$344.65	$565.00	—	—	39%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC ESOPHAGUS	$291.58	$478.00	—	19% below	39%
Barium swallow (esophagus X-ray with contrast) CPT 74220 CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY	$382.47	$627.00	—	7% above	39%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC ESOPHAGUS	$291.58	$478.00	—	—	39%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY	$382.47	$627.00	—	—	39%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE WHOLE BODY/JOINT SCAN	$900.97	$1,477.00	—	15% below	39%
Bone scan, whole body (nuclear medicine) CPT 78306 CHG BONE &/JOINT IMAGING WHOLE BODY	$1,049.81	$1,721.00	—	1% below	39%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE WHOLE BODY/JOINT SCAN	$900.97	$1,477.00	—	—	39%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 CHG BONE &/JOINT IMAGING WHOLE BODY	$1,049.81	$1,721.00	—	—	39%
Breast ultrasound, complete, one breast CPT 76641 CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE	$99.43	$163.00	—	71% below	39%
Breast ultrasound, complete, one breast one side CPT 76641 HC US BREAST UNILAT W/AXILLA COMPLETE	$251.32	$412.00	—	27% below	39%
Breast ultrasound, complete, one breast inpatient CPT 76641 CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE	$99.43	$163.00	—	—	39%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 HC US BREAST UNILAT W/AXILLA COMPLETE	$251.32	$412.00	—	—	39%
Breast ultrasound, limited (one breast or one area) CPT 76642 CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED	$97.60	$160.00	—	62% below	39%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC US BREAST UNILAT W/AXILLA LIMITED	$251.32	$412.00	—	3% below	39%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED	$97.60	$160.00	—	—	39%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HC US BREAST UNILAT W/AXILLA LIMITED	$251.32	$412.00	—	—	39%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CTA CHEST	$1,710.44	$2,804.00	—	19% below	39%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST	$2,044.11	$3,351.00	—	3% below	39%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CTA CHEST	$1,710.44	$2,804.00	—	—	39%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST	$2,044.11	$3,351.00	—	—	39%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 PR CARDIAC CTA SELF-PAY	$173.24	$284.00	—	92% below	39%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CARDIAC CTA SELF-PAY	$289.75	$475.00	—	86% below	39%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CT ANGIO HRT W/3D IMAGE	$1,191.94	$1,954.00	—	43% below	39%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST	$1,399.34	$2,294.00	—	33% below	39%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 PR CARDIAC CTA SELF-PAY	$173.24	$284.00	—	—	39%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CARDIAC CTA SELF-PAY	$289.75	$475.00	—	—	39%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CT ANGIO HRT W/3D IMAGE	$1,191.94	$1,954.00	—	—	39%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST	$1,399.34	$2,294.00	—	—	39%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT HRT W/O DYE W/CA TEST	$284.87	$467.00	—	8% above	39%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM	$334.89	$549.00	—	27% above	39%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT HRT W/O DYE W/CA TEST	$284.87	$467.00	—	—	39%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM	$334.89	$549.00	—	—	39%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD/PELVIS W/O CONTRAST	$2,408.28	$3,948.00	—	46% above	39%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL	$2,556.51	$4,191.00	—	55% above	39%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD/PELVIS W/O CONTRAST	$2,408.28	$3,948.00	—	—	39%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL	$2,556.51	$4,191.00	—	—	39%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABD/PELVIS W/CONTRAST	$2,738.29	$4,489.00	—	10% above	39%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL	$2,886.52	$4,732.00	—	16% above	39%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABD/PELVIS W/CONTRAST	$2,738.29	$4,489.00	—	—	39%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL	$2,886.52	$4,732.00	—	—	39%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD/PELVIS W/O&W CONTRAST	$2,996.93	$4,913.00	—	2% above	39%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CHG CT ABD&PLV W/O CNTRST 1/BTH FLWD CNTRST 1/BTH	$3,167.12	$5,192.00	—	8% above	39%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABD/PELVIS W/O&W CONTRAST	$2,996.93	$4,913.00	—	—	39%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CHG CT ABD&PLV W/O CNTRST 1/BTH FLWD CNTRST 1/BTH	$3,167.12	$5,192.00	—	—	39%
CT scan of the abdomen with contrast CPT 74160 HC CT ABD W/DYE	$1,435.33	$2,353.00	—	9% below	39%
CT scan of the abdomen with contrast CPT 74160 CHG CT ABDOMEN W/CONTRAST MATERIAL	$1,697.63	$2,783.00	—	8% above	39%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABD W/DYE	$1,435.33	$2,353.00	—	—	39%
CT scan of the abdomen with contrast inpatient CPT 74160 CHG CT ABDOMEN W/CONTRAST MATERIAL	$1,697.63	$2,783.00	—	—	39%
CT scan of the abdomen without contrast CPT 74150 HC CT ABD W/O DYE	$1,246.84	$2,044.00	—	at median	39%
CT scan of the abdomen without contrast CPT 74150 CHG CT ABDOMEN W/O CONTRAST MATERIAL	$1,495.11	$2,451.00	—	20% above	39%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABD W/O DYE	$1,246.84	$2,044.00	—	—	39%
CT scan of the abdomen without contrast inpatient CPT 74150 CHG CT ABDOMEN W/O CONTRAST MATERIAL	$1,495.11	$2,451.00	—	—	39%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT FACIAL BONES W/O CONTRAST	$1,072.38	$1,758.00	—	at median	39%
CT scan of the face and sinuses, no contrast dye CPT 70486 CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL	$1,313.94	$2,154.00	—	23% above	39%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT FACIAL BONES W/O CONTRAST	$1,072.38	$1,758.00	—	—	39%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL	$1,313.94	$2,154.00	—	—	39%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT BRAIN W/O CONTRAST	$1,146.80	$1,880.00	—	5% above	39%
CT scan of the head or brain, no contrast dye CPT 70450 CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL	$1,328.58	$2,178.00	—	21% above	39%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT BRAIN W/O CONTRAST	$1,146.80	$1,880.00	—	—	39%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL	$1,328.58	$2,178.00	—	—	39%
CT scan of the head with contrast CPT 70460 HC CT BRAIN W/CONTRAST	$1,204.75	$1,975.00	—	5% below	39%
CT scan of the head with contrast CPT 70460 CHG CT HEAD/BRAIN W/CONTRAST MATERIAL	$1,437.77	$2,357.00	—	14% above	39%
CT scan of the head with contrast inpatient CPT 70460 HC CT BRAIN W/CONTRAST	$1,204.75	$1,975.00	—	—	39%
CT scan of the head with contrast inpatient CPT 70460 CHG CT HEAD/BRAIN W/CONTRAST MATERIAL	$1,437.77	$2,357.00	—	—	39%
CT scan of the head without and with contrast CPT 70470 HC CT BRAIN W/WO CONTRAST	$1,580.51	$2,591.00	—	7% above	39%
CT scan of the head without and with contrast CPT 70470 CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL	$1,831.83	$3,003.00	—	24% above	39%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT BRAIN W/WO CONTRAST	$1,580.51	$2,591.00	—	—	39%
CT scan of the head without and with contrast inpatient CPT 70470 CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL	$1,831.83	$3,003.00	—	—	39%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT SPINE LUMBAR W/O DYE	$1,309.67	$2,147.00	—	1% above	39%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL	$1,545.74	$2,534.00	—	19% above	39%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT SPINE LUMBAR W/O DYE	$1,309.67	$2,147.00	—	—	39%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL	$1,545.74	$2,534.00	—	—	39%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT SPINE CERVICAL W/O DYE	$1,501.21	$2,461.00	—	13% above	39%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL	$1,745.82	$2,862.00	—	32% above	39%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT SPINE CERVICAL W/O DYE	$1,501.21	$2,461.00	—	—	39%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL	$1,745.82	$2,862.00	—	—	39%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W/DYE	$1,303.57	$2,137.00	—	18% below	39%
CT scan of the pelvis, with contrast dye CPT 72193 CHG CT PELVIS W/CONTRAST MATERIAL	$1,509.75	$2,475.00	—	5% below	39%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W/DYE	$1,303.57	$2,137.00	—	—	39%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CHG CT PELVIS W/CONTRAST MATERIAL	$1,509.75	$2,475.00	—	—	39%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 PR DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$744.81	$1,221.00	—	—	39%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 HC CAROTID DOPPLER	$600.24	$984.00	—	13% below	39%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 PR DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$744.81	$1,221.00	—	—	39%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 HC CAROTID DOPPLER	$600.24	$984.00	—	—	39%
Chest X-ray, 2 views CPT 71046 HC XRAY CHEST 2 VIEWS	$190.93	$313.00	—	14% above	39%
Chest X-ray, 2 views CPT 71046 CHG RADIOLOGIC EXAM CHEST 2 VIEWS	$233.63	$383.00	—	39% above	39%
Chest X-ray, 2 views inpatient CPT 71046 HC XRAY CHEST 2 VIEWS	$190.93	$313.00	—	—	39%
Chest X-ray, 2 views inpatient CPT 71046 CHG RADIOLOGIC EXAM CHEST 2 VIEWS	$233.63	$383.00	—	—	39%
Chest X-ray, single view CPT 71045 HC XRAY CHEST 1 VIEW	$143.96	$236.00	—	2% above	39%
Chest X-ray, single view CPT 71045 CHG RADIOLOGIC EXAM CHEST SINGLE VIEW	$186.05	$305.00	—	32% above	39%
Chest X-ray, single view inpatient CPT 71045 HC XRAY CHEST 1 VIEW	$143.96	$236.00	—	—	39%
Chest X-ray, single view inpatient CPT 71045 CHG RADIOLOGIC EXAM CHEST SINGLE VIEW	$186.05	$305.00	—	—	39%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERIT (RENAL LAAA)	$389.18	$638.00	—	4% below	39%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE	$506.91	$831.00	—	25% above	39%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERIT (RENAL LAAA)	$389.18	$638.00	—	—	39%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE	$506.91	$831.00	—	—	39%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DEXASCAN	$346.48	$568.00	—	30% above	39%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DEXASCAN W/VERTEBRAL FX ASSESSMENT	$346.48	$568.00	—	30% above	39%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL	$385.52	$632.00	—	45% above	39%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DEXASCAN W/VERTEBRAL FX ASSESSMENT	$346.48	$568.00	—	—	39%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DEXASCAN	$346.48	$568.00	—	—	39%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL	$385.52	$632.00	—	—	39%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC DEXA BONE DENSITY PERIPHERAL	$115.90	$190.00	—	4% above	39%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL	$132.98	$218.00	—	19% above	39%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC DEXA BONE DENSITY PERIPHERAL	$115.90	$190.00	—	—	39%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL	$132.98	$218.00	—	—	39%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC OB US DETAILED,SNGL	$289.75	$475.00	—	42% below	39%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION	$452.01	$741.00	—	10% below	39%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC OB US DETAILED,SNGL	$289.75	$475.00	—	—	39%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION	$452.01	$741.00	—	—	39%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT TOBACCO HX CHEST	$1,220.00	$2,000.00	—	at median	39%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX WO CONTRAST	$1,220.00	$2,000.00	—	at median	39%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 PR CT TOBACCO HX CHEST	$1,448.75	$2,375.00	—	19% above	39%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST	$1,448.75	$2,375.00	—	19% above	39%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT TOBACCO HX CHEST	$1,220.00	$2,000.00	—	—	39%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX WO CONTRAST	$1,220.00	$2,000.00	—	—	39%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST	$1,448.75	$2,375.00	—	—	39%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 PR CT TOBACCO HX CHEST	$1,448.75	$2,375.00	—	—	39%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W CONTRAST	$1,401.17	$2,297.00	—	at median	39%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST	$1,641.51	$2,691.00	—	17% above	39%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX W CONTRAST	$1,401.17	$2,297.00	—	—	39%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST	$1,641.51	$2,691.00	—	—	39%
Diagnostic mammogram, both breasts both sides CPT 77066 HC DIAGNOSTIC MAMMO CAD BILATERAL	$286.70	$470.00	—	—	39%
Diagnostic mammogram, both breasts both sides CPT 77066 CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	$397.72	$652.00	—	—	39%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DIAGNOSTIC MAMMO CAD BILATERAL	$286.70	$470.00	—	—	39%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	$397.72	$652.00	—	—	39%
Diagnostic mammogram, one breast CPT 77065 CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$320.25	$525.00	—	18% below	39%
Diagnostic mammogram, one breast one side CPT 77065 HC DIAGNOSTIC MAMMO CAD UNILATERAL	$236.07	$387.00	—	39% below	39%
Diagnostic mammogram, one breast inpatient CPT 77065 CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$320.25	$525.00	—	—	39%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC DIAGNOSTIC MAMMO CAD UNILATERAL	$236.07	$387.00	—	—	39%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$907.68	$1,488.00	—	—	39%
Duplex ultrasound of the leg arteries, both legs CPT 93925 HC DUPLEX LOWER EXTREMITY	$681.98	$1,118.00	—	20% below	39%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$907.68	$1,488.00	—	—	39%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 HC DUPLEX LOWER EXTREMITY	$681.98	$1,118.00	—	—	39%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY	$862.54	$1,414.00	—	—	39%
Duplex ultrasound of the leg veins, both legs CPT 93970 HC VENOUS IMAGING	$717.97	$1,177.00	—	at median	39%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY	$862.54	$1,414.00	—	—	39%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 HC VENOUS IMAGING	$717.97	$1,177.00	—	—	39%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC TTE W/DOPPLER COMPLETE	$610.00	$1,000.00	—	20% below	39%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D	$666.12	$1,092.00	—	13% below	39%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC TTE W/DOPPLER COMPLETE	$610.00	$1,000.00	—	—	39%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D	$666.12	$1,092.00	—	—	39%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HIDA IMAGE	$1,141.92	$1,872.00	—	7% below	39%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM HIDA IMAGE	$1,141.92	$1,872.00	—	—	39%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STUDY, UNATTENDED	$222.65	$365.00	—	30% below	39%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STUDY, UNATTENDED	$222.65	$365.00	—	—	39%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMNOGRAM;SPLIT NIGHT	$1,487.18	$2,438.00	—	38% below	39%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMNOGRAM;SLEEP STG;4+CPAP	$1,487.18	$2,438.00	—	38% below	39%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMNOGRAM;SPLIT NIGHT	$1,487.18	$2,438.00	—	—	39%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMNOGRAM;SLEEP STG;4+CPAP	$1,487.18	$2,438.00	—	—	39%
Knee X-ray, 3 views both sides CPT 73562 HC KNEE MIN 3 VIEWS BILATERAL	$149.45	$245.00	—	—	39%
Knee X-ray, 3 views CPT 73562 HC KNEE MIN 3 VIEWS	$149.45	$245.00	—	27% below	39%
Knee X-ray, 3 views CPT 73562 CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS	$162.26	$266.00	—	21% below	39%
Knee X-ray, 3 views inpatient both sides CPT 73562 HC KNEE MIN 3 VIEWS BILATERAL	$149.45	$245.00	—	—	39%
Knee X-ray, 3 views inpatient CPT 73562 HC KNEE MIN 3 VIEWS	$149.45	$245.00	—	—	39%
Knee X-ray, 3 views inpatient CPT 73562 CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS	$162.26	$266.00	—	—	39%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ECHO EXAM OF ABDOMEN	$383.69	$629.00	—	at median	39%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED	$483.12	$792.00	—	26% above	39%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ECHO EXAM OF ABDOMEN	$383.69	$629.00	—	—	39%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED	$483.12	$792.00	—	—	39%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CHG FREE CT LD - LUNG CANCER SCREEN MONTH	$215.94	$354.00	—	65% below	39%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC FREE CT LD - LUNG CANCER SCREEN MONTH	$1,151.68	$1,888.00	—	85% above	39%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC LDCT FOR LUNG CANCER SCREEN	$1,220.61	$2,001.00	—	96% above	39%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-	$1,449.97	$2,377.00	—	132% above	39%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CHG FREE CT LD - LUNG CANCER SCREEN MONTH	$215.94	$354.00	—	—	39%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC FREE CT LD - LUNG CANCER SCREEN MONTH	$1,151.68	$1,888.00	—	—	39%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC LDCT FOR LUNG CANCER SCREEN	$1,220.61	$2,001.00	—	—	39%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-	$1,449.97	$2,377.00	—	—	39%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST W&WO CONTRAST W/CAD BILATERAL	$1,160.22	$1,902.00	—	—	39%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 HC MRI BREAST W&WO CONTRAST W/CAD BILATERAL	$1,160.22	$1,902.00	—	—	39%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI-LOWER EXT JOINT W/O DYE	$1,743.38	$2,858.00	—	10% below	39%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL	$1,983.11	$3,251.00	—	3% above	39%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI-LOWER EXT JOINT W/O DYE	$1,743.38	$2,858.00	—	—	39%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL	$1,983.11	$3,251.00	—	—	39%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXT JOINT W/WO DYE	$2,236.26	$3,666.00	—	26% below	39%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL	$2,427.80	$3,980.00	—	20% below	39%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXT JOINT W/WO DYE	$2,236.26	$3,666.00	—	—	39%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL	$2,427.80	$3,980.00	—	—	39%
MRI of the abdomen without contrast CPT 74181 HC MRI-ABDOMEN W/O DYE	$2,473.55	$4,055.00	—	23% above	39%
MRI of the abdomen without contrast CPT 74181 CHG MRI ABDOMEN W/O CONTRAST MATERIAL	$2,765.13	$4,533.00	—	37% above	39%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI-ABDOMEN W/O DYE	$2,473.55	$4,055.00	—	—	39%
MRI of the abdomen without contrast inpatient CPT 74181 CHG MRI ABDOMEN W/O CONTRAST MATERIAL	$2,765.13	$4,533.00	—	—	39%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W/WO DYE	$3,411.73	$5,593.00	—	6% above	39%
MRI of the abdomen, without and then with contrast dye CPT 74183 CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST	$3,708.80	$6,080.00	—	15% above	39%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN W/WO DYE	$3,411.73	$5,593.00	—	—	39%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST	$3,708.80	$6,080.00	—	—	39%
MRI of the brain, no contrast dye CPT 70551 HC MRI-BRAIN/BRAIN STEM	$1,901.98	$3,118.00	—	14% above	39%
MRI of the brain, no contrast dye CPT 70551 CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL	$2,210.64	$3,624.00	—	32% above	39%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI-BRAIN/BRAIN STEM	$1,901.98	$3,118.00	—	—	39%
MRI of the brain, no contrast dye inpatient CPT 70551 CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL	$2,210.64	$3,624.00	—	—	39%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI-BRAIN W/WO DYE	$2,625.44	$4,304.00	—	19% below	39%
MRI of the brain, with and without contrast dye CPT 70553 CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL	$3,002.42	$4,922.00	—	7% below	39%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI-BRAIN W/WO DYE	$2,625.44	$4,304.00	—	—	39%
MRI of the brain, with and without contrast dye inpatient CPT 70553 CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL	$3,002.42	$4,922.00	—	—	39%
MRI of the lower back, no contrast dye CPT 72148 HC MRI-L-SPINE W/O DYE	$2,204.54	$3,614.00	—	7% above	39%
MRI of the lower back, no contrast dye CPT 72148 CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL	$2,460.13	$4,033.00	—	20% above	39%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI-L-SPINE W/O DYE	$2,204.54	$3,614.00	—	—	39%
MRI of the lower back, no contrast dye inpatient CPT 72148 CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL	$2,460.13	$4,033.00	—	—	39%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI L-SPINE W/WO DYE	$3,040.85	$4,985.00	—	8% below	39%
MRI of the lower back, without and then with contrast dye CPT 72158 CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL	$3,344.63	$5,483.00	—	2% above	39%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI L-SPINE W/WO DYE	$3,040.85	$4,985.00	—	—	39%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL	$3,344.63	$5,483.00	—	—	39%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI-T-SPINE W/O DYE	$2,319.22	$3,802.00	—	12% above	39%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL	$2,606.53	$4,273.00	—	26% above	39%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI-T-SPINE W/O DYE	$2,319.22	$3,802.00	—	—	39%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL	$2,606.53	$4,273.00	—	—	39%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI C-SPINE W/WO DYE	$2,627.27	$4,307.00	—	19% below	39%
MRI of the neck (cervical spine) without and with contrast CPT 72156 CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL	$2,919.46	$4,786.00	—	10% below	39%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI C-SPINE W/WO DYE	$2,627.27	$4,307.00	—	—	39%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL	$2,919.46	$4,786.00	—	—	39%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI-C-SPINE W/O DYE	$1,926.99	$3,159.00	—	at median	39%
MRI of the neck (cervical spine), no contrast dye CPT 72141 CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL	$2,205.15	$3,615.00	—	14% above	39%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI-C-SPINE W/O DYE	$1,926.99	$3,159.00	—	—	39%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL	$2,205.15	$3,615.00	—	—	39%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W/WO DYE	$2,302.75	$3,775.00	—	29% below	39%
MRI of the pelvis without and with contrast CPT 72197 CHG MRI PELVIS W/O & W/CONTRAST MATERIAL	$2,623.61	$4,301.00	—	19% below	39%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS W/WO DYE	$2,302.75	$3,775.00	—	—	39%
MRI of the pelvis without and with contrast inpatient CPT 72197 CHG MRI PELVIS W/O & W/CONTRAST MATERIAL	$2,623.61	$4,301.00	—	—	39%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO DYE	$2,175.87	$3,567.00	—	6% below	39%
MRI of the pelvis, no contrast dye CPT 72195 CHG MRI PELVIS W/O CONTRAST MATERIAL	$2,464.40	$4,040.00	—	7% above	39%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS WO DYE	$2,175.87	$3,567.00	—	—	39%
MRI of the pelvis, no contrast dye inpatient CPT 72195 CHG MRI PELVIS W/O CONTRAST MATERIAL	$2,464.40	$4,040.00	—	—	39%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI-UPPER EXT JOINT W/O DYE	$1,822.07	$2,987.00	—	6% below	39%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL	$2,077.66	$3,406.00	—	7% above	39%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI-UPPER EXT JOINT W/O DYE	$1,822.07	$2,987.00	—	—	39%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL	$2,077.66	$3,406.00	—	—	39%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM HT MUSCLE IMAGE SPECT,MULTIPLE	$2,845.65	$4,665.00	—	26% above	39%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM HT MUSCLE IMAGE SPECT,MULTIPLE	$2,845.65	$4,665.00	—	—	39%
OCT scan of the retina (optical coherence tomography) both sides CPT 92134 PR CPTRIZED OPH DX IMG PST SEGMENT UNI/BI RETINA	$35.38	$58.00	—	—	39%
OCT scan of the retina (optical coherence tomography) CPT 92134 HC CMPTR OPHTHALMIC IMAGING RETINA	$54.29	$89.00	—	21% below	39%
OCT scan of the retina (optical coherence tomography) inpatient both sides CPT 92134 PR CPTRIZED OPH DX IMG PST SEGMENT UNI/BI RETINA	$35.38	$58.00	—	—	39%
OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 HC CMPTR OPHTHALMIC IMAGING RETINA	$54.29	$89.00	—	—	39%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC NM PET CT SKULL-THIGH	$3,949.14	$6,474.00	—	at median	39%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH	$4,190.70	$6,870.00	—	6% above	39%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC NM PET CT SKULL-THIGH	$3,949.14	$6,474.00	—	—	39%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH	$4,190.70	$6,870.00	—	—	39%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIC LIMITED	$253.15	$415.00	—	19% below	39%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U	$350.75	$575.00	—	12% above	39%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIC LIMITED	$253.15	$415.00	—	—	39%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U	$350.75	$575.00	—	—	39%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIC COMPLETE	$330.01	$541.00	—	16% below	39%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE	$449.57	$737.00	—	15% above	39%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIC COMPLETE	$330.01	$541.00	—	—	39%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE	$449.57	$737.00	—	—	39%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US PREGNANCY >=14WKS SNGL FETUS	$395.89	$649.00	—	14% below	39%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION	$520.94	$854.00	—	14% above	39%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US PREGNANCY >=14WKS SNGL FETUS	$395.89	$649.00	—	—	39%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION	$520.94	$854.00	—	—	39%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US OB COMPLETE(<14 WKS)	$233.63	$383.00	—	38% below	39%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT	$325.74	$534.00	—	13% below	39%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US OB COMPLETE(<14 WKS)	$233.63	$383.00	—	—	39%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT	$325.74	$534.00	—	—	39%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US PREGNANCY LMTD	$196.42	$322.00	—	27% below	39%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 CHG US PREGNANT UTERUS LIMITED 1/> FETUSES	$288.53	$473.00	—	8% above	39%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US PREGNANCY LMTD	$196.42	$322.00	—	—	39%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 CHG US PREGNANT UTERUS LIMITED 1/> FETUSES	$288.53	$473.00	—	—	39%
Screening mammogram, both breasts both sides CPT 77067 HC SCREENING MAMMO CAD BILATERAL	$240.34	$394.00	—	—	39%
Screening mammogram, both breasts both sides CPT 77067 CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	$328.18	$538.00	—	—	39%
Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCREENING MAMMO CAD BILATERAL	$240.34	$394.00	—	—	39%
Screening mammogram, both breasts inpatient both sides CPT 77067 CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	$328.18	$538.00	—	—	39%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC SHOULDER MIN 2 VIEWS	$181.78	$298.00	—	at median	39%
Shoulder X-ray, complete, 2 or more views CPT 73030 CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS	$225.70	$370.00	—	24% above	39%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC SHOULDER MIN 2 VIEWS	$181.78	$298.00	—	—	39%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS	$225.70	$370.00	—	—	39%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAM;SLEEP STG;4+	$1,487.18	$2,438.00	—	34% below	39%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAM;SLEEP STG;4+	$1,487.18	$2,438.00	—	—	39%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC SWALLOWING FCN W CINE/VIDEO	$666.73	$1,093.00	—	33% above	39%
Swallow study (modified barium swallow, video X-ray) CPT 74230 CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$757.62	$1,242.00	—	51% above	39%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC SWALLOWING FCN W CINE/VIDEO	$666.73	$1,093.00	—	—	39%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$757.62	$1,242.00	—	—	39%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL	$316.59	$519.00	—	32% below	39%
Transvaginal pelvic ultrasound CPT 76830 CHG US TRANSVAGINAL	$455.06	$746.00	—	2% below	39%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL	$316.59	$519.00	—	—	39%
Transvaginal pelvic ultrasound inpatient CPT 76830 CHG US TRANSVAGINAL	$455.06	$746.00	—	—	39%
Transvaginal ultrasound during pregnancy CPT 76817 HC US TRANSVAGINAL(OB)	$335.50	$550.00	—	6% above	39%
Transvaginal ultrasound during pregnancy CPT 76817 CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG	$473.97	$777.00	—	50% above	39%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US TRANSVAGINAL(OB)	$335.50	$550.00	—	—	39%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG	$473.97	$777.00	—	—	39%
Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE	$450.79	$739.00	—	12% below	39%
Ultrasound of the abdomen, complete CPT 76700 CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION	$583.16	$956.00	—	14% above	39%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US EXAM ABDOMEN COMPLETE	$450.79	$739.00	—	—	39%
Ultrasound of the abdomen, complete inpatient CPT 76700 CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION	$583.16	$956.00	—	—	39%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM	$289.75	$475.00	—	25% below	39%
Ultrasound of the scrotum and testicles CPT 76870 CHG US SCROTUM & CONTENTS	$389.18	$638.00	—	at median	39%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM	$289.75	$475.00	—	—	39%
Ultrasound of the scrotum and testicles inpatient CPT 76870 CHG US SCROTUM & CONTENTS	$389.18	$638.00	—	—	39%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US EXAM HEAD/NECK	$355.63	$583.00	—	22% below	39%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM	$447.13	$733.00	—	1% below	39%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US EXAM HEAD/NECK	$355.63	$583.00	—	—	39%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM	$447.13	$733.00	—	—	39%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC UPPER GI	$673.44	$1,104.00	—	19% above	39%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY	$810.69	$1,329.00	—	43% above	39%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC UPPER GI	$673.44	$1,104.00	—	—	39%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY	$810.69	$1,329.00	—	—	39%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC UNILAT/LTD VENOUS	$583.77	$957.00	—	3% above	39%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$686.25	$1,125.00	—	21% above	39%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC UNILAT/LTD VENOUS	$583.77	$957.00	—	—	39%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$686.25	$1,125.00	—	—	39%
Wrist X-ray, complete, 3 or more views CPT 73110 HC WRIST COMP MIN 3 VIEWS	$146.40	$240.00	—	21% below	39%
Wrist X-ray, complete, 3 or more views CPT 73110 CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS	$182.39	$299.00	—	2% below	39%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC WRIST COMP MIN 3 VIEWS	$146.40	$240.00	—	—	39%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS	$182.39	$299.00	—	—	39%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VW	$397.72	$652.00	—	79% above	39%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS	$475.80	$780.00	—	114% above	39%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VW	$397.72	$652.00	—	—	39%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS	$475.80	$780.00	—	—	39%
X-ray of the abdomen, 1 view CPT 74018 HC XRAY ABDOMEN 1 VIEW	$192.15	$315.00	—	35% above	39%
X-ray of the abdomen, 1 view CPT 74018 CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW	$233.63	$383.00	—	64% above	39%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XRAY ABDOMEN 1 VIEW	$192.15	$315.00	—	—	39%
X-ray of the abdomen, 1 view inpatient CPT 74018 CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW	$233.63	$383.00	—	—	39%
X-ray of the ankle, 2 views CPT 73600 PR RED SERV X-RAY ANKLE 2 VW	$146.40	$240.00	—	9% below	39%
X-ray of the ankle, 2 views CPT 73600 HC X-RAY ANKLE 2 VIEWS	$146.40	$240.00	—	9% below	39%
X-ray of the ankle, 2 views CPT 73600 CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS	$182.39	$299.00	—	13% above	39%
X-ray of the ankle, 2 views inpatient CPT 73600 PR RED SERV X-RAY ANKLE 2 VW	$146.40	$240.00	—	—	39%
X-ray of the ankle, 2 views inpatient CPT 73600 HC X-RAY ANKLE 2 VIEWS	$146.40	$240.00	—	—	39%
X-ray of the ankle, 2 views inpatient CPT 73600 CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS	$182.39	$299.00	—	—	39%
X-ray of the finger(s), 2 or more views CPT 73140 HC FINGER MIN 2 VIEWS	$98.82	$162.00	—	38% below	39%
X-ray of the finger(s), 2 or more views CPT 73140 CHG RADEX FINGR MINIMUM 2 VIEWS	$125.05	$205.00	—	22% below	39%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC FINGER MIN 2 VIEWS	$98.82	$162.00	—	—	39%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 CHG RADEX FINGR MINIMUM 2 VIEWS	$125.05	$205.00	—	—	39%
X-ray of the foot, 2 views CPT 73620 HC FOOT 2 VIEWS	$109.80	$180.00	—	31% below	39%
X-ray of the foot, 2 views CPT 73620 CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS	$147.62	$242.00	—	7% below	39%
X-ray of the foot, 2 views inpatient CPT 73620 HC FOOT 2 VIEWS	$109.80	$180.00	—	—	39%
X-ray of the foot, 2 views inpatient CPT 73620 CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS	$147.62	$242.00	—	—	39%
X-ray of the foot, complete, 3 or more views CPT 73630 HC FOOT MIN 3 VIEWS	$146.40	$240.00	—	17% below	39%
X-ray of the foot, complete, 3 or more views CPT 73630 CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS	$184.22	$302.00	—	5% above	39%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC FOOT MIN 3 VIEWS	$146.40	$240.00	—	—	39%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS	$184.22	$302.00	—	—	39%
X-ray of the hand, 3 or more views CPT 73130 HC HAND MIN 3 VIEWS	$153.72	$252.00	—	19% below	39%
X-ray of the hand, 3 or more views CPT 73130 CHG RADEX HAND MINIMUM 3 VIEWS	$188.49	$309.00	—	1% below	39%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC HAND MIN 3 VIEWS	$153.72	$252.00	—	—	39%
X-ray of the hand, 3 or more views inpatient CPT 73130 CHG RADEX HAND MINIMUM 3 VIEWS	$188.49	$309.00	—	—	39%
X-ray of the knee, 1 or 2 views CPT 73560 HC KNEE 1 OR 2 VIEWS	$136.64	$224.00	—	27% below	39%
X-ray of the knee, 1 or 2 views CPT 73560 CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS	$173.85	$285.00	—	7% below	39%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC KNEE 1 OR 2 VIEWS	$136.64	$224.00	—	—	39%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS	$173.85	$285.00	—	—	39%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC LUMBAR SPINE 2 VIEWS	$206.18	$338.00	—	12% above	39%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS	$250.71	$411.00	—	36% above	39%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC LUMBAR SPINE 2 VIEWS	$206.18	$338.00	—	—	39%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS	$250.71	$411.00	—	—	39%
X-ray of the lower back, 4 or more views CPT 72110 HC LUMBAR SPINE COM	$229.36	$376.00	—	4% below	39%
X-ray of the lower back, 4 or more views CPT 72110 CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS	$294.63	$483.00	—	24% above	39%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC LUMBAR SPINE COM	$229.36	$376.00	—	—	39%
X-ray of the lower back, 4 or more views inpatient CPT 72110 CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS	$294.63	$483.00	—	—	39%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC SPINE THORACIC 2 VIEWS	$196.42	$322.00	—	23% above	39%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 CHG RADEX SPINE THORACIC 2 VIEWS	$242.78	$398.00	—	52% above	39%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC SPINE THORACIC 2 VIEWS	$196.42	$322.00	—	—	39%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 CHG RADEX SPINE THORACIC 2 VIEWS	$242.78	$398.00	—	—	39%
X-ray of the nasal bones, 3 or more views CPT 70160 HC NOSE BONES MIN 3 VIEWS	$165.92	$272.00	—	1% above	39%
X-ray of the nasal bones, 3 or more views CPT 70160 CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS	$199.47	$327.00	—	21% above	39%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC NOSE BONES MIN 3 VIEWS	$165.92	$272.00	—	—	39%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS	$199.47	$327.00	—	—	39%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC CERVICAL SPINE 2/3 VIEWS	$131.76	$216.00	—	18% below	39%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS	$182.39	$299.00	—	14% above	39%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC CERVICAL SPINE 2/3 VIEWS	$131.76	$216.00	—	—	39%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS	$182.39	$299.00	—	—	39%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC PELVIS	$131.76	$216.00	—	13% below	39%
X-ray of the pelvis, 1 or 2 views CPT 72170 CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS	$173.85	$285.00	—	14% above	39%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC PELVIS	$131.76	$216.00	—	—	39%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS	$173.85	$285.00	—	—	39%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC SACRUN COCCYX MIN 2 VIEWS	$145.18	$238.00	—	at median	39%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS	$187.88	$308.00	—	29% above	39%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC SACRUN COCCYX MIN 2 VIEWS	$145.18	$238.00	—	—	39%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS	$187.88	$308.00	—	—	39%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 CHG TRANSFERASE ALANINE AMINO ALT SGPT	$38.43	$63.00	—	7% below	39%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALT/(SGPT)	$38.43	$63.00	—	7% below	39%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC ALT/(SGPT)	$38.43	$63.00	—	—	39%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 CHG TRANSFERASE ALANINE AMINO ALT SGPT	$38.43	$63.00	—	—	39%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC AST (SGOT)	$38.43	$63.00	—	10% below	39%
AST (aspartate aminotransferase) enzyme test CPT 84450 CHG TRANSFERASE ASPARTATE AMINO AST SGOT	$38.43	$63.00	—	10% below	39%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC AST (SGOT)	$38.43	$63.00	—	—	39%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 CHG TRANSFERASE ASPARTATE AMINO AST SGOT	$38.43	$63.00	—	—	39%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC ACUTE HEPATITIS PANEL	$136.64	$224.00	—	37% below	39%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 CHG ACUTE HEPATITIS PANEL	$136.64	$224.00	—	37% below	39%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 CHG ACUTE HEPATITIS PANEL	$136.64	$224.00	—	—	39%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC ACUTE HEPATITIS PANEL	$136.64	$224.00	—	—	39%
Allergy blood test, specific IgE, per allergen CPT 86003 CHG ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH	$14.64	$24.00	—	at median	39%
Allergy blood test, specific IgE, per allergen CPT 86003 HC IGE,SINGLE ALLERGEN,EACH	$14.64	$24.00	—	at median	39%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE, QUANT OR SEMIQUANT, EA	$22.57	$37.00	—	54% above	39%
Allergy blood test, specific IgE, per allergen CPT 86003 CHG ALLERGEN SPECIFIC IGE, QUANT OR SEMIQUANT, EA	$22.57	$37.00	—	54% above	39%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE,QUANT OR SEMIQUANT,EA	$34.16	$56.00	—	133% above	39%
Allergy blood test, specific IgE, per allergen CPT 86003 CHG ALLERGEN SPECIFIC IGE,QUANT OR SEMIQUANT,EA	$34.16	$56.00	—	133% above	39%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE,EA ALLERGEN	$40.87	$67.00	—	179% above	39%
Allergy blood test, specific IgE, per allergen CPT 86003 CHG ALLERGEN SPECIFIC IGE,EA ALLERGEN	$40.87	$67.00	—	179% above	39%
Allergy blood test, specific IgE, per allergen CPT 86003 CHG ALLERGEN SPECIFIC IGG,EA ALLERGEN	$45.14	$74.00	—	208% above	39%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGG,EA ALLERGEN	$56.12	$92.00	—	283% above	39%
Allergy blood test, specific IgE, per allergen CPT 86003 CHG ALLERGEN SPECIFIC IGE,QUANT,EACH	$74.42	$122.00	—	408% above	39%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE,QUANT,EACH	$74.42	$122.00	—	408% above	39%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHG ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH	$14.64	$24.00	—	—	39%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC IGE,SINGLE ALLERGEN,EACH	$14.64	$24.00	—	—	39%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHG ALLERGEN SPECIFIC IGE, QUANT OR SEMIQUANT, EA	$22.57	$37.00	—	—	39%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE, QUANT OR SEMIQUANT, EA	$22.57	$37.00	—	—	39%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE,QUANT OR SEMIQUANT,EA	$34.16	$56.00	—	—	39%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHG ALLERGEN SPECIFIC IGE,QUANT OR SEMIQUANT,EA	$34.16	$56.00	—	—	39%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHG ALLERGEN SPECIFIC IGE,EA ALLERGEN	$40.87	$67.00	—	—	39%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE,EA ALLERGEN	$40.87	$67.00	—	—	39%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHG ALLERGEN SPECIFIC IGG,EA ALLERGEN	$45.14	$74.00	—	—	39%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGG,EA ALLERGEN	$56.12	$92.00	—	—	39%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE,QUANT,EACH	$74.42	$122.00	—	—	39%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHG ALLERGEN SPECIFIC IGE,QUANT,EACH	$74.42	$122.00	—	—	39%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CCP ANTIBODY	$34.16	$56.00	—	50% below	39%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CHG CCP ANTIBODY	$34.16	$56.00	—	50% below	39%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY	$38.43	$63.00	—	44% below	39%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CCP ANTIBODY	$34.16	$56.00	—	—	39%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CHG CCP ANTIBODY	$34.16	$56.00	—	—	39%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY	$38.43	$63.00	—	—	39%
Antinuclear antibody (ANA) blood test, screen CPT 86038 CHG ANTINUCLEAR ANTIBODY	$31.72	$52.00	—	47% below	39%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODY	$46.36	$76.00	—	23% below	39%
Antinuclear antibody (ANA) blood test, screen CPT 86038 CHG ANTINUCLEAR ANTIBODIES ANA	$46.36	$76.00	—	23% below	39%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 CHG ANTINUCLEAR ANTIBODY	$31.72	$52.00	—	—	39%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 CHG ANTINUCLEAR ANTIBODIES ANA	$46.36	$76.00	—	—	39%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODY	$46.36	$76.00	—	—	39%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 CHG NATRIURETIC PEPTIDE	$143.96	$236.00	—	39% below	39%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE	$143.96	$236.00	—	39% below	39%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 CHG NATRIURETIC PEPTIDE	$143.96	$236.00	—	—	39%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE	$143.96	$236.00	—	—	39%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL	$75.64	$124.00	—	at median	39%
Basic metabolic panel (blood test) CPT 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL	$75.64	$124.00	—	at median	39%
Basic metabolic panel (blood test) inpatient CPT 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL	$75.64	$124.00	—	—	39%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL	$75.64	$124.00	—	—	39%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC NEURO PATH TISSUE, EPON	$123.22	$202.00	—	4% above	39%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC SURGICAL PATH-LEVEL IV	$421.51	$691.00	—	257% above	39%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC NEURO PATH TISSUE, EPON	$123.22	$202.00	—	—	39%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC SURGICAL PATH-LEVEL IV	$421.51	$691.00	—	—	39%
Blood culture for bacteria CPT 87040 CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES	$122.61	$201.00	—	35% above	39%
Blood culture for bacteria CPT 87040 HC BLOOD AER/AN CULTURE	$122.61	$201.00	—	35% above	39%
Blood culture for bacteria inpatient CPT 87040 HC BLOOD AER/AN CULTURE	$122.61	$201.00	—	—	39%
Blood culture for bacteria inpatient CPT 87040 CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES	$122.61	$201.00	—	—	39%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC VENIPUNCTURE	$23.79	$39.00	—	35% above	39%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 PR COLLECTION VENOUS BLOOD VENIPUNCTURE	$23.79	$39.00	—	35% above	39%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 PR COLLECTION VENOUS BLOOD VENIPUNCTURE	$23.79	$39.00	—	—	39%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC VENIPUNCTURE	$23.79	$39.00	—	—	39%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE, QUANTITATIVE, BLOOD	$30.50	$50.00	—	2% above	39%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE,WHOLE BLOOD	$30.50	$50.00	—	2% above	39%
Blood glucose (sugar) test CPT 82947 CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP	$30.50	$50.00	—	2% above	39%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE,WHOLE BLOOD	$30.50	$50.00	—	—	39%
Blood glucose (sugar) test inpatient CPT 82947 CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP	$30.50	$50.00	—	—	39%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE, QUANTITATIVE, BLOOD	$30.50	$50.00	—	—	39%
Blood lead test CPT 83655 HC LEAD	$45.75	$75.00	—	at median	39%
Blood lead test CPT 83655 CHG ASSAY OF LEAD	$45.75	$75.00	—	at median	39%
Blood lead test CPT 83655 HC POCT LEAD,BLOOD	$47.58	$78.00	—	4% above	39%
Blood lead test CPT 83655 CHG LEAD,BLOOD (POC)	$50.63	$83.00	—	11% above	39%
Blood lead test inpatient CPT 83655 CHG ASSAY OF LEAD	$45.75	$75.00	—	—	39%
Blood lead test inpatient CPT 83655 HC LEAD	$45.75	$75.00	—	—	39%
Blood lead test inpatient CPT 83655 HC POCT LEAD,BLOOD	$47.58	$78.00	—	—	39%
Blood lead test inpatient CPT 83655 CHG LEAD,BLOOD (POC)	$50.63	$83.00	—	—	39%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHG GONADOTROPIN CHORIONIC QUALITATIVE	$65.88	$108.00	—	1% below	39%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC HCG QUALITATIVE	$65.88	$108.00	—	1% below	39%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC HCG QUALITATIVE	$65.88	$108.00	—	—	39%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 CHG GONADOTROPIN CHORIONIC QUALITATIVE	$65.88	$108.00	—	—	39%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPE, ABO DONOR	$8.54	$14.00	—	78% below	39%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 CHG BLOOD TYPING SEROLOGIC ABO	$8.54	$14.00	—	78% below	39%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 CHG BLOOD TYPE,ABO	$51.24	$84.00	—	31% above	39%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPE,ABO	$51.24	$84.00	—	31% above	39%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 CHG BLOOD TYPING SEROLOGIC ABO	$8.54	$14.00	—	—	39%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPE, ABO DONOR	$8.54	$14.00	—	—	39%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 CHG BLOOD TYPE,ABO	$51.24	$84.00	—	—	39%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPE,ABO	$51.24	$84.00	—	—	39%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN	$71.98	$118.00	—	95% above	39%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CHG C-REACTIVE PROTEIN	$71.98	$118.00	—	95% above	39%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN	$71.98	$118.00	—	—	39%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CHG C-REACTIVE PROTEIN	$71.98	$118.00	—	—	39%
C. difficile toxin gene test (stool PCR) CPT 87493 CHG C DIFF AMPLIFIED PROBE	$62.83	$103.00	—	67% below	39%
C. difficile toxin gene test (stool PCR) CPT 87493 HC C DIFF AMPLIFIED PROBE	$62.83	$103.00	—	67% below	39%
C. difficile toxin gene test (stool PCR) CPT 87493 HC C DIFFICILE,AMPLIFIED PROBE	$235.46	$386.00	—	24% above	39%
C. difficile toxin gene test (stool PCR) CPT 87493 CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE	$235.46	$386.00	—	24% above	39%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CHG C DIFF AMPLIFIED PROBE	$62.83	$103.00	—	—	39%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC C DIFF AMPLIFIED PROBE	$62.83	$103.00	—	—	39%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC C DIFFICILE,AMPLIFIED PROBE	$235.46	$386.00	—	—	39%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE	$235.46	$386.00	—	—	39%
CA 19-9 blood test (tumor marker) CPT 86301 HC CA 19-9	$89.06	$146.00	—	12% below	39%
CA 19-9 blood test (tumor marker) CPT 86301 CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9	$89.06	$146.00	—	12% below	39%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC CA 19-9	$89.06	$146.00	—	—	39%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9	$89.06	$146.00	—	—	39%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC CA 125,TUMOR AG IMMUNOASSAY	$131.76	$216.00	—	at median	39%
CA-125 blood test (ovarian cancer marker) CPT 86304 CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125	$131.76	$216.00	—	at median	39%
CA-125 blood test (ovarian cancer marker) CPT 86304 CHG CA 125, TUMOR AG IMMUNOASSAY	$173.24	$284.00	—	31% above	39%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC CA 125, TUMOR AG IMMUNOASSAY	$173.24	$284.00	—	31% above	39%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125	$131.76	$216.00	—	—	39%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC CA 125,TUMOR AG IMMUNOASSAY	$131.76	$216.00	—	—	39%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CHG CA 125, TUMOR AG IMMUNOASSAY	$173.24	$284.00	—	—	39%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC CA 125, TUMOR AG IMMUNOASSAY	$173.24	$284.00	—	—	39%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CHG IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ	$109.80	$180.00	—	8% below	39%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC SARS-COV-2 COVID-19 AMP PRB	$109.80	$180.00	—	8% below	39%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC SARS-COV-2 COVID-19 AMP PRB	$109.80	$180.00	—	—	39%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 CHG IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ	$109.80	$180.00	—	—	39%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACH AMP PROBE	$147.62	$242.00	—	at median	39%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ	$147.62	$242.00	—	at median	39%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHG CHLAMYDIA TRACH AMP PROBE	$433.10	$710.00	—	193% above	39%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ	$147.62	$242.00	—	—	39%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACH AMP PROBE	$147.62	$242.00	—	—	39%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHG CHLAMYDIA TRACH AMP PROBE	$433.10	$710.00	—	—	39%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$16.47	$27.00	—	79% below	39%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 CHG LIPID PANEL	$80.52	$132.00	—	4% above	39%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL	$16.47	$27.00	—	—	39%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 CHG LIPID PANEL	$80.52	$132.00	—	—	39%
Complete blood count (CBC) with differential CPT 85025 CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$88.45	$145.00	—	44% above	39%
Complete blood count (CBC) with differential CPT 85025 HC CBC,AUTOMATED DIFF	$88.45	$145.00	—	44% above	39%
Complete blood count (CBC) with differential inpatient CPT 85025 CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$88.45	$145.00	—	—	39%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC,AUTOMATED DIFF	$88.45	$145.00	—	—	39%
Complete blood count (CBC), no differential CPT 85027 CHG BLOOD COUNT COMPLETE AUTOMATED	$59.17	$97.00	—	24% above	39%
Complete blood count (CBC), no differential CPT 85027 HC CBC	$59.17	$97.00	—	24% above	39%
Complete blood count (CBC), no differential inpatient CPT 85027 HC CBC	$59.17	$97.00	—	—	39%
Complete blood count (CBC), no differential inpatient CPT 85027 CHG BLOOD COUNT COMPLETE AUTOMATED	$59.17	$97.00	—	—	39%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METABOLIC PANEL	$92.72	$152.00	—	at median	39%
Comprehensive metabolic panel (blood test) CPT 80053 CHG COMPREHENSIVE METABOLIC PANEL	$92.72	$152.00	—	at median	39%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHENSIVE METABOLIC PANEL	$92.72	$152.00	—	—	39%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CHG COMPREHENSIVE METABOLIC PANEL	$92.72	$152.00	—	—	39%
D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN,DEGRAD PRODUCTS,D-DIMER,QUANT	$18.30	$30.00	—	75% below	39%
D-dimer blood test (blood clot marker) CPT 85379 CHG FIBRIN DEGRAD PROD,D-DIMER,QUAN	$45.14	$74.00	—	39% below	39%
D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN DEGRAD PRODUCTS,D-DIMER,QUANT	$45.14	$74.00	—	39% below	39%
D-dimer blood test (blood clot marker) CPT 85379 HC D DIMER QUANTITATIVE	$96.99	$159.00	—	30% above	39%
D-dimer blood test (blood clot marker) CPT 85379 CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE	$96.99	$159.00	—	30% above	39%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC FIBRIN,DEGRAD PRODUCTS,D-DIMER,QUANT	$18.30	$30.00	—	—	39%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC FIBRIN DEGRAD PRODUCTS,D-DIMER,QUANT	$45.14	$74.00	—	—	39%
D-dimer blood test (blood clot marker) inpatient CPT 85379 CHG FIBRIN DEGRAD PROD,D-DIMER,QUAN	$45.14	$74.00	—	—	39%
D-dimer blood test (blood clot marker) inpatient CPT 85379 CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE	$96.99	$159.00	—	—	39%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC D DIMER QUANTITATIVE	$96.99	$159.00	—	—	39%
DHEA sulfate (DHEA-S) blood test CPT 82627 CHG DEHYDROEPIANDROSTERONE-SULFATE	$68.93	$113.00	—	27% below	39%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DHEA-SULFATE	$68.93	$113.00	—	27% below	39%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 CHG DEHYDROEPIANDROSTERONE-SULFATE	$68.93	$113.00	—	—	39%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DHEA-SULFATE	$68.93	$113.00	—	—	39%
Estradiol blood test CPT 82670 HC ESTRADIOL	$112.24	$184.00	—	at median	39%
Estradiol blood test CPT 82670 CHG ASSAY OF TOTAL ESTRADIOL	$112.24	$184.00	—	at median	39%
Estradiol blood test inpatient CPT 82670 CHG ASSAY OF TOTAL ESTRADIOL	$112.24	$184.00	—	—	39%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL	$112.24	$184.00	—	—	39%
FSH (follicle-stimulating hormone) test CPT 83001 CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE	$109.19	$179.00	—	11% above	39%
FSH (follicle-stimulating hormone) test CPT 83001 HC FSH(FOLLICLE STIM HORMONE)	$109.19	$179.00	—	11% above	39%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE	$109.19	$179.00	—	—	39%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC FSH(FOLLICLE STIM HORMONE)	$109.19	$179.00	—	—	39%
Fecal calprotectin (stool inflammation test) CPT 83993 CHG ASSAY OF CALPROTECTIN FECAL	$152.50	$250.00	—	at median	39%
Fecal calprotectin (stool inflammation test) CPT 83993 HC CALPROTECTIN,FECAL	$152.50	$250.00	—	at median	39%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC CALPROTECTIN,FECAL	$152.50	$250.00	—	—	39%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CHG ASSAY OF CALPROTECTIN FECAL	$152.50	$250.00	—	—	39%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN	$98.82	$162.00	—	29% above	39%
Ferritin blood test (iron stores) CPT 82728 CHG ASSAY OF FERRITIN	$98.82	$162.00	—	29% above	39%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN	$98.82	$162.00	—	—	39%
Ferritin blood test (iron stores) inpatient CPT 82728 CHG ASSAY OF FERRITIN	$98.82	$162.00	—	—	39%
Folate (folic acid) blood test CPT 82746 HC FOLATE(FOLIC ACID),SERUM	$90.89	$149.00	—	at median	39%
Folate (folic acid) blood test CPT 82746 CHG ASSAY OF FOLIC ACID SERUM	$90.89	$149.00	—	at median	39%
Folate (folic acid) blood test inpatient CPT 82746 HC FOLATE(FOLIC ACID),SERUM	$90.89	$149.00	—	—	39%
Folate (folic acid) blood test inpatient CPT 82746 CHG ASSAY OF FOLIC ACID SERUM	$90.89	$149.00	—	—	39%
Free T3 thyroid hormone test CPT 84481 CHG ASSAY OF TRIIODOTHYRONINE T3 FREE	$136.64	$224.00	—	36% above	39%
Free T3 thyroid hormone test CPT 84481 HC T3,FREE	$136.64	$224.00	—	36% above	39%
Free T3 thyroid hormone test inpatient CPT 84481 CHG ASSAY OF TRIIODOTHYRONINE T3 FREE	$136.64	$224.00	—	—	39%
Free T3 thyroid hormone test inpatient CPT 84481 HC T3,FREE	$136.64	$224.00	—	—	39%
Free T4 (free thyroxine) thyroid blood test CPT 84439 CHG ASSAY OF FREE THYROXINE	$79.30	$130.00	—	26% above	39%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC T4(THYROXINE),FREE	$79.30	$130.00	—	26% above	39%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC T4(THYROXINE),FREE	$79.30	$130.00	—	—	39%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 CHG ASSAY OF FREE THYROXINE	$79.30	$130.00	—	—	39%
Free testosterone test CPT 84402 CHG ASSAY OF TESTOSTERONE FREE	$45.75	$75.00	—	36% below	39%
Free testosterone test CPT 84402 HC TESTOSTERONE,FREE	$45.75	$75.00	—	36% below	39%
Free testosterone test inpatient CPT 84402 HC TESTOSTERONE,FREE	$45.75	$75.00	—	—	39%
Free testosterone test inpatient CPT 84402 CHG ASSAY OF TESTOSTERONE FREE	$45.75	$75.00	—	—	39%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PANEL	$236.07	$387.00	—	at median	39%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 CHG GENERAL HEALTH PANEL	$236.07	$387.00	—	at median	39%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 CHG GENERAL HEALTH PANEL	$236.07	$387.00	—	—	39%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC GENERAL HEALTH PANEL	$236.07	$387.00	—	—	39%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE,POST GLUCOSE DOSE	$35.38	$58.00	—	6% below	39%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 CHG GLUCOSE POST GLUCOSE DOSE	$35.38	$58.00	—	6% below	39%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 CHG GLUCOSE POST GLUCOSE DOSE	$35.38	$58.00	—	—	39%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE,POST GLUCOSE DOSE	$35.38	$58.00	—	—	39%
Glucose tolerance test, 3 samples CPT 82951 CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS	$80.52	$132.00	—	12% below	39%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE, TOLERANCE TEST (3SP)	$80.52	$132.00	—	12% below	39%
Glucose tolerance test, 3 samples inpatient CPT 82951 CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS	$80.52	$132.00	—	—	39%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE, TOLERANCE TEST (3SP)	$80.52	$132.00	—	—	39%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ	$147.62	$242.00	—	at median	39%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N GONORRHOEAE AMP PROBE	$147.62	$242.00	—	at median	39%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N GONORRHOEAE AMP PROBE	$147.62	$242.00	—	—	39%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ	$147.62	$242.00	—	—	39%
H. pylori antibody blood test CPT 86677 CHG ANTIBODY HELICOBACTER PYLORI	$30.50	$50.00	—	64% below	39%
H. pylori antibody blood test CPT 86677 HC HELICOBACTER PYLORI AB	$30.50	$50.00	—	64% below	39%
H. pylori antibody blood test inpatient CPT 86677 CHG ANTIBODY HELICOBACTER PYLORI	$30.50	$50.00	—	—	39%
H. pylori antibody blood test inpatient CPT 86677 HC HELICOBACTER PYLORI AB	$30.50	$50.00	—	—	39%
H. pylori stool antigen test CPT 87338 HC HPYLORI STOOL AG IA	$42.70	$70.00	—	58% below	39%
H. pylori stool antigen test CPT 87338 CHG HPYLORI STOOL, AG IA	$42.70	$70.00	—	58% below	39%
H. pylori stool antigen test CPT 87338 HC H PYLORI AG, FECES M	$187.88	$308.00	—	86% above	39%
H. pylori stool antigen test CPT 87338 CHG IAAD IA HPYLORI STOOL	$187.88	$308.00	—	86% above	39%
H. pylori stool antigen test inpatient CPT 87338 HC HPYLORI STOOL AG IA	$42.70	$70.00	—	—	39%
H. pylori stool antigen test inpatient CPT 87338 CHG HPYLORI STOOL, AG IA	$42.70	$70.00	—	—	39%
H. pylori stool antigen test inpatient CPT 87338 CHG IAAD IA HPYLORI STOOL	$187.88	$308.00	—	—	39%
H. pylori stool antigen test inpatient CPT 87338 HC H PYLORI AG, FECES M	$187.88	$308.00	—	—	39%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC IADNA HIV-1 QUANT & REVERSE TRANSC	$95.16	$156.00	—	60% below	39%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV-1 QUANTIFICATION	$97.60	$160.00	—	59% below	39%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION	$97.60	$160.00	—	59% below	39%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 CHG IADNA HIV-1 QUANT & REVERSE TRANSC	$175.68	$288.00	—	27% below	39%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC IADNA HIV-1QUANT & REVERSE TRANSC	$316.59	$519.00	—	32% above	39%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC IADNA HIV-1 QUANT & REVERSE TRANSC	$95.16	$156.00	—	—	39%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION	$97.60	$160.00	—	—	39%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV-1 QUANTIFICATION	$97.60	$160.00	—	—	39%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 CHG IADNA HIV-1 QUANT & REVERSE TRANSC	$175.68	$288.00	—	—	39%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC IADNA HIV-1QUANT & REVERSE TRANSC	$316.59	$519.00	—	—	39%
HIV-1 and HIV-2 antibody test CPT 86703 CHG VIRAL SEROLOGY	$28.67	$47.00	—	63% below	39%
HIV-1 and HIV-2 antibody test CPT 86703 CHG ANTIBODY HIV-1&HIV-2 SINGLE RESULT	$67.71	$111.00	—	13% below	39%
HIV-1 and HIV-2 antibody test CPT 86703 HC VIRAL SEROLOGY	$67.71	$111.00	—	13% below	39%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV 1/2 ANTIBODY	$76.86	$126.00	—	1% below	39%
HIV-1 and HIV-2 antibody test CPT 86703 CHG HIV 1/2 ANTIBODY	$76.86	$126.00	—	1% below	39%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 CHG VIRAL SEROLOGY	$28.67	$47.00	—	—	39%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 CHG ANTIBODY HIV-1&HIV-2 SINGLE RESULT	$67.71	$111.00	—	—	39%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC VIRAL SEROLOGY	$67.71	$111.00	—	—	39%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV 1/2 ANTIBODY	$76.86	$126.00	—	—	39%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 CHG HIV 1/2 ANTIBODY	$76.86	$126.00	—	—	39%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 CHG VIRAL SEROLOGY	$65.88	$108.00	—	37% below	39%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC VIRAL SEROLOGY	$65.88	$108.00	—	37% below	39%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE	$85.40	$140.00	—	18% below	39%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 CHG VIRAL SEROLOGY	$65.88	$108.00	—	—	39%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC VIRAL SEROLOGY	$65.88	$108.00	—	—	39%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE	$85.40	$140.00	—	—	39%
HPV test for high-risk types, one combined (pooled) result CPT 87624 CHG IADNA HUMAN PAPILLOMAVIRUS HI-RSK TYP POOLD RSLT	$85.40	$140.00	—	12% below	39%
HPV test for high-risk types, one combined (pooled) result CPT 87624 CHG HPV HIGH-RISK TYPES	$99.43	$163.00	—	3% above	39%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC HPV HIGH-RISK TYPES	$99.43	$163.00	—	3% above	39%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 CHG IADNA HUMAN PAPILLOMAVIRUS HI-RSK TYP POOLD RSLT	$85.40	$140.00	—	—	39%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC HPV HIGH-RISK TYPES	$99.43	$163.00	—	—	39%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 CHG HPV HIGH-RISK TYPES	$99.43	$163.00	—	—	39%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 CHG HGB A1C (POC)	$60.39	$99.00	—	15% below	39%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCATED HEMOGLOBIN	$60.39	$99.00	—	15% below	39%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 CHG HEMOGLOBIN GLYCOSYLATED A1C	$60.39	$99.00	—	15% below	39%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HGB A1C (POC)	$60.39	$99.00	—	15% below	39%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HGB A1C (POC)	$60.39	$99.00	—	—	39%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCATED HEMOGLOBIN	$60.39	$99.00	—	—	39%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 CHG HEMOGLOBIN GLYCOSYLATED A1C	$60.39	$99.00	—	—	39%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 CHG HGB A1C (POC)	$60.39	$99.00	—	—	39%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 CHG HEPATITIS B SURFACE ANTIBODY	$49.41	$81.00	—	12% below	39%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 CHG HEPATITIS B SURF ANTIBODY HBSAB	$65.88	$108.00	—	17% above	39%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE ANTIBODY	$101.87	$167.00	—	81% above	39%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 CHG HEPATITIS B SURFACE ANTIBODY	$49.41	$81.00	—	—	39%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 CHG HEPATITIS B SURF ANTIBODY HBSAB	$65.88	$108.00	—	—	39%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURFACE ANTIBODY	$101.87	$167.00	—	—	39%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC HEPATITIS B SURFACE ANTIGEN	$16.47	$27.00	—	68% below	39%
Hepatitis B surface antigen (HBsAg) test CPT 87340 CHG HEPATITIS B SURFACE ANTIGEN	$71.37	$117.00	—	39% above	39%
Hepatitis B surface antigen (HBsAg) test CPT 87340 CHG IAAD IA HEPATITIS B SURFACE ANTIGEN	$120.17	$197.00	—	134% above	39%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC HEPATITIS B SURFACE ANTIGEN	$16.47	$27.00	—	—	39%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 CHG HEPATITIS B SURFACE ANTIGEN	$71.37	$117.00	—	—	39%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 CHG IAAD IA HEPATITIS B SURFACE ANTIGEN	$120.17	$197.00	—	—	39%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY	$59.78	$98.00	—	5% below	39%
Hepatitis C antibody blood test (screening) CPT 86803 CHG HCV RIBA (MBC)	$75.03	$123.00	—	19% above	39%
Hepatitis C antibody blood test (screening) CPT 86803 HC HCV RIBA (MBC)	$75.03	$123.00	—	19% above	39%
Hepatitis C antibody blood test (screening) CPT 86803 CHG HEPATITIS C ANTIBODY	$86.62	$142.00	—	37% above	39%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY	$59.78	$98.00	—	—	39%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HCV RIBA (MBC)	$75.03	$123.00	—	—	39%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 CHG HCV RIBA (MBC)	$75.03	$123.00	—	—	39%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 CHG HEPATITIS C ANTIBODY	$86.62	$142.00	—	—	39%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C REVERS TRNSCRP	$118.34	$194.00	—	10% below	39%
Hepatitis C viral load (HCV RNA) test CPT 87522 CHG HEPATITIS C REVERS TRNSCRP	$118.34	$194.00	—	10% below	39%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C,QUANTIFICATION	$244.61	$401.00	—	86% above	39%
Hepatitis C viral load (HCV RNA) test CPT 87522 CHG IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION	$244.61	$401.00	—	86% above	39%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C REVERS TRNSCRP	$118.34	$194.00	—	—	39%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 CHG HEPATITIS C REVERS TRNSCRP	$118.34	$194.00	—	—	39%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C,QUANTIFICATION	$244.61	$401.00	—	—	39%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 CHG IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION	$244.61	$401.00	—	—	39%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES TYP 1 IGG OR M M	$29.89	$49.00	—	32% below	39%
Herpes blood test, HSV-1 antibody CPT 86695 CHG ANTIBODY HERPES SMPLX TYPE 1	$29.89	$49.00	—	32% below	39%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX TEST, TYPE 1	$49.41	$81.00	—	12% above	39%
Herpes blood test, HSV-1 antibody CPT 86695 CHG HERPES SIMPLEX TEST, TYPE 1	$49.41	$81.00	—	12% above	39%
Herpes blood test, HSV-1 antibody CPT 86695 CHG HERPES SIMPLEX TEST TYPE 1	$56.73	$93.00	—	29% above	39%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX TEST TYPE 1	$56.73	$93.00	—	29% above	39%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 CHG ANTIBODY HERPES SMPLX TYPE 1	$29.89	$49.00	—	—	39%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES TYP 1 IGG OR M M	$29.89	$49.00	—	—	39%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 CHG HERPES SIMPLEX TEST, TYPE 1	$49.41	$81.00	—	—	39%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES SIMPLEX TEST, TYPE 1	$49.41	$81.00	—	—	39%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 CHG HERPES SIMPLEX TEST TYPE 1	$56.73	$93.00	—	—	39%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES SIMPLEX TEST TYPE 1	$56.73	$93.00	—	—	39%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES TYP 2 IGG OR M M	$43.92	$72.00	—	25% below	39%
Herpes blood test, HSV-2 antibody CPT 86696 CHG ANTIBODY HERPES SMPLX TYPE 2	$43.92	$72.00	—	25% below	39%
Herpes blood test, HSV-2 antibody CPT 86696 CHG HERPES SIMPLEX TEST TYPE 2	$56.73	$93.00	—	3% below	39%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TEST TYPE 2	$56.73	$93.00	—	3% below	39%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TEST, TYPE 2	$72.59	$119.00	—	24% above	39%
Herpes blood test, HSV-2 antibody CPT 86696 CHG HERPES SIMPLEX TEST, TYPE 2	$72.59	$119.00	—	24% above	39%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES TYP 2 IGG OR M M	$43.92	$72.00	—	—	39%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 CHG ANTIBODY HERPES SMPLX TYPE 2	$43.92	$72.00	—	—	39%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 CHG HERPES SIMPLEX TEST TYPE 2	$56.73	$93.00	—	—	39%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX TEST TYPE 2	$56.73	$93.00	—	—	39%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX TEST, TYPE 2	$72.59	$119.00	—	—	39%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 CHG HERPES SIMPLEX TEST, TYPE 2	$72.59	$119.00	—	—	39%
High-sensitivity CRP (hs-CRP) test CPT 86141 CHG C-REACTIVE PROTEIN HIGH SENSITIVITY	$95.77	$157.00	—	23% above	39%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN,HIGH SENS	$95.77	$157.00	—	23% above	39%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN,HIGH SENS	$95.77	$157.00	—	—	39%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CHG C-REACTIVE PROTEIN HIGH SENSITIVITY	$95.77	$157.00	—	—	39%
Homocysteine blood test CPT 83090 HC HOMOCYSTINE (SO)	$96.99	$159.00	—	1% above	39%
Homocysteine blood test CPT 83090 CHG ASSAY OF HOMOCYSTEINE	$96.99	$159.00	—	1% above	39%
Homocysteine blood test CPT 83090 HC HOMOCYSTINE	$101.87	$167.00	—	6% above	39%
Homocysteine blood test CPT 83090 CHG HOMOCYSTINE	$101.87	$167.00	—	6% above	39%
Homocysteine blood test inpatient CPT 83090 CHG ASSAY OF HOMOCYSTEINE	$96.99	$159.00	—	—	39%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTINE (SO)	$96.99	$159.00	—	—	39%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTINE	$101.87	$167.00	—	—	39%
Homocysteine blood test inpatient CPT 83090 CHG HOMOCYSTINE	$101.87	$167.00	—	—	39%
Insulin blood test CPT 83525 HC INSULIN,TOTAL	$28.67	$47.00	—	50% below	39%
Insulin blood test CPT 83525 CHG ASSAY OF INSULIN TOTAL	$28.67	$47.00	—	50% below	39%
Insulin blood test inpatient CPT 83525 HC INSULIN,TOTAL	$28.67	$47.00	—	—	39%
Insulin blood test inpatient CPT 83525 CHG ASSAY OF INSULIN TOTAL	$28.67	$47.00	—	—	39%
Iron blood test (serum iron) CPT 83540 HC IRON	$38.43	$63.00	—	3% above	39%
Iron blood test (serum iron) CPT 83540 CHG ASSAY OF IRON	$38.43	$63.00	—	3% above	39%
Iron blood test (serum iron) CPT 83540 HC IRON,URINE	$75.03	$123.00	—	101% above	39%
Iron blood test (serum iron) CPT 83540 CHG IRON,URINE	$75.03	$123.00	—	101% above	39%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON	$38.43	$63.00	—	—	39%
Iron blood test (serum iron) inpatient CPT 83540 CHG ASSAY OF IRON	$38.43	$63.00	—	—	39%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON,URINE	$75.03	$123.00	—	—	39%
Iron blood test (serum iron) inpatient CPT 83540 CHG IRON,URINE	$75.03	$123.00	—	—	39%
Iron-binding capacity (TIBC) test CPT 83550 CHG IRON BINDING CAPACITY	$51.85	$85.00	—	at median	39%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY	$51.85	$85.00	—	at median	39%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY	$51.85	$85.00	—	—	39%
Iron-binding capacity (TIBC) test inpatient CPT 83550 CHG IRON BINDING CAPACITY	$51.85	$85.00	—	—	39%
Kidney function blood test panel CPT 80069 CHG RENAL FUNCTION PANEL	$80.52	$132.00	—	5% above	39%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL	$80.52	$132.00	—	5% above	39%
Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL	$80.52	$132.00	—	—	39%
Kidney function blood test panel inpatient CPT 80069 CHG RENAL FUNCTION PANEL	$80.52	$132.00	—	—	39%
LH (luteinizing hormone) test CPT 83002 CHG GONADOTROPIN LUTEINIZING HORMONE	$104.31	$171.00	—	at median	39%
LH (luteinizing hormone) test CPT 83002 HC LUTEINIZING HORMONE,LH	$104.31	$171.00	—	at median	39%
LH (luteinizing hormone) test inpatient CPT 83002 HC LUTEINIZING HORMONE,LH	$104.31	$171.00	—	—	39%
LH (luteinizing hormone) test inpatient CPT 83002 CHG GONADOTROPIN LUTEINIZING HORMONE	$104.31	$171.00	—	—	39%
Lipase blood test (pancreas enzyme) CPT 83690 CHG ASSAY OF LIPASE	$86.62	$142.00	—	55% above	39%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE	$86.62	$142.00	—	55% above	39%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 CHG ASSAY OF LIPASE	$86.62	$142.00	—	—	39%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE	$86.62	$142.00	—	—	39%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL	$72.59	$119.00	—	at median	39%
Liver function blood test panel CPT 80076 CHG HEPATIC FUNCTION PANEL	$72.59	$119.00	—	at median	39%
Liver function blood test panel inpatient CPT 80076 CHG HEPATIC FUNCTION PANEL	$72.59	$119.00	—	—	39%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL	$72.59	$119.00	—	—	39%
Lyme disease antibody test CPT 86618 CHG B. BURGDORFERI AB,LYME DISEASE	$42.70	$70.00	—	at median	39%
Lyme disease antibody test CPT 86618 HC B. BURGDORFERI AB,LYME DISEASE	$42.70	$70.00	—	at median	39%
Lyme disease antibody test CPT 86618 CHG ANTIBODY BORRELIA BURGDORFERI LYME DISEASE	$143.35	$235.00	—	236% above	39%
Lyme disease antibody test CPT 86618 HC BORRELLIA BURG AB,LYME DISEASE	$143.35	$235.00	—	236% above	39%
Lyme disease antibody test inpatient CPT 86618 HC B. BURGDORFERI AB,LYME DISEASE	$42.70	$70.00	—	—	39%
Lyme disease antibody test inpatient CPT 86618 CHG B. BURGDORFERI AB,LYME DISEASE	$42.70	$70.00	—	—	39%
Lyme disease antibody test inpatient CPT 86618 HC BORRELLIA BURG AB,LYME DISEASE	$143.35	$235.00	—	—	39%
Lyme disease antibody test inpatient CPT 86618 CHG ANTIBODY BORRELIA BURGDORFERI LYME DISEASE	$143.35	$235.00	—	—	39%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM	$17.69	$29.00	—	26% below	39%
Magnesium blood test CPT 83735 CHG ASSAY OF MAGNESIUM	$32.33	$53.00	—	35% above	39%
Magnesium blood test CPT 83735 CHG MAGNESIUM	$51.85	$85.00	—	116% above	39%
Magnesium blood test CPT 83735 HC MAGNESIUM	$51.85	$85.00	—	116% above	39%
Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM	$17.69	$29.00	—	—	39%
Magnesium blood test inpatient CPT 83735 CHG ASSAY OF MAGNESIUM	$32.33	$53.00	—	—	39%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM	$51.85	$85.00	—	—	39%
Magnesium blood test inpatient CPT 83735 CHG MAGNESIUM	$51.85	$85.00	—	—	39%
Measles (rubeola) antibody test CPT 86765 CHG RUBELOA AB	$15.25	$25.00	—	73% below	39%
Measles (rubeola) antibody test CPT 86765 HC RUBELOA AB	$15.25	$25.00	—	73% below	39%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA ANTIBODY	$36.60	$60.00	—	36% below	39%
Measles (rubeola) antibody test CPT 86765 CHG RUBEOLA ANTIBODY	$36.60	$60.00	—	36% below	39%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA AB	$48.80	$80.00	—	14% below	39%
Measles (rubeola) antibody test CPT 86765 CHG RUBEOLA AB	$48.80	$80.00	—	14% below	39%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA(MEASLES)AB M	$66.49	$109.00	—	17% above	39%
Measles (rubeola) antibody test CPT 86765 CHG ANTIBODY RUBEOLA	$66.49	$109.00	—	17% above	39%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBELOA AB	$15.25	$25.00	—	—	39%
Measles (rubeola) antibody test inpatient CPT 86765 CHG RUBELOA AB	$15.25	$25.00	—	—	39%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA ANTIBODY	$36.60	$60.00	—	—	39%
Measles (rubeola) antibody test inpatient CPT 86765 CHG RUBEOLA ANTIBODY	$36.60	$60.00	—	—	39%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA AB	$48.80	$80.00	—	—	39%
Measles (rubeola) antibody test inpatient CPT 86765 CHG RUBEOLA AB	$48.80	$80.00	—	—	39%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA(MEASLES)AB M	$66.49	$109.00	—	—	39%
Measles (rubeola) antibody test inpatient CPT 86765 CHG ANTIBODY RUBEOLA	$66.49	$109.00	—	—	39%
Mono test (heterophile antibody, Monospot) CPT 86308 CHG HETEROPHILE ANTIBODIES SCREEN	$49.41	$81.00	—	12% above	39%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODY,SCREEN	$49.41	$81.00	—	12% above	39%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 CHG HETEROPHILE ANTIBODIES SCREEN	$49.41	$81.00	—	—	39%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE ANTIBODY,SCREEN	$49.41	$81.00	—	—	39%
Obstetric blood test panel CPT 80055 CHG OBSTETRIC PANEL	$176.29	$289.00	—	37% below	39%
Obstetric blood test panel CPT 80055 HC OBSTETRICS PANEL	$176.29	$289.00	—	37% below	39%
Obstetric blood test panel inpatient CPT 80055 HC OBSTETRICS PANEL	$176.29	$289.00	—	—	39%
Obstetric blood test panel inpatient CPT 80055 CHG OBSTETRIC PANEL	$176.29	$289.00	—	—	39%
PSA (prostate-specific antigen) blood test, free CPT 84154 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE	$42.70	$70.00	—	30% below	39%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA,FREE	$42.70	$70.00	—	30% below	39%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PSA,FREE	$42.70	$70.00	—	—	39%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE	$42.70	$70.00	—	—	39%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGEN	$106.75	$175.00	—	19% above	39%
PSA (prostate-specific antigen) blood test, total CPT 84153 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL	$106.75	$175.00	—	19% above	39%
PSA (prostate-specific antigen) blood test, total CPT 84153 CHG PROSTATE SPECIFIC ANTIGEN (SO)	$160.43	$263.00	—	79% above	39%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGEN (SO)	$160.43	$263.00	—	79% above	39%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATE SPECIFIC ANTIGEN	$106.75	$175.00	—	—	39%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL	$106.75	$175.00	—	—	39%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATE SPECIFIC ANTIGEN (SO)	$160.43	$263.00	—	—	39%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CHG PROSTATE SPECIFIC ANTIGEN (SO)	$160.43	$263.00	—	—	39%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC PAP SMEAR (TL)	$81.74	$134.00	—	14% below	39%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CHG CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN	$81.74	$134.00	—	14% below	39%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC PAP SMEAR (TL)	$81.74	$134.00	—	—	39%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CHG CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN	$81.74	$134.00	—	—	39%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHYROID HORMONE	$137.25	$225.00	—	34% below	39%
Parathyroid hormone (PTH) blood test CPT 83970 CHG ASSAY OF PARATHORMONE	$137.25	$225.00	—	34% below	39%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 CHG ASSAY OF PARATHORMONE	$137.25	$225.00	—	—	39%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHYROID HORMONE	$137.25	$225.00	—	—	39%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT (SO)	$22.57	$37.00	—	29% below	39%
Partial thromboplastin time (PTT) clotting test CPT 85730 CHG PTT(SO)	$22.57	$37.00	—	29% below	39%
Partial thromboplastin time (PTT) clotting test CPT 85730 CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD	$44.53	$73.00	—	39% above	39%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT	$67.10	$110.00	—	110% above	39%
Partial thromboplastin time (PTT) clotting test CPT 85730 CHG PTT	$67.10	$110.00	—	110% above	39%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 CHG PTT(SO)	$22.57	$37.00	—	—	39%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT (SO)	$22.57	$37.00	—	—	39%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD	$44.53	$73.00	—	—	39%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT	$67.10	$110.00	—	—	39%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 CHG PTT	$67.10	$110.00	—	—	39%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC FETAL CHRMOML ANEUPLOIDY	$1,302.96	$2,136.00	—	1% above	39%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 CHG FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS	$1,302.96	$2,136.00	—	1% above	39%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 CHG FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS	$1,302.96	$2,136.00	—	—	39%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC FETAL CHRMOML ANEUPLOIDY	$1,302.96	$2,136.00	—	—	39%
Progesterone blood test CPT 84144 CHG PROGESTERONE ASSAY	$50.63	$83.00	—	54% below	39%
Progesterone blood test CPT 84144 HC PROGESTERONE ASSAY	$50.63	$83.00	—	54% below	39%
Progesterone blood test CPT 84144 HC PROGESTERONE	$90.28	$148.00	—	18% below	39%
Progesterone blood test CPT 84144 CHG ASSAY OF PROGESTERONE	$90.28	$148.00	—	18% below	39%
Progesterone blood test inpatient CPT 84144 HC PROGESTERONE ASSAY	$50.63	$83.00	—	—	39%
Progesterone blood test inpatient CPT 84144 CHG PROGESTERONE ASSAY	$50.63	$83.00	—	—	39%
Progesterone blood test inpatient CPT 84144 HC PROGESTERONE	$90.28	$148.00	—	—	39%
Progesterone blood test inpatient CPT 84144 CHG ASSAY OF PROGESTERONE	$90.28	$148.00	—	—	39%
Prolactin blood test CPT 84146 CHG ASSAY OF PROLACTIN	$104.92	$172.00	—	9% above	39%
Prolactin blood test CPT 84146 HC PROLACTIN	$104.92	$172.00	—	9% above	39%
Prolactin blood test inpatient CPT 84146 CHG ASSAY OF PROLACTIN	$104.92	$172.00	—	—	39%
Prolactin blood test inpatient CPT 84146 HC PROLACTIN	$104.92	$172.00	—	—	39%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME (SO)	$22.57	$37.00	—	9% below	39%
Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME(SO)	$22.57	$37.00	—	9% below	39%
Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME	$35.99	$59.00	—	46% above	39%
Prothrombin time (PT/INR) clotting test CPT 85610 CHG PT-PROTHROMBIN TIME	$50.63	$83.00	—	105% above	39%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PT-PROTHROMBIN TIME	$50.63	$83.00	—	105% above	39%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PT-PROTHROMBIN TIME (POC)	$50.63	$83.00	—	105% above	39%
Prothrombin time (PT/INR) clotting test CPT 85610 CHG PT-PROTHROMBIN TIME (POC)	$50.63	$83.00	—	105% above	39%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PROTHROMBIN TIME(SO)	$22.57	$37.00	—	—	39%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME (SO)	$22.57	$37.00	—	—	39%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PROTHROMBIN TIME	$35.99	$59.00	—	—	39%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PT-PROTHROMBIN TIME	$50.63	$83.00	—	—	39%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PT-PROTHROMBIN TIME (POC)	$50.63	$83.00	—	—	39%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PT-PROTHROMBIN TIME (POC)	$50.63	$83.00	—	—	39%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PT-PROTHROMBIN TIME	$50.63	$83.00	—	—	39%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG TEST PRSMV DIR OPT OBS	$140.91	$231.00	—	63% above	39%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE	$140.91	$231.00	—	63% above	39%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE	$140.91	$231.00	—	—	39%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC DRUG TEST PRSMV DIR OPT OBS	$140.91	$231.00	—	—	39%
Rapid flu test (influenza antigen) CPT 87804 CHG IAADIADOO INFLUENZA	$82.35	$135.00	—	2% below	39%
Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA A/B ANTIGEN	$82.35	$135.00	—	2% below	39%
Rapid flu test (influenza antigen) inpatient CPT 87804 CHG IAADIADOO INFLUENZA	$82.35	$135.00	—	—	39%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFLUENZA A/B ANTIGEN	$82.35	$135.00	—	—	39%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 CHG IAADIADOO STREPTOCOCCUS GROUP A	$65.88	$108.00	—	20% below	39%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP SCREEN,GROUP A (POC)	$65.88	$108.00	—	20% below	39%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 CHG STREP SCREEN,GRP A(POC)	$65.88	$108.00	—	20% below	39%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP SCREEN,GROUP A	$65.88	$108.00	—	20% below	39%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREP SCREEN,GROUP A	$65.88	$108.00	—	—	39%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREP SCREEN,GROUP A (POC)	$65.88	$108.00	—	—	39%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 CHG IAADIADOO STREPTOCOCCUS GROUP A	$65.88	$108.00	—	—	39%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 CHG STREP SCREEN,GRP A(POC)	$65.88	$108.00	—	—	39%
Rheumatoid factor (RF) test CPT 86431 CHG RHEUMATOID FACTOR QUANT	$36.60	$60.00	—	at median	39%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANT	$36.60	$60.00	—	at median	39%
Rheumatoid factor (RF) test CPT 86431 CHG RHEUMATOID FACTOR QUANTITATIVE	$53.07	$87.00	—	45% above	39%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACT,QUANT	$53.07	$87.00	—	45% above	39%
Rheumatoid factor (RF) test inpatient CPT 86431 CHG RHEUMATOID FACTOR QUANT	$36.60	$60.00	—	—	39%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR QUANT	$36.60	$60.00	—	—	39%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACT,QUANT	$53.07	$87.00	—	—	39%
Rheumatoid factor (RF) test inpatient CPT 86431 CHG RHEUMATOID FACTOR QUANTITATIVE	$53.07	$87.00	—	—	39%
Rubella antibody test (immunity check) CPT 86762 CHG RUBELLA AB	$21.35	$35.00	—	65% below	39%
Rubella antibody test (immunity check) CPT 86762 CHG ANTIBODY RUBELLA	$43.92	$72.00	—	29% below	39%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY	$43.92	$72.00	—	29% below	39%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA AB IGG	$60.39	$99.00	—	2% below	39%
Rubella antibody test (immunity check) CPT 86762 CHG RUBELLA AB IGG	$60.39	$99.00	—	2% below	39%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA AB	$170.80	$280.00	—	178% above	39%
Rubella antibody test (immunity check) inpatient CPT 86762 CHG RUBELLA AB	$21.35	$35.00	—	—	39%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA ANTIBODY	$43.92	$72.00	—	—	39%
Rubella antibody test (immunity check) inpatient CPT 86762 CHG ANTIBODY RUBELLA	$43.92	$72.00	—	—	39%
Rubella antibody test (immunity check) inpatient CPT 86762 CHG RUBELLA AB IGG	$60.39	$99.00	—	—	39%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA AB IGG	$60.39	$99.00	—	—	39%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA AB	$170.80	$280.00	—	—	39%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SED RATE,AUTOMATED	$35.38	$58.00	—	8% above	39%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 CHG SEDIMENTATION RATE RBC AUTOMATED	$35.38	$58.00	—	8% above	39%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 CHG SEDIMENTATION RATE RBC AUTOMATED	$35.38	$58.00	—	—	39%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SED RATE,AUTOMATED	$35.38	$58.00	—	—	39%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 CHG SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT	$121.39	$199.00	—	21% above	39%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS,COMPLETE	$121.39	$199.00	—	21% above	39%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 CHG SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT	$121.39	$199.00	—	—	39%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC SEMEN ANALYSIS,COMPLETE	$121.39	$199.00	—	—	39%
Stool ova and parasites exam CPT 87177 HC OVA & PARASITES	$37.82	$62.00	—	22% below	39%
Stool ova and parasites exam CPT 87177 CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID	$37.82	$62.00	—	22% below	39%
Stool ova and parasites exam inpatient CPT 87177 CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID	$37.82	$62.00	—	—	39%
Stool ova and parasites exam inpatient CPT 87177 HC OVA & PARASITES	$37.82	$62.00	—	—	39%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLD,SCREENING-3 (POC)	$28.06	$46.00	—	2% below	39%
Stool test for hidden blood (guaiac FOBT) CPT 82270 CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER	$29.28	$48.00	—	2% above	39%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCLT BLD,FECES,SCREENING	$29.28	$48.00	—	2% above	39%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLD,SCREENING (POC)	$29.28	$48.00	—	2% above	39%
Stool test for hidden blood (guaiac FOBT) CPT 82270 CHG OCCULT BLD,SCREENING (POC)	$29.28	$48.00	—	2% above	39%
Stool test for hidden blood (guaiac FOBT) CPT 82270 CHG OCCULT BLD,SCREENING-3 (POC)	$29.28	$48.00	—	2% above	39%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLD,SCREENING-3 (POC)	$28.06	$46.00	—	—	39%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER	$29.28	$48.00	—	—	39%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 CHG OCCULT BLD,SCREENING (POC)	$29.28	$48.00	—	—	39%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCLT BLD,FECES,SCREENING	$29.28	$48.00	—	—	39%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLD,SCREENING (POC)	$29.28	$48.00	—	—	39%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 CHG OCCULT BLD,SCREENING-3 (POC)	$29.28	$48.00	—	—	39%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC OCCULT BLOOD,FECAL HGB,IA	$36.60	$60.00	—	56% below	39%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3	$36.60	$60.00	—	56% below	39%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLOOD, OCCULT, FECAL HGB, FECES, 1-3	$53.07	$87.00	—	37% below	39%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CHG BLOOD, OCCULT, FECAL HGB, FECES, 1-3	$53.07	$87.00	—	37% below	39%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CHG BLOOD,OCCULT,FECAL HGB,FECES,1-3 S	$65.88	$108.00	—	22% below	39%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLOOD,OCCULT,FECAL HGB,FECES,1-3 S	$65.88	$108.00	—	22% below	39%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC OCCULT BLOOD,FECAL HGB,IA	$36.60	$60.00	—	—	39%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3	$36.60	$60.00	—	—	39%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC BLOOD, OCCULT, FECAL HGB, FECES, 1-3	$53.07	$87.00	—	—	39%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CHG BLOOD, OCCULT, FECAL HGB, FECES, 1-3	$53.07	$87.00	—	—	39%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC BLOOD,OCCULT,FECAL HGB,FECES,1-3 S	$65.88	$108.00	—	—	39%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CHG BLOOD,OCCULT,FECAL HGB,FECES,1-3 S	$65.88	$108.00	—	—	39%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST,QUALITATIVE	$43.92	$72.00	—	49% above	39%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL	$43.92	$72.00	—	49% above	39%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST,QUALITATIVE	$43.92	$72.00	—	—	39%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL	$43.92	$72.00	—	—	39%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB TEST, QUANTIFERRON	$25.01	$41.00	—	82% below	39%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 CHG TB TESTING	$72.59	$119.00	—	47% below	39%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$116.51	$191.00	—	16% below	39%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB TEST,QUANTIFERRON	$116.51	$191.00	—	16% below	39%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB TEST, QUANTIFERRON	$25.01	$41.00	—	—	39%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 CHG TB TESTING	$72.59	$119.00	—	—	39%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$116.51	$191.00	—	—	39%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB TEST,QUANTIFERRON	$116.51	$191.00	—	—	39%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE, TOTAL (SO)	$62.83	$103.00	—	14% below	39%
Testosterone blood test, total (not free testosterone) CPT 84403 CHG TESTOSTERONE,TOTAL (SO)	$62.83	$103.00	—	14% below	39%
Testosterone blood test, total (not free testosterone) CPT 84403 CHG ASSAY OF TESTOSTERONE TOTAL	$85.40	$140.00	—	17% above	39%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE,TOTAL (SO)	$85.40	$140.00	—	17% above	39%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE, TOTAL	$113.46	$186.00	—	56% above	39%
Testosterone blood test, total (not free testosterone) CPT 84403 CHG TESTOSTERONE, TOTAL	$113.46	$186.00	—	56% above	39%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE, TOTAL (SO)	$62.83	$103.00	—	—	39%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 CHG TESTOSTERONE,TOTAL (SO)	$62.83	$103.00	—	—	39%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE,TOTAL (SO)	$85.40	$140.00	—	—	39%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 CHG ASSAY OF TESTOSTERONE TOTAL	$85.40	$140.00	—	—	39%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 CHG TESTOSTERONE, TOTAL	$113.46	$186.00	—	—	39%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE, TOTAL	$113.46	$186.00	—	—	39%
Thyroid peroxidase (TPO) antibody test CPT 86376 CHG MICROSOMAL ANTIBODIES EACH	$64.05	$105.00	—	at median	39%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES,EACH	$64.05	$105.00	—	at median	39%
Thyroid peroxidase (TPO) antibody test CPT 86376 CHG MICROSOMAL ANTIBODIES, EACH	$75.03	$123.00	—	17% above	39%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES, EACH	$75.03	$123.00	—	17% above	39%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES,EACH	$64.05	$105.00	—	—	39%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 CHG MICROSOMAL ANTIBODIES EACH	$64.05	$105.00	—	—	39%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES, EACH	$75.03	$123.00	—	—	39%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 CHG MICROSOMAL ANTIBODIES, EACH	$75.03	$123.00	—	—	39%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH	$92.11	$151.00	—	10% below	39%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 CHG ASSAY OF THYROID STIMULATING HORMONE TSH	$92.11	$151.00	—	10% below	39%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 CHG ASSAY OF THYROID STIMULATING HORMONE TSH	$92.11	$151.00	—	—	39%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH	$92.11	$151.00	—	—	39%
Trichomonas test (NAAT) CPT 87661 CHG BACTERIAL VAGINOSIS - TRICHOMONOAS VAGINALIS, AMPLIFIED PROBE	$27.45	$45.00	—	59% below	39%
Trichomonas test (NAAT) CPT 87661 HC BACTERIAL VAGINOSIS - TRICHOMONOAS VAGINALIS, AMPLIFIED PROBE	$27.45	$45.00	—	59% below	39%
Trichomonas test (NAAT) CPT 87661 CHG IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH	$100.04	$164.00	—	51% above	39%
Trichomonas test (NAAT) CPT 87661 HC TRICHOMONAS VAGINALIS AMPLIF	$100.04	$164.00	—	51% above	39%
Trichomonas test (NAAT) inpatient CPT 87661 CHG BACTERIAL VAGINOSIS - TRICHOMONOAS VAGINALIS, AMPLIFIED PROBE	$27.45	$45.00	—	—	39%
Trichomonas test (NAAT) inpatient CPT 87661 HC BACTERIAL VAGINOSIS - TRICHOMONOAS VAGINALIS, AMPLIFIED PROBE	$27.45	$45.00	—	—	39%
Trichomonas test (NAAT) inpatient CPT 87661 CHG IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH	$100.04	$164.00	—	—	39%
Trichomonas test (NAAT) inpatient CPT 87661 HC TRICHOMONAS VAGINALIS AMPLIF	$100.04	$164.00	—	—	39%
Uric acid blood test CPT 84550 CHG ASSAY OF BLOOD/URIC ACID	$40.26	$66.00	—	at median	39%
Uric acid blood test CPT 84550 HC URIC ACID,BLOOD	$40.26	$66.00	—	at median	39%
Uric acid blood test inpatient CPT 84550 HC URIC ACID,BLOOD	$40.26	$66.00	—	—	39%
Uric acid blood test inpatient CPT 84550 CHG ASSAY OF BLOOD/URIC ACID	$40.26	$66.00	—	—	39%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS W/MICRO AUTO	$40.87	$67.00	—	14% above	39%
Urinalysis with microscope exam, automated CPT 81001 CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY	$40.87	$67.00	—	14% above	39%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS W/MICRO AUTO	$40.87	$67.00	—	—	39%
Urinalysis with microscope exam, automated inpatient CPT 81001 CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY	$40.87	$67.00	—	—	39%
Urinalysis with microscope exam, manual CPT 81000 CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY	$24.40	$40.00	—	8% below	39%
Urinalysis with microscope exam, manual CPT 81000 HC URINALYSIS, NON-AUTO, W/SCOPE	$24.40	$40.00	—	8% below	39%
Urinalysis with microscope exam, manual inpatient CPT 81000 HC URINALYSIS, NON-AUTO, W/SCOPE	$24.40	$40.00	—	—	39%
Urinalysis with microscope exam, manual inpatient CPT 81000 CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY	$24.40	$40.00	—	—	39%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS W/O MICRO AUTO	$28.67	$47.00	—	52% above	39%
Urinalysis without microscope exam, automated CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY	$28.67	$47.00	—	52% above	39%
Urinalysis without microscope exam, automated CPT 81003 HC UA C/OUT MICRO,AUTOMATED (POC)	$28.67	$47.00	—	52% above	39%
Urinalysis without microscope exam, automated CPT 81003 CHG UA C/OUT MICRO,AUTOMATED (POC)	$28.67	$47.00	—	52% above	39%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC UA C/OUT MICRO,AUTOMATED (POC)	$28.67	$47.00	—	—	39%
Urinalysis without microscope exam, automated inpatient CPT 81003 CHG UA C/OUT MICRO,AUTOMATED (POC)	$28.67	$47.00	—	—	39%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS W/O MICRO AUTO	$28.67	$47.00	—	—	39%
Urinalysis without microscope exam, automated inpatient CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY	$28.67	$47.00	—	—	39%
Urinalysis without microscope exam, manual CPT 81002 CHG URINALYSIS NONAUTO W/O MICRO (POC)	$26.84	$44.00	—	28% above	39%
Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS NONAUTO W/O MICRO (POC)	$26.84	$44.00	—	28% above	39%
Urinalysis without microscope exam, manual CPT 81002 HC DOT UA (POC)	$26.84	$44.00	—	28% above	39%
Urinalysis without microscope exam, manual CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$26.84	$44.00	—	28% above	39%
Urinalysis without microscope exam, manual CPT 81002 CHG DOT US (POC)	$26.84	$44.00	—	28% above	39%
Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS W/O MICRO NON-AUTO	$32.94	$54.00	—	57% above	39%
Urinalysis without microscope exam, manual CPT 81002 CHG URINALYSIS W/O MICRO NON-AUTO	$32.94	$54.00	—	57% above	39%
Urinalysis without microscope exam, manual inpatient CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$26.84	$44.00	—	—	39%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINALYSIS NONAUTO W/O MICRO (POC)	$26.84	$44.00	—	—	39%
Urinalysis without microscope exam, manual inpatient CPT 81002 CHG URINALYSIS NONAUTO W/O MICRO (POC)	$26.84	$44.00	—	—	39%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC DOT UA (POC)	$26.84	$44.00	—	—	39%
Urinalysis without microscope exam, manual inpatient CPT 81002 CHG DOT US (POC)	$26.84	$44.00	—	—	39%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINALYSIS W/O MICRO NON-AUTO	$32.94	$54.00	—	—	39%
Urinalysis without microscope exam, manual inpatient CPT 81002 CHG URINALYSIS W/O MICRO NON-AUTO	$32.94	$54.00	—	—	39%
Urine culture for bacteria, with colony count CPT 87086 CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE	$55.51	$91.00	—	14% below	39%
Urine culture for bacteria, with colony count CPT 87086 HC URINE CULTURE,QUANTITATION	$55.51	$91.00	—	14% below	39%
Urine culture for bacteria, with colony count inpatient CPT 87086 CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE	$55.51	$91.00	—	—	39%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC URINE CULTURE,QUANTITATION	$55.51	$91.00	—	—	39%
Urine pregnancy test, read by color change CPT 81025 CHG URINE PREGNANCY (POC)	$51.24	$84.00	—	10% below	39%
Urine pregnancy test, read by color change CPT 81025 CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS	$51.24	$84.00	—	10% below	39%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY (POC)	$51.24	$84.00	—	10% below	39%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST	$51.24	$84.00	—	10% below	39%
Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY (POC)	$51.24	$84.00	—	—	39%
Urine pregnancy test, read by color change inpatient CPT 81025 CHG URINE PREGNANCY (POC)	$51.24	$84.00	—	—	39%
Urine pregnancy test, read by color change inpatient CPT 81025 CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS	$51.24	$84.00	—	—	39%
Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY TEST	$51.24	$84.00	—	—	39%
Vitamin B12 (cobalamin) blood test CPT 82607 CHG CYANOCOBALAMIN VITAMIN B-12	$55.51	$91.00	—	31% below	39%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B-12	$55.51	$91.00	—	31% below	39%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B-12	$55.51	$91.00	—	—	39%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CHG CYANOCOBALAMIN VITAMIN B-12	$55.51	$91.00	—	—	39%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC CALCIFEDIOL(25-OH VITAMIN D)	$140.91	$231.00	—	13% below	39%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED	$140.91	$231.00	—	13% below	39%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED	$140.91	$231.00	—	—	39%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC CALCIFEDIOL(25-OH VITAMIN D)	$140.91	$231.00	—	—	39%
Zinc blood test CPT 84630 CHG ASSAY OF ZINC	$46.97	$77.00	—	15% above	39%
Zinc blood test CPT 84630 HC ZINC	$46.97	$77.00	—	15% above	39%
Zinc blood test CPT 84630 CHG ZINC	$65.88	$108.00	—	61% above	39%
Zinc blood test inpatient CPT 84630 CHG ASSAY OF ZINC	$46.97	$77.00	—	—	39%
Zinc blood test inpatient CPT 84630 HC ZINC	$46.97	$77.00	—	—	39%
Zinc blood test inpatient CPT 84630 CHG ZINC	$65.88	$108.00	—	—	39%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHG HCG,QUANTITATIVE,SO	$42.09	$69.00	—	42% below	39%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG,QUANTITATIVE,SO	$42.09	$69.00	—	42% below	39%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHG GONADOTROPIN CHORIONIC QUANTITATIVE	$72.59	$119.00	—	at median	39%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG, QUANTITATIVE (SO)	$72.59	$119.00	—	at median	39%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHG HCG,QUANTITATIVE	$102.48	$168.00	—	41% above	39%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG,QUANTITATIVE	$102.48	$168.00	—	41% above	39%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHG HCG,QUANTITATIVE,SO	$42.09	$69.00	—	—	39%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG,QUANTITATIVE,SO	$42.09	$69.00	—	—	39%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG, QUANTITATIVE (SO)	$72.59	$119.00	—	—	39%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHG GONADOTROPIN CHORIONIC QUANTITATIVE	$72.59	$119.00	—	—	39%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG,QUANTITATIVE	$102.48	$168.00	—	—	39%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHG HCG,QUANTITATIVE	$102.48	$168.00	—	—	39%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 PR ADENOIDECTOMY PRIMARY <AGE 12	$386.74	$634.00	—	35% below	39%
Adenoid removal (adenoidectomy), child under 12 CPT 42830 HC REMOVAL OF ADENOIDS PRIMARY <12YRS	$4,531.08	$7,428.00	—	663% above	39%
Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 PR ADENOIDECTOMY PRIMARY <AGE 12	$386.74	$634.00	—	—	39%
Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 HC REMOVAL OF ADENOIDS PRIMARY <12YRS	$4,531.08	$7,428.00	—	—	39%
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 PR ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2	$3,067.69	$5,029.00	—	—	39%
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 HC NECK SPINE FUSION & REMOVE BEL C2	$12,624.56	$20,696.00	—	—	39%
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 PR ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2	$3,067.69	$5,029.00	—	—	39%
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 HC NECK SPINE FUSION & REMOVE BEL C2	$12,624.56	$20,696.00	—	—	39%
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS	$2,223.45	$3,645.00	—	at median	39%
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 HC APPENDECTOMY,RUPT APPENDX+ABSCESS	$9,703.27	$15,907.00	—	336% above	39%
Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS	$2,223.45	$3,645.00	—	—	39%
Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 HC APPENDECTOMY,RUPT APPENDX+ABSCESS	$9,703.27	$15,907.00	—	—	39%
Appendectomy, open surgery CPT 44950 PR APPENDECTOMY	$1,151.07	$1,887.00	—	at median	39%
Appendectomy, open surgery CPT 44950 HC APPENDECTOMY	$4,762.27	$7,807.00	—	314% above	39%
Appendectomy, open surgery inpatient CPT 44950 PR APPENDECTOMY	$1,151.07	$1,887.00	—	—	39%
Appendectomy, open surgery inpatient CPT 44950 HC APPENDECTOMY	$4,762.27	$7,807.00	—	—	39%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 PR ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ	$1,752.53	$2,873.00	—	50% below	39%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 HC KNEE SCOPE,AID ANT CRUCIATE REPAIR	$9,910.06	$16,246.00	—	181% above	39%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 PR ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ	$1,752.53	$2,873.00	—	—	39%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 HC KNEE SCOPE,AID ANT CRUCIATE REPAIR	$9,910.06	$16,246.00	—	—	39%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 PR SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR	$2,752.93	$4,513.00	—	at median	39%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 HC ARTHROSCOPY ROTATOR CUFF REPAIR	$7,067.46	$11,586.00	—	157% above	39%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 PR SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR	$2,752.93	$4,513.00	—	—	39%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 HC ARTHROSCOPY ROTATOR CUFF REPAIR	$7,067.46	$11,586.00	—	—	39%
Balloon dilation of the maxillary sinus opening, one side CPT 31295 HC SINUS ENDO DILATION W/BALLOON FOSSA	$4,564.63	$7,483.00	—	36% below	39%
Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 HC SINUS ENDO DILATION W/BALLOON FOSSA	$4,564.63	$7,483.00	—	—	39%
Botox injections for chronic migraine CPT 64615 HC CHEMODENERV MUSCLE MIGRAINE	$425.17	$697.00	—	40% above	39%
Botox injections for chronic migraine CPT 64615 PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$564.86	$926.00	—	86% above	39%
Botox injections for chronic migraine inpatient CPT 64615 HC CHEMODENERV MUSCLE MIGRAINE	$425.17	$697.00	—	—	39%
Botox injections for chronic migraine inpatient CPT 64615 PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$564.86	$926.00	—	—	39%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 PR BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID	$2,231.38	$3,658.00	—	7% below	39%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESION STRTCTC	$2,397.30	$3,930.00	—	at median	39%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 PR BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID	$2,231.38	$3,658.00	—	—	39%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST 1ST LESION STRTCTC	$2,397.30	$3,930.00	—	—	39%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC CLOSED RX DIST FIBULA FX	$414.19	$679.00	—	at median	39%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ	$964.41	$1,581.00	—	134% above	39%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC CLOSED RX DIST FIBULA FX	$414.19	$679.00	—	—	39%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ	$964.41	$1,581.00	—	—	39%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC CLOSED RX METATARSAL FX	$414.19	$679.00	—	at median	39%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 PR CLTX METATARSAL FRACTURE W/O MANIPULATION EACH	$568.52	$932.00	—	37% above	39%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC CLOSED RX METATARSAL FX	$414.19	$679.00	—	—	39%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 PR CLTX METATARSAL FRACTURE W/O MANIPULATION EACH	$568.52	$932.00	—	—	39%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 PR CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT	$925.37	$1,517.00	—	77% below	39%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 HC CORRECT BUNION,METATARSAL OSTEOTOMY	$5,736.44	$9,404.00	—	46% above	39%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 PR CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT	$925.37	$1,517.00	—	—	39%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 HC CORRECT BUNION,METATARSAL OSTEOTOMY	$5,736.44	$9,404.00	—	—	39%
Bunion correction with removal of part of the big toe joint CPT 28292 PR CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE	$876.57	$1,437.00	—	74% below	39%
Bunion correction with removal of part of the big toe joint CPT 28292 HC CORRECT BUNION,KELLER/MCBRIDE/MAYO	$5,736.44	$9,404.00	—	72% above	39%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 PR CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE	$876.57	$1,437.00	—	—	39%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 HC CORRECT BUNION,KELLER/MCBRIDE/MAYO	$5,736.44	$9,404.00	—	—	39%
Cardiac catheterization with coronary angiogram CPT 93458 HC L HRT ARTERY/VENTRICLE ANGIO	$10,171.14	$16,674.00	—	at median	39%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 HC L HRT ARTERY/VENTRICLE ANGIO	$10,171.14	$16,674.00	—	—	39%
Cardioversion, elective (restoring heart rhythm) CPT 92960 PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$866.20	$1,420.00	—	at median	39%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION	$1,197.43	$1,963.00	—	38% above	39%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$866.20	$1,420.00	—	—	39%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION	$1,197.43	$1,963.00	—	—	39%
Carpal tunnel release, open surgery CPT 64721 PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE	$1,110.20	$1,820.00	—	60% below	39%
Carpal tunnel release, open surgery CPT 64721 HC CARPAL TUNNEL MEDIDAN NERVE	$3,220.19	$5,279.00	—	16% above	39%
Carpal tunnel release, open surgery inpatient CPT 64721 PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE	$1,110.20	$1,820.00	—	—	39%
Carpal tunnel release, open surgery inpatient CPT 64721 HC CARPAL TUNNEL MEDIDAN NERVE	$3,220.19	$5,279.00	—	—	39%
Cataract surgery with lens implant CPT 66984 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP	$2,047.16	$3,356.00	—	at median	39%
Cataract surgery with lens implant CPT 66984 HC CATARACT SURG W IOL,1 STAGE	$3,496.52	$5,732.00	—	71% above	39%
Cataract surgery with lens implant inpatient CPT 66984 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP	$2,047.16	$3,356.00	—	—	39%
Cataract surgery with lens implant inpatient CPT 66984 HC CATARACT SURG W IOL,1 STAGE	$3,496.52	$5,732.00	—	—	39%
Catheter ablation for atrial fibrillation CPT 93656 HC TX ATRIAL FIB PULM VEIN ISOL	$22,463.86	$36,826.00	—	3% below	39%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC TX ATRIAL FIB PULM VEIN ISOL	$22,463.86	$36,826.00	—	—	39%
Cervical biopsy CPT 57500 PR BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX	$134.81	$221.00	—	72% below	39%
Cervical biopsy CPT 57500 HC BIOPSY OF CERVIX	$1,049.20	$1,720.00	—	115% above	39%
Cervical biopsy inpatient CPT 57500 PR BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX	$134.81	$221.00	—	—	39%
Cervical biopsy inpatient CPT 57500 HC BIOPSY OF CERVIX	$1,049.20	$1,720.00	—	—	39%
Cesarean delivery, including prenatal and postpartum care CPT 59510 PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM	$4,834.86	$7,926.00	—	—	39%
Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM	$4,834.86	$7,926.00	—	—	39%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 PR CIRCUMCISION AGE >28 DAYS	$352.58	$578.00	—	81% below	39%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC CIRCUMCISION 28 DAYS OR OLDER	$3,167.73	$5,193.00	—	72% above	39%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 PR CIRCUMCISION AGE >28 DAYS	$352.58	$578.00	—	—	39%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 HC CIRCUMCISION 28 DAYS OR OLDER	$3,167.73	$5,193.00	—	—	39%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 PR CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK	$314.15	$515.00	—	60% below	39%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 PR CIRCUMCISION W/REGIONAL BLOCK (IN HOSPITAL)	$314.15	$515.00	—	60% below	39%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 PR CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK	$314.15	$515.00	—	—	39%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 PR CIRCUMCISION W/REGIONAL BLOCK (IN HOSPITAL)	$314.15	$515.00	—	—	39%
Circumcision, surgical, older than a newborn CPT 54160 PR CIRCUMCISION NEONATE	$259.86	$426.00	—	62% below	39%
Circumcision, surgical, older than a newborn inpatient CPT 54160 PR CIRCUMCISION NEONATE	$259.86	$426.00	—	—	39%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC CLOSED RX DIST RAD/ULNA FX	$449.57	$737.00	—	at median	39%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ	$829.60	$1,360.00	—	85% above	39%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC CLOSED RX DIST RAD/ULNA FX	$449.57	$737.00	—	—	39%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ	$829.60	$1,360.00	—	—	39%
Colonoscopy with endoscopic ultrasound CPT 45391 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX	$452.01	$741.00	—	at median	39%
Colonoscopy with endoscopic ultrasound CPT 45391 HC COLONOSCOPY W/ENDOSCOPE US	$1,561.60	$2,560.00	—	245% above	39%
Colonoscopy with endoscopic ultrasound inpatient CPT 45391 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX	$452.01	$741.00	—	—	39%
Colonoscopy with endoscopic ultrasound inpatient CPT 45391 HC COLONOSCOPY W/ENDOSCOPE US	$1,561.60	$2,560.00	—	—	39%
Colonoscopy with polyp removal CPT 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ	$445.91	$731.00	—	77% below	39%
Colonoscopy with polyp removal CPT 45385 HC COLONOSCOPY/POLYPECTOMY SNARE	$1,561.60	$2,560.00	—	21% below	39%
Colonoscopy with polyp removal inpatient CPT 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ	$445.91	$731.00	—	—	39%
Colonoscopy with polyp removal inpatient CPT 45385 HC COLONOSCOPY/POLYPECTOMY SNARE	$1,561.60	$2,560.00	—	—	39%
Colonoscopy with tissue sample CPT 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$352.58	$578.00	—	81% below	39%
Colonoscopy with tissue sample CPT 45380 HC COLONOSCOPY W/BIOPSY(S)	$1,561.60	$2,560.00	—	15% below	39%
Colonoscopy with tissue sample inpatient CPT 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$352.58	$578.00	—	—	39%
Colonoscopy with tissue sample inpatient CPT 45380 HC COLONOSCOPY W/BIOPSY(S)	$1,561.60	$2,560.00	—	—	39%
Colonoscopy, diagnostic CPT 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD	$644.16	$1,056.00	—	31% below	39%
Colonoscopy, diagnostic CPT 45378 HC COLONOSCOPY	$1,561.60	$2,560.00	—	67% above	39%
Colonoscopy, diagnostic inpatient CPT 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD	$644.16	$1,056.00	—	—	39%
Colonoscopy, diagnostic inpatient CPT 45378 HC COLONOSCOPY	$1,561.60	$2,560.00	—	—	39%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC CERV COLP LEEP W/BX	$3,949.14	$6,474.00	—	21% above	39%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 PR COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX	$4,104.69	$6,729.00	—	25% above	39%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HC CERV COLP LEEP W/BX	$3,949.14	$6,474.00	—	—	39%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 PR COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX	$4,104.69	$6,729.00	—	—	39%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 PR COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE	$259.86	$426.00	—	at median	39%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC BX/CURETT OF CERVIX W/SCOPE	$666.12	$1,092.00	—	156% above	39%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 PR COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE	$259.86	$426.00	—	—	39%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC BX/CURETT OF CERVIX W/SCOPE	$666.12	$1,092.00	—	—	39%
Complex cataract surgery with lens implant CPT 66982 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP	$1,316.99	$2,159.00	—	12% below	39%
Complex cataract surgery with lens implant CPT 66982 HC CATARACT SURGERY,CMPLX	$3,496.52	$5,732.00	—	133% above	39%
Complex cataract surgery with lens implant inpatient CPT 66982 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP	$1,316.99	$2,159.00	—	—	39%
Complex cataract surgery with lens implant inpatient CPT 66982 HC CATARACT SURGERY,CMPLX	$3,496.52	$5,732.00	—	—	39%
Coronary stent placement, one artery CPT 92928 PR PERQ TCAT PLMT NTRAC ST 1 LES 1+C SEGMENTS	$3,329.99	$5,459.00	—	75% below	39%
Coronary stent placement, one artery CPT 92928 HC PRQ CARD STNT W/ANGIO 1 VSL	$11,968.20	$19,620.00	—	9% below	39%
Coronary stent placement, one artery inpatient CPT 92928 PR PERQ TCAT PLMT NTRAC ST 1 LES 1+C SEGMENTS	$3,329.99	$5,459.00	—	—	39%
Coronary stent placement, one artery inpatient CPT 92928 HC PRQ CARD STNT W/ANGIO 1 VSL	$11,968.20	$19,620.00	—	—	39%
Cystoscopy with ureteral stent placement CPT 52332 PR CYSTO W/INSERT URETERAL STENT	$1,143.75	$1,875.00	—	67% below	39%
Cystoscopy with ureteral stent placement CPT 52332 HC CYSTOSCOPY INSERT STENT	$2,895.67	$4,747.00	—	18% below	39%
Cystoscopy with ureteral stent placement inpatient CPT 52332 PR CYSTO W/INSERT URETERAL STENT	$1,143.75	$1,875.00	—	—	39%
Cystoscopy with ureteral stent placement inpatient CPT 52332 HC CYSTOSCOPY INSERT STENT	$2,895.67	$4,747.00	—	—	39%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 PR CYSTOURETHROSCOPY	$144.57	$237.00	—	79% below	39%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOURETHROSCOPY	$872.30	$1,430.00	—	27% above	39%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 PR CYSTOURETHROSCOPY	$144.57	$237.00	—	—	39%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC CYSTOURETHROSCOPY	$872.30	$1,430.00	—	—	39%
D&C (dilation and curettage), not related to pregnancy CPT 58120 PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC	$931.47	$1,527.00	—	56% below	39%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HC DILATION & CURETTAGE	$4,565.24	$7,484.00	—	117% above	39%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC	$931.47	$1,527.00	—	—	39%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC DILATION & CURETTAGE	$4,565.24	$7,484.00	—	—	39%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 PR DESTRUCTION PREMALIGNANT LESION 1ST	$98.21	$161.00	—	39% below	39%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DESTRUCT PREMALG LESION	$283.04	$464.00	—	76% above	39%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 PR DESTRUCTION PREMALIGNANT LESION 1ST	$98.21	$161.00	—	—	39%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DESTRUCT PREMALG LESION	$283.04	$464.00	—	—	39%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 PR TYMPANOSTOMY GENERAL ANESTHESIA	$288.53	$473.00	—	81% below	39%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 HC CREATE EARDRUM OPENING GEN ANESTH	$2,508.93	$4,113.00	—	65% above	39%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 PR TYMPANOSTOMY GENERAL ANESTHESIA	$288.53	$473.00	—	—	39%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 HC CREATE EARDRUM OPENING GEN ANESTH	$2,508.93	$4,113.00	—	—	39%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA	$435.54	$714.00	—	22% below	39%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 HC CREATE EARDRUM OPENING LOCAL ANESTH	$1,198.65	$1,965.00	—	116% above	39%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA	$435.54	$714.00	—	—	39%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 HC CREATE EARDRUM OPENING LOCAL ANESTH	$1,198.65	$1,965.00	—	—	39%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC REMOVE IMPACTED EAR WAX IRRIGATION	$107.97	$177.00	—	89% above	39%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$28.67	$47.00	—	50% below	39%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC REMOVE IMPACTED EAR WAX IRRIGATION	$107.97	$177.00	—	—	39%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$28.67	$47.00	—	—	39%
Earwax removal with instruments, one ear CPT 69210 HC REMOVE IMPACTED EAR WAX	$123.22	$202.00	—	22% above	39%
Earwax removal with instruments, one ear one side CPT 69210 PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	$57.95	$95.00	—	42% below	39%
Earwax removal with instruments, one ear inpatient CPT 69210 HC REMOVE IMPACTED EAR WAX	$123.22	$202.00	—	—	39%
Earwax removal with instruments, one ear inpatient one side CPT 69210 PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	$57.95	$95.00	—	—	39%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC BIOPSY OF UTERUS LINING	$420.29	$689.00	—	69% above	39%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX	$634.40	$1,040.00	—	156% above	39%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC BIOPSY OF UTERUS LINING	$420.29	$689.00	—	—	39%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX	$634.40	$1,040.00	—	—	39%
Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY	$573.40	$940.00	—	—	39%
Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 HC NASAL SCOPY,REMV TOTL ETHMOID	$4,564.63	$7,483.00	—	—	39%
Endoscopic sinus surgery: full ethmoid sinus opening inpatient CPT 31255 PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY	$573.40	$940.00	—	—	39%
Endoscopic sinus surgery: full ethmoid sinus opening inpatient CPT 31255 HC NASAL SCOPY,REMV TOTL ETHMOID	$4,564.63	$7,483.00	—	—	39%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS	$1,933.09	$3,169.00	—	—	39%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 HC SINUS ENDOSCOPY	$4,564.63	$7,483.00	—	—	39%
Endoscopic sinus surgery: opening the frontal sinus inpatient CPT 31276 PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS	$1,933.09	$3,169.00	—	—	39%
Endoscopic sinus surgery: opening the frontal sinus inpatient CPT 31276 HC SINUS ENDOSCOPY	$4,564.63	$7,483.00	—	—	39%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY	$319.64	$524.00	—	at median	39%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 HC EXPLORATION,MAXILLARY SINUS	$3,325.72	$5,452.00	—	940% above	39%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY	$319.64	$524.00	—	—	39%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 HC EXPLORATION,MAXILLARY SINUS	$3,325.72	$5,452.00	—	—	39%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS	$471.53	$773.00	—	at median	39%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 HC ENDOSCOPY,MAXILLARY SINUS	$5,050.80	$8,280.00	—	971% above	39%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS	$471.53	$773.00	—	—	39%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 HC ENDOSCOPY,MAXILLARY SINUS	$5,050.80	$8,280.00	—	—	39%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN	$190.32	$312.00	—	73% below	39%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC NJX INTERLAMINAR CRV/THRC W/IMG	$1,126.06	$1,846.00	—	58% above	39%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN	$190.32	$312.00	—	—	39%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC NJX INTERLAMINAR CRV/THRC W/IMG	$1,126.06	$1,846.00	—	—	39%
Eye injection into the vitreous (intravitreal injection) CPT 67028 HC INJECT EYE DRUG	$494.10	$810.00	—	15% above	39%
Eye injection into the vitreous (intravitreal injection) CPT 67028 PR INTRAVITREAL NJX PHARMACOLOGIC AGT SPX	$593.53	$973.00	—	38% above	39%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HC INJECT EYE DRUG	$494.10	$810.00	—	—	39%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 PR INTRAVITREAL NJX PHARMACOLOGIC AGT SPX	$593.53	$973.00	—	—	39%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL	$161.04	$264.00	—	85% below	39%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV	$1,556.72	$2,552.00	—	43% above	39%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL	$161.04	$264.00	—	—	39%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV	$1,556.72	$2,552.00	—	—	39%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 PR RPR AA HERNIA 1ST 3-10 CM REDUCIBLE	$1,650.05	$2,705.00	—	at median	39%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 HC RPR AA HERNIA 1ST 3-10 CM REDUCIBLE	$4,716.52	$7,732.00	—	186% above	39%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 PR RPR AA HERNIA 1ST 3-10 CM REDUCIBLE	$1,650.05	$2,705.00	—	—	39%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 HC RPR AA HERNIA 1ST 3-10 CM REDUCIBLE	$4,716.52	$7,732.00	—	—	39%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 PR RPR AA HERNIA 1ST > 10 CM REDUCIBLE	$2,217.96	$3,636.00	—	26% above	39%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 HC RPR AA HERNIA 1ST > 10 CM REDUCIBLE	$4,716.52	$7,732.00	—	168% above	39%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 PR RPR AA HERNIA 1ST > 10 CM REDUCIBLE	$2,217.96	$3,636.00	—	—	39%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 HC RPR AA HERNIA 1ST > 10 CM REDUCIBLE	$4,716.52	$7,732.00	—	—	39%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 PR RPR AA HERNIA 1ST < 3 CM REDUCIBLE	$1,265.14	$2,074.00	—	at median	39%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 HC RPR AA HERNIA 1ST < 3 CM REDUCIBLE	$4,716.52	$7,732.00	—	273% above	39%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 PR RPR AA HERNIA 1ST < 3 CM REDUCIBLE	$1,265.14	$2,074.00	—	—	39%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 HC RPR AA HERNIA 1ST < 3 CM REDUCIBLE	$4,716.52	$7,732.00	—	—	39%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD	$197.03	$323.00	—	39% below	39%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC DIAGNOSTIC SIGMOIDOSCOPY	$1,278.56	$2,096.00	—	297% above	39%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD	$197.03	$323.00	—	—	39%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC DIAGNOSTIC SIGMOIDOSCOPY	$1,278.56	$2,096.00	—	—	39%
Gallbladder removal, laparoscopic CPT 47562 PR LAPAROSCOPY SURG CHOLECYSTECTOMY	$2,262.49	$3,709.00	—	at median	39%
Gallbladder removal, laparoscopic CPT 47562 HC LAPAROSCOPIC CHOLECYSTECTOMY	$6,256.16	$10,256.00	—	177% above	39%
Gallbladder removal, laparoscopic inpatient CPT 47562 PR LAPAROSCOPY SURG CHOLECYSTECTOMY	$2,262.49	$3,709.00	—	—	39%
Gallbladder removal, laparoscopic inpatient CPT 47562 HC LAPAROSCOPIC CHOLECYSTECTOMY	$6,256.16	$10,256.00	—	—	39%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY	$1,289.54	$2,114.00	—	at median	39%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 HC LAPARO CHOLECYSTECTOMY/GRAPH	$6,420.25	$10,525.00	—	398% above	39%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY	$1,289.54	$2,114.00	—	—	39%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 HC LAPARO CHOLECYSTECTOMY/GRAPH	$6,420.25	$10,525.00	—	—	39%
Gallbladder removal, open surgery through a larger incision CPT 47600 PR CHOLECYSTECTOMY	$2,475.38	$4,058.00	—	at median	39%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 PR CHOLECYSTECTOMY	$2,475.38	$4,058.00	—	—	39%
Hammertoe correction surgery CPT 28285 PR CORRECTION HAMMERTOE	$994.30	$1,630.00	—	70% below	39%
Hammertoe correction surgery CPT 28285 HC REPAIR OF HAMMERTOE	$3,990.01	$6,541.00	—	20% above	39%
Hammertoe correction surgery inpatient CPT 28285 PR CORRECTION HAMMERTOE	$994.30	$1,630.00	—	—	39%
Hammertoe correction surgery inpatient CPT 28285 HC REPAIR OF HAMMERTOE	$3,990.01	$6,541.00	—	—	39%
Hemorrhoid banding (rubber band ligation) CPT 46221 PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS	$345.26	$566.00	—	63% below	39%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC LIGATION OF HEMORRHOID(S)	$1,209.63	$1,983.00	—	29% above	39%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS	$345.26	$566.00	—	—	39%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC LIGATION OF HEMORRHOID(S)	$1,209.63	$1,983.00	—	—	39%
Hemorrhoidectomy (internal and external), one area CPT 46255 PR HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP	$1,709.22	$2,802.00	—	at median	39%
Hemorrhoidectomy (internal and external), one area CPT 46255 HC HEMORRHOIDECTOMY INT/EXT SMPL	$3,497.74	$5,734.00	—	105% above	39%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 PR HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP	$1,709.22	$2,802.00	—	—	39%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HC HEMORRHOIDECTOMY INT/EXT SMPL	$3,497.74	$5,734.00	—	—	39%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 PR CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT	$4,945.88	$8,108.00	—	—	39%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 HC CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT	$15,480.58	$25,378.00	—	—	39%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 PR CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT	$4,945.88	$8,108.00	—	—	39%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 HC CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT	$15,480.58	$25,378.00	—	—	39%
Hysterectomy through an abdominal incision (total) CPT 58150 PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY	$2,827.35	$4,635.00	—	at median	39%
Hysterectomy through an abdominal incision (total) CPT 58150 HC TOTAL HYSTERECTOMY	$8,254.52	$13,532.00	—	192% above	39%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY	$2,827.35	$4,635.00	—	—	39%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 HC TOTAL HYSTERECTOMY	$8,254.52	$13,532.00	—	—	39%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$153.11	$251.00	—	52% below	39%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI	$170.19	$279.00	—	47% below	39%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$153.11	$251.00	—	—	39%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI	$170.19	$279.00	—	—	39%
Hysteroscopy with endometrial ablation CPT 58563 PR HYSTEROSCOPY ENDOMETRIAL ABLATION	$437.98	$718.00	—	78% below	39%
Hysteroscopy with endometrial ablation CPT 58563 HC HYSTEROSCOPY,ABLATION	$7,660.99	$12,559.00	—	281% above	39%
Hysteroscopy with endometrial ablation inpatient CPT 58563 PR HYSTEROSCOPY ENDOMETRIAL ABLATION	$437.98	$718.00	—	—	39%
Hysteroscopy with endometrial ablation inpatient CPT 58563 HC HYSTEROSCOPY,ABLATION	$7,660.99	$12,559.00	—	—	39%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HC HYSTEROSCOPY,BIOPSY	$4,565.24	$7,484.00	—	40% above	39%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HC HYSTEROSCOPY,BIOPSY	$4,565.24	$7,484.00	—	—	39%
IUD insertion (the device itself billed separately) CPT 58300 PR INSERTION INTRAUTERINE DEVICE IUD	$89.06	$146.00	—	29% below	39%
IUD insertion (the device itself billed separately) CPT 58300 HC INSERT INTRAUTERINE DEVICE	$177.51	$291.00	—	41% above	39%
IUD insertion (the device itself billed separately) inpatient CPT 58300 PR INSERTION INTRAUTERINE DEVICE IUD	$89.06	$146.00	—	—	39%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC INSERT INTRAUTERINE DEVICE	$177.51	$291.00	—	—	39%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I & D ABSCESS, SMPL	$449.57	$737.00	—	45% above	39%
Incision and drainage of a simple or single skin abscess CPT 10060 PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$678.93	$1,113.00	—	120% above	39%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I & D ABSCESS, SMPL	$449.57	$737.00	—	—	39%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$678.93	$1,113.00	—	—	39%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE	$942.45	$1,545.00	—	35% below	39%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC RPR INITIAL HERNIA >5 YRS REDUC	$5,844.41	$9,581.00	—	304% above	39%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE	$942.45	$1,545.00	—	—	39%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HC RPR INITIAL HERNIA >5 YRS REDUC	$5,844.41	$9,581.00	—	—	39%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ TENDON SHEATH/LIGAMENT	$414.80	$680.00	—	156% above	39%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$527.65	$865.00	—	226% above	39%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ TENDON SHEATH/LIGAMENT	$414.80	$680.00	—	—	39%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$527.65	$865.00	—	—	39%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC RAD INJECT/ASPIR JNTMAJOR-RADIOLOGY USE ONLY	$527.65	$865.00	—	165% above	39%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC RAD INJECT/ASPIR JNTMAJOR	$527.65	$865.00	—	165% above	39%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$691.13	$1,133.00	—	247% above	39%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC RAD INJECT/ASPIR JNTMAJOR	$527.65	$865.00	—	—	39%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC RAD INJECT/ASPIR JNTMAJOR-RADIOLOGY USE ONLY	$527.65	$865.00	—	—	39%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$691.13	$1,133.00	—	—	39%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 PR INSERTION DRUG DELIVERY IMPLANT	$233.63	$383.00	—	at median	39%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERT DRUG IMPLANT DEVICE	$255.59	$419.00	—	9% above	39%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 PR INSERTION DRUG DELIVERY IMPLANT	$233.63	$383.00	—	—	39%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC INSERT DRUG IMPLANT DEVICE	$255.59	$419.00	—	—	39%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	$65.27	$107.00	—	59% below	39%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRAIN/INJECT MEDIUM JOINT/BURSA	$527.65	$865.00	—	228% above	39%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	$65.27	$107.00	—	—	39%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC DRAIN/INJECT MEDIUM JOINT/BURSA	$527.65	$865.00	—	—	39%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC DRAIN/INJECT SMALL JOINT/BURSA	$527.65	$865.00	—	165% above	39%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	$669.78	$1,098.00	—	237% above	39%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC DRAIN/INJECT SMALL JOINT/BURSA	$527.65	$865.00	—	—	39%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	$669.78	$1,098.00	—	—	39%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 PR ARTHROSCOPY KNE SURG MENISCUS RPR MEDIAL/LATERAL	$2,257.00	$3,700.00	—	57% below	39%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 HC KNEE SCOPE,MED OR LAT MENIS REPAIR	$4,325.51	$7,091.00	—	18% below	39%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 PR ARTHROSCOPY KNE SURG MENISCUS RPR MEDIAL/LATERAL	$2,257.00	$3,700.00	—	—	39%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 HC KNEE SCOPE,MED OR LAT MENIS REPAIR	$4,325.51	$7,091.00	—	—	39%
Knee arthroscopy with meniscus trim CPT 29881 PR ARTHRS KNEE SURG W/MENISCECTOMY MED/LAT W/SHVG	$982.71	$1,611.00	—	69% below	39%
Knee arthroscopy with meniscus trim CPT 29881 HC KNEE SCOPE,MED/LAT MENISCECTOMY	$4,325.51	$7,091.00	—	38% above	39%
Knee arthroscopy with meniscus trim inpatient CPT 29881 PR ARTHRS KNEE SURG W/MENISCECTOMY MED/LAT W/SHVG	$982.71	$1,611.00	—	—	39%
Knee arthroscopy with meniscus trim inpatient CPT 29881 HC KNEE SCOPE,MED/LAT MENISCECTOMY	$4,325.51	$7,091.00	—	—	39%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 PR ARTHRS KNEE SURG MENISCECTOMY MED&LAT W/SHAVING	$1,019.92	$1,672.00	—	81% below	39%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 HC KNEE SCOPE,SINGLE MENISCECTOMY	$4,325.51	$7,091.00	—	18% below	39%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 PR ARTHRS KNEE SURG MENISCECTOMY MED&LAT W/SHAVING	$1,019.92	$1,672.00	—	—	39%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 HC KNEE SCOPE,SINGLE MENISCECTOMY	$4,325.51	$7,091.00	—	—	39%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 PR ARTHRS KNEE SURG DEBRIDEMENT/SHVG ARTCLR CRTLG	$1,125.45	$1,845.00	—	28% below	39%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 HC KNEE SCOPE,SHAVE ARTICULAR CART	$4,325.51	$7,091.00	—	178% above	39%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 PR ARTHRS KNEE SURG DEBRIDEMENT/SHVG ARTCLR CRTLG	$1,125.45	$1,845.00	—	—	39%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 HC KNEE SCOPE,SHAVE ARTICULAR CART	$4,325.51	$7,091.00	—	—	39%
Laparoscopic Roux-en-Y gastric bypass, standard limb length CPT 43644 PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM	$10,008.27	$16,407.00	—	—	39%
Laparoscopic Roux-en-Y gastric bypass, standard limb length inpatient CPT 43644 PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM	$10,008.27	$16,407.00	—	—	39%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 PR LAPAROSCOPIC APPENDECTOMY	$2,160.62	$3,542.00	—	35% above	39%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 HC LAPAROSCOPY/APPENDECTOMY	$7,742.12	$12,692.00	—	384% above	39%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 PR LAPAROSCOPIC APPENDECTOMY	$2,160.62	$3,542.00	—	—	39%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 HC LAPAROSCOPY/APPENDECTOMY	$7,742.12	$12,692.00	—	—	39%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 PR LAPS SURG ESOPG/GSTR FUNDOPLASTY	$3,711.85	$6,085.00	—	at median	39%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 HC LAPAROSCOPY,FUNDOPLASTY	$12,924.07	$21,187.00	—	248% above	39%
Laparoscopic fundoplication (anti-reflux surgery) inpatient CPT 43280 PR LAPS SURG ESOPG/GSTR FUNDOPLASTY	$3,711.85	$6,085.00	—	—	39%
Laparoscopic fundoplication (anti-reflux surgery) inpatient CPT 43280 HC LAPAROSCOPY,FUNDOPLASTY	$12,924.07	$21,187.00	—	—	39%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 PR LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<	$1,451.19	$2,379.00	—	—	39%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 HC TLH UTERUS 250G OR LESS	$7,335.25	$12,025.00	—	—	39%
Laparoscopic hysterectomy (uterus 250 g or less) inpatient CPT 58570 PR LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<	$1,451.19	$2,379.00	—	—	39%
Laparoscopic hysterectomy (uterus 250 g or less) inpatient CPT 58570 HC TLH UTERUS 250G OR LESS	$7,335.25	$12,025.00	—	—	39%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 PR LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY	$2,244.19	$3,679.00	—	at median	39%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 HC TLH W/T/O UTERUS 250G OR <	$7,335.25	$12,025.00	—	227% above	39%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries inpatient CPT 58571 PR LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY	$2,244.19	$3,679.00	—	—	39%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries inpatient CPT 58571 HC TLH W/T/O UTERUS 250G OR <	$7,335.25	$12,025.00	—	—	39%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA	$1,612.84	$2,644.00	—	36% above	39%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 HC LAPARO HERNIA REPAIR INITIAL	$7,742.12	$12,692.00	—	555% above	39%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA	$1,612.84	$2,644.00	—	—	39%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 HC LAPARO HERNIA REPAIR INITIAL	$7,742.12	$12,692.00	—	—	39%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 PR LAPS SURG RPR RECURRENT INGUINAL HERNIA	$1,019.92	$1,672.00	—	2% above	39%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 HC LAPAROSCOPY INGUINAL HERNIA	$7,153.47	$11,727.00	—	614% above	39%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 PR LAPS SURG RPR RECURRENT INGUINAL HERNIA	$1,019.92	$1,672.00	—	—	39%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 HC LAPAROSCOPY INGUINAL HERNIA	$7,153.47	$11,727.00	—	—	39%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES	$1,170.59	$1,919.00	—	at median	39%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 HC LAPAROSCOPY,REMOVE ADNEXA	$7,593.89	$12,449.00	—	549% above	39%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES	$1,170.59	$1,919.00	—	—	39%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 HC LAPAROSCOPY,REMOVE ADNEXA	$7,593.89	$12,449.00	—	—	39%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 PR POST-CATARACT LASER SURGERY	$295.24	$484.00	—	56% below	39%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 HC DISCISSION,2ND CATARACT,LASER	$738.10	$1,210.00	—	11% above	39%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 PR POST-CATARACT LASER SURGERY	$295.24	$484.00	—	—	39%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 HC DISCISSION,2ND CATARACT,LASER	$738.10	$1,210.00	—	—	39%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<	$315.37	$517.00	—	32% below	39%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC LAYR CLOS WND TRUNK,ARM,LEG <2.5CM	$553.27	$907.00	—	20% above	39%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<	$315.37	$517.00	—	—	39%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC LAYR CLOS WND TRUNK,ARM,LEG <2.5CM	$553.27	$907.00	—	—	39%
Left heart catheterization, diagnostic one side CPT 93452 HC LEFT HEART CATH W/VENTRCLGRPHY	$9,625.19	$15,779.00	—	at median	39%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC LEFT HEART CATH W/VENTRCLGRPHY	$9,625.19	$15,779.00	—	—	39%
Lower-back epidural injection, with imaging guidance CPT 62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	$320.25	$525.00	—	55% below	39%
Lower-back epidural injection, with imaging guidance CPT 62323 HC NJX INTERLAMINAR LMBR/SAC W/IMG	$1,126.06	$1,846.00	—	58% above	39%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	$320.25	$525.00	—	—	39%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC NJX INTERLAMINAR LMBR/SAC W/IMG	$1,126.06	$1,846.00	—	—	39%
Lower-back epidural injection, without imaging guidance CPT 62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	$245.83	$403.00	—	73% below	39%
Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX INTERLAMINAR LMBR/SAC W/O IMG	$1,126.06	$1,846.00	—	23% above	39%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	$245.83	$403.00	—	—	39%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC NJX INTERLAMINAR LMBR/SAC W/O IMG	$1,126.06	$1,846.00	—	—	39%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL	$301.95	$495.00	—	67% below	39%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ FORAMEN EPIDURAL L/S	$1,143.14	$1,874.00	—	25% above	39%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL	$301.95	$495.00	—	—	39%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ FORAMEN EPIDURAL L/S	$1,143.14	$1,874.00	—	—	39%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 PR LAMINOTOMY DCMPRN NRV ROOT 1 NTRSPC LUMBAR	$1,659.20	$2,720.00	—	—	39%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 HC LOW BACK DISK SURGERY	$8,681.52	$14,232.00	—	—	39%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 PR LAMINOTOMY DCMPRN NRV ROOT 1 NTRSPC LUMBAR	$1,659.20	$2,720.00	—	—	39%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 HC LOW BACK DISK SURGERY	$8,681.52	$14,232.00	—	—	39%
Lumbar laminectomy (spinal decompression), one level CPT 63047 PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM LUMBAR	$3,187.86	$5,226.00	—	—	39%
Lumbar laminectomy (spinal decompression), one level CPT 63047 HC REMOVAL OF SPINAL LAMINA LUMBAR	$6,029.85	$9,885.00	—	—	39%
Lumbar laminectomy (spinal decompression), one level inpatient CPT 63047 PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM LUMBAR	$3,187.86	$5,226.00	—	—	39%
Lumbar laminectomy (spinal decompression), one level inpatient CPT 63047 HC REMOVAL OF SPINAL LAMINA LUMBAR	$6,029.85	$9,885.00	—	—	39%
Lumbar spinal fusion (posterior), one level CPT 22612 PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR	$2,846.87	$4,667.00	—	—	39%
Lumbar spinal fusion (posterior), one level CPT 22612 HC LUMBAR SPINE FUSION	$10,751.25	$17,625.00	—	—	39%
Lumbar spinal fusion (posterior), one level inpatient CPT 22612 PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR	$2,846.87	$4,667.00	—	—	39%
Lumbar spinal fusion (posterior), one level inpatient CPT 22612 HC LUMBAR SPINE FUSION	$10,751.25	$17,625.00	—	—	39%
Lumpectomy (partial mastectomy) CPT 19301 PR MASTECTOMY PARTIAL	$1,243.79	$2,039.00	—	at median	39%
Lumpectomy (partial mastectomy) CPT 19301 HC PARTIAL MASTECTOMY	$2,502.22	$4,102.00	—	101% above	39%
Lumpectomy (partial mastectomy) inpatient CPT 19301 PR MASTECTOMY PARTIAL	$1,243.79	$2,039.00	—	—	39%
Lumpectomy (partial mastectomy) inpatient CPT 19301 HC PARTIAL MASTECTOMY	$2,502.22	$4,102.00	—	—	39%
Mastectomy (total removal of the breast) CPT 19303 PR MASTECTOMY SIMPLE COMPLETE	$1,720.20	$2,820.00	—	at median	39%
Mastectomy (total removal of the breast) CPT 19303 HC MASTECTOMY,SMPL,COMPLETE	$4,389.56	$7,196.00	—	155% above	39%
Mastectomy (total removal of the breast) inpatient CPT 19303 PR MASTECTOMY SIMPLE COMPLETE	$1,720.20	$2,820.00	—	—	39%
Mastectomy (total removal of the breast) inpatient CPT 19303 HC MASTECTOMY,SMPL,COMPLETE	$4,389.56	$7,196.00	—	—	39%
Miscarriage treatment with D&C, first trimester CPT 59820 PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL	$1,454.85	$2,385.00	—	at median	39%
Miscarriage treatment with D&C, first trimester CPT 59820 HC TREATMENT OF MISCARRIAGE 1ST TRI	$4,565.24	$7,484.00	—	214% above	39%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL	$1,454.85	$2,385.00	—	—	39%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC TREATMENT OF MISCARRIAGE 1ST TRI	$4,565.24	$7,484.00	—	—	39%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 HC MOHS,1ST STG,UP TO 5 BLOCKS,H/N/HF/G	$880.84	$1,444.00	—	17% above	39%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 PR MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS	$1,083.36	$1,776.00	—	43% above	39%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 HC MOHS,1ST STG,UP TO 5 BLOCKS,H/N/HF/G	$880.84	$1,444.00	—	—	39%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 PR MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS	$1,083.36	$1,776.00	—	—	39%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<	$93.33	$153.00	—	72% below	39%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC BENIG .1-.5CM TRUNK,ARM,LEG	$861.93	$1,413.00	—	157% above	39%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<	$93.33	$153.00	—	—	39%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXC BENIG .1-.5CM TRUNK,ARM,LEG	$861.93	$1,413.00	—	—	39%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXC SKIN BENIG <5MM FACE,FACIAL	$861.93	$1,413.00	—	124% above	39%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<	$982.71	$1,611.00	—	156% above	39%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC EXC SKIN BENIG <5MM FACE,FACIAL	$861.93	$1,413.00	—	—	39%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<	$982.71	$1,611.00	—	—	39%
Nail removal (partial or complete), one nail CPT 11730 PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1	$256.20	$420.00	—	5% below	39%
Nail removal (partial or complete), one nail CPT 11730 HC REMOVE NAIL PLATE	$308.66	$506.00	—	14% above	39%
Nail removal (partial or complete), one nail inpatient CPT 11730 PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1	$256.20	$420.00	—	—	39%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC REMOVE NAIL PLATE	$308.66	$506.00	—	—	39%
Occipital nerve block (injection for headaches) CPT 64405 HC OCCIPITAL NERVE BLOCK	$719.80	$1,180.00	—	81% above	39%
Occipital nerve block (injection for headaches) CPT 64405 PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$807.64	$1,324.00	—	103% above	39%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC OCCIPITAL NERVE BLOCK	$719.80	$1,180.00	—	—	39%
Occipital nerve block (injection for headaches) inpatient CPT 64405 PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$807.64	$1,324.00	—	—	39%
Pacemaker implant (dual chamber) CPT 33208 HC INSERT HEART PACEMAKER ATR/VENTR	$24,626.31	$40,371.00	—	37% above	39%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC INSERT HEART PACEMAKER ATR/VENTR	$24,626.31	$40,371.00	—	—	39%
Paracentesis with imaging guidance CPT 49083 PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE	$186.05	$305.00	—	79% below	39%
Paracentesis with imaging guidance CPT 49083 HC ABD PARACENTESIS W/IMAGING	$812.52	$1,332.00	—	8% below	39%
Paracentesis with imaging guidance inpatient CPT 49083 PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE	$186.05	$305.00	—	—	39%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABD PARACENTESIS W/IMAGING	$812.52	$1,332.00	—	—	39%
Partial knee replacement (one compartment) CPT 27446 PR ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT	$3,442.84	$5,644.00	—	at median	39%
Partial knee replacement (one compartment) CPT 27446 HC ARTHROPLASTY OF KNEE JOINT	$12,378.12	$20,292.00	—	260% above	39%
Partial knee replacement (one compartment) inpatient CPT 27446 PR ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT	$3,442.84	$5,644.00	—	—	39%
Partial knee replacement (one compartment) inpatient CPT 27446 HC ARTHROPLASTY OF KNEE JOINT	$12,378.12	$20,292.00	—	—	39%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC REMOVE NAIL BED	$833.26	$1,366.00	—	90% above	39%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 PR EXCISION NAIL&NAIL MATRIX PRTL/COMPL PERM RMVL	$1,047.98	$1,718.00	—	139% above	39%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC REMOVE NAIL BED	$833.26	$1,366.00	—	—	39%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 PR EXCISION NAIL&NAIL MATRIX PRTL/COMPL PERM RMVL	$1,047.98	$1,718.00	—	—	39%
Prostate biopsy CPT 55700 PR PROSTATE NEEDLE BIOPSY ANY APPROACH	$290.97	$477.00	—	54% below	39%
Prostate biopsy CPT 55700 HC BIOPSY OF PROSTRATE NEEDLE/PUNCH	$2,745.00	$4,500.00	—	335% above	39%
Prostate biopsy inpatient CPT 55700 PR PROSTATE NEEDLE BIOPSY ANY APPROACH	$290.97	$477.00	—	—	39%
Prostate biopsy inpatient CPT 55700 HC BIOPSY OF PROSTRATE NEEDLE/PUNCH	$2,745.00	$4,500.00	—	—	39%
Prostate removal (prostatectomy), laparoscopic CPT 55866 PR LAPS SURG PRST8ECT RPBIC RAD W/NERVE SPARING	$2,116.70	$3,470.00	—	—	39%
Prostate removal (prostatectomy), laparoscopic CPT 55866 HC LAPARO RADICAL PROSTATECTOMY	$10,098.55	$16,555.00	—	—	39%
Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 PR LAPS SURG PRST8ECT RPBIC RAD W/NERVE SPARING	$2,116.70	$3,470.00	—	—	39%
Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 HC LAPARO RADICAL PROSTATECTOMY	$10,098.55	$16,555.00	—	—	39%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	$342.82	$562.00	—	82% below	39%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTROY LUMB/SAC FACET JNT	$2,065.46	$3,386.00	—	9% above	39%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	$342.82	$562.00	—	—	39%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DESTROY LUMB/SAC FACET JNT	$2,065.46	$3,386.00	—	—	39%
Removal of a breast lump, open surgery CPT 19120 PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION	$753.96	$1,236.00	—	42% below	39%
Removal of a breast lump, open surgery CPT 19120 HC REMOVE BREAST LESION	$3,649.63	$5,983.00	—	180% above	39%
Removal of a breast lump, open surgery inpatient CPT 19120 PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION	$753.96	$1,236.00	—	—	39%
Removal of a breast lump, open surgery inpatient CPT 19120 HC REMOVE BREAST LESION	$3,649.63	$5,983.00	—	—	39%
Removal of a foreign object under the skin, simple CPT 10120 PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$194.59	$319.00	—	52% below	39%
Removal of a foreign object under the skin, simple CPT 10120 HC REMOVE FOREIGN BODY,SMPL	$574.62	$942.00	—	41% above	39%
Removal of a foreign object under the skin, simple inpatient CPT 10120 PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$194.59	$319.00	—	—	39%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC REMOVE FOREIGN BODY,SMPL	$574.62	$942.00	—	—	39%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY	$1,269.41	$2,081.00	—	—	39%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 HC PARTIAL REMOVAL OF THYROID	$4,588.42	$7,522.00	—	—	39%
Removal of one lobe of the thyroid (lobectomy) inpatient CPT 60220 PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY	$1,269.41	$2,081.00	—	—	39%
Removal of one lobe of the thyroid (lobectomy) inpatient CPT 60220 HC PARTIAL REMOVAL OF THYROID	$4,588.42	$7,522.00	—	—	39%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 PR COLON CA SCRN NOT HI RSK IND	$644.16	$1,056.00	—	59% below	39%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 HC SCRN COLONOSCOPY NOT HI RISK	$1,561.60	$2,560.00	—	at median	39%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 PR COLON CA SCRN NOT HI RSK IND	$644.16	$1,056.00	—	—	39%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 HC SCRN COLONOSCOPY NOT HI RISK	$1,561.60	$2,560.00	—	—	39%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HC SCRN COLONOSCOPY HI RISK	$1,561.60	$2,560.00	—	10% below	39%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 PR COLORECTAL SCRN; HI RISK IND	$2,180.14	$3,574.00	—	25% above	39%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 HC SCRN COLONOSCOPY HI RISK	$1,561.60	$2,560.00	—	—	39%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 PR COLORECTAL SCRN; HI RISK IND	$2,180.14	$3,574.00	—	—	39%
Septoplasty to straighten the nasal septum CPT 30520 PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF	$1,638.46	$2,686.00	—	50% below	39%
Septoplasty to straighten the nasal septum CPT 30520 HC SEPTOPLASTY	$3,655.73	$5,993.00	—	12% above	39%
Septoplasty to straighten the nasal septum inpatient CPT 30520 PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF	$1,638.46	$2,686.00	—	—	39%
Septoplasty to straighten the nasal septum inpatient CPT 30520 HC SEPTOPLASTY	$3,655.73	$5,993.00	—	—	39%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 PR LITHOTRIPSY XTRCORP SHOCK WAVE	$3,428.81	$5,621.00	—	26% below	39%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 HC LITHOTRIPSY	$9,492.82	$15,562.00	—	104% above	39%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 PR LITHOTRIPSY XTRCORP SHOCK WAVE	$3,428.81	$5,621.00	—	—	39%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 HC LITHOTRIPSY	$9,492.82	$15,562.00	—	—	39%
Short arm cast (elbow to hand) CPT 29075 HC APPLY FOREARM CAST	$406.26	$666.00	—	49% above	39%
Short arm cast (elbow to hand) CPT 29075 PR APPLICATION CAST ELBOW TO FINGER SHORT ARM	$581.33	$953.00	—	113% above	39%
Short arm cast (elbow to hand) inpatient CPT 29075 HC APPLY FOREARM CAST	$406.26	$666.00	—	—	39%
Short arm cast (elbow to hand) inpatient CPT 29075 PR APPLICATION CAST ELBOW TO FINGER SHORT ARM	$581.33	$953.00	—	—	39%
Short arm splint (forearm and hand) CPT 29125 PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC	$73.81	$121.00	—	57% below	39%
Short arm splint (forearm and hand) CPT 29125 HC APPLY FOREARM SPLINT,STATIC	$255.59	$419.00	—	49% above	39%
Short arm splint (forearm and hand) inpatient CPT 29125 PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC	$73.81	$121.00	—	—	39%
Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLY FOREARM SPLINT,STATIC	$255.59	$419.00	—	—	39%
Short leg cast (below the knee) CPT 29405 HC APPLY SHORT LEG CAST	$519.72	$852.00	—	52% above	39%
Short leg cast (below the knee) CPT 29405 PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$622.81	$1,021.00	—	82% above	39%
Short leg cast (below the knee) inpatient CPT 29405 HC APPLY SHORT LEG CAST	$519.72	$852.00	—	—	39%
Short leg cast (below the knee) inpatient CPT 29405 PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$622.81	$1,021.00	—	—	39%
Short leg splint (calf to foot) CPT 29515 HC APPLY LOWER LEG SPLINT	$248.27	$407.00	—	16% above	39%
Short leg splint (calf to foot) CPT 29515 PR APPLICATION SHORT LEG SPLINT CALF TO FOOT	$308.66	$506.00	—	44% above	39%
Short leg splint (calf to foot) inpatient CPT 29515 HC APPLY LOWER LEG SPLINT	$248.27	$407.00	—	—	39%
Short leg splint (calf to foot) inpatient CPT 29515 PR APPLICATION SHORT LEG SPLINT CALF TO FOOT	$308.66	$506.00	—	—	39%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC	$1,226.71	$2,011.00	—	at median	39%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 HC SHOULDER ARTHROSCOPY/SURGER	$5,501.59	$9,019.00	—	348% above	39%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC	$1,226.71	$2,011.00	—	—	39%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 HC SHOULDER ARTHROSCOPY/SURGER	$5,501.59	$9,019.00	—	—	39%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS	$1,701.90	$2,790.00	—	at median	39%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 HC SHLDR ARTHROSCOP,PART ACROMIOPLAS	$5,501.59	$9,019.00	—	223% above	39%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS	$1,701.90	$2,790.00	—	—	39%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 HC SHLDR ARTHROSCOP,PART ACROMIOPLAS	$5,501.59	$9,019.00	—	—	39%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC REPR SUPERF WND BODY <2.5CM	$337.94	$554.00	—	26% above	39%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<	$705.77	$1,157.00	—	162% above	39%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC REPR SUPERF WND BODY <2.5CM	$337.94	$554.00	—	—	39%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<	$705.77	$1,157.00	—	—	39%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BX SNGL SKIN LESION	$437.98	$718.00	—	33% above	39%
Skin biopsy, punch, one lesion CPT 11104 PR PUNCH BIOPSY SKIN SINGLE LESION	$488.61	$801.00	—	48% above	39%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BX SNGL SKIN LESION	$437.98	$718.00	—	—	39%
Skin biopsy, punch, one lesion inpatient CPT 11104 PR PUNCH BIOPSY SKIN SINGLE LESION	$488.61	$801.00	—	—	39%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 PR EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<	$139.69	$229.00	—	71% below	39%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC EXC SKIN MALIG <5MM TRUNK,ARM,LEG	$1,685.43	$2,763.00	—	244% above	39%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 PR EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<	$139.69	$229.00	—	—	39%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC EXC SKIN MALIG <5MM TRUNK,ARM,LEG	$1,685.43	$2,763.00	—	—	39%
Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL OF SKIN TAGS	$256.81	$421.00	—	16% above	39%
Skin tag removal, up to 15 tags CPT 11200 PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15	$353.80	$580.00	—	60% above	39%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC REMOVAL OF SKIN TAGS	$256.81	$421.00	—	—	39%
Skin tag removal, up to 15 tags inpatient CPT 11200 PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15	$353.80	$580.00	—	—	39%
Spinal tap (lumbar puncture), diagnostic CPT 62270 PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$507.52	$832.00	—	29% below	39%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL PUNCTURE,DIAGNOSTIC	$1,189.50	$1,950.00	—	67% above	39%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$507.52	$832.00	—	—	39%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL PUNCTURE,DIAGNOSTIC	$1,189.50	$1,950.00	—	—	39%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC REPR SUP NPTERF WND BODY 2.6-7.5	$337.94	$554.00	—	17% above	39%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM	$409.31	$671.00	—	42% above	39%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC REPR SUP NPTERF WND BODY 2.6-7.5	$337.94	$554.00	—	—	39%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM	$409.31	$671.00	—	—	39%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC REPR SUPERF WND FACE <2.5CM	$337.94	$554.00	—	16% above	39%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<	$405.65	$665.00	—	39% above	39%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC REPR SUPERF WND FACE <2.5CM	$337.94	$554.00	—	—	39%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<	$405.65	$665.00	—	—	39%
TURP (transurethral resection of the prostate) CPT 52601 PR TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE	$1,294.42	$2,122.00	—	at median	39%
TURP (transurethral resection of the prostate) CPT 52601 HC PROSTATECTOMY (TURP)	$3,584.97	$5,877.00	—	177% above	39%
TURP (transurethral resection of the prostate) inpatient CPT 52601 PR TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE	$1,294.42	$2,122.00	—	—	39%
TURP (transurethral resection of the prostate) inpatient CPT 52601 HC PROSTATECTOMY (TURP)	$3,584.97	$5,877.00	—	—	39%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BX SNGL SKIN LESION	$437.98	$718.00	—	78% above	39%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 PR TANGENTIAL BIOPSY SKIN SINGLE LESION	$488.61	$801.00	—	98% above	39%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BX SNGL SKIN LESION	$437.98	$718.00	—	—	39%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 PR TANGENTIAL BIOPSY SKIN SINGLE LESION	$488.61	$801.00	—	—	39%
Thoracentesis with imaging guidance CPT 32555 HC ASPIRATE PLEURA W/IMAGING	$1,361.52	$2,232.00	—	52% above	39%
Thoracentesis with imaging guidance CPT 32555 PR THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$1,817.19	$2,979.00	—	103% above	39%
Thoracentesis with imaging guidance inpatient CPT 32555 HC ASPIRATE PLEURA W/IMAGING	$1,361.52	$2,232.00	—	—	39%
Thoracentesis with imaging guidance inpatient CPT 32555 PR THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$1,817.19	$2,979.00	—	—	39%
Tonsil and adenoid removal, age 12 or older CPT 42821 PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/>	$550.22	$902.00	—	35% below	39%
Tonsil and adenoid removal, age 12 or older CPT 42821 HC TONSILLECTOMY/ADENOIDECT>12YRS	$2,508.93	$4,113.00	—	194% above	39%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/>	$550.22	$902.00	—	—	39%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 HC TONSILLECTOMY/ADENOIDECT>12YRS	$2,508.93	$4,113.00	—	—	39%
Tonsil and adenoid removal, child under 12 CPT 42820 PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12	$870.47	$1,427.00	—	at median	39%
Tonsil and adenoid removal, child under 12 CPT 42820 HC TONSILLECTOMY/ADENOIDECT<12YRS	$4,793.99	$7,859.00	—	451% above	39%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12	$870.47	$1,427.00	—	—	39%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 HC TONSILLECTOMY/ADENOIDECT<12YRS	$4,793.99	$7,859.00	—	—	39%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>	$463.60	$760.00	—	35% below	39%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 HC TONSILLECTOMY,PRIM OR SEC>12YR	$2,508.93	$4,113.00	—	251% above	39%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>	$463.60	$760.00	—	—	39%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 HC TONSILLECTOMY,PRIM OR SEC>12YR	$2,508.93	$4,113.00	—	—	39%
Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12	$792.39	$1,299.00	—	at median	39%
Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 HC TONSILLECTOMY 12 OR OVER	$4,531.08	$7,428.00	—	472% above	39%
Tonsil removal (tonsillectomy) only, child under 12 inpatient CPT 42825 PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12	$792.39	$1,299.00	—	—	39%
Tonsil removal (tonsillectomy) only, child under 12 inpatient CPT 42825 HC TONSILLECTOMY 12 OR OVER	$4,531.08	$7,428.00	—	—	39%
Total hip replacement CPT 27130 PR ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT	$4,249.87	$6,967.00	—	at median	39%
Total hip replacement CPT 27130 HC TOTAL HIP ARTHROPLASTY	$14,385.63	$23,583.00	—	238% above	39%
Total hip replacement inpatient CPT 27130 PR ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT	$4,249.87	$6,967.00	—	—	39%
Total hip replacement inpatient CPT 27130 HC TOTAL HIP ARTHROPLASTY	$14,385.63	$23,583.00	—	—	39%
Total knee replacement CPT 27447 PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS	$2,297.26	$3,766.00	—	at median	39%
Total knee replacement CPT 27447 HC TOTAL KNEE ARTHROPLASTY	$12,378.12	$20,292.00	—	439% above	39%
Total knee replacement inpatient CPT 27447 PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS	$2,297.26	$3,766.00	—	—	39%
Total knee replacement inpatient CPT 27447 HC TOTAL KNEE ARTHROPLASTY	$12,378.12	$20,292.00	—	—	39%
Total shoulder replacement CPT 23472 PR ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER	$3,222.02	$5,282.00	—	at median	39%
Total shoulder replacement CPT 23472 HC RECONSTRUCT SHOULDER JOINT	$10,668.29	$17,489.00	—	231% above	39%
Total shoulder replacement inpatient CPT 23472 PR ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER	$3,222.02	$5,282.00	—	—	39%
Total shoulder replacement inpatient CPT 23472 HC RECONSTRUCT SHOULDER JOINT	$10,668.29	$17,489.00	—	—	39%
Total thyroid removal (thyroidectomy) CPT 60240 PR THYROIDECTOMY TOTAL/COMPLETE	$2,938.98	$4,818.00	—	—	39%
Total thyroid removal (thyroidectomy) CPT 60240 HC REMOVE THYROID	$4,588.42	$7,522.00	—	—	39%
Total thyroid removal (thyroidectomy) inpatient CPT 60240 PR THYROIDECTOMY TOTAL/COMPLETE	$2,938.98	$4,818.00	—	—	39%
Total thyroid removal (thyroidectomy) inpatient CPT 60240 HC REMOVE THYROID	$4,588.42	$7,522.00	—	—	39%
Trigger finger release surgery CPT 26055 PR TENDON SHEATH INCISION	$534.97	$877.00	—	79% below	39%
Trigger finger release surgery CPT 26055 HC INCISE FINGER TENDON SHEATH	$2,647.40	$4,340.00	—	2% above	39%
Trigger finger release surgery inpatient CPT 26055 PR TENDON SHEATH INCISION	$534.97	$877.00	—	—	39%
Trigger finger release surgery inpatient CPT 26055 HC INCISE FINGER TENDON SHEATH	$2,647.40	$4,340.00	—	—	39%
Trigger point injections, 1 or 2 muscles CPT 20552 PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$65.27	$107.00	—	66% below	39%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ TRIGGER POINT,1 OR 2	$414.80	$680.00	—	118% above	39%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$65.27	$107.00	—	—	39%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ TRIGGER POINT,1 OR 2	$414.80	$680.00	—	—	39%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 PR LAPAROSCOPY FULGURATION OVIDUCTS	$1,481.08	$2,428.00	—	at median	39%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 HC LAPAROSCOPY,TUBAL CAUTERY	$7,742.12	$12,692.00	—	423% above	39%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 PR LAPAROSCOPY FULGURATION OVIDUCTS	$1,481.08	$2,428.00	—	—	39%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 HC LAPAROSCOPY,TUBAL CAUTERY	$7,742.12	$12,692.00	—	—	39%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 PR BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID	$269.62	$442.00	—	84% below	39%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMAGE	$2,031.91	$3,331.00	—	18% above	39%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 PR BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID	$269.62	$442.00	—	—	39%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US IMAGE	$2,031.91	$3,331.00	—	—	39%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM	$502.64	$824.00	—	77% below	39%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC UPPER GI BALLOON DILATION	$3,394.04	$5,564.00	—	55% above	39%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM	$502.64	$824.00	—	—	39%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC UPPER GI BALLOON DILATION	$3,394.04	$5,564.00	—	—	39%
Upper endoscopy (EGD) with biopsy CPT 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE	$496.54	$814.00	—	69% below	39%
Upper endoscopy (EGD) with biopsy CPT 43239 HC UPPER GI ENDOSCOPY,BIOPSY	$1,382.26	$2,266.00	—	14% below	39%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE	$496.54	$814.00	—	—	39%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC UPPER GI ENDOSCOPY,BIOPSY	$1,382.26	$2,266.00	—	—	39%
Upper endoscopy (EGD) with injection into the lining CPT 43236 PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION	$507.52	$832.00	—	59% below	39%
Upper endoscopy (EGD) with injection into the lining CPT 43236 HC UPPER GI SCOPE W/SUBMUC INJ	$1,382.26	$2,266.00	—	11% above	39%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION	$507.52	$832.00	—	—	39%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 HC UPPER GI SCOPE W/SUBMUC INJ	$1,382.26	$2,266.00	—	—	39%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH	$344.04	$564.00	—	83% below	39%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 HC UP GI ENDOSCOPY,REMV TUMOR,SNARE	$3,394.04	$5,564.00	—	72% above	39%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH	$344.04	$564.00	—	—	39%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 HC UP GI ENDOSCOPY,REMV TUMOR,SNARE	$3,394.04	$5,564.00	—	—	39%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS	$292.19	$479.00	—	83% below	39%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 HC UPPER GI ENDOSCOPY/GUIDE WIRE	$1,382.26	$2,266.00	—	17% below	39%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS	$292.19	$479.00	—	—	39%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 HC UPPER GI ENDOSCOPY/GUIDE WIRE	$1,382.26	$2,266.00	—	—	39%
Upper endoscopy (EGD), diagnostic CPT 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$1,212.68	$1,988.00	—	17% below	39%
Upper endoscopy (EGD), diagnostic CPT 43235 HC UPPER GI ENDOSCOPY,DX	$1,382.26	$2,266.00	—	6% below	39%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$1,212.68	$1,988.00	—	—	39%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC UPPER GI ENDOSCOPY,DX	$1,382.26	$2,266.00	—	—	39%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST	$796.66	$1,306.00	—	at median	39%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 HC EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST	$3,226.29	$5,289.00	—	305% above	39%
Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST	$796.66	$1,306.00	—	—	39%
Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 HC EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST	$3,226.29	$5,289.00	—	—	39%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY	$1,479.86	$2,426.00	—	at median	39%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 HC CYSTOURETERO W/LITHOTRIPSY	$4,315.14	$7,074.00	—	192% above	39%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY	$1,479.86	$2,426.00	—	—	39%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 HC CYSTOURETERO W/LITHOTRIPSY	$4,315.14	$7,074.00	—	—	39%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT	$728.95	$1,195.00	—	53% below	39%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 HC CYSTO/URETERO W/LITHOTRIPSY	$5,160.60	$8,460.00	—	234% above	39%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT	$728.95	$1,195.00	—	—	39%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 HC CYSTO/URETERO W/LITHOTRIPSY	$5,160.60	$8,460.00	—	—	39%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB	$5,382.03	$8,823.00	—	at median	39%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB	$5,382.03	$8,823.00	—	—	39%
Vaginal delivery, including prenatal and postpartum care CPT 59400 PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM	$4,348.69	$7,129.00	—	—	39%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM	$4,348.69	$7,129.00	—	—	39%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS	$412.97	$677.00	—	—	39%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 HC REMOVAL OF SPERM DUCT(S)	$2,032.52	$3,332.00	—	at median	39%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS	$412.97	$677.00	—	—	39%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 HC REMOVAL OF SPERM DUCT(S)	$2,032.52	$3,332.00	—	—	39%
Vein ablation, radiofrequency, first vein CPT 36475 PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN	$1,087.02	$1,782.00	—	63% below	39%
Vein ablation, radiofrequency, first vein CPT 36475 HC ENDOVENOUS RF,1ST VEIN	$6,816.14	$11,174.00	—	133% above	39%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN	$1,087.02	$1,782.00	—	—	39%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC ENDOVENOUS RF,1ST VEIN	$6,816.14	$11,174.00	—	—	39%
Wart removal, up to 14 warts CPT 17110 PR DESTRUCTION BENIGN LESIONS UP TO 14	$123.22	$202.00	—	40% below	39%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCT BENIGN LESION, 1-14	$256.81	$421.00	—	26% above	39%
Wart removal, up to 14 warts inpatient CPT 17110 PR DESTRUCTION BENIGN LESIONS UP TO 14	$123.22	$202.00	—	—	39%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCT BENIGN LESION, 1-14	$256.81	$421.00	—	—	39%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<	$107.97	$177.00	—	67% below	39%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDE SKIN/TISSUE	$544.12	$892.00	—	65% above	39%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<	$107.97	$177.00	—	—	39%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDE SKIN/TISSUE	$544.12	$892.00	—	—	39%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION	$1,346.27	$2,207.00	—	at median	39%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 HC TREAT FX RAD EXTRA-ARTICUL	$9,491.60	$15,560.00	—	605% above	39%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION	$1,346.27	$2,207.00	—	—	39%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 HC TREAT FX RAD EXTRA-ARTICUL	$9,491.60	$15,560.00	—	—	39%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD ADMIN 0-2 HRS	$669.78	$1,098.00	—	12% below	39%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD ADMIN 2+ HRS	$669.78	$1,098.00	—	12% below	39%
Blood transfusion (giving blood or blood components) CPT 36430 PR TRANSFUSION BLOOD/BLOOD COMPONENTS	$669.78	$1,098.00	—	12% below	39%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD ADMIN 2+ HRS	$669.78	$1,098.00	—	—	39%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 PR TRANSFUSION BLOOD/BLOOD COMPONENTS	$669.78	$1,098.00	—	—	39%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD ADMIN 0-2 HRS	$669.78	$1,098.00	—	—	39%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$267.18	$438.00	—	114% above	39%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC METANEB TX	$267.18	$438.00	—	114% above	39%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AIRWAY INHALATION TRMT	$267.18	$438.00	—	114% above	39%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC METANEB TX	$267.18	$438.00	—	—	39%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AIRWAY INHALATION TRMT	$267.18	$438.00	—	—	39%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$267.18	$438.00	—	—	39%
Chemotherapy IV infusion, first hour CPT 96413 PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG	$615.49	$1,009.00	—	12% below	39%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO,IV INFUSION,1 HR	$615.49	$1,009.00	—	12% below	39%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO,IV INFUSION,1 HR	$615.49	$1,009.00	—	—	39%
Chemotherapy IV infusion, first hour inpatient CPT 96413 PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG	$615.49	$1,009.00	—	—	39%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 HC EYE EXAM NEW PT COMPREH	$109.80	$180.00	—	9% below	39%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 PR OPH SVCS MEDICAL XM&EVAL COMPRE NEW PT 1/> VST	$245.83	$403.00	—	103% above	39%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 HC EYE EXAM NEW PT COMPREH	$109.80	$180.00	—	—	39%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 PR OPH SVCS MEDICAL XM&EVAL COMPRE NEW PT 1/> VST	$245.83	$403.00	—	—	39%
Comprehensive eye exam, returning patient CPT 92014 HC EYE EXAM & TREATMENT	$109.80	$180.00	—	9% below	39%
Comprehensive eye exam, returning patient CPT 92014 PR OPH SVCS MEDICAL XM&EVAL COMPRE EST PT 1/>VST	$208.01	$341.00	—	71% above	39%
Comprehensive eye exam, returning patient inpatient CPT 92014 HC EYE EXAM & TREATMENT	$109.80	$180.00	—	—	39%
Comprehensive eye exam, returning patient inpatient CPT 92014 PR OPH SVCS MEDICAL XM&EVAL COMPRE EST PT 1/>VST	$208.01	$341.00	—	—	39%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC COMPREHENSIVE HEARING TEST	$140.91	$231.00	—	23% below	39%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ	$165.31	$271.00	—	9% below	39%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC COMPREHENSIVE HEARING TEST	$140.91	$231.00	—	—	39%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ	$165.31	$271.00	—	—	39%
Critical care, first 30 to 74 minutes CPT 99291 PR CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN	$588.65	$965.00	—	27% below	39%
Critical care, first 30 to 74 minutes CPT 99291 HC CRITICAL CARE 1ST HOUR	$3,218.36	$5,276.00	—	302% above	39%
Critical care, first 30 to 74 minutes inpatient CPT 99291 PR CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN	$588.65	$965.00	—	—	39%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC CRITICAL CARE 1ST HOUR	$3,218.36	$5,276.00	—	—	39%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG,AWAKE & DROWSY	$583.16	$956.00	—	12% below	39%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG,AWAKE & DROWSY	$583.16	$956.00	—	—	39%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R	$171.41	$281.00	—	110% above	39%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R	$171.41	$281.00	—	—	39%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ROUTINE EKG	$147.62	$242.00	—	21% above	39%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R	$147.62	$242.00	—	21% above	39%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R	$147.62	$242.00	—	—	39%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC ROUTINE EKG	$147.62	$242.00	—	—	39%
Electroconvulsive therapy (ECT), one session CPT 90870 PR ELECTROCONVULSIVE THERAPY	$333.06	$546.00	—	65% below	39%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY	$844.24	$1,384.00	—	12% below	39%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 PR ELECTROCONVULSIVE THERAPY	$333.06	$546.00	—	—	39%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY	$844.24	$1,384.00	—	—	39%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP	$103.70	$170.00	—	at median	39%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED LEVEL I	$169.58	$278.00	—	64% above	39%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP	$103.70	$170.00	—	—	39%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED LEVEL I	$169.58	$278.00	—	—	39%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM	$134.81	$221.00	—	at median	39%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED LEVEL II	$297.68	$488.00	—	121% above	39%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM	$134.81	$221.00	—	—	39%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED LEVEL II	$297.68	$488.00	—	—	39%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 PR EMERGENCY DEPARTMENT VISIT LOW MDM	$202.52	$332.00	—	4% below	39%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED LEVEL III	$442.25	$725.00	—	109% above	39%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 PR EMERGENCY DEPARTMENT VISIT LOW MDM	$202.52	$332.00	—	—	39%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED LEVEL III	$442.25	$725.00	—	—	39%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 PR EMERGENCY DEPARTMENT VISIT MODERATE MDM	$298.90	$490.00	—	17% below	39%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED LEVEL IV	$788.73	$1,293.00	—	118% above	39%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 PR EMERGENCY DEPARTMENT VISIT MODERATE MDM	$298.90	$490.00	—	—	39%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED LEVEL IV	$788.73	$1,293.00	—	—	39%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 PR EMERGENCY DEPARTMENT VISIT HIGH MDM	$442.25	$725.00	—	16% below	39%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED LEVEL V	$1,235.25	$2,025.00	—	134% above	39%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 PR EMERGENCY DEPARTMENT VISIT HIGH MDM	$442.25	$725.00	—	—	39%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED LEVEL V	$1,235.25	$2,025.00	—	—	39%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC STRESS TEST	$269.62	$442.00	—	24% below	39%
Exercise stress test, tracing only, the hospital charge CPT 93017 PR CV STRS TST XERS&/RX CONT ECG TRCG ONLY W/O I&R	$269.62	$442.00	—	24% below	39%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 PR CV STRS TST XERS&/RX CONT ECG TRCG ONLY W/O I&R	$269.62	$442.00	—	—	39%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC STRESS TEST	$269.62	$442.00	—	—	39%
Eye exam, returning patient, intermediate CPT 92012 PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE EST PT	$25.01	$41.00	—	68% below	39%
Eye exam, returning patient, intermediate CPT 92012 HC EYE EXAM ESTABLISHED PT	$35.99	$59.00	—	54% below	39%
Eye exam, returning patient, intermediate inpatient CPT 92012 PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE EST PT	$25.01	$41.00	—	—	39%
Eye exam, returning patient, intermediate inpatient CPT 92012 HC EYE EXAM ESTABLISHED PT	$35.99	$59.00	—	—	39%
Family therapy with the patient, 50 minutes CPT 90847 HC FAMILY PSYCHOTHERAPY W/PATIENT	$168.36	$276.00	—	67% below	39%
Family therapy with the patient, 50 minutes CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$203.13	$333.00	—	60% below	39%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC FAMILY PSYCHOTHERAPY W/PATIENT	$168.36	$276.00	—	—	39%
Family therapy with the patient, 50 minutes inpatient CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$203.13	$333.00	—	—	39%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYCHOTHERAPY W/O PATIENT	$153.72	$252.00	—	67% below	39%
Family therapy without the patient, 50 minutes CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$244.61	$401.00	—	48% below	39%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYCHOTHERAPY W/O PATIENT	$153.72	$252.00	—	—	39%
Family therapy without the patient, 50 minutes inpatient CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$244.61	$401.00	—	—	39%
Group psychotherapy session CPT 90853 HC LEVEL C - ADULT PER 15 MIN	$17.69	$29.00	—	96% below	39%
Group psychotherapy session CPT 90853 HC LEVEL C - ADOLESCENT PER 15 MIN	$18.91	$31.00	—	96% below	39%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY	$124.44	$204.00	—	71% below	39%
Group psychotherapy session CPT 90853 HC OT GROUP PSYCHOTHERAPY	$124.44	$204.00	—	71% below	39%
Group psychotherapy session CPT 90853 PR GROUP PSYCHOTHERAPY	$161.65	$265.00	—	62% below	39%
Group psychotherapy session CPT 90853 HC LEVEL B - ADULT	$312.32	$512.00	—	27% below	39%
Group psychotherapy session CPT 90853 HC LEVEL B - ADOLESCENT	$353.80	$580.00	—	17% below	39%
Group psychotherapy session CPT 90853 HC LEVEL B - CHILD	$383.69	$629.00	—	10% below	39%
Group psychotherapy session CPT 90853 HC LEVEL A - ADULT	$486.17	$797.00	—	14% above	39%
Group psychotherapy session CPT 90853 HC LEVEL A - ADOLESCENT	$503.25	$825.00	—	18% above	39%
Group psychotherapy session CPT 90853 HC LEVEL A - CHILD	$547.17	$897.00	—	28% above	39%
Group psychotherapy session inpatient CPT 90853 HC LEVEL C - ADULT PER 15 MIN	$17.69	$29.00	—	—	39%
Group psychotherapy session inpatient CPT 90853 HC LEVEL C - ADOLESCENT PER 15 MIN	$18.91	$31.00	—	—	39%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY	$124.44	$204.00	—	—	39%
Group psychotherapy session inpatient CPT 90853 HC OT GROUP PSYCHOTHERAPY	$124.44	$204.00	—	—	39%
Group psychotherapy session inpatient CPT 90853 PR GROUP PSYCHOTHERAPY	$161.65	$265.00	—	—	39%
Group psychotherapy session inpatient CPT 90853 HC LEVEL B - ADULT	$312.32	$512.00	—	—	39%
Group psychotherapy session inpatient CPT 90853 HC LEVEL B - ADOLESCENT	$353.80	$580.00	—	—	39%
Group psychotherapy session inpatient CPT 90853 HC LEVEL B - CHILD	$383.69	$629.00	—	—	39%
Group psychotherapy session inpatient CPT 90853 HC LEVEL A - ADULT	$486.17	$797.00	—	—	39%
Group psychotherapy session inpatient CPT 90853 HC LEVEL A - ADOLESCENT	$503.25	$825.00	—	—	39%
Group psychotherapy session inpatient CPT 90853 HC LEVEL A - CHILD	$547.17	$897.00	—	—	39%
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 PR XTRNL ECG REC<48 HRS RECORDING SCAN A/R R&I	$475.80	$780.00	—	69% above	39%
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient CPT 93224 PR XTRNL ECG REC<48 HRS RECORDING SCAN A/R R&I	$475.80	$780.00	—	—	39%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC HYDRATION IV INFUSION,INIT	$290.36	$476.00	—	at median	39%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$290.36	$476.00	—	at median	39%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$290.36	$476.00	—	—	39%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC HYDRATION IV INFUSION,INIT	$290.36	$476.00	—	—	39%
IV infusion of a medicine, first hour CPT 96365 PR IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR	$378.20	$620.00	—	9% below	39%
IV infusion of a medicine, first hour CPT 96365 HC THER/PROPH/DIAG IV INF,INIT	$378.20	$620.00	—	9% below	39%
IV infusion of a medicine, first hour inpatient CPT 96365 PR IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR	$378.20	$620.00	—	—	39%
IV infusion of a medicine, first hour inpatient CPT 96365 HC THER/PROPH/DIAG IV INF,INIT	$378.20	$620.00	—	—	39%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$23.18	$38.00	—	49% below	39%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC THER/PROPH/DIAG INJ,SC/IM	$110.41	$181.00	—	144% above	39%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$23.18	$38.00	—	—	39%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC THER/PROPH/DIAG INJ,SC/IM	$110.41	$181.00	—	—	39%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PR PSYCHIATRIC DIAGNOSTIC EVALUATION	$237.29	$389.00	—	at median	39%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSYCH DIAGNOSTIC EVALUATION	$276.94	$454.00	—	17% above	39%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PR PSYCHIATRIC DIAGNOSTIC EVALUATION	$237.29	$389.00	—	—	39%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PSYCH DIAGNOSTIC EVALUATION	$276.94	$454.00	—	—	39%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NERVE CONDUCTION STUDIES,7-8	$145.18	$238.00	—	11% below	39%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 PR NERVE CONDUCTION STUDIES 7-8 STUDIES	$362.95	$595.00	—	122% above	39%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC NERVE CONDUCTION STUDIES,7-8	$145.18	$238.00	—	—	39%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 PR NERVE CONDUCTION STUDIES 7-8 STUDIES	$362.95	$595.00	—	—	39%
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSC RE-ED 15MIN	$123.83	$203.00	—	10% above	39%
Neuromuscular re-education, 15 minutes CPT 97112 PR THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA	$123.83	$203.00	—	10% above	39%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSC RE-ED 15MIN	$123.83	$203.00	—	—	39%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PR THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA	$123.83	$203.00	—	—	39%
New patient office visit, about 30 minutes CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES	$210.45	$345.00	—	at median	39%
New patient office visit, about 30 minutes inpatient CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES	$210.45	$345.00	—	—	39%
New patient office visit, about 45 minutes CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES	$236.68	$388.00	—	12% below	39%
New patient office visit, about 45 minutes inpatient CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES	$236.68	$388.00	—	—	39%
New patient office visit, about 60 minutes CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES	$397.11	$651.00	—	1% above	39%
New patient office visit, about 60 minutes inpatient CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES	$397.11	$651.00	—	—	39%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES	$164.70	$270.00	—	at median	39%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES	$164.70	$270.00	—	—	39%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 PR MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI	$80.52	$132.00	—	13% below	39%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 PR MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI	$80.52	$132.00	—	—	39%
Occupational therapy evaluation, low complexity CPT 97165 HC DRIVING TRAINING LOW COMPLEX 30 MIN	$166.53	$273.00	—	37% below	39%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEX 30 MIN	$188.49	$309.00	—	28% below	39%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC DRIVING TRAINING LOW COMPLEX 30 MIN	$166.53	$273.00	—	—	39%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEX 30 MIN	$188.49	$309.00	—	—	39%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEX 45 MIN	$215.94	$354.00	—	30% below	39%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEX 45 MIN	$215.94	$354.00	—	—	39%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEX 20 MIN	$188.49	$309.00	—	28% below	39%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEX 20 MIN	$188.49	$309.00	—	—	39%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEX 30 MIN	$200.08	$328.00	—	28% below	39%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEX 30 MIN	$200.08	$328.00	—	—	39%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES	$46.97	$77.00	—	55% below	39%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY 15MIN	$87.23	$143.00	—	17% below	39%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES	$46.97	$77.00	—	—	39%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY 15MIN	$87.23	$143.00	—	—	39%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PR THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES	$60.39	$99.00	—	44% below	39%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAP EX 15MIN	$118.95	$195.00	—	11% above	39%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PR THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES	$60.39	$99.00	—	—	39%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAP EX 15MIN	$118.95	$195.00	—	—	39%
Preventive checkup, new patient aged 18–39 CPT 99385 HC NEW PT,PREV MED,AGE 18-39	$109.19	$179.00	—	26% below	39%
Preventive checkup, new patient aged 18–39 CPT 99385 PR EPSDT,NEW,AGE 18	$155.55	$255.00	—	5% above	39%
Preventive checkup, new patient aged 18–39 CPT 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS	$165.31	$271.00	—	12% above	39%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC NEW PT,PREV MED,AGE 18-39	$109.19	$179.00	—	—	39%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR EPSDT,NEW,AGE 18	$155.55	$255.00	—	—	39%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS	$165.31	$271.00	—	—	39%
Preventive checkup, new patient aged 40–64 CPT 99386 HC NEW PT,PREV MED,AGE 40-64	$143.96	$236.00	—	3% below	39%
Preventive checkup, new patient aged 40–64 CPT 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS	$322.08	$528.00	—	117% above	39%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC NEW PT,PREV MED,AGE 40-64	$143.96	$236.00	—	—	39%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS	$322.08	$528.00	—	—	39%
Preventive checkup, new patient aged 65 or older CPT 99387 HC NEW PT,PREV MED, 65+	$167.14	$274.00	—	at median	39%
Preventive checkup, new patient aged 65 or older CPT 99387 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>	$215.94	$354.00	—	29% above	39%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC NEW PT,PREV MED, 65+	$167.14	$274.00	—	—	39%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>	$215.94	$354.00	—	—	39%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC PREV MED, EST MED, AGE 18-39	$96.38	$158.00	—	35% below	39%
Preventive checkup, returning patient aged 18–39 CPT 99395 PR PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS	$151.28	$248.00	—	2% above	39%
Preventive checkup, returning patient aged 18–39 CPT 99395 PR EPSDT,EST,AGE 18	$155.55	$255.00	—	5% above	39%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC PREV MED, EST MED, AGE 18-39	$96.38	$158.00	—	—	39%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PR PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS	$151.28	$248.00	—	—	39%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PR EPSDT,EST,AGE 18	$155.55	$255.00	—	—	39%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC PREV MED, EST.PT, AGE40-64	$126.88	$208.00	—	14% below	39%
Preventive checkup, returning patient aged 40–64 CPT 99396 PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$140.91	$231.00	—	5% below	39%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC PREV MED, EST.PT, AGE40-64	$126.88	$208.00	—	—	39%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$140.91	$231.00	—	—	39%
Preventive checkup, returning patient aged 65 or older CPT 99397 PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$140.30	$230.00	—	5% below	39%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC PREV MED, EST.PT,AGE 65+	$160.43	$263.00	—	8% above	39%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$140.30	$230.00	—	—	39%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC PREV MED, EST.PT,AGE 65+	$160.43	$263.00	—	—	39%
Psychiatric evaluation with medical services CPT 90792 PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	$145.79	$239.00	—	6% below	39%
Psychiatric evaluation with medical services CPT 90792 HC PSYCH DIAGNOSTIC EVAL W/MED SVCS	$276.94	$454.00	—	78% above	39%
Psychiatric evaluation with medical services inpatient CPT 90792 PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	$145.79	$239.00	—	—	39%
Psychiatric evaluation with medical services inpatient CPT 90792 HC PSYCH DIAGNOSTIC EVAL W/MED SVCS	$276.94	$454.00	—	—	39%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC PSYCOTHERAPY FOR CRISIS,60 MIN	$109.19	$179.00	—	20% below	39%
Psychotherapy for crisis, first 60 minutes CPT 90839 PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES	$181.78	$298.00	—	33% above	39%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PSYCOTHERAPY FOR CRISIS,60 MIN	$109.19	$179.00	—	—	39%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES	$181.78	$298.00	—	—	39%
Psychotherapy session, 30 minutes CPT 90832 HC PSYTX PT & FAMILY 30MIN	$100.65	$165.00	—	60% below	39%
Psychotherapy session, 30 minutes CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES	$214.72	$352.00	—	14% below	39%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYTX PT & FAMILY 30MIN	$100.65	$165.00	—	—	39%
Psychotherapy session, 30 minutes inpatient CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES	$214.72	$352.00	—	—	39%
Psychotherapy session, 45 minutes CPT 90834 HC PSYTX PT & FAMILY 45MIN	$109.19	$179.00	—	66% below	39%
Psychotherapy session, 45 minutes CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES	$245.83	$403.00	—	24% below	39%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYTX PT & FAMILY 45MIN	$109.19	$179.00	—	—	39%
Psychotherapy session, 45 minutes inpatient CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES	$245.83	$403.00	—	—	39%
Psychotherapy session, 60 minutes CPT 90837 HC PSYTX PT & FAMILY 60MIN	$109.19	$179.00	—	68% below	39%
Psychotherapy session, 60 minutes CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES	$223.26	$366.00	—	35% below	39%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYTX PT & FAMILY 60MIN	$109.19	$179.00	—	—	39%
Psychotherapy session, 60 minutes inpatient CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES	$223.26	$366.00	—	—	39%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC SMOKING/TOBACCO CESSATION COUNSELING>3 MIN UP TO 10 MIN	$38.43	$63.00	—	at median	39%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES	$51.24	$84.00	—	33% above	39%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC SMOKING/TOBACCO CESSATION COUNSELING>3 MIN UP TO 10 MIN	$38.43	$63.00	—	—	39%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES	$51.24	$84.00	—	—	39%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN	$279.38	$458.00	—	9% below	39%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC L&D OUTPT EVALUATION-LEVEL V	$1,235.25	$2,025.00	—	303% above	39%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN	$279.38	$458.00	—	—	39%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC L&D OUTPT EVALUATION-LEVEL V	$1,235.25	$2,025.00	—	—	39%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$173.85	$285.00	—	2% below	39%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC L&D OUTPT EVALUATION-LEVEL III	$442.25	$725.00	—	149% above	39%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$173.85	$285.00	—	—	39%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC L&D OUTPT EVALUATION-LEVEL III	$442.25	$725.00	—	—	39%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$89.67	$147.00	—	53% below	39%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC L&D OUTPT EVALUATION-LEVEL IV	$788.73	$1,293.00	—	312% above	39%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$89.67	$147.00	—	—	39%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC L&D OUTPT EVALUATION-LEVEL IV	$788.73	$1,293.00	—	—	39%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN	$62.83	$103.00	—	6% below	39%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC L&D OUTPT EVALUATION-LEVEL II	$297.68	$488.00	—	345% above	39%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN	$62.83	$103.00	—	—	39%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC L&D OUTPT EVALUATION-LEVEL II	$297.68	$488.00	—	—	39%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HC OFFICE CONSULT LEVEL III	$110.41	$181.00	—	58% below	39%
Specialist consultation, low complexity or 30+ minutes CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES	$179.95	$295.00	—	32% below	39%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC OFFICE CONSULT LEVEL III	$110.41	$181.00	—	—	39%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES	$179.95	$295.00	—	—	39%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC OFFICE CONSULT LEVEL IV	$151.89	$249.00	—	28% below	39%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$251.32	$412.00	—	19% above	39%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HC OFFICE CONSULT LEVEL IV	$151.89	$249.00	—	—	39%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$251.32	$412.00	—	—	39%
Speech and language evaluation CPT 92523 HC EVAL OF SPEECH SOUND LANG COMPREHEN	$337.33	$553.00	—	37% below	39%
Speech and language evaluation inpatient CPT 92523 HC EVAL OF SPEECH SOUND LANG COMPREHEN	$337.33	$553.00	—	—	39%
Speech therapy session, individual CPT 92507 HC SPEECH/HEARING THERAPY INDIV	$211.67	$347.00	—	19% below	39%
Speech therapy session, individual CPT 92507 PR TX SPEECH LANG VOICE COMMJ&/AUD PROC DO INDIV	$211.67	$347.00	—	19% below	39%
Speech therapy session, individual inpatient CPT 92507 HC SPEECH/HEARING THERAPY INDIV	$211.67	$347.00	—	—	39%
Speech therapy session, individual inpatient CPT 92507 PR TX SPEECH LANG VOICE COMMJ&/AUD PROC DO INDIV	$211.67	$347.00	—	—	39%
Spirometry (breathing test) CPT 94010 HC SPIROMETRY	$138.47	$227.00	—	at median	39%
Spirometry (breathing test) CPT 94010 PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$172.02	$282.00	—	24% above	39%
Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY	$138.47	$227.00	—	—	39%
Spirometry (breathing test) inpatient CPT 94010 PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$172.02	$282.00	—	—	39%
Spirometry before and after a bronchodilator CPT 94060 HC PRE/POST SPIRO	$215.94	$354.00	—	26% below	39%
Spirometry before and after a bronchodilator CPT 94060 PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN	$259.25	$425.00	—	11% below	39%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC PRE/POST SPIRO	$215.94	$354.00	—	—	39%
Spirometry before and after a bronchodilator inpatient CPT 94060 PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN	$259.25	$425.00	—	—	39%
Therapeutic activities (functional training), 15 minutes CPT 97530 PR THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$67.71	$111.00	—	41% below	39%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAP ACTIVITY 15MIN	$118.95	$195.00	—	3% above	39%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PR THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$67.71	$111.00	—	—	39%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAP ACTIVITY 15MIN	$118.95	$195.00	—	—	39%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE	$124.44	$204.00	—	54% below	39%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC THERAPEUTIC PHLEBOTOMY	$124.44	$204.00	—	54% below	39%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY	$139.69	$229.00	—	48% below	39%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY IN INFUSION CTR	$293.41	$481.00	—	8% above	39%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC THERAPEUTIC PHLEBOTOMY	$124.44	$204.00	—	—	39%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE	$124.44	$204.00	—	—	39%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY	$139.69	$229.00	—	—	39%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY IN INFUSION CTR	$293.41	$481.00	—	—	39%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 PR CV STRESS TST XERS&/RX CONT ECG W/SI&R	$378.81	$621.00	—	at median	39%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 PR CV STRESS TST XERS&/RX CONT ECG W/SI&R	$378.81	$621.00	—	—	39%
Visual field test, extended both sides CPT 92083 PR EXTENDED VISUAL FIELD XM UNI/BI I&R	$181.78	$298.00	—	—	39%
Visual field test, extended CPT 92083 HC VISUAL FIELD EXAM, EXTENDED	$111.63	$183.00	—	8% below	39%
Visual field test, extended inpatient both sides CPT 92083 PR EXTENDED VISUAL FIELD XM UNI/BI I&R	$181.78	$298.00	—	—	39%
Visual field test, extended inpatient CPT 92083 HC VISUAL FIELD EXAM, EXTENDED	$111.63	$183.00	—	—	39%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 PR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$70.94	$116.30	—	45% below	39%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 mRNA Vaccine-Moderna IM Susp Pref Syr 50 MCG/0.5ML	$142.95	$234.35	—	12% above	39%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 PR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$70.94	$116.30	—	—	39%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID-19 mRNA Vaccine-Moderna IM Susp Pref Syr 50 MCG/0.5ML	$142.95	$234.35	—	—	39%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 PR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$180.56	$296.00	—	at median	39%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 PR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$180.56	$296.00	—	—	39%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE	$162.26	$266.00	—	2% below	39%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella Virus Vac Live For Inj 1350 PFU/0.5ML	$166.24	$272.53	—	1% above	39%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE	$162.26	$266.00	—	—	39%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varicella Virus Vac Live For Inj 1350 PFU/0.5ML	$166.24	$272.53	—	—	39%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$27.45	$45.00	—	14% below	39%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza Virus Vaccine Split PF Susp Pref Syringe 0.5 ML	$27.45	$45.00	—	14% below	39%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 PR FLU SHOT ON - SITE CLINIC	$28.06	$46.00	—	12% below	39%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$27.45	$45.00	—	—	39%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Influenza Virus Vaccine Split PF Susp Pref Syringe 0.5 ML	$27.45	$45.00	—	—	39%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 PR FLU SHOT ON - SITE CLINIC	$28.06	$46.00	—	—	39%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Human Papillomavirus (HPV) 9-Valent Recomb Vac Susp Pref Syr	$345.70	$566.72	—	at median	39%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE	$356.85	$585.00	—	3% above	39%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Human Papillomavirus (HPV) 9-Valent Recomb Vac Susp Pref Syr	$345.70	$566.72	—	—	39%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE	$356.85	$585.00	—	—	39%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 PR HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM	$135.42	$222.00	—	8% below	39%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 PR HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM	$135.42	$222.00	—	—	39%
Hepatitis A vaccine, adult dose CPT 90632 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE	$87.23	$143.00	—	at median	39%
Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A Vaccine Susp Prefilled Syr 1440 EL Unit/ML	$93.98	$154.07	—	8% above	39%
Hepatitis A vaccine, adult dose inpatient CPT 90632 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE	$87.23	$143.00	—	—	39%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis A Vaccine Susp Prefilled Syr 1440 EL Unit/ML	$93.98	$154.07	—	—	39%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B Vaccine (Recombinant) Susp 10 MCG/ML	$24.72	$40.53	—	69% below	39%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC HEP B VACC CONTRACTED RATE 2024	$45.14	$74.00	—	44% below	39%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B Vaccine (Recombinant) Susp Pref Syr 20 MCG/ML	$78.99	$129.49	—	1% below	39%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE	$86.01	$141.00	—	8% above	39%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepatitis B Vaccine (Recombinant) Susp 10 MCG/ML	$24.72	$40.53	—	—	39%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HC HEP B VACC CONTRACTED RATE 2024	$45.14	$74.00	—	—	39%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepatitis B Vaccine (Recombinant) Susp Pref Syr 20 MCG/ML	$78.99	$129.49	—	—	39%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE	$86.01	$141.00	—	—	39%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza Virus Vac Split High-Dose PF Susp Pref Syr 0.5ML	$57.95	$95.00	—	26% below	39%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM	$57.95	$95.00	—	26% below	39%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM	$57.95	$95.00	—	—	39%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Influenza Virus Vac Split High-Dose PF Susp Pref Syr 0.5ML	$57.95	$95.00	—	—	39%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles-Mumps-Rubella Virus Vaccines For Inj Soln	$74.45	$122.05	—	45% below	39%
MMR vaccine (measles, mumps and rubella), live CPT 90707 PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ	$76.86	$126.00	—	43% below	39%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Measles-Mumps-Rubella Virus Vaccines For Inj Soln	$74.45	$122.05	—	—	39%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ	$76.86	$126.00	—	—	39%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE	$98.82	$162.00	—	29% below	39%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal (A, C, Y, and W-135) Diphth Conjugate Vaccine	$110.89	$181.79	—	20% below	39%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal (A, C, Y, and W-135) Oligo Conj Vac For Inj	$167.54	$274.65	—	21% above	39%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE	$98.82	$162.00	—	—	39%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Meningococcal (A, C, Y, and W-135) Diphth Conjugate Vaccine	$110.89	$181.79	—	—	39%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Meningococcal (A, C, Y, and W-135) Oligo Conj Vac For Inj	$167.54	$274.65	—	—	39%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal Vac B (Recomb OMV Adjuv) Inj Prefilled Syringe	$256.05	$419.76	—	at median	39%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 PR MENB-4C RECOMBNT PRTN & OUTER MEMB VESIC VACC IM	$264.13	$433.00	—	3% above	39%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Meningococcal Vac B (Recomb OMV Adjuv) Inj Prefilled Syringe	$256.05	$419.76	—	—	39%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 PR MENB-4C RECOMBNT PRTN & OUTER MEMB VESIC VACC IM	$264.13	$433.00	—	—	39%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE	$234.85	$385.00	—	33% below	39%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal 20-Valent Conjugate Vaccine Sus Pref Syr 0.5 ML	$276.20	$452.78	—	21% below	39%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE	$234.85	$385.00	—	—	39%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumococcal 20-Valent Conjugate Vaccine Sus Pref Syr 0.5 ML	$276.20	$452.78	—	—	39%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE	$103.70	$170.00	—	32% below	39%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML	$133.53	$218.90	—	13% below	39%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE	$103.70	$170.00	—	—	39%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML	$133.53	$218.90	—	—	39%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE	$121.39	$199.00	—	82% below	39%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Nirsevimab-alip IM Soln Prefilled Syringe 50 MG/0.5ML	$252.86	$414.53	—	62% below	39%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE	$121.39	$199.00	—	—	39%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 Nirsevimab-alip IM Soln Prefilled Syringe 50 MG/0.5ML	$252.86	$414.53	—	—	39%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV Pre-Fusion F A&B Vac Recomb For IM Soln 120 MCG/0.5ML	$316.95	$519.59	—	37% below	39%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$362.34	$594.00	—	28% below	39%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV Pre-Fusion F A&B Vac Recomb For IM Soln 120 MCG/0.5ML	$316.95	$519.59	—	—	39%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$362.34	$594.00	—	—	39%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSVPreF3 Vaccine Recomb Adjuvanted For IM Susp 120 MCG/0.5ML	$312.02	$511.51	—	19% above	39%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 PR RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE	$340.99	$559.00	—	30% above	39%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 RSVPreF3 Vaccine Recomb Adjuvanted For IM Susp 120 MCG/0.5ML	$312.02	$511.51	—	—	39%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 PR RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE	$340.99	$559.00	—	—	39%
Rabies vaccine, one dose CPT 90675 Rabies Vaccine, PCEC For Inj	$344.50	$564.76	—	46% below	39%
Rabies vaccine, one dose CPT 90675 Rabies Virus Vaccine, HDC For Inj Susp	$364.58	$597.67	—	43% below	39%
Rabies vaccine, one dose CPT 90675 PR RABIES VACCINE INTRAMUSCULAR	$371.49	$609.00	—	42% below	39%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vaccine, PCEC For Inj	$344.50	$564.76	—	—	39%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Virus Vaccine, HDC For Inj Susp	$364.58	$597.67	—	—	39%
Rabies vaccine, one dose inpatient CPT 90675 PR RABIES VACCINE INTRAMUSCULAR	$371.49	$609.00	—	—	39%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Zoster Vac Recombinant Adjuvanted for IM Inj 50 MCG/0.5ML	$160.13	$262.51	—	25% below	39%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX	$213.50	$350.00	—	at median	39%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Zoster Vac Recombinant Adjuvanted for IM Inj 50 MCG/0.5ML	$160.13	$262.51	—	—	39%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX	$213.50	$350.00	—	—	39%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LF/0.5ML	$33.56	$55.01	—	35% below	39%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE	$48.19	$79.00	—	7% below	39%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LF/0.5ML	$33.56	$55.01	—	—	39%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE	$48.19	$79.00	—	—	39%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tet-Diph-Acell Pertuss Ad Pref Syr 5-2-15.5 LF-MCG/0.5ML	$46.37	$76.02	—	34% below	39%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 PR TDAP VACCINE 7 YRS/> IM	$54.90	$90.00	—	22% below	39%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tet-Diph-Acell Pertuss Ad Pref Syr 5-2.5-18.5 LF-MCG/0.5ML	$55.89	$91.62	—	21% below	39%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tet-Diph-Acell Pertuss Ad Pref Syr 5-2-15.5 LF-MCG/0.5ML	$46.37	$76.02	—	—	39%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 PR TDAP VACCINE 7 YRS/> IM	$54.90	$90.00	—	—	39%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tet-Diph-Acell Pertuss Ad Pref Syr 5-2.5-18.5 LF-MCG/0.5ML	$55.89	$91.62	—	—	39%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 PR TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM	$107.36	$176.00	—	29% below	39%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Typhoid VI Polysaccharide Vacc IM Soln Pref Syr 25 MCG/0.5ML	$126.29	$207.03	—	16% below	39%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 PR TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM	$107.36	$176.00	—	—	39%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 Typhoid VI Polysaccharide Vacc IM Soln Pref Syr 25 MCG/0.5ML	$126.29	$207.03	—	—	39%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC VACCINE ADMIN CHARGE CONTRACTED 2024	$23.79	$39.00	—	48% below	39%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE	$47.58	$78.00	—	3% above	39%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMINISTRATION	$47.58	$78.00	—	3% above	39%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC VACCINE ADMIN CHARGE CONTRACTED 2024	$23.79	$39.00	—	—	39%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE	$47.58	$78.00	—	—	39%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMINISTRATION	$47.58	$78.00	—	—	39%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE	$28.06	$46.00	—	4% below	39%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMIN EA ADDL	$28.06	$46.00	—	4% below	39%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE	$28.06	$46.00	—	—	39%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADMIN EA ADDL	$28.06	$46.00	—	—	39%

Dental

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
Deep cleaning (scaling and root planing), 4 or more teeth in one quadrant CDT D4341 HC PERIDONTAL SCALING & ROOT	$102.48	$168.00	—	—	39%
Deep cleaning (scaling and root planing), 4 or more teeth in one quadrant inpatient CDT D4341 HC PERIDONTAL SCALING & ROOT	$102.48	$168.00	—	—	39%
Dental implant, surgical placement CDT D6010 HC ODONTICS ENDOSTEAL IMPLANT	$634.40	$1,040.00	—	—	39%
Dental implant, surgical placement inpatient CDT D6010 HC ODONTICS ENDOSTEAL IMPLANT	$634.40	$1,040.00	—	—	39%
Removal of an impacted tooth fully covered by bone, often a wisdom tooth CDT D7240 HC IMPACT TOOTH REMOV COMP BONY	$634.40	$1,040.00	—	—	39%
Removal of an impacted tooth fully covered by bone, often a wisdom tooth inpatient CDT D7240 HC IMPACT TOOTH REMOV COMP BONY	$634.40	$1,040.00	—	—	39%
Simple extraction of a tooth or exposed root that is above the gum CDT D7140 HC EXTRACTION ERUPTED TOOTH/EXR	$634.40	$1,040.00	—	—	39%
Simple extraction of a tooth or exposed root that is above the gum inpatient CDT D7140 HC EXTRACTION ERUPTED TOOTH/EXR	$634.40	$1,040.00	—	—	39%

Source file: https://altru.org/documents/33-1282332altru-hospital-devils-lakestandardcharges.csv