Hospital Bainbridge, GA

Memorial Hospital and Manor

Memorial Hospital and Manor in Bainbridge, GA publishes cash prices for 280 common procedures listed here, from its own machine-readable price file updated May 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Georgia median for 165 of 277 procedures and above it for 112. By typical cash price it ranks #27 of 89 Georgia hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1500 E Shotwell St, Bainbridge, GA 39819 Collected Sep 29, 2026 Source price file (229) 246-3500

Acute care hospital No emergency department CMS star rating 1 of 5 CCN 110132 · CMS hospital register NPI 1053388256

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 2 actions for a hospital named Memorial Hospital and Manor in Bainbridge, GA:

Feb 25, 2026 Warning notice
May 29, 2026 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Georgia	Off list
Ankle X-ray, complete, 3 or more views both sides CPT 73610 BILATERAL ANKLE ORTHO MIN 3 VI	$264.60	$378.00	$70.66–$450.00	—	30%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 BILATERAL ANKLE LIMIT MIN 3 V	$283.50	$405.00	$70.66–$450.00	—	30%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 ANKLE 3 VIEW BILATERAL ORTHO	$310.80	$444.00	$70.66–$450.00	—	30%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 ANKLES BILATERAL MIN 3 VIEWS	$366.10	$523.00	$70.66–$496.85	—	30%
Ankle X-ray, complete, 3 or more views CPT 73610 L ANKLE COMPLETE MIN 3 VIEWS	$239.40	$342.00	$70.66–$450.00	12% below	30%
Ankle X-ray, complete, 3 or more views CPT 73610 R ANKLE COMPLETE MIN 3 VIEWS	$239.40	$342.00	$70.66–$450.00	12% below	30%
Ankle X-ray, complete, 3 or more views CPT 73610 L ANKLE COMPLETE ORTHO MIN 3 V	$239.40	$342.00	$70.66–$450.00	12% below	30%
Ankle X-ray, complete, 3 or more views CPT 73610 R ANKLE CMPL ORTHO MIN 3 VIEWS	$239.40	$342.00	$70.66–$450.00	12% below	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 LTD BIL PHYS STDY EX ART 1-2LE	$109.20	$156.00	$98.28–$450.00	73% below	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 NON INVASIVE VASC STUDY LMTD	$182.00	$260.00	$99.33–$450.00	55% below	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 LTD BIL PHYS STUDY EXT ARTERIE	$218.40	$312.00	$99.33–$450.00	45% below	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS BAR SWALLOW 1 CNTRST	$256.20	$366.00	$142.87–$450.00	25% below	30%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN/WHOLE BODY	$716.80	$1,024.00	$320.72–$972.80	44% below	30%
Breast ultrasound, complete, one breast both sides CPT 76641 BREAST US BILATERAL COMPLETE	$270.90	$387.00	$85.49–$450.00	—	30%
Breast ultrasound, complete, one breast both sides CPT 76641 US BILATERAL BREAST	$270.90	$387.00	$85.49–$450.00	—	30%
Breast ultrasound, complete, one breast one side CPT 76641 BREAST ULTRASOUND COMPLETE RT	$270.90	$387.00	$85.49–$450.00	36% below	30%
Breast ultrasound, complete, one breast one side CPT 76641 BREAST ULTRASOUND COMPLETE LT	$270.90	$387.00	$85.49–$450.00	36% below	30%
Breast ultrasound, limited (one breast or one area) CPT 76642 BREAST US BILATERIAL LIMITED	$282.80	$404.00	$70.66–$450.00	23% below	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 BREAST ULTRASOUND LIMITED RT	$282.80	$404.00	$70.66–$450.00	23% below	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 BREAST ULTRASOUND LIMITED LT	$282.80	$404.00	$70.66–$450.00	23% below	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA THORACIC AORTA	$1,992.90	$2,847.00	$142.87–$2,704.65	35% above	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT PULMONARY EMBOLUS	$1,992.90	$2,847.00	$142.87–$2,704.65	35% above	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN & PELVIS/RENL WO CT	$2,249.10	$3,213.00	$190.54–$3,052.35	2% above	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN & PELVIS WITH CONT	$4,158.00	$5,940.00	$299.06–$5,643.00	61% above	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD & PELV W & WO CONT	$2,604.70	$3,721.00	$299.06–$3,534.95	17% below	30%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN WITH CONSTRAST	$1,102.50	$1,575.00	$142.87–$1,496.25	35% below	30%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W CONTRAST LMTD	$1,102.50	$1,575.00	$142.87–$1,496.25	35% below	30%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$936.60	$1,338.00	$85.48–$1,271.10	27% below	30%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O	$936.60	$1,338.00	$85.48–$1,271.10	27% below	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 M-FACIAL/SINUSES W/0 CONTRAST	$1,067.50	$1,525.00	$85.48–$1,448.75	4% above	30%
CT scan of the head or brain, no contrast dye CPT 70450 STROKE PROTOCOL CT BRAIN	$477.40	$682.00	$85.48–$647.90	63% below	30%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/0 CONTRAST	$477.40	$682.00	$85.48–$647.90	63% below	30%
CT scan of the head with contrast CPT 70460 CT HEAD WITH CONTRAST	$1,010.80	$1,444.00	$142.87–$1,371.80	36% below	30%
CT scan of the head without and with contrast CPT 70470 CT HEAD W & W/O CONTRAST	$1,107.40	$1,582.00	$142.87–$1,502.90	40% below	30%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$1,328.60	$1,898.00	$85.48–$1,803.10	3% above	30%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O CONTRAST	$1,217.30	$1,739.00	$85.48–$1,652.05	2% above	30%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS WITH CONTRAST	$1,064.70	$1,521.00	$142.87–$1,444.95	34% below	30%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 CAROTID DUPLEX COMPLETE	$608.30	$869.00	$190.54–$825.55	4% below	30%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 DPLX SCN EXCRANIAL ART COM BIL	$608.30	$869.00	$190.54–$825.55	4% below	30%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 DUPLEX SCAN EXTCRAN ART/BILCMP	$608.30	$869.00	$190.54–$825.55	4% below	30%
Chest X-ray, 2 views CPT 71046 CHEST FRONT & LATERAL 2 VIEWS	$275.80	$394.00	$70.65–$450.00	19% above	30%
Chest X-ray, 2 views CPT 71046 CHEST PA & LATERAL 2 VIEWS	$275.80	$394.00	$70.65–$450.00	19% above	30%
Chest X-ray, single view CPT 71045 CHEST PA ONLY ORTHO	$123.90	$177.00	$70.65–$450.00	29% below	30%
Chest X-ray, single view CPT 71045 CHEST PA ONLY SINGLE VIEW	$123.90	$177.00	$70.65–$450.00	29% below	30%
Chest X-ray, single view CPT 71045 CHEST SINGLE VIEW	$123.90	$177.00	$70.65–$450.00	29% below	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 RENAL SCAN	$472.50	$675.00	$85.48–$641.25	6% below	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 RENAL W BLADDER SONOGRAM CMPL	$472.50	$675.00	$85.48–$641.25	6% below	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 RENAL RETROPERITONEAL COMPLETE	$472.50	$675.00	$85.48–$641.25	6% below	30%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DUAL ENERGY XRAY ABSORPTIOMETR	$245.00	$350.00	$85.48–$450.00	36% below	30%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMPLETE	$363.30	$519.00	$190.54–$493.05	6% above	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST DIAG W/O CONTRAST	$893.90	$1,277.00	$85.48–$1,213.15	15% below	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HI RES CT THORAX DX W/O CONTRA	$893.90	$1,277.00	$85.48–$1,213.15	15% below	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST DIAG WITH CONTRAST	$1,526.70	$2,181.00	$142.87–$2,071.95	2% below	30%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIAGNOSTIC BILATERAL	$389.20	$556.00	$91.72–$528.20	—	30%
Diagnostic mammogram, one breast one side CPT 77065 DIAG MAMMO CAD UNILAT RIGHT	$312.20	$446.00	$71.49–$450.00	31% above	30%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO DIAGNOSTIC RIGHT BREAST	$312.20	$446.00	$71.49–$450.00	31% above	30%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO DIAGNOSTIC LEFT BREAST	$312.20	$446.00	$71.49–$450.00	31% above	30%
Diagnostic mammogram, one breast one side CPT 77065 DIAG MAMMO CAD UNILAT LEFT	$312.20	$446.00	$71.49–$450.00	31% above	30%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US ARTERIAL STUDY BILAT LEGS	$402.50	$575.00	$190.54–$546.25	—	30%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US BILAT ARTERIES LOWER EXT	$402.50	$575.00	$190.54–$546.25	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 UPPER EXTREM BILATERAL COMPLET	$914.20	$1,306.00	$190.54–$1,240.70	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 DUPLEX SCAN EXT VEINS BILAT CO	$914.20	$1,306.00	$190.54–$1,240.70	—	30%
Duplex ultrasound of the leg veins, both legs CPT 93970 DUPLEX SCAN EXT VEINS.CMP BIL	$914.20	$1,306.00	$190.54–$1,240.70	5% below	30%
Duplex ultrasound of the leg veins, both legs CPT 93970 VENOUS INSUFFICIENCY EXT BILA	$914.20	$1,306.00	$190.54–$1,240.70	5% below	30%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO 2D W/DOPPLER & COLOR FLOW	$1,280.30	$1,829.00	$428.99–$1,737.55	18% below	30%
Knee X-ray, 3 views both sides CPT 73562 BILATERAL KNEES COMPL 3 VIEWS	$182.00	$260.00	$70.66–$450.00	—	30%
Knee X-ray, 3 views CPT 73562 L KNEE COMPLETE 3 VIEWS	$142.10	$203.00	$70.66–$450.00	40% below	30%
Knee X-ray, 3 views CPT 73562 R KNEE COMPLETE 3 VIEWS	$142.10	$203.00	$70.66–$450.00	40% below	30%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEW ORTHO LEFT	$142.10	$203.00	$70.66–$450.00	40% below	30%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEW ORTHO RIGHT	$142.10	$203.00	$70.66–$450.00	40% below	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ABDOMEN-SUPERFICIAL LIMITED	$472.50	$675.00	$85.48–$641.25	4% below	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ABDOMEN LIMITED	$472.50	$675.00	$85.48–$641.25	4% below	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 LIMITED SINGLE QUADRANT	$472.50	$675.00	$85.48–$641.25	4% below	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 COMP TOPO THORAX LD LUNG CA SC	$305.90	$437.00	$85.48–$450.00	22% above	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT CHEST W WO CONT LDCT SMOKER	$305.90	$437.00	$85.48–$450.00	22% above	30%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST W/WO CONTRAST BILAT	$2,907.80	$4,154.00	$450.00–$3,946.30	—	30%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW EXT JT W/O CONT BILATE	$1,328.60	$1,898.00	$190.54–$1,803.10	12% below	30%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXTREMITY JOINT WO	$1,328.60	$1,898.00	$190.54–$1,803.10	12% below	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI RT HIP WO CONTRAST	$1,328.60	$1,898.00	$190.54–$1,803.10	12% below	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LT KNEE WO CONTRAST	$1,328.60	$1,898.00	$190.54–$1,803.10	12% below	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LT HIP WO CONTRAST	$1,328.60	$1,898.00	$190.54–$1,803.10	12% below	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI RT KNEE WO CONTRAST	$1,328.60	$1,898.00	$190.54–$1,803.10	12% below	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LT ANKLE WO CONTRAST	$1,328.60	$1,898.00	$190.54–$1,803.10	12% below	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI RT ANKLE WO CONTRAST	$1,328.60	$1,898.00	$190.54–$1,803.10	12% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MRI LOW EXT JOINT W/WO CONT BI	$1,362.20	$1,946.00	$299.06–$1,848.70	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI ANY JT LOW EXT W/WO CONTRA	$1,362.20	$1,946.00	$299.06–$1,848.70	46% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI RT HIP W W/O CONTRAST	$1,362.20	$1,946.00	$299.06–$1,848.70	46% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LT HIP W W/O CONTRAST	$1,362.20	$1,946.00	$299.06–$1,848.70	46% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LEFT KNEE W W/O CONTRAST	$1,362.20	$1,946.00	$299.06–$1,848.70	46% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI RT KNEE W W/O CONTRAST	$1,362.20	$1,946.00	$299.06–$1,848.70	46% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LT ANKLE W W/O CONTRAST	$1,362.20	$1,946.00	$299.06–$1,848.70	46% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI RT ANKLE W W/O CONTRAST	$1,362.20	$1,946.00	$299.06–$1,848.70	46% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOW EXT JT W/WO C RT ARTHR	$1,362.20	$1,946.00	$299.06–$1,848.70	46% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOW EXT JT W/WO CO LT ARTH	$1,362.20	$1,946.00	$299.06–$1,848.70	46% below	30%
MRI of the abdomen without contrast CPT 74181 MRA ABDOMEN (MRI) W/O CONTRAST	$1,192.80	$1,704.00	$190.54–$1,618.80	35% below	30%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST LMTED	$1,192.80	$1,704.00	$190.54–$1,618.80	35% below	30%
MRI of the abdomen without contrast CPT 74181 MRI ADRENAL GLAND W/O CONTRAST	$1,192.80	$1,704.00	$190.54–$1,618.80	35% below	30%
MRI of the abdomen without contrast CPT 74181 MRI MRCP & ABD W/O CONTRAST	$1,192.80	$1,704.00	$190.54–$1,618.80	35% below	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ADRENAL GLAD W/WO CONT	$1,957.90	$2,797.00	$299.06–$2,657.15	7% below	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W&W/O DYE	$1,957.90	$2,797.00	$299.06–$2,657.15	7% below	30%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$1,104.60	$1,578.00	$190.54–$1,499.10	24% below	30%
MRI of the brain, no contrast dye CPT 70551 MRI INTER AUDITORY CANAL W/O C	$1,104.60	$1,578.00	$190.54–$1,499.10	24% below	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN & PIT GLD W/WO CONT	$2,781.10	$3,973.00	$299.06–$3,774.35	14% above	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI INTER AUDITORY CANALS W/WO	$2,781.10	$3,973.00	$299.06–$3,774.35	14% above	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI INT AUD CANAL W/W/O CON	$2,781.10	$3,973.00	$299.06–$3,774.35	14% above	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO CONTRAST	$2,781.10	$3,973.00	$299.06–$3,774.35	14% above	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN & PITUITA W/WO CONTR	$2,781.10	$3,973.00	$299.06–$3,774.35	14% above	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI PITUITARY W/WO CONTRAST	$2,781.10	$3,973.00	$299.06–$3,774.35	14% above	30%
MRI of the lower back, no contrast dye CPT 72148 MRI L-SPINAL CANAL/CONTS W/O	$1,550.50	$2,215.00	$190.54–$2,104.25	13% below	30%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L-SPINE CANAL/CONTS W/WO	$1,873.20	$2,676.00	$299.06–$2,542.20	21% below	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T-SPINAL CANAL/CONTS W/O	$1,192.80	$1,704.00	$190.54–$1,618.80	32% below	30%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C-SPINAL CANAL/CONTS W/W/O	$1,873.20	$2,676.00	$299.06–$2,542.20	21% below	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C-SPINAL CANAL/CONTS W/O	$1,550.50	$2,215.00	$190.54–$2,104.25	12% below	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C SPINE LIMITED WO CONTRAS	$1,550.50	$2,215.00	$190.54–$2,104.25	12% below	30%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/WO CONTRAST	$1,873.20	$2,676.00	$299.06–$2,542.20	16% below	30%
MRI of the pelvis without and with contrast CPT 72197 MRI SACRUM & COCCYX W/WO CONTR	$1,873.20	$2,676.00	$299.06–$2,542.20	16% below	30%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WITHOUT CONTRAST	$1,336.30	$1,909.00	$190.54–$1,813.55	26% below	30%
MRI of the pelvis, no contrast dye CPT 72195 MRI SACRUM & COCCYX WO CONTRAS	$1,336.30	$1,909.00	$190.54–$1,813.55	26% below	30%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS LIMITED	$1,336.30	$1,909.00	$190.54–$1,813.55	26% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 BILAT UPPER EXT JT W/O CONTRAS	$1,677.90	$2,397.00	$190.54–$2,277.15	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXTRM ANY JOINT	$1,677.90	$2,397.00	$190.54–$2,277.15	8% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI RT WRIST W/O CONTRAST	$1,677.90	$2,397.00	$190.54–$2,277.15	8% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI LT WRIST W/O CONTRAST	$1,677.90	$2,397.00	$190.54–$2,277.15	8% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI RT ELBOW W/O CONTRAST	$1,677.90	$2,397.00	$190.54–$2,277.15	8% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI LT SHOULDER W/O CONTRAST	$1,677.90	$2,397.00	$190.54–$2,277.15	8% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI RT SHOULDER W/O CONTRAST	$1,677.90	$2,397.00	$190.54–$2,277.15	8% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI LT ELBOW W/O CONTRAST	$1,677.90	$2,397.00	$190.54–$2,277.15	8% above	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIMITED (NON OB)	$296.80	$424.00	$85.48–$450.00	20% below	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 INGUINAL-GROIN ULTRASOUND	$296.80	$424.00	$85.48–$450.00	20% below	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BUTTOCK-SUPERFICIAL	$296.80	$424.00	$85.48–$450.00	20% below	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC (NON-OB) COMPLETE	$303.80	$434.00	$85.48–$450.00	37% below	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PELVIS SONOGRAM COMPLETE	$303.80	$434.00	$85.48–$450.00	37% below	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB 2-3RD TANSABD >14WKS	$363.30	$519.00	$85.48–$493.05	33% below	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OBS US EXAM,PG.UTERUS,COMPL	$363.30	$519.00	$85.48–$493.05	33% below	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB 1ST TRI TRANABD <14 WKS	$363.30	$519.00	$85.48–$493.05	28% below	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB SONOGRAM LIMITED	$363.30	$519.00	$85.49–$493.05	38% above	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB PORTABLE US LIMITED	$363.30	$519.00	$85.49–$493.05	38% above	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LTD 1 OR MORE	$363.30	$519.00	$85.49–$493.05	38% above	30%
Screening mammogram, both breasts both sides CPT 77067 MAMMO SCREENING BILATERAL	$359.10	$513.00	$75.58–$487.35	—	30%
Screening mammogram, both breasts CPT 77067 MAMMO SCREEN OCTOBER SPECIAL	$359.10	$513.00	$75.58–$487.35	28% above	30%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 BILAT SHOULDERS 2 VIEW ORTHO	$185.50	$265.00	$70.66–$450.00	—	30%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 BILATERAL SHOULDERS 2 VIEWS	$238.00	$340.00	$70.66–$450.00	—	30%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 ORTHO BILATERAL SHLDER MIN 3 V	$242.90	$347.00	$70.66–$450.00	—	30%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 BILATERAL SHOULDER MIN 2 VIEWS	$312.20	$446.00	$70.66–$450.00	—	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER ORTHO LT 2 VIEWS	$148.40	$212.00	$70.66–$450.00	32% below	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER ORTHO RT 2 VIEWS	$148.40	$212.00	$70.66–$450.00	32% below	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER LT WGT BEAR MIN 2 VI	$148.40	$212.00	$70.66–$450.00	32% below	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER LT 2 VIEWS	$148.40	$212.00	$70.66–$450.00	32% below	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER RT 2 VIEWS	$148.40	$212.00	$70.66–$450.00	32% below	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER ORTHO LEFT 3 VIEWS	$382.20	$546.00	$70.66–$518.70	76% above	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER LEFT MIN 3 VIEWS	$382.20	$546.00	$70.66–$518.70	76% above	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER ORTHO RIGHT 3 VIEWS	$382.20	$546.00	$70.66–$518.70	76% above	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER RIGHT MIN 3 VIEWS	$382.20	$546.00	$70.66–$518.70	76% above	30%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XRAY XM SWLNG FUNCJ CINER VIDE	$249.20	$356.00	$142.87–$450.00	33% below	30%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$303.80	$434.00	$85.48–$450.00	38% below	30%
Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL < 14 WEEKS	$314.30	$449.00	$85.49–$450.00	19% below	30%
Ultrasound of the abdomen, complete CPT 76700 COMPLETE ABDOMEN SONOGRAM	$795.20	$1,136.00	$85.48–$1,079.20	9% above	30%
Ultrasound of the scrotum and testicles CPT 76870 TESTICULAR SONOGRAM	$742.70	$1,061.00	$85.49–$1,007.95	24% above	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 NECK ULTRASOUND	$472.50	$675.00	$85.49–$641.25	23% below	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 THYROID SONOGRAM	$472.50	$675.00	$85.49–$641.25	23% below	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI SERIES WO KUB	$319.20	$456.00	$142.87–$450.00	34% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VENOUS INSUFFICIENCY EXT UNILA	$709.10	$1,013.00	$85.48–$962.35	18% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 DUPLEX SCAN EXT VEINS/LMT	$709.10	$1,013.00	$85.48–$962.35	18% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LOWER EXT RT LEG FOR CLOT	$709.10	$1,013.00	$85.48–$962.35	18% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 UPPER EXTREMITY UNILATERAL	$709.10	$1,013.00	$85.48–$962.35	18% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUPLEX SCAN EXT VEINS RIGHT	$709.10	$1,013.00	$85.48–$962.35	18% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUPLEX SCAN EXT VEINS LEFT	$709.10	$1,013.00	$85.48–$962.35	18% above	30%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 WRIST BILATERAL MIN 3 VIEWS	$170.80	$244.00	$70.66–$450.00	—	30%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 WRIST 3 VEIW BILATERAL ORTHO	$258.30	$369.00	$70.66–$450.00	—	30%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 WRIST BILATERAL CMPLTE MIN 3 V	$259.35	$370.50	$70.66–$450.00	—	30%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST LEFT MIN 3 VIEWS	$259.00	$370.00	$70.66–$450.00	10% above	30%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST RIGHT MIN 3 VIEWS	$259.00	$370.00	$70.66–$450.00	10% above	30%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST CMPLT ORTHO RIGHT MIN 3V	$259.00	$370.00	$70.66–$450.00	10% above	30%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST CMPLT ORTHO LEFT MIN 3VI	$259.00	$370.00	$70.66–$450.00	10% above	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 L HIP CMPL ORTHO 2-3 VIEWS	$186.20	$266.00	$70.66–$450.00	9% below	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 R HIP CMPL ORTHO 2-3 VIEWS	$186.20	$266.00	$70.66–$450.00	9% below	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 R HIP CMPL/UNILATERAL 2-3VIEWS	$186.20	$266.00	$70.66–$450.00	9% below	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 L HIP CMPL/UNILATERAL 2-3VIEWS	$186.20	$266.00	$70.66–$450.00	9% below	30%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN/PORTABLE SINGLE VIEW	$206.50	$295.00	$70.66–$450.00	8% below	30%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN SINGLE VIEW	$206.50	$295.00	$70.66–$450.00	8% below	30%
X-ray of the ankle, 2 views both sides CPT 73600 ANKLE BILATERAL ORTHO 2 VIEWS	$150.50	$215.00	$70.66–$450.00	—	30%
X-ray of the ankle, 2 views both sides CPT 73600 ANKLE 2 VIEW BILATERAL ORTHO	$269.50	$385.00	$70.66–$450.00	—	30%
X-ray of the ankle, 2 views both sides CPT 73600 ANKLE 2 VIEWS BILAT	$283.50	$405.00	$70.66–$450.00	—	30%
X-ray of the ankle, 2 views CPT 73600 ANKLE LTD ORTHO RIGHT2 VIEWS	$143.50	$205.00	$70.66–$450.00	33% below	30%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 1 VIEW ORTHO LEFT	$143.50	$205.00	$70.66–$450.00	33% below	30%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE LEFT LIMITED 2 VIEWS	$143.50	$205.00	$70.66–$450.00	33% below	30%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 1 VIEW ORTHO RIGHT	$143.50	$205.00	$70.66–$450.00	33% below	30%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE LIMITED/TWO VIEWS RIGHT	$143.50	$205.00	$70.66–$450.00	33% below	30%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE LTD ORTHO LEFT 2 VIEWS	$143.50	$205.00	$70.66–$450.00	33% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 RGHT FING 1ST DIG IV MIN 2 VIE	$143.50	$205.00	$70.66–$450.00	27% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LFT FING 5TH DIG IV MIN 2 VIEW	$143.50	$205.00	$70.66–$450.00	27% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LFT FNGER 4TH DIG IV MIN 2 VIE	$143.50	$205.00	$70.66–$450.00	27% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LFT FNGER 3RD DIG IV MIN 2 VIE	$143.50	$205.00	$70.66–$450.00	27% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LFT FING 1ST DIG IV MIN 2 VIEW	$143.50	$205.00	$70.66–$450.00	27% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LFT FING 1ST DIG IV MIN 2 VIE	$143.50	$205.00	$70.66–$450.00	27% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 RGHT FING 5TH DIG IV MIN 2 VIE	$143.50	$205.00	$70.66–$450.00	27% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 RGHT FING 4TH DIG ORTH MIN 2 V	$143.50	$205.00	$70.66–$450.00	27% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 RGHT FING 3RD DIG ORTH MIN 2VI	$143.50	$205.00	$70.66–$450.00	27% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 RGHT FING 2ND DIG IV MIN 2 VIE	$143.50	$205.00	$70.66–$450.00	27% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LHAND THIRD DIG ORTHO MIN 3V	$144.20	$206.00	$70.66–$450.00	27% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LFT FGER 5TH DIG ORTHO MIN 2VI	$168.00	$240.00	$70.66–$450.00	15% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 RGT FING 1ST DIG ORTHO MIN 2 V	$168.00	$240.00	$70.66–$450.00	15% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LFT FING 4TH DIGIT ORTHO MN 2V	$168.00	$240.00	$70.66–$450.00	15% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LFT FING 2ND DIG ORTHO MIN 2 V	$168.00	$240.00	$70.66–$450.00	15% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 RGT FING 5TH DIG ORTHO MIN 2 V	$168.00	$240.00	$70.66–$450.00	15% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 RGT FING 4TH DIG ORTHO MIN 2 V	$168.00	$240.00	$70.66–$450.00	15% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 RGHT FING 3RD DIG ORTHO MIN 2V	$168.00	$240.00	$70.66–$450.00	15% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LFT FING 3RD DIG ORTHO MIN 2 V	$168.00	$240.00	$70.66–$450.00	15% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LFT FING 1ST DIG ORTHO MIN 2 V	$168.00	$240.00	$70.66–$450.00	15% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 RGT FING 2ND DIG ORTHO MIN 2 V	$168.00	$240.00	$70.66–$450.00	15% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LHAND FIFTH DIG ORTHO MIN 3V	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LHAND FOURTH DIG ORHTO MIN 3 V	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LHAND SECOND DIGIT ORTH MIN 3V	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 R HAND 5TH DIGIT ORTHO MIN 3 V	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 R HAND 4TH DIGIT ORTHO MIN 3VI	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 R HAND 3RD DIGIT ORTHO MIN 3V	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 RHAND 2ND DIGIT ORTHO MIN 3 VI	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 LHAND, FOURTH DIGIT MIN 2 VIEW	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 L HAND, SECOND DIGIT MIN 2 VIE	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 R HAND, 5TH DIGIT MIN 2 VIEWS	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 R HAND,4TH DIGIT MIN 2 VIEWS	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views one side CPT 73140 RIGHT HAND THUMB MIN 2 VIEWS	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views one side CPT 73140 RIGHT HAND,SECOND DIGIT MIN 2V	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views one side CPT 73140 RIGHT HAND, THIRD DIGIT MIN 2V	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views one side CPT 73140 LEFT HAND, THIRD DIGIT MIN 2 V	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views one side CPT 73140 LEFT HAND, FIFTH DIGIT MIN 2 V	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views one side CPT 73140 LEFT HAND THUMB MIN 2 VIEWS	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views one side CPT 73140 RIGHT HAND THUMB ORTHO MIN 3 V	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the finger(s), 2 or more views one side CPT 73140 LEFT HAND THUMB ORTHO MIN 3 V	$189.00	$270.00	$70.66–$450.00	4% below	30%
X-ray of the foot, 2 views both sides CPT 73620 BILATERAL FOOT 2 VIEWS	$145.60	$208.00	$70.66–$450.00	—	30%
X-ray of the foot, 2 views both sides CPT 73620 BILAT FEET STANDING ORTH 2VIEW	$145.60	$208.00	$70.66–$450.00	—	30%
X-ray of the foot, 2 views both sides CPT 73620 BILATERAL FEET 2 VIEWS	$204.40	$292.00	$70.66–$450.00	—	30%
X-ray of the foot, 2 views both sides CPT 73620 BILATERAL FEET AP LATERAL 2 VI	$204.40	$292.00	$70.66–$450.00	—	30%
X-ray of the foot, 2 views one side CPT 73620 FOOT 1 VIEW LEFT	$74.90	$107.00	$67.41–$450.00	60% below	30%
X-ray of the foot, 2 views one side CPT 73620 FOOT 1 VIEW RIGHT	$74.90	$107.00	$67.41–$450.00	60% below	30%
X-ray of the foot, 2 views one side CPT 73620 FOOT 1 VIEW ORTHO LEFT	$143.50	$205.00	$70.66–$450.00	23% below	30%
X-ray of the foot, 2 views one side CPT 73620 FOOT 1 VIEW ORTHO RIGHT	$143.50	$205.00	$70.66–$450.00	23% below	30%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEWS RIGHT	$143.50	$205.00	$70.66–$450.00	23% below	30%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VEIWS ORTHO RIGHT	$143.50	$205.00	$70.66–$450.00	23% below	30%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEWS LEFT	$143.50	$205.00	$70.66–$450.00	23% below	30%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEWS ORTHO LEFT	$143.50	$205.00	$70.66–$450.00	23% below	30%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 BILATERAL FT COMPLETE MIN 3 VI	$205.80	$294.00	$70.66–$450.00	—	30%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 BILATERAL FEET 3 VIEWS ORTHO	$205.80	$294.00	$70.66–$450.00	—	30%
X-ray of the foot, complete, 3 or more views CPT 73630 R FOOT CMPL ORTHO MIN 3 VIEWS	$205.80	$294.00	$70.66–$450.00	16% below	30%
X-ray of the foot, complete, 3 or more views CPT 73630 L FOOT CMPL ORTHO MIN 3 VIEWS	$205.80	$294.00	$70.66–$450.00	16% below	30%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT 3 VIEWS RIGHT	$205.80	$294.00	$70.66–$450.00	16% below	30%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT 3 VIEWS LEFT	$205.80	$294.00	$70.66–$450.00	16% below	30%
X-ray of the hand, 3 or more views both sides CPT 73130 HAND BILAT COMP ORTHO MIN 3 VI	$448.00	$640.00	$70.66–$608.00	—	30%
X-ray of the hand, 3 or more views both sides CPT 73130 BILATERAL HANDS 3 VIEWS	$448.00	$640.00	$70.66–$608.00	—	30%
X-ray of the hand, 3 or more views CPT 73130 HAND CMPLT ORTHO L MIN 3 VIEWS	$448.00	$640.00	$70.66–$608.00	69% above	30%
X-ray of the hand, 3 or more views CPT 73130 HAND BILATER COMPLETE MIN 3 VI	$448.00	$640.00	$70.66–$608.00	69% above	30%
X-ray of the hand, 3 or more views CPT 73130 HAND CMPL ORTHO R MIN 3 VIEWS	$448.00	$640.00	$70.66–$608.00	69% above	30%
X-ray of the hand, 3 or more views one side CPT 73130 HAND COMPL LEFT MIN 3 VIEWS	$448.00	$640.00	$70.66–$608.00	69% above	30%
X-ray of the hand, 3 or more views one side CPT 73130 HAND COMPLETE 3 VIEWS RIGHT	$448.00	$640.00	$70.66–$608.00	69% above	30%
X-ray of the knee, 1 or 2 views both sides CPT 73560 KNEES 1 VIEW BILATERAL ORTHO	$221.90	$317.00	$70.66–$450.00	—	30%
X-ray of the knee, 1 or 2 views both sides CPT 73560 BILATERAL KNEES STAND 2 V ORTH	$275.10	$393.00	$70.66–$450.00	—	30%
X-ray of the knee, 1 or 2 views CPT 73560 L KNEE 1 VIEW ORTHO	$143.50	$205.00	$70.66–$450.00	23% below	30%
X-ray of the knee, 1 or 2 views CPT 73560 R KNEE 1 VIEW ORTHO	$143.50	$205.00	$70.66–$450.00	23% below	30%
X-ray of the knee, 1 or 2 views CPT 73560 KNEE BILATR COMPLETE 1/2 VIEWS	$168.00	$240.00	$70.66–$450.00	10% below	30%
X-ray of the knee, 1 or 2 views CPT 73560 L KNEE LIMITED VIEWS 1/2 VIEWS	$168.00	$240.00	$70.66–$450.00	10% below	30%
X-ray of the knee, 1 or 2 views CPT 73560 R KNEE LMTD 1/2 VIEWS	$168.00	$240.00	$70.66–$450.00	10% below	30%
X-ray of the knee, 1 or 2 views CPT 73560 R KNEE LTD ORTHO 2 VIEWS	$168.00	$240.00	$70.66–$450.00	10% below	30%
X-ray of the knee, 1 or 2 views CPT 73560 L KNEE LTD ORTHO 2 VIEWS	$168.00	$240.00	$70.66–$450.00	10% below	30%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1/2 VIEWS RT	$168.00	$240.00	$70.66–$450.00	10% below	30%
X-ray of the knee, 1 or 2 views one side CPT 73560 PATELLA RIGHT 1/2 VIEWS	$207.20	$296.00	$70.66–$450.00	11% above	30%
X-ray of the knee, 1 or 2 views one side CPT 73560 PATELLA LEFT 1/2 VIEWS	$207.20	$296.00	$70.66–$450.00	11% above	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMB SPINE LTD/AP LAT 2/3 VIE	$309.40	$442.00	$85.49–$450.00	9% below	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 L SPINE 2/3 VIEWS AP-LAT SPOT	$309.40	$442.00	$85.49–$450.00	9% below	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 L-SPINE LTD ORTHO 2/3 VIEWS	$309.40	$442.00	$85.49–$450.00	9% below	30%
X-ray of the lower back, 4 or more views CPT 72110 LUMBSPINE COMPL MIN 4V	$431.90	$617.00	$34.94	5% below	30%
X-ray of the lower back, 4 or more views CPT 72110 L-SPINE CMPL ORTHO MIN 4 VIEWS	$431.90	$617.00	$85.49–$586.15	5% below	30%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE CMPL MIN 4 VIEWS	$432.60	$618.00	$85.49–$587.10	5% below	30%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2 VIEW	$170.10	$243.00	$85.49–$450.00	36% below	30%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES COMPL MIN 3 VIEWS	$143.50	$205.00	$70.66–$450.00	39% below	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE ORTHO 2/3 VIEWS	$288.40	$412.00	$70.66–$450.00	1% above	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 C SPINE FLEXION/EXT 2/3 VIEWS	$288.40	$412.00	$70.66–$450.00	1% above	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVI SPINE LTD/AP LAT 2/3 VIE	$288.40	$412.00	$70.66–$450.00	1% above	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS ORTHO 1 OR 2 VIEWS	$309.40	$442.00	$85.49–$450.00	48% above	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 OR 2 VIEWS	$309.40	$442.00	$85.49–$450.00	48% above	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM AND COCCYX MIN 2 VIEWS	$202.30	$289.00	$70.66–$450.00	29% below	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SCARUM/COCCYX ORTHO MIN 2 VIEW	$202.30	$289.00	$70.66–$450.00	29% below	30%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Georgia	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (SGPT) P5P	$29.40	$42.00	$4.93–$450.00	8% below	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST (SGOT) P5P	$49.70	$71.00	$4.82–$450.00	59% above	30%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS B PRO PANEL	$203.70	$291.00	$44.30–$450.00	27% below	30%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PROFILE PANEL	$203.70	$291.00	$44.30–$450.00	27% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MUCOR RACEMOSUS IGE	$7.70	$11.00	$4.85–$450.00	73% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 EPICOCCUM PURPUR IGE	$7.70	$11.00	$4.85–$450.00	73% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 FUSARIUM PROLIFERATION IGE	$7.70	$11.00	$4.85–$450.00	73% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 SETOMELANOMMA ROSTRAT IGE	$7.70	$11.00	$4.85–$450.00	73% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 STEMPHYLIUM HERBARUM	$7.70	$11.00	$4.85–$450.00	73% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 LEMON ALLERGEN	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 COFFEE ALLERGEN	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CINNAMON ALLERGEN	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 WHEAT CULTIVATED AG	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 VANILLA ALLERGEN	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CHICKEN ALLERGEN	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CHOCOLATE ALLERGEN	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 GARLIC ALLERGEN	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 OAT ALLERGEN	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PORK ALLERGEN	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 TOMATO ALLERGEN	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PEPPER BLACK ALLERGEN	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ONION ALLERGEN	$9.80	$14.00	$4.85–$450.00	65% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 GLUTEN F79 ALLERGEN	$10.50	$15.00	$4.85–$450.00	63% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN,MOLD,PHOMA BETAE	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 COMMON RAGWEED	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 C HERBARUM ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 APPLE ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MAIZE ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MUSHROOM ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 BLACKBERRY ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 RASPBERRY ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALFALFA ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MUGWORT ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 WHITE HICKORY ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 WHITE MULBERRY AG	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 WHEAT ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 TRYPTASE	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 WALNUT ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 DOG DANDER ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN,FOOD,BEEF	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN,FOOD,PORK	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN,EPIDER & AMIMAL PROT	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 BARLEY ALLERGN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CLAM ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS FUMIGATUS IGE	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 SCALLOP ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CRAB ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 OYSTER ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 BIRCH TREE ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CEDAR TREES ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 SHEEP SORREL ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PTERONYSSINUS	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 SYCAMORE TREES ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 TIMOTHY GRASS ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 LOBSTER ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 BLUE MUSSEL ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 BEEF ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 POTOTO ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ELM ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 STRAWBERRY ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 LETTUCE ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CABBAGE ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CLADOSPORIUM AG CHILD	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 BLUEBERRY ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE AUREOBASIN PULL	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CAT DANDER ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIUM NATATUM ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 OAK ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 A ALTERNATE ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 BERMUDA GRASS ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 BANANA ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CORN ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 EGG WHITE ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MILK ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ORANGE ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PECAN ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 RICE ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PINE AG	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 SWEET GUM AG	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 SHRIMP ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 SOYBEAN ALLERGEN	$11.90	$17.00	$4.85–$450.00	58% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 BRAZIL NUT ALLERGEN	$12.60	$18.00	$4.85–$450.00	55% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PISTACHIO ALLERGEN	$12.60	$18.00	$4.85–$450.00	55% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 TUNA ALLERGEN	$12.60	$18.00	$4.85–$450.00	55% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 JOHNSON GRASS ALLERGEN	$12.60	$18.00	$4.85–$450.00	55% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 FLOUNDER ALLERGEN	$12.60	$18.00	$4.85–$450.00	55% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 TURKEY ALLERGEN	$12.60	$18.00	$4.85–$450.00	55% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MOSQUITO ALLERGEN	$14.70	$21.00	$4.85–$450.00	48% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MOUSE URINE ALLERGEN	$17.50	$25.00	$4.85–$450.00	38% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 COMMON REED ALLERGEN	$17.50	$25.00	$4.85–$450.00	38% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT F422	$19.60	$28.00	$4.85–$450.00	31% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT F427	$19.60	$28.00	$4.85–$450.00	31% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT F352	$19.60	$28.00	$4.85–$450.00	31% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT F423	$19.60	$28.00	$4.85–$450.00	31% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT F424	$19.60	$28.00	$4.85–$450.00	31% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HAMSTER EPI ALLERGEN	$20.30	$29.00	$4.85–$450.00	28% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MILK F78	$20.30	$29.00	$4.85–$450.00	28% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 RABBIT EPI ALLERGEN	$20.30	$29.00	$4.85–$450.00	28% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MILK F76	$20.30	$29.00	$4.85–$450.00	28% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MILK F77	$20.30	$29.00	$4.85–$450.00	28% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CRAYFISH ALLERGEN	$21.00	$30.00	$4.85–$450.00	26% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 RASTS,MOSQUITO	$21.70	$31.00	$4.85–$450.00	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 GREEN BEAN ALLERGAN	$23.80	$34.00	$4.85–$450.00	16% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 TEA ALLERGEN	$23.80	$34.00	$4.85–$450.00	16% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 SPINACH ALLERGEN	$23.80	$34.00	$4.85–$450.00	16% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HOUSEDUST MITES ALLERGEN	$24.50	$35.00	$4.85–$450.00	13% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 SALMON ALLERGEN	$24.50	$35.00	$4.85–$450.00	13% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 IMPORTED FIRE ANTS ALLERGEN	$24.50	$35.00	$4.85–$450.00	13% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CANDIDA ALBICANS AG	$25.20	$36.00	$4.85–$450.00	11% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MEADOW FESCUE AG	$25.20	$36.00	$4.85–$450.00	11% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 WHITE PINE ALLERGEN	$25.20	$36.00	$4.85–$450.00	11% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HORMODENDRUM CLADOSPORIUM	$25.20	$36.00	$4.85–$450.00	11% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MACADAMIA ALLERGEN	$25.20	$36.00	$4.85–$450.00	11% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS FAVUS IGG	$25.20	$36.00	$4.85–$450.00	11% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 SQUID ALLERGEN	$25.90	$37.00	$4.85–$450.00	8% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 WASP AG	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 WHITE HORNET AG	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 YELLOW HORNET AG	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PLANTAIN ENGLISH ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 BAHAI GRASS	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS FLAVUS IGE	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HELMINTHOSPORIUM HALO AG	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HONEY BEE AG	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IgE	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 BOX ELDER ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 COTTON WOOD ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 LAMBS QUARTER ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 COMMON PIGWEED ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PULLULANS ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PHOMA ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS NIGER IGE	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS NIGER IGG	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS FUMIGATUS IGG	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 LATEX ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 YELLOW JACKET AG	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 COW ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HAZEL NUT ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PEACH ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 WATY ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 COCKELBUR AG	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 GOLDEN ROD AG	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 RYE GRASS AG	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 OAT CULTIVATED AG	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 KENTUCKY BLUE GRASS	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ORCHARD GRASS ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALMOND ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 COCKROACH ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 MARSH ELDER	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 EGG YOLK ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 CASHEW ALLERGEN	$28.00	$40.00	$4.85–$450.00	1% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN TILAPIA	$35.00	$50.00	$4.85–$450.00	24% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 PINTO ALLERGEN	$37.80	$54.00	$4.85–$450.00	34% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 DEER ALLEGERN	$39.90	$57.00	$4.85–$450.00	41% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 RAST FOOD	$79.10	$113.00	$4.85–$450.00	180% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ECHINOCOCCUS IGE	$110.60	$158.00	$4.85–$450.00	292% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ECHIGE	$121.80	$174.00	$4.85–$450.00	332% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 RAST,FOOD (6->)	$151.20	$216.00	$4.85–$450.00	436% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 RAST SOUTHEAST	$169.40	$242.00	$4.85–$450.00	500% above	30%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULINATED	$141.40	$202.00	$12.04–$450.00	50% above	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA	$90.30	$129.00	$11.24–$450.00	2% below	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA DIRECT	$90.30	$129.00	$11.24–$450.00	2% below	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 SLE SCREEN	$90.30	$129.00	$11.24–$450.00	2% below	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 LUPUS ERYTHEMATOSUS (DNP)	$90.30	$129.00	$11.24–$450.00	2% below	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA (ANA-12)	$90.30	$129.00	$11.24–$450.00	2% below	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-TYPE NATRIURETIC PEPTIDE	$132.30	$189.00	$36.51–$450.00	9% above	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-proBNP	$182.00	$260.00	$36.51–$450.00	50% above	30%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$121.80	$174.00	$7.87–$450.00	5% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATH TISSUE PROC LEVEL IV	$182.00	$260.00	$42.13–$450.00	126% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATHOLOGY	$182.00	$260.00	$42.13–$450.00	126% above	30%
Blood culture for bacteria CPT 87040 BLOOD CULTURE	$149.10	$213.00	$9.60–$450.00	1% below	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$18.20	$26.00	$8.21–$450.00	36% above	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION FEE	$18.20	$26.00	$8.21–$450.00	36% above	30%
Blood glucose (sugar) test CPT 82947 GLUCOSE URINE QUANTITATIVE	$51.10	$73.00	$3.65–$450.00	38% above	30%
Blood glucose (sugar) test CPT 82947 GLUCOSE (URINE-QUANT) 24HR	$51.10	$73.00	$3.65–$450.00	38% above	30%
Blood glucose (sugar) test CPT 82947 GLUCOSE	$51.10	$73.00	$3.65–$450.00	38% above	30%
Blood lead test CPT 83655 LEAD/BLOOD OR URINE SCREEN	$18.20	$26.00	$10.00–$450.00	73% below	30%
Blood lead test CPT 83655 LEAD SCREEN	$18.20	$26.00	$10.00–$450.00	73% below	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 ER PREGANCY TEST (SERUM) QUAL	$163.80	$234.00	$6.99–$450.00	67% above	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGANCY TEST (SERUM) QUAL	$163.80	$234.00	$6.99–$450.00	67% above	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 RH	$172.20	$246.00	$3.75–$450.00	211% above	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 RH BLOOD TYPING SEROLOGIC ABO	$172.20	$246.00	$3.75–$450.00	211% above	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN,QUANT	$91.70	$131.00	$4.82–$450.00	3% above	30%
C. difficile toxin gene test (stool PCR) CPT 87493 CLOSTRIDIUM TOXIN A/B	$116.20	$166.00	$34.66–$450.00	32% above	30%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFFICLE TOXIN PCR	$116.20	$166.00	$34.66–$450.00	32% above	30%
CA 19-9 blood test (tumor marker) CPT 86301 CA19-9	$117.60	$168.00	$19.35–$450.00	22% above	30%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$158.90	$227.00	$19.35–$450.00	4% above	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID 19 PCR	$77.70	$111.00	$47.72–$450.00	9% below	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C TRACHOMATIS	$30.10	$43.00	$24.67–$450.00	64% below	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$159.60	$228.00	$12.45–$450.00	110% above	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID WITH LDL:HDL RATIO	$159.60	$228.00	$12.45–$450.00	110% above	30%
Complete blood count (CBC) with differential CPT 85025 CBC W DIFF	$82.60	$118.00	$7.23–$450.00	34% above	30%
Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFF	$120.40	$172.00	$6.02–$450.00	113% above	30%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$144.90	$207.00	$9.82–$450.00	1% below	30%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER	$179.90	$257.00	$9.47–$450.00	86% above	30%
DHEA sulfate (DHEA-S) blood test CPT 82627 DNEA-S	$87.50	$125.00	$20.67–$450.00	11% below	30%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEAS	$87.50	$125.00	$20.67–$450.00	11% below	30%
Estradiol blood test CPT 82670 ESTRADID FREE	$175.70	$251.00	$25.98–$450.00	46% above	30%
Estradiol blood test CPT 82670 ESTRADIOL	$175.70	$251.00	$25.98–$450.00	46% above	30%
Estradiol blood test CPT 82670 ESTRADIOL TOTAL	$175.70	$251.00	$25.98–$450.00	46% above	30%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$147.70	$211.00	$17.28–$450.00	17% above	30%
FSH (follicle-stimulating hormone) test CPT 83001 FSHP - FSH PEDIATRICS	$147.70	$211.00	$17.28–$450.00	17% above	30%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL	$127.40	$182.00	$18.26–$450.00	53% below	30%
Ferritin blood test (iron stores) CPT 82728 FERRITIN/RIA	$139.30	$199.00	$12.68–$450.00	51% above	30%
Folate (folic acid) blood test CPT 82746 FOLIC ACID	$133.00	$190.00	$13.67–$450.00	54% above	30%
Free T3 thyroid hormone test CPT 84481 T3 FREE (FT3)	$124.60	$178.00	$15.75–$450.00	13% above	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HYPERTHYROID	$108.50	$155.00	$8.39–$450.00	43% above	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE (FT4)	$108.50	$155.00	$8.39–$450.00	43% above	30%
Free testosterone test CPT 84402 TESTOSTERONE,FREE	$115.50	$165.00	$23.69–$450.00	28% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 DIABETIC PRENATAL SCREENING	$67.90	$97.00	$4.42–$450.00	9% above	30%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST 2HR	$147.70	$211.00	$11.97–$450.00	78% above	30%
Glucose tolerance test, 3 samples CPT 82951 TOLERANCE GTT 3 SPECIMENS	$147.70	$211.00	$11.97–$450.00	78% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N GONORRHEA	$97.30	$139.00	$21.42–$450.00	18% above	30%
H. pylori antibody blood test CPT 86677 H PYLORI IgA	$81.20	$116.00	$15.67–$450.00	36% below	30%
H. pylori antibody blood test CPT 86677 H-PYLORI IgG	$81.20	$116.00	$15.67–$450.00	36% below	30%
H. pylori antibody blood test CPT 86677 H-PYLORI IgM	$81.20	$116.00	$15.67–$450.00	36% below	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV RNA,PCR QUANT	$82.60	$118.00	$56.50–$450.00	76% below	30%
HIV-1 and HIV-2 antibody test CPT 86703 RAPID HIV	$144.20	$206.00	$12.75–$450.00	31% above	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C	$109.90	$157.00	$9.03–$450.00	104% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY	$116.20	$166.00	$9.99–$450.00	51% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB	$116.20	$166.00	$9.99–$450.00	51% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB QT	$116.20	$166.00	$9.99–$450.00	51% above	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG	$76.30	$109.00	$9.61–$450.00	17% above	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGEN	$76.30	$109.00	$9.61–$450.00	17% above	30%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$175.70	$251.00	$10.00–$450.00	46% above	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPCRNARTR	$109.90	$157.00	$39.84–$450.00	60% below	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C RNA b DNA	$109.90	$157.00	$39.84–$450.00	60% below	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C VIRUS RNA-QUANT REAL TM	$109.90	$157.00	$39.84–$450.00	60% below	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C RNA(DNA-PCR) QUANT	$109.90	$157.00	$39.84–$450.00	60% below	30%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES I IgM	$57.40	$82.00	$12.27–$450.00	15% below	30%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES I IgG	$57.40	$82.00	$12.27–$450.00	15% below	30%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES II IgM	$58.80	$84.00	$18.00–$450.00	8% below	30%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES II IgG	$58.80	$84.00	$18.00–$450.00	8% below	30%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN,HS	$101.50	$145.00	$12.04–$450.00	14% above	30%
Insulin blood test CPT 83525 ASSAY OF INSULIN	$45.50	$65.00	$10.63–$450.00	38% below	30%
Iron blood test (serum iron) CPT 83540 IRON (FE)	$91.00	$130.00	$6.02–$450.00	79% above	30%
Iron-binding capacity (TIBC) test CPT 83550 TIBC (BINDING CAPACITY)	$114.80	$164.00	$8.13–$450.00	101% above	30%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$219.10	$313.00	$8.07–$450.00	152% above	30%
LH (luteinizing hormone) test CPT 83002 LH (LUTENIZING HORMINE)	$158.20	$226.00	$17.22–$450.00	124% above	30%
LH (luteinizing hormone) test CPT 83002 LHPED - LH PEDIATRICS	$158.20	$226.00	$17.22–$450.00	124% above	30%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$133.70	$191.00	$6.41–$450.00	52% above	30%
Liver function blood test panel CPT 80076 HEPATIC PROFILE PANEL	$156.80	$224.00	$7.60–$450.00	48% above	30%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODIES	$268.80	$384.00	$15.84–$450.00	173% above	30%
Lyme disease antibody test CPT 86618 LYME ANTIBODIES,CSF	$268.80	$384.00	$15.84–$450.00	173% above	30%
Magnesium blood test CPT 83735 MAGNESIUM	$61.60	$88.00	$6.23–$450.00	37% above	30%
Magnesium blood test CPT 83735 MAGNESIUM STOOL	$61.60	$88.00	$6.23–$450.00	37% above	30%
Magnesium blood test CPT 83735 MAGANESIUM	$61.60	$88.00	$6.23–$450.00	37% above	30%
Magnesium blood test CPT 83735 MAGNESIUM STONE RISK	$61.60	$88.00	$6.23–$450.00	37% above	30%
Magnesium blood test CPT 83735 MAGNESIUM URINE	$61.60	$88.00	$6.23–$450.00	37% above	30%
Measles (rubeola) antibody test CPT 86765 MEASLE,IGM (RUBEOLA)	$60.20	$86.00	$11.98–$450.00	24% below	30%
Measles (rubeola) antibody test CPT 86765 RUBEOLA IgG	$60.20	$86.00	$11.98–$450.00	24% below	30%
Obstetric blood test panel CPT 80055 PRENATAL PANEL	$72.80	$104.00	$28.08–$450.00	41% below	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 FREE PSA	$133.70	$191.00	$17.10–$450.00	62% above	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA HEALTH FAIR TOTAL	$18.20	$26.00	$17.10–$450.00	82% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA	$136.50	$195.00	$17.10–$450.00	35% above	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA SCREENING TOTAL	$136.50	$195.00	$17.10–$450.00	35% above	30%
Parathyroid hormone (PTH) blood test CPT 83970 PTH OR PTH INTACT	$156.10	$223.00	$38.39–$450.00	4% below	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME	$109.20	$156.00	$5.59–$450.00	123% above	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT MIXING	$109.20	$156.00	$5.59–$450.00	123% above	30%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 MATERNI T21 PLUS CORE	$1,252.30	$1,789.00	$450.00–$1,699.55	29% above	30%
Progesterone blood test CPT 84144 PROGESTERONE, ANY METHOD	$189.00	$270.00	$19.40–$450.00	94% above	30%
Prolactin blood test CPT 84146 PROLACTIN ICMA	$138.60	$198.00	$18.02–$450.00	13% above	30%
Prolactin blood test CPT 84146 MACRO PROLACTIN	$138.60	$198.00	$18.02–$450.00	13% above	30%
Prolactin blood test CPT 84146 PROLACTIN (MAMOTHROPHIN)	$138.60	$198.00	$18.02–$450.00	13% above	30%
Prothrombin time (PT/INR) clotting test CPT 85610 COUMADIN CLINIC INR	$60.20	$86.00	$3.99–$450.00	54% above	30%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$78.40	$112.00	$3.99–$450.00	101% above	30%
Prothrombin time (PT/INR) clotting test CPT 85610 PT 1:1 MIX	$78.40	$112.00	$3.99–$450.00	101% above	30%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A SCREEN RAPID	$41.30	$59.00	$15.08–$450.00	43% below	30%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA B	$65.80	$94.00	$15.08–$450.00	10% below	30%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA	$65.80	$94.00	$15.08–$450.00	10% below	30%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A	$65.80	$94.00	$15.08–$450.00	10% below	30%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP SCREEN RAPID	$38.50	$55.00	$15.08–$450.00	47% below	30%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP SCREEN	$69.30	$99.00	$15.08–$450.00	4% below	30%
Rheumatoid factor (RF) test CPT 86431 RF IgA	$91.70	$131.00	$5.27–$450.00	22% above	30%
Rheumatoid factor (RF) test CPT 86431 RF IgM	$91.70	$131.00	$5.27–$450.00	22% above	30%
Rheumatoid factor (RF) test CPT 86431 RF IgG	$91.70	$131.00	$5.27–$450.00	22% above	30%
Rheumatoid factor (RF) test CPT 86431 RA FACTOR TEST,QUANTITATIVE	$91.70	$131.00	$5.27–$450.00	22% above	30%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR	$91.70	$131.00	$5.27–$450.00	22% above	30%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODIES IGM	$66.50	$95.00	$13.38–$450.00	4% below	30%
Rubella antibody test (immunity check) CPT 86762 RUBELLA	$66.50	$95.00	$13.38–$450.00	4% below	30%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODIES IgG	$66.50	$95.00	$13.38–$450.00	4% below	30%
Rubella antibody test (immunity check) CPT 86762 RUBELLA SCREEN	$66.50	$95.00	$13.38–$450.00	4% below	30%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS (FERTILITY)	$180.60	$258.00	$7.25–$450.00	67% above	30%
Stool ova and parasites exam CPT 87177 CRYSTOSPORDIUM	$105.70	$151.00	$8.28–$450.00	30% above	30%
Stool ova and parasites exam CPT 87177 OVA AND PARASITE (O&P)	$105.70	$151.00	$8.28–$450.00	30% above	30%
Stool ova and parasites exam CPT 87177 O&P (INC OCCULT BLOOD)	$105.70	$151.00	$8.28–$450.00	30% above	30%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD	$35.00	$50.00	$4.04–$450.00	27% below	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD FECAL IMMUNOASSAY	$60.90	$87.00	$14.81–$450.00	69% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 FTA	$84.00	$120.00	$3.97–$450.00	98% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL,QUALITATIVE	$84.00	$120.00	$3.97–$450.00	98% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RAPID PLASMA REAGIN	$84.00	$120.00	$3.97–$450.00	98% above	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB	$87.50	$125.00	$57.64–$450.00	47% below	30%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE	$184.10	$263.00	$24.00–$450.00	40% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE,TOTAL	$184.10	$263.00	$24.00–$450.00	40% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANIT-MICROSOMAL ANTI (ANA-12)	$170.80	$244.00	$13.53–$450.00	85% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTI-THYROGLOBULIN (ANA-12)	$170.80	$244.00	$13.53–$450.00	85% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSOME	$170.80	$244.00	$13.53–$450.00	85% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 URTICARIA	$170.80	$244.00	$13.53–$450.00	85% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID-MICROSOMAL ANTIBODIES	$170.80	$244.00	$13.53–$450.00	85% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTI-MICROSOMAL ANTIBODY	$170.80	$244.00	$13.53–$450.00	85% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE	$123.20	$176.00	$15.62–$450.00	24% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH THYROID STIM. HORMONE	$123.20	$176.00	$15.62–$450.00	24% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMU HORMONE 3RD GEN	$123.20	$176.00	$15.62–$450.00	24% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH 3RD GENERATION	$123.20	$176.00	$15.62–$450.00	24% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$123.20	$176.00	$15.62–$450.00	24% above	30%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAG	$97.30	$139.00	$21.42–$450.00	7% above	30%
Uric acid blood test CPT 84550 URIC ACID	$64.40	$92.00	$4.20–$450.00	17% above	30%
Urinalysis with microscope exam, automated CPT 81001 STOOL REDUCING SUBSTANCES	$59.50	$85.00	$2.95–$450.00	6% below	30%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS	$59.50	$85.00	$2.95–$450.00	6% below	30%
Urinalysis with microscope exam, manual CPT 81000 PH/REDUCING SUB	$17.50	$25.00	$3.74–$450.00	55% below	30%
Urinalysis with microscope exam, manual CPT 81000 SPECIFIC GRAVITY	$17.50	$25.00	$3.74–$450.00	55% below	30%
Urinalysis without microscope exam, automated CPT 81003 TOLERANCE URINE #7	$6.30	$9.00	$2.09–$450.00	83% below	30%
Urinalysis without microscope exam, automated CPT 81003 TOLERANCE URINE #1	$7.00	$10.00	$2.09–$450.00	81% below	30%
Urinalysis without microscope exam, automated CPT 81003 UA DIP STICK	$7.00	$10.00	$2.09–$450.00	81% below	30%
Urinalysis without microscope exam, automated CPT 81003 TOLERANCE URINE #4	$7.00	$10.00	$2.09–$450.00	81% below	30%
Urinalysis without microscope exam, automated CPT 81003 TOLERANCE URINE #3	$7.00	$10.00	$2.09–$450.00	81% below	30%
Urinalysis without microscope exam, automated CPT 81003 TOLERANCE URINE #2	$7.00	$10.00	$2.09–$450.00	81% below	30%
Urinalysis without microscope exam, automated CPT 81003 KEYTONE	$8.40	$12.00	$2.09–$450.00	77% below	30%
Urinalysis without microscope exam, automated CPT 81003 TOLERANCE URINE #5	$17.50	$25.00	$2.09–$450.00	52% below	30%
Urinalysis without microscope exam, automated CPT 81003 TOLERANCE URINE #6	$17.50	$25.00	$2.09–$450.00	52% below	30%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTOMATED W/O MICRO	$18.90	$27.00	$2.09–$450.00	48% below	30%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$23.10	$33.00	$3.21–$450.00	37% below	30%
Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK W/O MICROSCOPE	$23.80	$34.00	$3.21–$450.00	35% below	30%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE	$88.90	$127.00	$7.51–$450.00	4% above	30%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$25.90	$37.00	$7.96–$450.00	67% below	30%
Urine pregnancy test, read by color change CPT 81025 BETA HCG URINE	$51.80	$74.00	$7.96–$450.00	35% below	30%
Urine pregnancy test, read by color change CPT 81025 URINE PREG TEST BY VISUAL COLL	$51.80	$74.00	$7.96–$450.00	35% below	30%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST URINE	$51.80	$74.00	$7.96–$450.00	35% below	30%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$130.20	$186.00	$14.02–$450.00	61% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25 HYDROXY VITAMIN D2/D3	$154.70	$221.00	$27.53–$450.00	44% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25-HYDROXY	$154.70	$221.00	$27.53–$450.00	44% above	30%
Zinc blood test CPT 84630 ZINC,URINE OR BLOOD	$58.80	$84.00	$10.59–$450.00	9% below	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 PREGANCY TEST (SERUM) HCVQUANT	$248.50	$355.00	$8.07–$450.00	107% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG REFERENCE OUT	$248.50	$355.00	$8.07–$450.00	107% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 ER PREGNANCY TEST (SERUM)QUANT	$248.50	$355.00	$8.07–$450.00	107% above	30%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Georgia	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MAMMO GUIDED RT BREAST BIOPSY	$1,969.80	$2,814.00	$450.00–$2,673.30	12% below	30%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MAMMO GUIDED LT BREAST BIOPSY	$1,969.80	$2,814.00	$450.00–$2,673.30	12% below	30%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 FX FIBULA DIST CLSD NO MANIP	$255.50	$365.00	$183.38–$881.00	57% below	30%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 FX METATARSAL CLSD NO MANIP EA	$255.50	$365.00	$183.38–$881.00	68% below	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 EXT CARDIOVERSION ELECTIVE	$649.60	$928.00	$450.00–$881.60	56% below	30%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX	$542.50	$775.00	$450.00–$1,075.52	54% below	30%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION <28 DAYS	$605.50	$865.00	$450.00–$913.90	60% below	30%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 FX RAD DIST CLSD NO MANIP	$255.50	$365.00	$183.38–$881.00	59% below	30%
Colonoscopy with tissue sample CPT 45380 OR COLONOSCOPY FLEX W/BIOPSY	$5,637.80	$8,054.00	$450.00–$7,651.30	305% above	30%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION 1 LES BENIGN CRYFR	$48.30	$69.00	$43.47–$450.00	71% below	30%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM OF IMPACTD CERUMEN LAV IRR	$35.70	$51.00	$32.13–$450.00	65% below	30%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED CERUMEN IRRIGA	$77.00	$110.00	$47.56–$881.00	25% below	30%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPACTED CERUMEN W LAV IRR	$114.80	$164.00	$47.56–$450.00	11% above	30%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED CERUMEN INSTRU	$38.50	$55.00	$34.65–$450.00	89% below	30%
Earwax removal with instruments, one ear CPT 69210 REM IMPACTED CERUMEN W INSTRUM	$114.80	$164.00	$47.56–$450.00	68% below	30%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED CERUMEN 1/BOTH	$114.84	$164.05	$47.56–$881.00	68% below	30%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY ENDOMETRIUM	$278.60	$398.00	$154.94–$881.00	15% below	30%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRAL BIOPSY W/O DILATION	$278.60	$398.00	$154.94–$450.00	15% below	30%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ SUB CERV/THOR W GUIDE	$886.90	$1,267.00	$450.00–$1,203.65	41% below	30%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 OR FLEX SIGMOIDOSCOPY DIAGNOST	$1,303.40	$1,862.00	$450.00–$1,768.90	2% above	30%
Hemorrhoid banding (rubber band ligation) CPT 46221 HEMORRHOID LIG INT RUBBER BAND	$1,203.30	$1,719.00	$450.00–$1,633.05	13% below	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATH/INTRO SALINE OR CONT MATL	$519.40	$742.00	$450.00–$704.90	17% below	30%
IUD insertion (the device itself billed separately) CPT 58300 OR INSERTION OF IUD	$518.00	$740.00	$450.00–$703.00	11% above	30%
IUD insertion (the device itself billed separately) CPT 58300 INSERTION OF IUD	$518.00	$740.00	$450.00–$703.00	11% above	30%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D SINGLE OR SIMPLE	$88.20	$126.00	$79.38–$450.00	86% below	30%
Incision and drainage of a simple or single skin abscess CPT 10060 ABSCESS SKIN/SQ SMPL OR SINGLE	$263.90	$377.00	$155.66–$881.00	59% below	30%
Incision and drainage of a simple or single skin abscess CPT 10060 TR DRAINAGE OF SKIN ABCESS	$263.90	$377.00	$155.66–$450.00	59% below	30%
Incision and drainage of a simple or single skin abscess CPT 10060 SIMPLE INCISION & DRAINAGE	$264.00	$377.14	$155.66–$450.00	59% below	30%
Incision and drainage of a simple or single skin abscess CPT 10060 PF DRAINAGE OF SKIN ABSCESS	$287.70	$411.00	$99.84	55% below	30%
Incision and drainage of a simple or single skin abscess CPT 10060 ABS INCISION & DRAIN SMPL SGLE	$449.40	$642.00	$155.66–$609.90	30% below	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION, TENDON, LIGAMENT	$136.50	$195.00	$122.85–$450.00	88% below	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TNDN SHTH/LIGMNT, SINGLE	$297.50	$425.00	$230.31–$881.00	75% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJEC,JNT/BURSA/KNEE,HIP,SHLDR	$175.00	$250.00	$157.50–$450.00	81% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTES ASP/INJ JNT WO GU	$497.70	$711.00	$230.31–$675.45	45% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 OBS DRAIN/INJ JOINT BURSA	$497.70	$711.00	$230.31–$675.45	45% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS ASP/INJ JOINT	$497.70	$711.00	$230.31–$675.45	45% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 CT ASPIR/INJECT JNT W/O US GU	$497.70	$711.00	$230.31–$675.45	45% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHRO INJ LTD RSHOULDER W/O G	$497.70	$711.00	$230.31–$675.45	45% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHRO INJ LTD LSHLDER W/O GUI	$497.70	$711.00	$230.31–$675.45	45% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 CT ASPIR/INJECT JOINT BURSA	$497.70	$711.00	$230.31–$675.45	45% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROGRAM HIP W/INJ PAIN MED	$497.70	$711.00	$230.31–$675.45	45% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ HIP ARTHOGRAM W/O ANES	$497.70	$711.00	$230.31–$675.45	45% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASP/INJ JNT/BURSA MAJ W/O U/S	$497.70	$711.00	$230.31–$881.00	45% below	30%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG DELIVERY IMPLANT	$241.50	$345.00	$99.33–$450.00	53% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIRATION JOINT/BURSA	$54.60	$78.00	$49.14–$450.00	93% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIRATE/INJ JOINT/BEDSIDE	$366.10	$523.00	$230.31–$496.85	51% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASP/INJ JNT/BURSA INT W/O U/S	$366.10	$523.00	$230.31–$881.00	51% below	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN INJ JOINT BURSA WO US	$39.90	$57.00	$35.91–$450.00	92% below	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASP/INJ JNT/BURSA SML W/O U/S	$366.10	$523.00	$230.31–$881.00	26% below	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAC INT SCLP/TNK/EXT 2.5CM OR<	$213.50	$305.00	$192.15–$881.00	55% below	30%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ SUB LUMBAR/SACRAL W GUIDE	$886.90	$1,267.00	$450.00–$1,203.65	34% below	30%
Lower-back epidural injection, without imaging guidance CPT 62322 INJ SUB LUMBAR/SACRAL WO GUIDE	$886.90	$1,267.00	$450.00–$1,219.44	47% below	30%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC SKIN FACE 0.5 CM OR <	$469.00	$670.00	$422.10–$941.28	21% below	30%
Nail removal (partial or complete), one nail CPT 11730 PF REMOVAL OF NAIL PLATE	$135.80	$194.00	$51.48	80% below	30%
Nail removal (partial or complete), one nail CPT 11730 OBS RML SIMPLE SING NAIL PLATE	$362.60	$518.00	$155.68–$492.10	46% below	30%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SIMP QTY 1	$362.60	$518.00	$155.68–$492.10	46% below	30%
Nail removal (partial or complete), one nail CPT 11730 AVULSE NAIL PLATE SINGLE	$362.60	$518.00	$155.68–$881.00	46% below	30%
Paracentesis with imaging guidance CPT 49083 US PARACENT W/US GUID ABDOMIN	$1,142.40	$1,632.00	$450.00–$1,550.40	27% below	30%
Paracentesis with imaging guidance CPT 49083 US PARACENTE W/ IMAGING ABDOMI	$1,142.40	$1,632.00	$450.00–$1,550.40	27% below	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION/REMOVAL OF NAIL	$136.50	$195.00	$122.85–$533.46	85% below	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 PF REMOVAL OF NAIL BED	$247.80	$354.00	$96.57	73% below	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL & MATRIX	$645.40	$922.00	$310.07–$881.00	31% below	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION NAIL/MATRIX PERM REMO	$645.40	$922.00	$310.07–$875.90	31% below	30%
Removal of a foreign object under the skin, simple CPT 10120 PF REMOVE FOREIGN BODY	$247.80	$354.00	$99.05	78% below	30%
Removal of a foreign object under the skin, simple CPT 10120 INCIS REMV FOREIGN BODY SUB SI	$645.40	$922.00	$310.07–$875.90	42% below	30%
Removal of a foreign object under the skin, simple CPT 10120 FB REMOVAL SQ W/INC SMPL	$645.40	$922.00	$310.07–$881.00	42% below	30%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLONOSCOPY SCREEN-NOT HI RISK	$2,695.70	$3,851.00	$450.00–$3,658.45	77% above	30%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY SCREEN-HIGH RISK	$2,695.70	$3,851.00	$450.00–$3,658.45	77% above	30%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 OR LITHOTRIPSY	$10,395.00	$14,850.00	$450.00–$14,107.50	15% below	30%
Short arm cast (elbow to hand) CPT 29075 OT APPL PL FIG 8 ELBOW TO FING	$322.00	$460.00	$208.83–$450.00	64% below	30%
Short arm cast (elbow to hand) CPT 29075 APPLY CAST SHORT ARM	$322.00	$460.00	$208.83–$881.00	64% below	30%
Short arm splint (forearm and hand) CPT 29125 OBS APPLY FOREARM SPLINT	$215.60	$308.00	$99.33–$450.00	44% below	30%
Short arm splint (forearm and hand) CPT 29125 APPLICATION SHORT ARM SPLINT	$215.60	$308.00	$99.33–$450.00	44% below	30%
Short arm splint (forearm and hand) CPT 29125 OT APPL SHORT ARM SPLT STATIC	$215.60	$308.00	$99.33–$450.00	44% below	30%
Short arm splint (forearm and hand) CPT 29125 APPLY SPLINT SHORT ARM, STATIC	$215.60	$308.00	$99.33–$881.00	44% below	30%
Short leg cast (below the knee) CPT 29405 APPLY CAST SHORT LEG	$203.70	$291.00	$183.33–$881.00	40% below	30%
Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT	$299.60	$428.00	$122.53–$450.00	24% below	30%
Short leg splint (calf to foot) CPT 29515 APPLY SPLINT SHORT LEG	$299.60	$428.00	$122.53–$881.00	24% below	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 OBS RPR SUPERFICIAL WOUND <2.5	$361.20	$516.00	$155.68–$490.20	12% above	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 LAC SP SCLP/TRK/EXT 2.5CM OR<	$361.20	$516.00	$155.68–$881.00	12% above	30%
Skin biopsy, punch, one lesion CPT 11104 PF PUNCH BX SKIN SINGLE LESION	$122.50	$175.00	$44.49	79% below	30%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$362.60	$518.00	$310.07–$533.46	38% below	30%
Skin biopsy, punch, one lesion CPT 11104 PUNCH SKIN BIOPSY SNGLE LESION	$362.60	$518.00	$310.07–$533.46	38% below	30%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC MAL LES TRUNK ARM LEG 0.5C	$130.90	$187.00	$117.81–$941.28	79% below	30%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC CA TRUNK/EXT 0.5 CM OR <	$942.90	$1,347.00	$450.00–$1,279.65	49% above	30%
Skin tag removal, up to 15 tags CPT 11200 REMOVE SKIN TAG 1-15 LESIONS	$305.90	$437.00	$155.68–$881.00	3% below	30%
Skin tag removal, up to 15 tags CPT 11200 REM SKIN TAG 1-15 LESI BEDSIDE	$305.90	$437.00	$155.68–$450.00	3% below	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 TR DX LUMBAR SPINAL PUNCTURE	$1,384.60	$1,978.00	$450.00–$1,879.10	9% above	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 OBS SPINAL FLUID TAP DIAGNOSTI	$1,384.60	$1,978.00	$450.00–$1,879.10	9% above	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LUMBAR SPINAL PUNCTURE	$1,384.60	$1,978.00	$450.00–$1,879.10	9% above	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 ER DX LUMBAR SPINAL PUNCTURE	$1,384.60	$1,978.00	$450.00–$1,879.10	9% above	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 BS DX LUMBAR SPINAL PUNCTURE	$1,384.60	$1,978.00	$450.00–$1,879.10	9% above	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR SPRFICIAL WOUND 2.6-7.5CM	$543.20	$776.00	$155.68–$737.20	36% above	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 LAC SP SCLP/TRK/EXT 2.6-7.5CM	$543.20	$776.00	$155.68–$881.00	36% above	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 LAC SP SCP/TRK/EX 2.6-7.5CM BS	$543.20	$776.00	$155.68–$737.20	36% above	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR SUPERFICIAL WND 2.6-7.5	$543.20	$776.00	$155.68–$737.20	36% above	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR LAC < 2.5CM	$543.20	$776.00	$155.68–$737.20	53% above	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 LAC SMPL FACE 2.5CM OR <	$543.20	$776.00	$155.68–$881.00	53% above	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOP SKIN SGL LESIO	$72.10	$103.00	$64.89–$450.00	87% below	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 PF TANGNTL BX SKIN SINGLE LES	$98.00	$140.00	$35.77	83% below	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LESION	$362.60	$518.00	$155.66–$492.10	35% below	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL SKIN BIOPSY SGL LES	$362.60	$518.00	$155.66–$492.10	35% below	30%
Thoracentesis with imaging guidance CPT 32555 US THORACENTE W IMAGE CATH/NEE	$1,335.60	$1,908.00	$450.00–$1,812.60	5% below	30%
Trigger point injections, 1 or 2 muscles CPT 20552 TWO TRIGGER POINT INJECTIONS	$103.60	$148.00	$93.24–$450.00	91% below	30%
Trigger point injections, 1 or 2 muscles CPT 20552 OR TRIGGER POINT INJ, 1 OR 2	$366.10	$523.00	$230.31–$496.85	70% below	30%
Trigger point injections, 1 or 2 muscles CPT 20552 TRIGGER PNT INJ 1-2- MUSCLES	$366.10	$523.00	$230.31–$881.00	70% below	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 NEEDLE LOC BREAST 1ST LESION	$3,066.70	$4,381.00	$450.00–$4,161.95	40% above	30%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30 MM	$2,855.30	$4,079.00	$450.00–$3,875.05	37% above	30%
Upper endoscopy (EGD) with biopsy CPT 43239 OBS UPPER GASTROINTEST ENDO	$465.50	$665.00	$418.95–$1,212.75	67% below	30%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 OR EGD FLEX TRANS REM BY SNARE	$2,595.60	$3,708.00	$450.00–$3,522.60	95% above	30%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LES TO 14	$80.50	$115.00	$72.45–$450.00	93% below	30%
Wart removal, up to 14 warts CPT 17110 DESTRUCT BENIGN LESIONS, #1-14	$278.60	$398.00	$155.68–$881.00	75% below	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SKIN SUBCUTANEOUS TISSUE	$98.00	$140.00	$88.20–$533.46	91% below	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 PF DEB SUBQ TISSUE 20 SQ CM<	$150.50	$215.00	$57.66	87% below	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SQ,1ST 20 SQCM OR LESS	$558.60	$798.00	$310.07–$881.00	50% below	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SQ,1ST 20 SQCM OR<BEDS	$558.60	$798.00	$310.07–$758.10	50% below	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SUBQ 1ST 20 SQ CM OR <	$645.40	$922.00	$310.07–$875.90	43% below	30%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Georgia	Off list
Blood transfusion (giving blood or blood components) CPT 36430 OB BLOOD TRANSFUSION 2+ UNITS	$472.50	$675.00	$337.56–$641.25	39% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 SDC BLOOD TRANSFUSION SERVICES	$472.50	$675.00	$337.56–$641.25	39% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 ER BLOOD TRANSFUSION SERVICE	$472.50	$675.00	$337.56–$641.25	39% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 SDC TRANSFUSION BLOOD/COMPONEN	$472.50	$675.00	$337.56–$641.25	39% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION SERVICE	$472.50	$675.00	$337.56–$641.25	39% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 TR BLOOD TRANSFUSION SERVICE	$472.50	$675.00	$337.56–$641.25	39% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 OB BLOOD TRANSFUSION 1 UNIT	$472.50	$675.00	$337.56–$641.25	39% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION/COMPONENT	$546.00	$780.00	$337.56–$741.00	29% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER TX	$42.00	$60.00	$37.80–$450.00	76% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INHALATION TX FOR ACUTE AIRWAY	$152.60	$218.00	$137.34–$450.00	14% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SVN RX	$222.60	$318.00	$165.86–$450.00	26% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI TX	$222.60	$318.00	$165.86–$450.00	26% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB SUBSEQUENT	$257.60	$368.00	$165.86–$450.00	45% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZ PAP TX	$257.60	$368.00	$165.86–$450.00	45% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI SUBSEQUENT TREATMENT	$257.60	$368.00	$165.86–$450.00	45% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB INITIAL	$257.60	$368.00	$165.86–$450.00	45% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INITIAL EZ PAP TX	$257.60	$368.00	$165.86–$450.00	45% above	30%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE HOUR 1	$476.00	$680.00	$204.74	74% below	30%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 1ST 30-74 MIN	$1,381.80	$1,974.00	$450.00–$1,875.30	24% below	30%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG WITH INTERPRETATION	$63.70	$91.00	$57.33–$450.00	128% above	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$198.10	$283.00	$47.56–$450.00	4% above	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL 1 MAYX REQ PHYS/QHP	$121.10	$173.00	$69.03–$881.00	53% below	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL 2 SF MDM	$312.20	$446.00	$127.18–$881.00	18% below	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL 3 LOW MDM	$469.00	$670.00	$221.87–$881.00	26% below	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL 4 MOD MDM	$784.00	$1,120.00	$344.42–$1,064.00	3% below	30%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL 5	$1,136.10	$1,623.00	$450.00–$1,541.85	1% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV FLUIDS	$143.50	$205.00	$129.15–$450.00	51% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION INITIAL 31MIN-1 HR	$333.90	$477.00	$166.67–$453.15	15% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION INITIAL 31-60 MIN	$333.90	$477.00	$166.67–$881.00	15% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OB IV INF INITIAL 31MIN-1HR	$333.90	$477.00	$166.67–$453.15	15% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 TR IV INFUSION,HYDRATIN < 1HR	$333.90	$477.00	$166.67–$453.15	15% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION INITIAL 31MIN-1HR	$333.90	$477.00	$166.67–$453.15	15% above	30%
IV infusion of a medicine, first hour CPT 96365 NEWBORN IV INFUSION,UP TO 1 HR	$463.40	$662.00	$166.67–$628.90	59% above	30%
IV infusion of a medicine, first hour CPT 96365 OBS IV INFUSION UP TO 1 HR	$463.40	$662.00	$166.67–$628.90	59% above	30%
IV infusion of a medicine, first hour CPT 96365 OB IV INFUSION UP TO 1 HR	$463.40	$662.00	$166.67–$628.90	59% above	30%
IV infusion of a medicine, first hour CPT 96365 TR IV INFUSION UP TO 1 HR	$463.40	$662.00	$166.67–$628.90	59% above	30%
IV infusion of a medicine, first hour CPT 96365 TR IV INF THERAPY UP TO 1HR	$463.40	$662.00	$166.67–$628.90	59% above	30%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION INITIAL 30-60 MIN	$463.40	$662.00	$166.67–$628.90	59% above	30%
IV infusion of a medicine, first hour CPT 96365 INTRAVENOUS INFUSION	$463.40	$662.00	$166.67–$628.90	59% above	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM INJECTION THERAPEUTIC DIAG	$39.90	$57.00	$35.91–$450.00	61% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM OR SUBCUTANEOUS INJECT	$114.80	$164.00	$54.78–$450.00	11% above	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 OB IM OR SUBCUTANEOUS INJ	$114.80	$164.00	$54.78–$450.00	11% above	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 OBS IM OR SUBCUTANEOUS INJECT	$114.80	$164.00	$54.78–$450.00	11% above	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECT DRUG SQ/IM	$114.80	$164.00	$54.78–$881.00	11% above	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERA PROPHYLACTIC OR DIAG INJ	$133.00	$190.00	$54.78–$450.00	29% above	30%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCU REEDUCATION,15 MINS	$78.40	$112.00	$29.43–$450.00	20% above	30%
New patient office visit, about 30 minutes CPT 99203 OB INTER EX LEVEL 3 30 MIN	$161.00	$230.00	$144.90–$450.00	3% above	30%
New patient office visit, about 30 minutes CPT 99203 EM NEW WC PROF LEV 3 30 MIN	$185.50	$265.00	$78.60	18% above	30%
New patient office visit, about 30 minutes CPT 99203 New Pt Lvl 3 (<45 min)	$202.30	$289.00	$78.60	29% above	30%
New patient office visit, about 30 minutes CPT 99203 NEW WC INTE EX LEV 3 30 MIN	$238.00	$340.00	$214.20–$450.00	52% above	30%
New patient office visit, about 45 minutes CPT 99204 New Pt Lvl 4 (<60 min)	$308.00	$440.00	$127.79	54% above	30%
New patient office visit, about 45 minutes CPT 99204 EM NEW WC PROF LEV 4 45 MIN	$313.60	$448.00	$127.79	57% above	30%
New patient office visit, about 45 minutes CPT 99204 NEW WC COMP EX LEV 4 45 MIN	$315.00	$450.00	$283.50–$450.00	58% above	30%
New patient office visit, about 45 minutes CPT 99204 OB NEW COMP EX LEV 4 45 MIN	$315.00	$450.00	$283.50–$450.00	58% above	30%
New patient office visit, about 60 minutes CPT 99205 New Pt Lvl 5 (60+min)	$388.50	$555.00	$173.69	62% above	30%
New patient office visit, about 60 minutes CPT 99205 EM NEW WC PROF LEV 5 60 MIN	$409.50	$585.00	$173.69	70% above	30%
New patient office visit, about 60 minutes CPT 99205 EM WC COMP EXAM LEV 5 60 MIN	$431.20	$616.00	$388.08–$585.20	79% above	30%
New patient office visit, about 60 minutes CPT 99205 OB COMP EX LEV 5 60 MIN	$560.70	$801.00	$450.00–$760.95	133% above	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW WC PROF LEV 2 15 MIN	$123.20	$176.00	$45.39	10% below	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW OB EXAM LEV 2 15 MIN	$123.20	$176.00	$110.88–$450.00	10% below	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Pt Lvl 2 (<30 min)	$142.10	$203.00	$45.39	4% above	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW WC LIM EX LEV 2 15 MIN	$180.60	$258.00	$162.54–$450.00	32% above	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 INTIAL ASSESSMENT 15 MIN MN TH	$69.30	$99.00	$27.90–$450.00	91% above	30%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL, UE ORTHOTICS	$133.00	$190.00	$88.75–$450.00	24% below	30%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL, LOW COMPLEXITY	$133.00	$190.00	$88.75–$450.00	24% below	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL, HIGH COMPLEXITY	$137.20	$196.00	$87.93–$450.00	34% below	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL, LOW COMPLEXITY	$137.20	$196.00	$87.93–$450.00	22% below	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL, MODERATE COMPLEXITY	$119.00	$170.00	$87.93–$450.00	33% below	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY, EA 15 MINS	$103.60	$148.00	$23.72–$450.00	6% above	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THEREX, EACH 15 MINS	$115.50	$165.00	$25.70–$450.00	52% above	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THEREX, EA 15 MINS	$115.50	$165.00	$25.70–$450.00	52% above	30%
Preventive checkup, new patient aged 18–39 CPT 99385 NEW 18-39 YR PREVENTATIVE CARE	$189.70	$271.00	$89.66	66% below	30%
Preventive checkup, new patient aged 40–64 CPT 99386 NEW PT PREVENT CARE 40-64 YRS	$209.30	$299.00	$108.68	67% below	30%
Preventive checkup, new patient aged 65 or older CPT 99387 PREVEN CARE NEW PT 65 AND OVER	$226.10	$323.00	$116.73	68% below	30%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREVENTAT PHYSICAL 18-39 YEARS	$159.60	$228.00	$81.91	68% below	30%
Preventive checkup, returning patient aged 65 or older CPT 99397 PREVENTIVE PHYSICAL EST PT >65	$187.60	$268.00	$93.50	67% below	30%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHANGE SMOKING 3-10 MIN	$18.20	$26.00	$16.38–$450.00	48% below	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST WC SIMP PROF LEV 5 40 MIN	$269.50	$385.00	$137.88	27% above	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EM EST OB EXAM LEV 5 40 MIN	$272.30	$389.00	$245.07–$450.00	29% above	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Estab Pt Lvl 5 (40+min)	$273.00	$390.00	$137.88	29% above	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EM EST WC COMP EX LEV 5 40 MIN	$315.00	$450.00	$283.50–$450.00	49% above	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST WC SIMP PROF LEV 3 20 MIN	$123.90	$177.00	$63.07	18% below	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Estab Pt Lvl 3 (<30 min)	$138.60	$198.00	$63.07	8% below	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST OB INT EX LEV 3 20 MIN	$156.10	$223.00	$140.49–$450.00	3% above	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EM EST WC INTER EX LEV 3 20 MI	$180.60	$258.00	$162.54–$450.00	20% above	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST WC SIMP PROF LEV 4 30 MIN	$191.10	$273.00	$92.98	11% above	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Estab Pt Lvl 4 (<40 min)	$203.00	$290.00	$92.98	17% above	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST OB COMP EX LEV 4 30 MIN	$205.80	$294.00	$185.22–$450.00	19% above	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EM EST WC COMP EX LEV 4 30 MIN	$238.00	$340.00	$214.20–$450.00	38% above	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST WC SIM PROF LEV 2 10 MIN	$62.30	$89.00	$33.83	50% below	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Estab Pt Lvl 2 (<20 min)	$91.00	$130.00	$33.83	28% below	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST OB LIM EX LEV 2 10 MIN	$156.10	$223.00	$140.49–$450.00	24% above	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EM EST WC LTD EX LEV 2 10 MIN	$180.60	$258.00	$162.54–$450.00	44% above	30%
Speech and language evaluation CPT 92523 SPEECH SOUND/LANGU COMPRE EVAL	$452.90	$647.00	$201.10–$614.65	92% above	30%
Speech therapy session, individual CPT 92507 TREATMENT OF SPEECH	$185.50	$265.00	$67.37–$450.00	30% above	30%
Spirometry (breathing test) CPT 94010 ER SPIROMETRY	$249.20	$356.00	$121.47–$450.00	2% above	30%
Spirometry (breathing test) CPT 94010 SPIROMETRY	$249.20	$356.00	$121.47–$450.00	2% above	30%
Spirometry before and after a bronchodilator CPT 94060 BRONCOSPASM EVALUATION	$460.60	$658.00	$244.07–$625.10	3% above	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITY,EA 15 MIN	$93.10	$133.00	$31.66–$450.00	29% above	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC BLEEDING	$225.40	$322.00	$99.33–$450.00	26% above	30%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Georgia	Off list
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B 20 YRS AND OVER V05.3	$93.80	$134.00	$70.38–$450.00	34% below	30%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS&RUBELLA VACCINE	$131.60	$188.00	$92.49–$450.00	4% above	30%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENING A CONJ VAC 2OF2/PF 10MC	$238.53	$340.75	$157.35–$450.00	18% below	30%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENING B VAC 4-COMP 0.5	$326.76	$466.80	$223.75–$450.00	28% below	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE INTRAMUSC USE	$249.20	$356.00	$274.90–$450.00	69% below	30%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMONIA VACCINE V03.82	$80.50	$115.00	$88.80–$450.00	78% below	30%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACC 23 VALENT	$332.50	$475.00	$133.47–$451.25	10% below	30%
Rabies vaccine, one dose CPT 90675 RABIES VAC,PF CHICK-EMB CELL	$623.70	$891.00	$325.63–$846.45	21% below	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS/DIPHTHERIA TOX AD 0.5M	$57.40	$82.00	$32.51–$450.00	59% below	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP BOOSTRIX 10-18 YRS	$59.50	$85.00	$38.52–$450.00	53% below	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH PERTUSS TET VAC 0.5M 7>	$60.20	$86.00	$38.52–$450.00	52% below	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 ADACEL INJ 0.5ML VIAL	$115.50	$165.00	$38.52–$450.00	8% below	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 SINGLE IM SUBQ INJECTION	$33.60	$48.00	$30.24–$450.00	27% below	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IM VACCINE ADMINISTRATION	$67.90	$97.00	$54.78–$450.00	48% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN VACC SKIN/MSCL 1	$67.90	$97.00	$54.78–$450.00	48% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 SDC IMMUNIZATION ADMINISTRATIO	$67.90	$97.00	$54.78–$450.00	48% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 TR IM VACCINE ADMINISTRATION	$67.90	$97.00	$54.78–$450.00	48% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 OP VACCINE IM ADMINISTRATION	$67.90	$97.00	$54.78–$450.00	48% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 OBS ADMIN OF INFLUENZA VACCINE	$67.90	$97.00	$54.78–$450.00	48% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 OBS ADM OF PNEUMOCOCCAL VACC	$67.90	$97.00	$54.78–$450.00	48% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HEPATITIS B ADM FEE 10MCG EA	$100.10	$143.00	$54.78–$450.00	118% above	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 2 OR MORE ADMIN IM SUBQ INJ	$25.90	$37.00	$23.31–$450.00	33% below	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 TR EA ADDL VACCINE	$31.50	$45.00	$28.35–$450.00	19% below	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN VACC SKN/MSCL EA ADD VAC	$31.50	$45.00	$28.35–$450.00	19% below	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 OBS IMMUNIZATION ADMIN,EA ADD	$31.50	$45.00	$28.35–$450.00	19% below	30%

Source file: https://memorialhospitalmanor.pg.quadax.revenuemasters.com/cdm-files/134148824_memorial-hospital-and-manor_standardcharges.csv