Hospital Russellville, AR

Dardanelle Regional Medical Center

Listed in its price file as “Dardanelle Regional LLC dba Dardanelle Regional Medical Center”.

Dardanelle Regional Medical Center in Dardanelle, AR publishes cash prices for 282 common procedures listed here, from its own machine-readable price file updated Aug 17, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Arkansas median for 247 of 280 procedures and above it for 25. By typical cash price it ranks #6 of 36 Arkansas hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

200 North 3rd St Dardanelle, AR, 72834 Collected Sep 29, 2026 Source price file (479) 229-4677

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 041302 · CMS hospital register NPI 1184629594

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Arkansas	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE MIN 3 VUE	$107.97	$431.87	$104.97–$431.87	34% below	75%
Ankle X-ray, complete, 3 or more views CPT 73610 LT ANKLE MIN 3 VUE	$107.97	$431.87	$104.97–$431.87	34% below	75%
Ankle X-ray, complete, 3 or more views CPT 73610 RT ANKLE MIN 3 VUE	$107.97	$431.87	$104.97–$431.87	34% below	75%
Ankle X-ray, complete, 3 or more views CPT 73610 IC ANKLE MIN 3 VUE	$107.97	$431.87	$104.97–$431.87	34% below	75%
Ankle X-ray, complete, 3 or more views one side CPT 73610 IC LT ANKLE MIN 3 VUE	$107.97	$431.87	$104.97–$431.87	34% below	75%
Ankle X-ray, complete, 3 or more views one side CPT 73610 IC RT ANKLE MIN 3 VUE	$107.97	$431.87	$104.97–$431.87	34% below	75%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 X RAY EXAM OF ANKLE, 3 VIEWS	$76.00	$76.00	$19.00–$76.00	—	—
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 X RAY EXAM OF ANKLE, 3V	$76.00	$76.00	$19.00–$76.00	—	—
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RT ANKLE MIN 3 VUE	$431.87	$431.87	$107.97–$431.87	—	—
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 LT ANKLE MIN 3 VUE	$431.87	$431.87	$107.97–$431.87	—	—
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 IC ANKLE MIN 3 VUE	$431.87	$431.87	$107.97–$431.87	—	—
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 ANKLE MIN 3 VUE	$431.87	$431.87	$107.97–$431.87	—	—
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 IC LT ANKLE MIN 3 VUE	$431.87	$431.87	$107.97–$431.87	—	—
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 IC RT ANKLE MIN 3 VUE	$431.87	$431.87	$107.97–$431.87	—	—
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGRAM	$149.31	$597.24	$149.31–$597.24	37% below	75%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGRAM	$597.24	$597.24	$149.31–$597.24	—	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST W/CONTRAST	$624.50	$2,497.99	$239.67–$2,497.99	46% below	75%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST W/CONTRAST	$2,497.99	$2,497.99	$624.50–$2,497.99	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PELVIS W/O CONTRAST	$854.50	$3,418.01	$306.51–$3,418.01	39% below	75%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PELVIS W/O CONTRAST	$3,418.01	$3,418.01	$854.50–$3,418.01	—	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELVIS W/CONTRAST	$907.76	$3,631.04	$502.23–$3,631.04	44% below	75%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELVIS W/CONTRAST	$3,631.04	$3,631.04	$907.76–$3,631.04	—	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PELVIS W/WO CONTRAST	$1,131.17	$4,524.66	$502.23–$4,524.66	41% below	75%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD/PELVIS W/WO CONTRAST	$4,524.66	$4,524.66	$1,131.16–$4,524.66	—	—
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST	$670.69	$2,682.74	$239.67–$2,682.74	39% below	75%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST	$2,682.74	$2,682.74	$670.68–$2,682.74	—	—
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$553.57	$2,214.26	$147.41–$2,214.26	38% below	75%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$2,214.26	$2,214.26	$553.57–$2,214.26	—	—
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILO/SINUS W/O CONTRAST	$741.86	$2,967.42	$147.41–$2,967.42	5% below	75%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILO/SINUS W/O CONTRAST	$2,967.42	$2,967.42	$741.86–$2,967.42	—	—
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O CONTRAST	$662.44	$2,649.76	$147.41–$2,649.76	22% below	75%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O CONTRAST	$2,649.76	$2,649.76	$662.44–$2,649.76	—	—
CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W W/O CONTRAST	$914.60	$3,658.38	$239.67–$3,658.38	22% below	75%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN W W/O CONTRAST	$3,658.38	$3,658.38	$914.60–$3,658.38	—	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L-SPINE W/O CONTRAST	$516.10	$2,064.38	$147.41–$2,064.38	45% below	75%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L-SPINE W/O CONTRAST	$2,064.38	$2,064.38	$516.10–$2,064.38	—	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C-SPINE W/O CONTRAST	$516.10	$2,064.38	$147.41–$2,064.38	45% below	75%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C-SPINE W/O CONTRAST	$2,064.38	$2,064.38	$516.10–$2,064.38	—	—
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS WITH CONTRAST	$560.13	$2,240.50	$239.67–$2,240.50	47% below	75%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS WITH CONTRAST	$2,240.50	$2,240.50	$560.13–$2,240.50	—	—
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 CVC EXTRACRANIAL BILAT STUDY	$357.54	$1,430.16	$303.69–$1,430.16	—	75%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US CAROTID DUP BL	$339.66	$1,358.65	$303.69–$1,358.65	20% below	75%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 CVC EXTRACRANIAL BILAT STUDY	$1,430.16	$1,430.16	$357.54–$1,430.16	—	—
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US CAROTID DUP BL	$1,358.65	$1,358.65	$339.66–$1,358.65	—	—
Chest X-ray, 2 views CPT 71046 IC CHEST SPECIAL VIEW	$110.78	$443.10	$104.97–$443.10	25% below	75%
Chest X-ray, 2 views CPT 71046 CHEST 2 VUE	$110.78	$443.10	$104.97–$443.10	25% below	75%
Chest X-ray, 2 views CPT 71046 CHEST SPECIAL VIEW	$110.78	$443.10	$104.97–$443.10	25% below	75%
Chest X-ray, 2 views CPT 71046 IC CHEST 2 VW	$110.78	$443.10	$104.97–$443.10	25% below	75%
Chest X-ray, 2 views CPT 71046 CHEST PORTABLE 2VW	$110.78	$443.10	$104.97–$443.10	25% below	75%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEW	$116.32	$465.26	$104.97–$465.26	22% below	75%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2V FRONTAL & LATERA	$75.00	$75.00	$18.75–$75.00	—	—
Chest X-ray, 2 views inpatient CPT 71046 CHEST XRAY 2 VW FRONTAL & LATL	$75.00	$75.00	$18.75–$75.00	—	—
Chest X-ray, 2 views inpatient CPT 71046 IC CHEST SPECIAL VIEW	$443.10	$443.10	$110.78–$443.10	—	—
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VUE	$443.10	$443.10	$110.78–$443.10	—	—
Chest X-ray, 2 views inpatient CPT 71046 CHEST PORTABLE 2VW	$443.10	$443.10	$110.78–$443.10	—	—
Chest X-ray, 2 views inpatient CPT 71046 IC CHEST 2 VW	$443.10	$443.10	$110.78–$443.10	—	—
Chest X-ray, 2 views inpatient CPT 71046 CHEST SPECIAL VIEW	$443.10	$443.10	$110.78–$443.10	—	—
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEW	$465.26	$465.26	$116.31–$465.26	—	—
Chest X-ray, single view CPT 71045 IC CHEST 1 VUE	$107.89	$431.55	$104.97–$431.55	15% below	75%
Chest X-ray, single view CPT 71045 CHEST 1 VUE	$107.89	$431.55	$104.97–$431.55	15% below	75%
Chest X-ray, single view CPT 71045 CHEST PORTABLE 1VW	$107.89	$431.55	$104.97–$431.55	15% below	75%
Chest X-ray, single view CPT 71045 XR CHEST SGL VIEW	$113.28	$453.13	$104.97–$453.13	10% below	75%
Chest X-ray, single view inpatient CPT 71045 CHEST 1 VUE	$431.55	$431.55	$107.89–$431.55	—	—
Chest X-ray, single view inpatient CPT 71045 IC CHEST 1 VUE	$431.55	$431.55	$107.89–$431.55	—	—
Chest X-ray, single view inpatient CPT 71045 CHEST PORTABLE 1VW	$431.55	$431.55	$107.89–$431.55	—	—
Chest X-ray, single view inpatient CPT 71045 XR CHEST SGL VIEW	$453.13	$453.13	$113.28–$453.13	—	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST	$544.85	$2,179.38	$147.41–$2,179.38	30% below	75%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTRAST	$2,179.38	$2,179.38	$544.85–$2,179.38	—	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CONTRAST	$624.50	$2,497.99	$239.67–$2,497.99	43% below	75%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CONTRAST	$2,497.99	$2,497.99	$624.50–$2,497.99	—	—
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US ARTERY LOW EXT BI	$303.98	$1,215.92	$303.69–$1,215.92	—	75%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US ARTERY LOW EXT BI	$1,215.92	$1,215.92	$303.98–$1,215.92	—	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHOCARDIOGRAM	$654.22	$2,616.89	$654.22–$2,616.89	42% below	75%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 OIU TTE W/DOPPLER COMPLETE	$654.22	$2,616.89	$654.22–$2,616.89	42% below	75%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHOCARDIOGRAM	$2,616.89	$2,616.89	$654.22–$2,616.89	—	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 OIU TTE W/DOPPLER COMPLETE	$2,616.89	$2,616.89	$654.22–$2,616.89	—	—
Knee X-ray, 3 views CPT 73562 LT KNEE 3 VUE	$89.78	$359.10	$89.78–$359.10	52% below	75%
Knee X-ray, 3 views CPT 73562 KNEE 3 VUE	$89.78	$359.10	$89.78–$359.10	52% below	75%
Knee X-ray, 3 views CPT 73562 IC KNEE 3 VUE	$89.78	$359.10	$89.78–$359.10	52% below	75%
Knee X-ray, 3 views CPT 73562 RT KNEE 3 VUE	$89.78	$359.10	$89.78–$359.10	52% below	75%
Knee X-ray, 3 views one side CPT 73562 IC RT KNEE 3 VUE	$89.78	$359.10	$89.78–$359.10	52% below	75%
Knee X-ray, 3 views one side CPT 73562 IC LT KNEE 3 VUE	$89.78	$359.10	$89.78–$359.10	52% below	75%
Knee X-ray, 3 views inpatient CPT 73562 X RAY EXAM OF KNEE 3	$89.00	$89.00	$22.25–$89.00	—	—
Knee X-ray, 3 views inpatient CPT 73562 RT KNEE 3 VUE	$359.10	$359.10	$89.78–$359.10	—	—
Knee X-ray, 3 views inpatient CPT 73562 LT KNEE 3 VUE	$359.10	$359.10	$89.78–$359.10	—	—
Knee X-ray, 3 views inpatient CPT 73562 IC KNEE 3 VUE	$359.10	$359.10	$89.78–$359.10	—	—
Knee X-ray, 3 views inpatient CPT 73562 KNEE 3 VUE	$359.10	$359.10	$89.78–$359.10	—	—
Knee X-ray, 3 views inpatient one side CPT 73562 IC LT KNEE 3 VUE	$359.10	$359.10	$89.78–$359.10	—	—
Knee X-ray, 3 views inpatient one side CPT 73562 IC RT KNEE 3 VUE	$359.10	$359.10	$89.78–$359.10	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US LIVER	$206.25	$824.99	$147.41–$824.99	22% below	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US GALLBLADDER	$216.56	$866.24	$147.41–$866.24	18% below	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SINGLE ORGAN	$216.56	$866.24	$147.41–$866.24	18% below	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED	$248.71	$994.85	$147.41–$994.85	6% below	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US LIVER	$824.99	$824.99	$206.25–$824.99	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US SINGLE ORGAN	$866.24	$866.24	$216.56–$866.24	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US GALLBLADDER	$866.24	$866.24	$216.56–$866.24	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LIMITED	$994.85	$994.85	$248.71–$994.85	—	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR C-	$74.08	$296.31	$74.08–$296.31	69% below	75%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCR C-	$296.31	$296.31	$74.08–$296.31	—	—
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTR	$913.60	$3,654.41	$306.51–$3,654.41	23% below	75%
MRI of the abdomen without contrast CPT 74181 DRMC MRCP	$913.60	$3,654.41	$306.51–$3,654.41	23% below	75%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTR	$3,654.41	$3,654.41	$913.60–$3,654.41	—	—
MRI of the abdomen without contrast inpatient CPT 74181 DRMC MRCP	$3,654.41	$3,654.41	$913.60–$3,654.41	—	—
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/WO CONTR	$1,087.58	$4,350.31	$502.23–$4,350.31	14% below	75%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/WO CONTR	$4,350.31	$4,350.31	$1,087.58–$4,350.31	—	—
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$983.06	$3,932.23	$306.51–$3,932.23	19% below	75%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST	$3,932.23	$3,932.23	$983.06–$3,932.23	—	—
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W W/O CONTRAST	$1,411.29	$5,645.17	$502.23–$5,645.17	19% below	75%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W W/O CONTRAST	$5,645.17	$5,645.17	$1,411.29–$5,645.17	—	—
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONTRAST	$1,018.68	$4,074.71	$306.51–$4,074.71	at median	75%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CONTRAST	$4,074.71	$4,074.71	$1,018.68–$4,074.71	—	—
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE W/WO CONTRAST	$1,260.32	$5,041.28	$502.23–$5,041.28	25% below	75%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L SPINE W/WO CONTRAST	$5,041.28	$5,041.28	$1,260.32–$5,041.28	—	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T-SPINE W/O CONTRAST	$898.82	$3,595.26	$306.51–$3,595.26	27% below	75%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T-SPINE W/O CONTRAST	$3,595.26	$3,595.26	$898.82–$3,595.26	—	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C-SPINE W/WO CONTRAST	$1,276.12	$5,104.47	$502.23–$5,104.47	25% below	75%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C-SPINE W/WO CONTRAST	$5,104.47	$5,104.47	$1,276.12–$5,104.47	—	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C-SPINE W/O CONTRAST	$785.28	$3,141.13	$306.51–$3,141.13	37% below	75%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C-SPINE W/O CONTRAST	$3,141.13	$3,141.13	$785.28–$3,141.13	—	—
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/WO CONTRAST	$1,082.55	$4,330.18	$502.23–$4,330.18	14% below	75%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/WO CONTRAST	$4,330.18	$4,330.18	$1,082.55–$4,330.18	—	—
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$821.11	$3,284.43	$306.51–$3,284.43	13% below	75%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$3,284.43	$3,284.43	$821.11–$3,284.43	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PEL TRNS ABD/VAG	$278.91	$1,115.64	$147.41–$1,115.64	31% below	75%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PEL TRNS ABD/VAG	$1,115.64	$1,115.64	$278.91–$1,115.64	—	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 ER BEDSIDE US 14 WKS OR MORE	$79.73	$318.90	$79.72–$318.90	76% below	75%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 ER BEDSIDE US 14 WKS OR MORE	$318.90	$318.90	$79.72–$318.90	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG UTERUS <14 WKS 1 GEST	$79.73	$318.90	$79.72–$318.90	75% below	75%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 ER BEDSIDE US UNDER 14 WKS	$79.73	$318.90	$79.72–$318.90	75% below	75%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG UTERUS <14 WKS 1 GEST	$318.90	$318.90	$79.72–$318.90	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 ER BEDSIDE US UNDER 14 WKS	$318.90	$318.90	$79.72–$318.90	—	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED	$79.73	$318.90	$79.72–$318.90	57% below	75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED	$318.90	$318.90	$79.72–$318.90	—	—
Shoulder X-ray, complete, 2 or more views CPT 73030 LT SHOULDER MIN 2 VUE	$103.95	$415.80	$103.95–$415.80	40% below	75%
Shoulder X-ray, complete, 2 or more views CPT 73030 SHOULDER MIN 2 VUE	$103.95	$415.80	$103.95–$415.80	40% below	75%
Shoulder X-ray, complete, 2 or more views CPT 73030 RT SHOULDER MIN 2 VUE	$103.95	$415.80	$103.95–$415.80	40% below	75%
Shoulder X-ray, complete, 2 or more views CPT 73030 IC SHOULDER MIN 2 VUE	$103.95	$415.80	$103.95–$415.80	40% below	75%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 IC RT SHOULDER MIN 2 VUE	$103.95	$415.80	$103.95–$415.80	40% below	75%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 IC LT SHOULDER MIN 2 VUE	$103.95	$415.80	$103.95–$415.80	40% below	75%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X RAY EXAM OF HUMERUS, 2V	$70.00	$70.00	$17.50–$70.00	—	—
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 SHOULDER MIN 2 VUE	$415.80	$415.80	$103.95–$415.80	—	—
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RT SHOULDER MIN 2 VUE	$415.80	$415.80	$103.95–$415.80	—	—
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 LT SHOULDER MIN 2 VUE	$415.80	$415.80	$103.95–$415.80	—	—
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 IC SHOULDER MIN 2 VUE	$415.80	$415.80	$103.95–$415.80	—	—
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 IC LT SHOULDER MIN 2 VUE	$415.80	$415.80	$103.95–$415.80	—	—
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 IC RT SHOULDER MIN 2 VUE	$415.80	$415.80	$103.95–$415.80	—	—
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 OIU DOBUTAMINE ECHO	$500.49	$2,001.97	$500.49–$2,001.97	11% below	75%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 OIU DOBUTAMINE ECHO	$2,001.97	$2,001.97	$500.49–$2,001.97	—	—
Swallow study (modified barium swallow, video X-ray) CPT 74230 SWALLOW STUDY W/VIDEO	$131.81	$527.25	$131.81–$527.25	42% below	75%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 SWALLOW STUDY W/VIDEO	$527.25	$527.25	$131.81–$527.25	—	—
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$220.79	$883.17	$147.41–$883.17	33% below	75%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$883.17	$883.17	$220.79–$883.17	—	—
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE	$248.71	$994.85	$147.41–$994.85	42% below	75%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE	$994.85	$994.85	$248.71–$994.85	—	—
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM/TESTICLES	$257.83	$1,031.31	$147.41–$1,031.31	19% below	75%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM/TESTICLES	$1,031.31	$1,031.31	$257.83–$1,031.31	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE	$233.04	$932.16	$147.41–$932.16	29% below	75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE	$932.16	$932.16	$233.04–$932.16	—	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 G I SERIES	$251.84	$1,007.37	$239.67–$1,007.37	1% above	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 G I SERIES	$1,007.37	$1,007.37	$251.84–$1,007.37	—	—
Wrist X-ray, complete, 3 or more views CPT 73110 WRIST MIN 3 VUE	$105.37	$421.47	$104.97–$421.47	35% below	75%
Wrist X-ray, complete, 3 or more views CPT 73110 LT WRIST MIN 3 VUE	$105.37	$421.47	$104.97–$421.47	35% below	75%
Wrist X-ray, complete, 3 or more views CPT 73110 RT WRIST MIN 3 VUE	$105.37	$421.47	$104.97–$421.47	35% below	75%
Wrist X-ray, complete, 3 or more views CPT 73110 IC WRIST MIN 3 VUE	$105.37	$421.47	$104.97–$421.47	35% below	75%
Wrist X-ray, complete, 3 or more views one side CPT 73110 IC RT WRIST MIN 3 VUE	$105.37	$421.47	$104.97–$421.47	35% below	75%
Wrist X-ray, complete, 3 or more views one side CPT 73110 IC LT WRIST MIN 3 VUE	$105.37	$421.47	$104.97–$421.47	35% below	75%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 X RAY EXAM OF WRIST, 3V	$81.00	$81.00	$20.25–$81.00	—	—
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 WRIST MIN 3 VUE	$421.47	$421.47	$105.37–$421.47	—	—
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 LT WRIST MIN 3 VUE	$421.47	$421.47	$105.37–$421.47	—	—
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 IC WRIST MIN 3 VUE	$421.47	$421.47	$105.37–$421.47	—	—
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RT WRIST MIN 3 VUE	$421.47	$421.47	$105.37–$421.47	—	—
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 IC RT WRIST MIN 3 VUE	$421.47	$421.47	$105.37–$421.47	—	—
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 IC LT WRIST MIN 3 VUE	$421.47	$421.47	$105.37–$421.47	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 XR HIP UNI W/WO PELV 2-3 VIEWS	$30.75	$123.00	$30.75–$123.00	79% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 IC HIP UNI 2-3 VUE	$55.05	$220.19	$55.05–$220.19	62% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 IC PELVIS W/HIP UNI 2-3 VUE	$55.05	$220.19	$55.05–$220.19	62% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 RT HIP UNI 2-3 VUE	$65.67	$262.68	$65.67–$262.68	54% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIP UNI 2-3 VUE	$65.67	$262.68	$65.67–$262.68	54% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 PELVIS W/HIP UNI 2-3 VUE	$65.67	$262.68	$65.67–$262.68	54% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 LT PELVIS W/HIP UNI 2-3 VUE	$65.67	$262.68	$65.67–$262.68	54% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 LT HIP UNI 2-3 VUE	$65.67	$262.68	$65.67–$262.68	54% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 RT PELVIS W/HIP UNI 2-3 VUE	$65.67	$262.68	$65.67–$262.68	54% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 IC LT PELVIS W/HIP UNI 2-3 VUE	$55.05	$220.19	$55.05–$220.19	62% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 IC RT PELVIS W/HIP UNI 2-3 VUE	$55.05	$220.19	$55.05–$220.19	62% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 IC LT HIP UNI 2-3 VUE	$55.05	$220.19	$55.05–$220.19	62% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 IC RT HIP UNI 2-3 VUE	$55.05	$220.19	$55.05–$220.19	62% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 XR HIP UNI W/WO PELV 2-3 VIEWS	$123.00	$123.00	$30.75–$123.00	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 IC HIP UNI 2-3 VUE	$220.19	$220.19	$55.05–$220.19	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 IC PELVIS W/HIP UNI 2-3 VUE	$220.19	$220.19	$55.05–$220.19	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 LT PELVIS W/HIP UNI 2-3 VUE	$262.68	$262.68	$65.67–$262.68	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 LT HIP UNI 2-3 VUE	$262.68	$262.68	$65.67–$262.68	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 RT HIP UNI 2-3 VUE	$262.68	$262.68	$65.67–$262.68	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 PELVIS W/HIP UNI 2-3 VUE	$262.68	$262.68	$65.67–$262.68	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HIP UNI 2-3 VUE	$262.68	$262.68	$65.67–$262.68	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 RT PELVIS W/HIP UNI 2-3 VUE	$262.68	$262.68	$65.67–$262.68	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP UNILATERAL COMPL MIN O	$37.00	$37.00	$9.25–$37.00	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 IC LT HIP UNI 2-3 VUE	$220.19	$220.19	$55.05–$220.19	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 IC RT PELVIS W/HIP UNI 2-3 VUE	$220.19	$220.19	$55.05–$220.19	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 IC LT PELVIS W/HIP UNI 2-3 VUE	$220.19	$220.19	$55.05–$220.19	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 IC RT HIP UNI 2-3 VUE	$220.19	$220.19	$55.05–$220.19	—	—
X-ray of the abdomen, 1 view CPT 74018 IC ABDOMEN 1 AP	$89.07	$356.27	$89.07–$356.27	39% below	75%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 AP	$89.07	$356.27	$89.07–$356.27	39% below	75%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW	$105.96	$423.83	$104.97–$423.83	28% below	75%
X-ray of the abdomen, 1 view inpatient CPT 74018 IC ABDOMEN 1 AP	$356.27	$356.27	$89.07–$356.27	—	—
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 AP	$356.27	$356.27	$89.07–$356.27	—	—
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN 1 VIEW	$423.83	$423.83	$105.96–$423.83	—	—
X-ray of the ankle, 2 views CPT 73600 X RAY EXAM OF ANKLE, 2 VIEW	$29.00	$116.00	$29.00–$116.00	79% below	75%
X-ray of the ankle, 2 views CPT 73600 ANKLE 2 VUE	$100.88	$403.52	$100.88–$403.52	27% below	75%
X-ray of the ankle, 2 views CPT 73600 LT ANKLE 2 VUE	$100.88	$403.52	$100.88–$403.52	27% below	75%
X-ray of the ankle, 2 views CPT 73600 RT ANKLE 2 VUE	$100.88	$403.52	$100.88–$403.52	27% below	75%
X-ray of the ankle, 2 views CPT 73600 IC ANKLE 2 VUE	$100.88	$403.52	$100.88–$403.52	27% below	75%
X-ray of the ankle, 2 views one side CPT 73600 IC RT ANKLE 2 VUE	$100.88	$403.52	$100.88–$403.52	27% below	75%
X-ray of the ankle, 2 views one side CPT 73600 IC LT ANKLE 2 VUE	$100.88	$403.52	$100.88–$403.52	27% below	75%
X-ray of the ankle, 2 views inpatient CPT 73600 XR ANKLE 2V	$47.00	$47.00	$11.75–$47.00	—	—
X-ray of the ankle, 2 views inpatient CPT 73600 X RAY EXAM OF ANKLE, 2 VIEW	$116.00	$116.00	$29.00–$116.00	—	—
X-ray of the ankle, 2 views inpatient CPT 73600 IC ANKLE 2 VUE	$403.52	$403.52	$100.88–$403.52	—	—
X-ray of the ankle, 2 views inpatient CPT 73600 LT ANKLE 2 VUE	$403.52	$403.52	$100.88–$403.52	—	—
X-ray of the ankle, 2 views inpatient CPT 73600 ANKLE 2 VUE	$403.52	$403.52	$100.88–$403.52	—	—
X-ray of the ankle, 2 views inpatient CPT 73600 RT ANKLE 2 VUE	$403.52	$403.52	$100.88–$403.52	—	—
X-ray of the ankle, 2 views inpatient one side CPT 73600 IC RT ANKLE 2 VUE	$403.52	$403.52	$100.88–$403.52	—	—
X-ray of the ankle, 2 views inpatient one side CPT 73600 IC LT ANKLE 2 VUE	$403.52	$403.52	$100.88–$403.52	—	—
X-ray of the finger(s), 2 or more views CPT 73140 X RAY EXAM OF FINGER (S)	$31.25	$125.00	$31.25–$125.00	76% below	75%
X-ray of the finger(s), 2 or more views CPT 73140 IC FINGER MIN 2 VUE	$59.77	$239.09	$59.77–$239.09	53% below	75%
X-ray of the finger(s), 2 or more views CPT 73140 RT FINGER MIN 2 VUE	$65.67	$262.68	$65.67–$262.68	49% below	75%
X-ray of the finger(s), 2 or more views CPT 73140 LT FINGER MIN 2 VUE	$65.67	$262.68	$65.67–$262.68	49% below	75%
X-ray of the finger(s), 2 or more views CPT 73140 FINGER MIN 2 VUE	$65.67	$262.68	$65.67–$262.68	49% below	75%
X-ray of the finger(s), 2 or more views one side CPT 73140 IC LT FINGER MIN 2 VUE	$59.77	$239.09	$59.77–$239.09	53% below	75%
X-ray of the finger(s), 2 or more views one side CPT 73140 IC RT FINGER MIN 2 VUE	$59.77	$239.09	$59.77–$239.09	53% below	75%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 XR FINGER (S) MIN 2V	$51.00	$51.00	$12.75–$51.00	—	—
X-ray of the finger(s), 2 or more views inpatient CPT 73140 X RAY EXAM OF FINGER (S)	$125.00	$125.00	$31.25–$125.00	—	—
X-ray of the finger(s), 2 or more views inpatient CPT 73140 IC FINGER MIN 2 VUE	$239.09	$239.09	$59.77–$239.09	—	—
X-ray of the finger(s), 2 or more views inpatient CPT 73140 FINGER MIN 2 VUE	$262.68	$262.68	$65.67–$262.68	—	—
X-ray of the finger(s), 2 or more views inpatient CPT 73140 RT FINGER MIN 2 VUE	$262.68	$262.68	$65.67–$262.68	—	—
X-ray of the finger(s), 2 or more views inpatient CPT 73140 LT FINGER MIN 2 VUE	$262.68	$262.68	$65.67–$262.68	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 IC LT FINGER MIN 2 VUE	$239.09	$239.09	$59.77–$239.09	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 IC RT FINGER MIN 2 VUE	$239.09	$239.09	$59.77–$239.09	—	—
X-ray of the foot, 2 views CPT 73620 RT FOOT 2 VUE	$88.12	$352.49	$88.12–$352.49	25% below	75%
X-ray of the foot, 2 views CPT 73620 IC FOOT 2 VUE	$88.12	$352.49	$88.12–$352.49	25% below	75%
X-ray of the foot, 2 views CPT 73620 LT FOOT 2 VUE	$88.12	$352.49	$88.12–$352.49	25% below	75%
X-ray of the foot, 2 views CPT 73620 FOOT 2 VUE	$88.12	$352.49	$88.12–$352.49	25% below	75%
X-ray of the foot, 2 views one side CPT 73620 IC RT FOOT 2 VUE	$88.12	$352.49	$88.12–$352.49	25% below	75%
X-ray of the foot, 2 views one side CPT 73620 IC LT FOOT 2 VUE	$88.12	$352.49	$88.12–$352.49	25% below	75%
X-ray of the foot, 2 views inpatient CPT 73620 X RAY EXAM OF FOOT, 2 VIEW	$62.00	$62.00	$15.50–$62.00	—	—
X-ray of the foot, 2 views inpatient CPT 73620 LT FOOT 2 VUE	$352.49	$352.49	$88.12–$352.49	—	—
X-ray of the foot, 2 views inpatient CPT 73620 IC FOOT 2 VUE	$352.49	$352.49	$88.12–$352.49	—	—
X-ray of the foot, 2 views inpatient CPT 73620 RT FOOT 2 VUE	$352.49	$352.49	$88.12–$352.49	—	—
X-ray of the foot, 2 views inpatient CPT 73620 FOOT 2 VUE	$352.49	$352.49	$88.12–$352.49	—	—
X-ray of the foot, 2 views inpatient one side CPT 73620 IC LT FOOT 2 VUE	$352.49	$352.49	$88.12–$352.49	—	—
X-ray of the foot, 2 views inpatient one side CPT 73620 IC RT FOOT 2 VUE	$352.49	$352.49	$88.12–$352.49	—	—
X-ray of the foot, complete, 3 or more views CPT 73630 FOOT MIN 3 VUE	$104.66	$418.64	$104.66–$418.64	36% below	75%
X-ray of the foot, complete, 3 or more views CPT 73630 LT FOOT MIN 3 VUE	$104.66	$418.64	$104.66–$418.64	36% below	75%
X-ray of the foot, complete, 3 or more views CPT 73630 RT FOOT MIN 3 VUE	$104.66	$418.64	$104.66–$418.64	36% below	75%
X-ray of the foot, complete, 3 or more views CPT 73630 IC FOOT MIN 2 VUE	$104.66	$418.64	$104.66–$418.64	36% below	75%
X-ray of the foot, complete, 3 or more views one side CPT 73630 IC RT FOOT MIN 2 VUE	$104.66	$418.64	$104.66–$418.64	36% below	75%
X-ray of the foot, complete, 3 or more views one side CPT 73630 IC LT FOOT MIN 2 VUE	$104.66	$418.64	$104.66–$418.64	36% below	75%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 X RAY EXAM OF FOOT, COMP 3V	$70.00	$70.00	$17.50–$70.00	—	—
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 IC FOOT MIN 2 VUE	$418.64	$418.64	$104.66–$418.64	—	—
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RT FOOT MIN 3 VUE	$418.64	$418.64	$104.66–$418.64	—	—
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT MIN 3 VUE	$418.64	$418.64	$104.66–$418.64	—	—
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 LT FOOT MIN 3 VUE	$418.64	$418.64	$104.66–$418.64	—	—
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 IC LT FOOT MIN 2 VUE	$418.64	$418.64	$104.66–$418.64	—	—
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 IC RT FOOT MIN 2 VUE	$418.64	$418.64	$104.66–$418.64	—	—
X-ray of the hand, 3 or more views CPT 73130 LT HAND MIN 3 VUE	$96.86	$387.45	$96.86–$387.45	47% below	75%
X-ray of the hand, 3 or more views CPT 73130 RT HAND MIN 3 VUE	$96.86	$387.45	$96.86–$387.45	47% below	75%
X-ray of the hand, 3 or more views CPT 73130 IC HAND MIN 3 VUE	$96.86	$387.45	$96.86–$387.45	47% below	75%
X-ray of the hand, 3 or more views CPT 73130 HAND MIN 3 VUE	$96.86	$387.45	$96.86–$387.45	47% below	75%
X-ray of the hand, 3 or more views one side CPT 73130 IC LT HAND MIN 3 VUE	$96.86	$387.45	$96.86–$387.45	47% below	75%
X-ray of the hand, 3 or more views one side CPT 73130 IC RT HAND MIN 3 VUE	$96.86	$387.45	$96.86–$387.45	47% below	75%
X-ray of the hand, 3 or more views inpatient CPT 73130 RT HAND MIN 3 VUE	$387.45	$387.45	$96.86–$387.45	—	—
X-ray of the hand, 3 or more views inpatient CPT 73130 HAND MIN 3 VUE	$387.45	$387.45	$96.86–$387.45	—	—
X-ray of the hand, 3 or more views inpatient CPT 73130 IC HAND MIN 3 VUE	$387.45	$387.45	$96.86–$387.45	—	—
X-ray of the hand, 3 or more views inpatient CPT 73130 LT HAND MIN 3 VUE	$387.45	$387.45	$96.86–$387.45	—	—
X-ray of the hand, 3 or more views inpatient one side CPT 73130 IC RT HAND MIN 3 VUE	$387.45	$387.45	$96.86–$387.45	—	—
X-ray of the hand, 3 or more views inpatient one side CPT 73130 IC LT HAND MIN 3 VUE	$387.45	$387.45	$96.86–$387.45	—	—
X-ray of the knee, 1 or 2 views CPT 73560 X RAY KNEE 1 OR 2 VIEWS	$31.00	$124.00	$31.00–$124.00	75% below	75%
X-ray of the knee, 1 or 2 views CPT 73560 X RAY EXAM OF KNEE 1 OR 2	$31.00	$124.00	$31.00–$124.00	75% below	75%
X-ray of the knee, 1 or 2 views CPT 73560 LT KNEE 1 OR 2 VUE	$86.47	$345.87	$86.47–$345.87	29% below	75%
X-ray of the knee, 1 or 2 views CPT 73560 KNEE 1 OR 2 VUE	$86.47	$345.87	$86.47–$345.87	29% below	75%
X-ray of the knee, 1 or 2 views CPT 73560 IC KNEE 1 OR 2 VUE	$86.47	$345.87	$86.47–$345.87	29% below	75%
X-ray of the knee, 1 or 2 views CPT 73560 RT KNEE 1 OR 2 VUE	$86.47	$345.87	$86.47–$345.87	29% below	75%
X-ray of the knee, 1 or 2 views one side CPT 73560 IC RT KNEE 1 OR 2 VUE	$86.47	$345.87	$86.47–$345.87	29% below	75%
X-ray of the knee, 1 or 2 views one side CPT 73560 IC LT KNEE 1 OR 2 VUE	$86.47	$345.87	$86.47–$345.87	29% below	75%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR KNEE 1 OR 2 V	$51.00	$51.00	$12.75–$51.00	—	—
X-ray of the knee, 1 or 2 views inpatient CPT 73560 X RAY EXAM OF KNEE 1 OR 2	$124.00	$124.00	$31.00–$124.00	—	—
X-ray of the knee, 1 or 2 views inpatient CPT 73560 X RAY KNEE 1 OR 2 VIEWS	$124.00	$124.00	$31.00–$124.00	—	—
X-ray of the knee, 1 or 2 views inpatient CPT 73560 KNEE 1 OR 2 VUE	$345.87	$345.87	$86.47–$345.87	—	—
X-ray of the knee, 1 or 2 views inpatient CPT 73560 IC KNEE 1 OR 2 VUE	$345.87	$345.87	$86.47–$345.87	—	—
X-ray of the knee, 1 or 2 views inpatient CPT 73560 RT KNEE 1 OR 2 VUE	$345.87	$345.87	$86.47–$345.87	—	—
X-ray of the knee, 1 or 2 views inpatient CPT 73560 LT KNEE 1 OR 2 VUE	$345.87	$345.87	$86.47–$345.87	—	—
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 IC RT KNEE 1 OR 2 VUE	$345.87	$345.87	$86.47–$345.87	—	—
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 IC LT KNEE 1 OR 2 VUE	$345.87	$345.87	$86.47–$345.87	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBOSACRAL 2-3 VIEW	$108.17	$432.68	$108.17–$432.68	44% below	75%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 IC LUMBAR SPINE 2 OR 3 VUE	$108.44	$433.76	$108.44–$433.76	44% below	75%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE 2 OR 3 VUE	$108.44	$433.76	$108.44–$433.76	44% below	75%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 X RAY EXAM L-S SPINE 2/3 VIEWS	$82.00	$82.00	$20.50–$82.00	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBOSACRAL 2-3 VIEW	$432.68	$432.68	$108.17–$432.68	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR SPINE 2 OR 3 VUE	$433.76	$433.76	$108.44–$433.76	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 IC LUMBAR SPINE 2 OR 3 VUE	$433.76	$433.76	$108.44–$433.76	—	—
X-ray of the lower back, 4 or more views CPT 72110 LUMBOSACRAL MIN 4 VIEW	$130.08	$520.33	$130.08–$520.33	52% below	75%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE MIN 4 VUE	$130.41	$521.64	$130.41–$521.64	51% below	75%
X-ray of the lower back, 4 or more views CPT 72110 IC LUMBAR SPINE MIN 4 VUE	$130.41	$521.64	$130.41–$521.64	51% below	75%
X-ray of the lower back, 4 or more views inpatient CPT 72110 X RAY EXAM L-2 SPINE 4/>VWS	$113.00	$113.00	$28.25–$113.00	—	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBOSACRAL MIN 4 VIEW	$520.33	$520.33	$130.08–$520.33	—	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPINE MIN 4 VUE	$521.64	$521.64	$130.41–$521.64	—	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 IC LUMBAR SPINE MIN 4 VUE	$521.64	$521.64	$130.41–$521.64	—	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2 VIEW	$115.95	$463.78	$115.94–$463.78	43% below	75%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2 VUE	$116.24	$464.94	$116.23–$464.94	42% below	75%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 IC THORACIC SPINE 2 VUE	$116.24	$464.94	$116.23–$464.94	42% below	75%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 X RAY EXAM THORAC SPINE 2 VIEW	$81.00	$81.00	$20.25–$81.00	—	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE 2 VIEW	$463.78	$463.78	$115.94–$463.78	—	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE 2 VUE	$464.94	$464.94	$116.23–$464.94	—	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 IC THORACIC SPINE 2 VUE	$464.94	$464.94	$116.23–$464.94	—	—
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONE MIN 3 VIEW	$68.11	$272.43	$68.11–$272.43	44% below	75%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES MIN 3 VUE	$68.28	$273.11	$68.28–$273.11	44% below	75%
X-ray of the nasal bones, 3 or more views CPT 70160 IC NASAL BONES MIN 3 VUE	$68.28	$273.11	$68.28–$273.11	44% below	75%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 X RAY EXAM OF NASAL BONES 3V	$76.00	$76.00	$19.00–$76.00	—	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONE MIN 3 VIEW	$272.43	$272.43	$68.11–$272.43	—	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 IC NASAL BONES MIN 3 VUE	$273.11	$273.11	$68.28–$273.11	—	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES MIN 3 VUE	$273.11	$273.11	$68.28–$273.11	—	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 2-3 VIEW	$94.50	$378.01	$94.50–$378.01	23% below	75%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 IC CERVICAL SPINE 2 OR 3V	$94.74	$378.95	$94.74–$378.95	22% below	75%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 2 OR 3V	$94.74	$378.95	$94.74–$378.95	22% below	75%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X RAY EXAM NECK SPINE 2-3 VIEW	$76.00	$76.00	$19.00–$76.00	—	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE 2-3 VIEW	$378.01	$378.01	$94.50–$378.01	—	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 IC CERVICAL SPINE 2 OR 3V	$378.95	$378.95	$94.74–$378.95	—	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE 2 OR 3V	$378.95	$378.95	$94.74–$378.95	—	—
X-ray of the pelvis, 1 or 2 views CPT 72170 IC PELVIS 1 OR 2 VUE	$52.45	$209.79	$52.45–$209.79	71% below	75%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1-2 VIEW	$74.08	$296.31	$74.08–$296.31	59% below	75%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 OR 2 VUE	$79.73	$318.90	$79.72–$318.90	56% below	75%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X RAY EXAM OF PELVIS	$76.00	$76.00	$19.00–$76.00	—	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 IC PELVIS 1 OR 2 VUE	$209.79	$209.79	$52.45–$209.79	—	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1-2 VIEW	$296.31	$296.31	$74.08–$296.31	—	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1 OR 2 VUE	$318.90	$318.90	$79.72–$318.90	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM & COCCYX MIN 2 VIEW	$89.08	$356.32	$89.08–$356.32	51% below	75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM/COCCYX MIN 2 VUE	$89.30	$357.21	$89.30–$357.21	51% below	75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 IC SACRUM/COCCYX MIN 2 VUE	$89.30	$357.21	$89.30–$357.21	51% below	75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR SACRUM & COCCYX MIN 2V	$70.00	$70.00	$17.50–$70.00	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM & COCCYX MIN 2 VIEW	$356.32	$356.32	$89.08–$356.32	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 IC SACRUM/COCCYX MIN 2 VUE	$357.21	$357.21	$89.30–$357.21	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM/COCCYX MIN 2 VUE	$357.21	$357.21	$89.30–$357.21	—	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Arkansas	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT)	$7.00	$28.00	$7.00–$28.00	74% below	75%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (SGPT)	$23.46	$93.83	$8.27–$93.83	12% below	75%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINO (ALT) (SGPT)	$28.00	$28.00	$7.00–$28.00	—	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT (SGPT)	$93.83	$93.83	$23.46–$93.83	—	—
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT)	$7.00	$28.00	$7.00–$28.00	77% below	75%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST (SGOT)	$22.82	$91.29	$8.10–$91.29	25% below	75%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE (AST) (SGOT)	$28.00	$28.00	$7.00–$28.00	—	—
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST (SGOT)	$91.29	$91.29	$22.82–$91.29	—	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$89.58	$358.31	$74.39–$358.31	58% below	75%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$358.31	$358.31	$89.58–$358.31	—	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE EACH	$6.62	$26.46	$6.62–$26.46	59% below	75%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IGE,EA	$14.50	$58.00	$8.15–$58.00	11% below	75%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IgE CRUDE XTRC EA	$21.74	$86.94	$8.15–$86.94	34% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 STRAWBERRY IgE	$21.74	$86.94	$8.15–$86.94	34% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 TILAPIA IgE	$21.74	$86.94	$8.15–$86.94	34% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 BANANA IgE	$21.74	$86.94	$8.15–$86.94	34% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 POLLOCK WHITE IGE	$21.74	$86.94	$8.15–$86.94	34% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 WASP VENOM IgE, SERUM	$21.74	$86.94	$8.15–$86.94	34% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIN V, IgE, SERUM	$21.74	$86.94	$8.15–$86.94	34% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIN G, IgE, SERUM	$21.74	$86.94	$8.15–$86.94	34% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 BUMBLE BEE VENOM IgE	$21.74	$86.94	$8.15–$86.94	34% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 FIRE ANT, IGE	$21.74	$86.94	$8.15–$86.94	34% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 GREEN PEPPER IgE SERUM	$21.74	$86.94	$8.15–$86.94	34% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 BARLEY IGE	$22.82	$91.29	$8.15–$91.29	41% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 BUCKWHEAT IGE	$22.82	$91.29	$8.15–$91.29	41% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 White-faced Hornet IgE	$22.82	$91.29	$8.15–$91.29	41% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 CHOCOLATE IGE	$22.82	$91.29	$8.15–$91.29	41% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 Yellow Jacket Ven IgE	$22.82	$91.29	$8.15–$91.29	41% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 BAKERS YEAST IGE	$22.82	$91.29	$8.15–$91.29	41% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 YellowFaced Hornet IgE	$22.82	$91.29	$8.15–$91.29	41% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 Honey Bee Venom IgE	$22.82	$91.29	$8.15–$91.29	41% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 Paper Wasp IgE	$22.82	$91.29	$8.15–$91.29	41% above	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE EACH	$26.46	$26.46	$6.62–$26.46	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IGE,EA	$58.00	$58.00	$14.50–$58.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 STRAWBERRY IgE	$86.94	$86.94	$21.73–$86.94	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TILAPIA IgE	$86.94	$86.94	$21.73–$86.94	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BANANA IgE	$86.94	$86.94	$21.73–$86.94	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 POLLOCK WHITE IGE	$86.94	$86.94	$21.73–$86.94	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WASP VENOM IgE, SERUM	$86.94	$86.94	$21.73–$86.94	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PENICILLIN V, IgE, SERUM	$86.94	$86.94	$21.73–$86.94	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PENICILLIN G, IgE, SERUM	$86.94	$86.94	$21.73–$86.94	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BUMBLE BEE VENOM IgE	$86.94	$86.94	$21.73–$86.94	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 FIRE ANT, IGE	$86.94	$86.94	$21.73–$86.94	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GREEN PEPPER IgE SERUM	$86.94	$86.94	$21.73–$86.94	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLG SPEC IgE CRUDE XTRC EA	$86.94	$86.94	$21.73–$86.94	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White-faced Hornet IgE	$91.29	$91.29	$22.82–$91.29	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Paper Wasp IgE	$91.29	$91.29	$22.82–$91.29	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Honey Bee Venom IgE	$91.29	$91.29	$22.82–$91.29	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 YellowFaced Hornet IgE	$91.29	$91.29	$22.82–$91.29	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Yellow Jacket Ven IgE	$91.29	$91.29	$22.82–$91.29	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BAKERS YEAST IGE	$91.29	$91.29	$22.82–$91.29	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BARLEY IGE	$91.29	$91.29	$22.82–$91.29	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BUCKWHEAT IGE	$91.29	$91.29	$22.82–$91.29	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHOCOLATE IGE	$91.29	$91.29	$22.82–$91.29	—	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY	$16.75	$67.00	$16.75–$67.00	73% below	75%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE	$41.21	$164.83	$20.22–$164.83	33% below	75%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP AB	$58.43	$233.73	$20.22–$233.73	5% below	75%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODY	$67.00	$67.00	$16.75–$67.00	—	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE	$164.83	$164.83	$41.21–$164.83	—	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP AB	$233.73	$233.73	$58.43–$233.73	—	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 QNA QUAL SCREEN	$14.06	$56.23	$14.06–$56.23	78% below	75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES	$16.00	$64.00	$16.00–$64.00	75% below	75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES SCREEN	$44.68	$178.71	$18.88–$178.71	31% below	75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES SENDOUT	$46.91	$187.65	$18.88–$187.65	27% below	75%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 QNA QUAL SCREEN	$56.23	$56.23	$14.06–$56.23	—	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES	$64.00	$64.00	$16.00–$64.00	—	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES SCREEN	$178.71	$178.71	$44.68–$178.71	—	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES SENDOUT	$187.65	$187.65	$46.91–$187.65	—	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE	$44.75	$179.00	$44.75–$179.00	50% below	75%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP B NATRIURETIC PROTEIN	$90.97	$363.88	$61.32–$363.88	2% above	75%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 ASSAY OF NATRIURETIC PEPTIDE	$179.00	$179.00	$44.75–$179.00	—	—
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP B NATRIURETIC PROTEIN	$363.88	$363.88	$90.97–$363.88	—	—
Basic metabolic panel (blood test) CPT 80048 METABOLIC PANEL TOTAL CA	$11.25	$45.00	$11.25–$45.00	90% below	75%
Basic metabolic panel (blood test) CPT 80048 BMP OUTREACH	$134.93	$539.70	$13.21–$539.70	21% above	75%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$141.67	$566.69	$13.21–$566.69	27% above	75%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANE	$141.67	$566.69	$13.21–$566.69	27% above	75%
Basic metabolic panel (blood test) inpatient CPT 80048 METABOLIC PANEL TOTAL CA	$45.00	$45.00	$11.25–$45.00	—	—
Basic metabolic panel (blood test) inpatient CPT 80048 BMP OUTREACH	$539.70	$539.70	$134.93–$539.70	—	—
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANE	$566.69	$566.69	$141.67–$566.69	—	—
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$566.69	$566.69	$141.67–$566.69	—	—
Biopsy tissue exam by a pathologist (level IV) CPT 88305 APA PATHOLOGIST INTERPRETATION	$82.94	$331.74	$70.77–$331.74	25% below	75%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 CELL BLOCK	$82.94	$331.74	$70.77–$331.74	25% below	75%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 APA LEVEL IV TISSUE	$82.94	$331.74	$70.77–$331.74	25% below	75%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 GROSS & MICROSCOPIC LEVEL 4	$87.08	$348.33	$70.77–$348.33	21% below	75%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 APA PATHOLOGIST INTERPRETATION	$331.74	$331.74	$82.94–$331.74	—	—
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 APA LEVEL IV TISSUE	$331.74	$331.74	$82.94–$331.74	—	—
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 CELL BLOCK	$331.74	$331.74	$82.94–$331.74	—	—
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 GROSS & MICROSCOPIC LEVEL 4	$348.33	$348.33	$87.08–$348.33	—	—
Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA	$13.75	$55.00	$13.75–$55.00	80% below	75%
Blood culture for bacteria CPT 87040 CULTURE BLOOD	$71.95	$287.81	$16.11–$287.81	2% above	75%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE FOR BACTERIA	$55.00	$55.00	$13.75–$55.00	—	—
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD	$287.81	$287.81	$71.95–$287.81	—	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$8.76	$35.02	$8.76–$35.02	27% below	75%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE	$8.76	$35.02	$8.76–$35.02	27% below	75%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCTURE	$35.02	$35.02	$8.76–$35.02	—	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$35.02	$35.02	$8.76–$35.02	—	—
Blood glucose (sugar) test CPT 82947 HEART HEALTHY GLUCOSE	$3.49	$13.94	$3.48–$13.94	88% below	75%
Blood glucose (sugar) test CPT 82947 GLUCOSE BLD QN	$17.43	$69.73	$6.14–$69.73	40% below	75%
Blood glucose (sugar) test CPT 82947 GLUCOSE	$17.43	$69.73	$6.14–$69.73	40% below	75%
Blood glucose (sugar) test inpatient CPT 82947 CORP HEART HEALTHY GLUCOSE	$8.82	$8.82	$2.21–$8.82	—	—
Blood glucose (sugar) test inpatient CPT 82947 DRMC CORP HHW GLUCOSE	$8.82	$8.82	$2.21–$8.82	—	—
Blood glucose (sugar) test inpatient CPT 82947 DRMC HEART HEALTHY GLUCOSE	$10.50	$10.50	$2.63–$10.50	—	—
Blood glucose (sugar) test inpatient CPT 82947 HEART HEALTHY GLUCOSE	$13.94	$13.94	$3.48–$13.94	—	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE	$69.73	$69.73	$17.43–$69.73	—	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE BLD QN	$69.73	$69.73	$17.43–$69.73	—	—
Blood lead test CPT 83655 ASSAY OF LEAD	$10.25	$41.00	$10.25–$41.00	75% below	75%
Blood lead test CPT 83655 LEAD	$37.13	$148.52	$18.92–$148.52	8% below	75%
Blood lead test CPT 83655 LEAD RANDOM U	$37.13	$148.52	$18.92–$148.52	8% below	75%
Blood lead test CPT 83655 LEAD LEVEL	$38.99	$155.95	$18.92–$155.95	3% below	75%
Blood lead test inpatient CPT 83655 ASSAY OF LEAD	$41.00	$41.00	$10.25–$41.00	—	—
Blood lead test inpatient CPT 83655 LEAD	$148.52	$148.52	$37.13–$148.52	—	—
Blood lead test inpatient CPT 83655 LEAD RANDOM U	$148.52	$148.52	$37.13–$148.52	—	—
Blood lead test inpatient CPT 83655 LEAD LEVEL	$155.95	$155.95	$38.99–$155.95	—	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY QUALITATIVE SERUM	$54.84	$219.35	$11.74–$219.35	12% above	75%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY QUAL. SERUM ASD	$54.84	$219.35	$11.74–$219.35	12% above	75%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY QUALITATIVE SERUM	$219.35	$219.35	$54.84–$219.35	—	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY QUAL. SERUM ASD	$219.35	$219.35	$54.84–$219.35	—	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 REF ABO TYPING	$95.99	$383.97	$95.99–$383.97	43% above	75%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPE ABO	$95.99	$383.97	$95.99–$383.97	43% above	75%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO GROUP	$95.99	$383.97	$95.99–$383.97	43% above	75%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO	$16.00	$16.00	$4.00–$16.00	—	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 REF ABO TYPING	$383.97	$383.97	$95.99–$383.97	—	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO GROUP	$383.97	$383.97	$95.99–$383.97	—	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPE ABO	$383.97	$383.97	$95.99–$383.97	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$23.55	$94.19	$8.10–$94.19	38% below	75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP	$23.55	$94.19	$8.10–$94.19	38% below	75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$94.19	$94.19	$23.55–$94.19	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP	$94.19	$94.19	$23.55–$94.19	—	—
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF MOLECULAR TEST	$30.00	$120.00	$30.00–$120.00	72% below	75%
C. difficile toxin gene test (stool PCR) CPT 87493 CDIFF TOXIN BY PCR	$54.04	$216.14	$54.03–$216.14	50% below	75%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFFICILE MOLECULAR TEST	$54.04	$216.14	$54.03–$216.14	50% below	75%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF MOLECULAR TEST	$120.00	$120.00	$30.00–$120.00	—	—
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFFICILE MOLECULAR TEST	$216.14	$216.14	$54.03–$216.14	—	—
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CDIFF TOXIN BY PCR	$216.14	$216.14	$54.03–$216.14	—	—
CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR CA 19-9	$26.75	$107.00	$26.75–$107.00	72% below	75%
CA 19-9 blood test (tumor marker) CPT 86301 CANCER ANTIGEN 19-9	$51.54	$206.17	$32.50–$206.17	46% below	75%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$84.00	$335.99	$32.50–$335.99	12% below	75%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 IMMUNOASSAY TUMOR CA 19-9	$107.00	$107.00	$26.75–$107.00	—	—
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CANCER ANTIGEN 19-9	$206.17	$206.17	$51.54–$206.17	—	—
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$335.99	$335.99	$84.00–$335.99	—	—
CA-125 blood test (ovarian cancer marker) CPT 86304 CA125	$67.92	$271.69	$32.50–$271.69	3% below	75%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$71.32	$285.27	$32.50–$285.27	1% above	75%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA125	$271.69	$271.69	$67.92–$271.69	—	—
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$285.27	$285.27	$71.32–$285.27	—	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 RESPIRATORY PATHOGEN PCR	$167.61	$670.45	$70.29–$670.45	29% above	75%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 RESPIRATORY PATHOGEN PCR	$670.45	$670.45	$167.61–$670.45	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA T AMP PROB	$43.83	$175.30	$43.83–$175.30	41% below	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHYLMD TRACH DNA AMP PROBE	$46.00	$184.00	$46.00–$184.00	38% below	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis DNA	$60.98	$243.92	$54.80–$243.92	18% below	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 APA CHLAMYDIA	$64.03	$256.12	$54.80–$256.12	14% below	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA T AMP PROB	$175.30	$175.30	$43.83–$175.30	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHYLMD TRACH DNA AMP PROBE	$184.00	$184.00	$46.00–$184.00	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Trachomatis DNA	$243.92	$243.92	$60.98–$243.92	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 APA CHLAMYDIA	$256.12	$256.12	$64.03–$256.12	—	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID OUTREACH	$104.48	$417.90	$20.91–$417.90	16% above	75%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$109.70	$438.80	$20.91–$438.80	22% above	75%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 CORP HEART HEALTHY LIPID PANEL	$8.82	$8.82	$2.21–$8.82	—	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 DRMC CORP HHW LIPID PANEL	$8.82	$8.82	$2.21–$8.82	—	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 DRMC HEART HEALTHY LIPID PANEL	$10.50	$10.50	$2.63–$10.50	—	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HEART HEALTHY LIPID PANEL	$11.03	$11.03	$2.76–$11.03	—	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID OUTREACH	$417.90	$417.90	$104.47–$417.90	—	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$438.80	$438.80	$109.70–$438.80	—	—
Complete blood count (CBC) with differential CPT 85025 CBC AUTO DIFF	$28.94	$115.76	$12.14–$115.76	31% below	75%
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$38.33	$153.30	$12.14–$153.30	9% below	75%
Complete blood count (CBC) with differential CPT 85025 VET CBC HEALTH PANEL	$38.33	$153.30	$12.14–$153.30	9% below	75%
Complete blood count (CBC) with differential CPT 85025 CBC W/AUTOMATED 5 PART DIF	$40.24	$160.97	$12.14–$160.97	4% below	75%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC AUTO DIFF	$115.76	$115.76	$28.94–$115.76	—	—
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$153.30	$153.30	$38.33–$153.30	—	—
Complete blood count (CBC) with differential inpatient CPT 85025 VET CBC HEALTH PANEL	$153.30	$153.30	$38.33–$153.30	—	—
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/AUTOMATED 5 PART DIF	$160.97	$160.97	$40.24–$160.97	—	—
Complete blood count (CBC), no differential CPT 85027 HEMOGRAM	$8.75	$35.00	$8.75–$35.00	71% below	75%
Complete blood count (CBC), no differential CPT 85027 HEMOGRAM W/ PLATELET COUNT	$31.50	$126.00	$10.11–$126.00	4% above	75%
Complete blood count (CBC), no differential CPT 85027 CBC HEMOGRAM	$33.08	$132.30	$10.11–$132.30	10% above	75%
Complete blood count (CBC), no differential CPT 85027 CBC/HEMOGRAM	$33.08	$132.30	$10.11–$132.30	10% above	75%
Complete blood count (CBC), no differential CPT 85027 CBC WITH MAN DIFF	$37.21	$148.84	$10.11–$148.84	23% above	75%
Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM	$35.00	$35.00	$8.75–$35.00	—	—
Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM W/ PLATELET COUNT	$126.00	$126.00	$31.50–$126.00	—	—
Complete blood count (CBC), no differential inpatient CPT 85027 CBC HEMOGRAM	$132.30	$132.30	$33.08–$132.30	—	—
Complete blood count (CBC), no differential inpatient CPT 85027 CBC/HEMOGRAM	$132.30	$132.30	$33.08–$132.30	—	—
Complete blood count (CBC), no differential inpatient CPT 85027 CBC WITH MAN DIFF	$148.84	$148.84	$37.21–$148.84	—	—
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL	$15.50	$62.00	$15.50–$62.00	88% below	75%
Comprehensive metabolic panel (blood test) CPT 80053 COMPLETE METABOLIC PANEL	$252.47	$1,009.89	$16.49–$1,009.89	97% above	75%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$252.47	$1,009.89	$16.49–$1,009.89	97% above	75%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL	$62.00	$62.00	$15.50–$62.00	—	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPLETE METABOLIC PANEL	$1,009.89	$1,009.89	$252.47–$1,009.89	—	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$1,009.89	$1,009.89	$252.47–$1,009.89	—	—
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QUANT	$43.83	$175.30	$15.91–$175.30	28% below	75%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER	$47.78	$191.10	$15.91–$191.10	21% below	75%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QUANTITATIVE	$50.17	$200.66	$15.91–$200.66	17% below	75%
D-dimer blood test (blood clot marker) CPT 85379 BLOOD CLOT INHIBITOR TEST	$54.94	$219.77	$15.91–$219.77	9% below	75%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER QUANT	$175.30	$175.30	$43.83–$175.30	—	—
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER	$191.10	$191.10	$47.77–$191.10	—	—
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER QUANTITATIVE	$200.66	$200.66	$50.16–$200.66	—	—
D-dimer blood test (blood clot marker) inpatient CPT 85379 BLOOD CLOT INHIBITOR TEST	$219.77	$219.77	$54.94–$219.77	—	—
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA	$20.83	$83.32	$20.83–$83.32	73% below	75%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE	$51.67	$206.66	$34.72–$206.66	33% below	75%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA	$83.32	$83.32	$20.83–$83.32	—	—
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE	$206.66	$206.66	$51.66–$206.66	—	—
Estradiol blood test CPT 82670 ASSAY OF ESTRADIOL	$37.00	$148.00	$37.00–$148.00	62% below	75%
Estradiol blood test CPT 82670 ESTRADIOL	$53.74	$214.94	$43.63–$214.94	45% below	75%
Estradiol blood test CPT 82670 ESTRADIOL SERUM	$53.74	$214.94	$43.63–$214.94	45% below	75%
Estradiol blood test CPT 82670 ESTRADIOL FOLLICULAR PHASE	$53.74	$214.94	$43.63–$214.94	45% below	75%
Estradiol blood test inpatient CPT 82670 ASSAY OF ESTRADIOL	$148.00	$148.00	$37.00–$148.00	—	—
Estradiol blood test inpatient CPT 82670 ESTRADIOL FOLLICULAR PHASE	$214.94	$214.94	$53.73–$214.94	—	—
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$214.94	$214.94	$53.73–$214.94	—	—
Estradiol blood test inpatient CPT 82670 ESTRADIOL SERUM	$214.94	$214.94	$53.73–$214.94	—	—
FSH (follicle-stimulating hormone) test CPT 83001 ASSAY OF GONADOTROPIN (FSH)	$24.50	$98.00	$24.50–$98.00	66% below	75%
FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE-STIMULATIN HORMONE S	$47.40	$189.58	$29.02–$189.58	34% below	75%
FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIMULATING HORMONE	$49.77	$199.06	$29.02–$199.06	31% below	75%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 ASSAY OF GONADOTROPIN (FSH)	$98.00	$98.00	$24.50–$98.00	—	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE-STIMULATIN HORMONE S	$189.58	$189.58	$47.40–$189.58	—	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE STIMULATING HORMONE	$199.06	$199.06	$49.77–$199.06	—	—
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN	$153.73	$614.92	$30.66–$614.92	24% above	75%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN	$614.92	$614.92	$153.73–$614.92	—	—
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN	$18.50	$74.00	$18.50–$74.00	69% below	75%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$67.32	$269.27	$21.29–$269.27	14% above	75%
Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN	$74.00	$74.00	$18.50–$74.00	—	—
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$269.27	$269.27	$67.32–$269.27	—	—
Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM	$19.50	$78.00	$19.50–$78.00	69% below	75%
Folate (folic acid) blood test CPT 82746 FOLATE SERUM	$70.37	$281.47	$22.96–$281.47	11% above	75%
Folate (folic acid) blood test inpatient CPT 82746 ASSAY OF FOLIC ACID SERUM	$78.00	$78.00	$19.50–$78.00	—	—
Folate (folic acid) blood test inpatient CPT 82746 FOLATE SERUM	$281.47	$281.47	$70.37–$281.47	—	—
Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3)	$22.50	$90.00	$22.50–$90.00	65% below	75%
Free T3 thyroid hormone test CPT 84481 FREE T3	$28.98	$115.92	$26.45–$115.92	55% below	75%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$30.43	$121.72	$26.45–$121.72	52% below	75%
Free T3 thyroid hormone test inpatient CPT 84481 FREE ASSAY (FT-3)	$90.00	$90.00	$22.50–$90.00	—	—
Free T3 thyroid hormone test inpatient CPT 84481 FREE T3	$115.92	$115.92	$28.98–$115.92	—	—
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE	$121.72	$121.72	$30.43–$121.72	—	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4	$32.00	$128.00	$14.08–$128.00	33% below	75%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE	$33.60	$134.40	$14.08–$134.40	30% below	75%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4	$128.00	$128.00	$32.00–$128.00	—	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE	$134.40	$134.40	$33.60–$134.40	—	—
Free testosterone test CPT 84402 TESTOSTERONE FREE	$75.17	$300.67	$39.78–$300.67	17% below	75%
Free testosterone test CPT 84402 TESTOSTERONE	$75.17	$300.67	$39.78–$300.67	17% below	75%
Free testosterone test CPT 84402 TESTOSTERONE,FREE (DIALYSIS)	$75.17	$300.67	$39.78–$300.67	17% below	75%
Free testosterone test inpatient CPT 84402 TESTOSTERONE	$300.67	$300.67	$75.17–$300.67	—	—
Free testosterone test inpatient CPT 84402 TESTOSTERONE,FREE (DIALYSIS)	$300.67	$300.67	$75.17–$300.67	—	—
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$300.67	$300.67	$75.17–$300.67	—	—
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$101.85	$407.40	$32.28–$407.40	35% below	75%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$407.40	$407.40	$101.85–$407.40	—	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TOLERANCE SCREEN 1 HR	$39.55	$158.18	$7.43–$158.18	15% above	75%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE TOLERANCE SCREEN 1 HR	$158.18	$158.18	$39.55–$158.18	—	—
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE THREE SPEC	$46.19	$184.75	$20.10–$184.75	28% below	75%
Glucose tolerance test, 3 samples CPT 82951 TOLERANCE TEST 3 SPECIMENS	$46.19	$184.75	$20.10–$184.75	28% below	75%
Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerence Test	$46.19	$184.75	$20.10–$184.75	28% below	75%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE THREE SPEC	$184.75	$184.75	$46.19–$184.75	—	—
Glucose tolerance test, 3 samples inpatient CPT 82951 TOLERANCE TEST 3 SPECIMENS	$184.75	$184.75	$46.19–$184.75	—	—
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose Tolerence Test	$184.75	$184.75	$46.19–$184.75	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC AMP PROBE	$43.83	$175.30	$43.83–$175.30	43% below	75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N GONORRHOEAE DNA AMP PROB	$46.00	$184.00	$46.00–$184.00	40% below	75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae DNA	$69.73	$278.93	$54.80–$278.93	9% below	75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 APA GONORRHOEAE	$73.22	$292.88	$54.80–$292.88	5% below	75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC AMP PROBE	$175.30	$175.30	$43.83–$175.30	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N GONORRHOEAE DNA AMP PROB	$184.00	$184.00	$46.00–$184.00	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Gonorrhoeae DNA	$278.93	$278.93	$69.73–$278.93	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 APA GONORRHOEAE	$292.88	$292.88	$73.22–$292.88	—	—
H. pylori antibody blood test CPT 86677 H PYLORI AB QUAL	$15.16	$60.64	$15.16–$60.64	80% below	75%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI ANTIBODY	$19.25	$77.00	$19.25–$77.00	74% below	75%
H. pylori antibody blood test CPT 86677 HPYLORI IGG ANTIBODY	$59.17	$236.67	$26.32–$236.67	20% below	75%
H. pylori antibody blood test CPT 86677 H. PYLORI AB IGA	$59.17	$236.67	$26.32–$236.67	20% below	75%
H. pylori antibody blood test CPT 86677 H. PYLORI AB IGM	$59.17	$236.67	$26.32–$236.67	20% below	75%
H. pylori antibody blood test CPT 86677 HPYLORI IGM ANTIBODY	$59.17	$236.67	$26.32–$236.67	20% below	75%
H. pylori antibody blood test CPT 86677 HPYLORI IGA ANTIBODY	$59.17	$236.67	$26.32–$236.67	20% below	75%
H. pylori antibody blood test CPT 86677 H. PYLORI ANTIBODY IGG	$62.13	$248.50	$26.32–$248.50	16% below	75%
H. pylori antibody blood test inpatient CPT 86677 H PYLORI AB QUAL	$60.64	$60.64	$15.16–$60.64	—	—
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI ANTIBODY	$77.00	$77.00	$19.25–$77.00	—	—
H. pylori antibody blood test inpatient CPT 86677 HPYLORI IGA ANTIBODY	$236.67	$236.67	$59.17–$236.67	—	—
H. pylori antibody blood test inpatient CPT 86677 HPYLORI IGG ANTIBODY	$236.67	$236.67	$59.17–$236.67	—	—
H. pylori antibody blood test inpatient CPT 86677 HPYLORI IGM ANTIBODY	$236.67	$236.67	$59.17–$236.67	—	—
H. pylori antibody blood test inpatient CPT 86677 H. PYLORI AB IGA	$236.67	$236.67	$59.17–$236.67	—	—
H. pylori antibody blood test inpatient CPT 86677 H. PYLORI AB IGM	$236.67	$236.67	$59.17–$236.67	—	—
H. pylori antibody blood test inpatient CPT 86677 H. PYLORI ANTIBODY IGG	$248.50	$248.50	$62.13–$248.50	—	—
H. pylori stool antigen test CPT 87338 HPYLORI STOOL IA	$18.75	$75.00	$18.75–$75.00	74% below	75%
H. pylori stool antigen test CPT 87338 H PYLORI ANTIGEN STOOL	$39.62	$158.49	$22.45–$158.49	44% below	75%
H. pylori stool antigen test CPT 87338 H PYLORI ANTIGEN	$59.54	$238.14	$22.45–$238.14	16% below	75%
H. pylori stool antigen test inpatient CPT 87338 HPYLORI STOOL IA	$75.00	$75.00	$18.75–$75.00	—	—
H. pylori stool antigen test inpatient CPT 87338 H PYLORI ANTIGEN STOOL	$158.49	$158.49	$39.62–$158.49	—	—
H. pylori stool antigen test inpatient CPT 87338 H PYLORI ANTIGEN	$238.14	$238.14	$59.53–$238.14	—	—
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT & REVRSE TRNSCRPJ	$72.75	$291.00	$72.75–$291.00	68% below	75%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANTITATION PCR	$136.45	$545.79	$132.90–$545.79	39% below	75%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 DNA QUANT	$136.45	$545.79	$132.90–$545.79	39% below	75%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV TYPE 1 RNA QUANT PLASMA	$143.27	$573.08	$132.90–$573.08	36% below	75%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANT & REVRSE TRNSCRPJ	$291.00	$291.00	$72.75–$291.00	—	—
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANTITATION PCR	$545.79	$545.79	$136.45–$545.79	—	—
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 DNA QUANT	$545.79	$545.79	$136.45–$545.79	—	—
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV TYPE 1 RNA QUANT PLASMA	$573.08	$573.08	$143.27–$573.08	—	—
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1 HIV-2 1 RESULT ANTIBODY	$18.50	$74.00	$18.50–$74.00	79% below	75%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1 & 2 SCREENING	$52.53	$210.11	$21.41–$210.11	40% below	75%
HIV-1 and HIV-2 antibody test CPT 86703 HIV ANTIBODY STAT EXPOSURE	$52.53	$210.11	$21.41–$210.11	40% below	75%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/2 AB SCRN	$52.53	$210.11	$21.41–$210.11	40% below	75%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1 HIV-2 1 RESULT ANTIBODY	$74.00	$74.00	$18.50–$74.00	—	—
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1 & 2 SCREENING	$210.11	$210.11	$52.53–$210.11	—	—
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV ANTIBODY STAT EXPOSURE	$210.11	$210.11	$52.53–$210.11	—	—
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1/2 AB SCRN	$210.11	$210.11	$52.53–$210.11	—	—
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1&2 Ag Ab EVALUATION	$24.73	$98.90	$24.73–$98.90	67% below	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 AG/AB W/RFX	$28.39	$113.56	$28.39–$113.56	62% below	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV	$28.39	$113.56	$28.39–$113.56	62% below	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1&2 Ag Ab EVALUATION	$98.90	$98.90	$24.73–$98.90	—	—
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 AG/AB W/RFX	$113.56	$113.56	$28.39–$113.56	—	—
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV	$113.56	$113.56	$28.39–$113.56	—	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 HUMAN PAPILLOMAVIRUS DETECTION	$15.70	$62.79	$15.70–$62.79	85% below	75%
HPV test for high-risk types, one combined (pooled) result CPT 87624 APA HPV DETECTION AND ID	$16.48	$65.93	$16.48–$65.93	84% below	75%
HPV test for high-risk types, one combined (pooled) result CPT 87624 APA HPV DetecID	$29.75	$119.00	$29.75–$119.00	72% below	75%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV	$39.97	$159.86	$39.97–$159.86	62% below	75%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HUMAN PAPILLOMAVIRUS DETECTION	$62.79	$62.79	$15.70–$62.79	—	—
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 APA HPV DETECTION AND ID	$65.93	$65.93	$16.48–$65.93	—	—
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 APA HPV DetecID	$119.00	$119.00	$29.75–$119.00	—	—
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV	$159.86	$159.86	$39.97–$159.86	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOBIN TEST	$13.25	$53.00	$13.25–$53.00	65% below	75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 ANCA SCREEN EACH ANTIBODY	$28.47	$113.87	$15.17–$113.87	25% below	75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C	$64.03	$256.12	$15.17–$256.12	68% above	75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 CORP HEART HEALTHY HEMO A1C	$8.40	$8.40	$2.10–$8.40	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 DRMC CORP HHW HEMO A1C	$8.82	$8.82	$2.21–$8.82	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 DRMC HEART HLTH HEMOGLOBIN A1C	$10.50	$10.50	$2.63–$10.50	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEART HEALTHY HEMOGLOBIN A1C	$13.94	$13.94	$3.48–$13.94	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HEMOGLOBIN TEST	$53.00	$53.00	$13.25–$53.00	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 ANCA SCREEN EACH ANTIBODY	$113.87	$113.87	$28.47–$113.87	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C	$256.12	$256.12	$64.03–$256.12	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY	$14.25	$57.00	$14.25–$57.00	76% below	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HB S AB QUAL	$39.97	$159.86	$16.77–$159.86	34% below	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY	$62.76	$251.04	$16.77–$251.04	4% above	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE ANTIBODY	$57.00	$57.00	$14.25–$57.00	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HB S AB QUAL	$159.86	$159.86	$39.97–$159.86	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY	$251.04	$251.04	$62.76–$251.04	—	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA	$14.00	$56.00	$14.00–$56.00	67% below	75%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP B S AG EIA	$25.08	$100.33	$16.14–$100.33	40% below	75%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGEN	$97.63	$390.51	$16.14–$390.51	132% above	75%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG IA	$56.00	$56.00	$14.00–$56.00	—	—
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEP B S AG EIA	$100.33	$100.33	$25.08–$100.33	—	—
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTIGEN	$390.51	$390.51	$97.63–$390.51	—	—
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB QUAL	$20.40	$81.59	$20.40–$81.59	64% below	75%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY QUAL	$108.09	$432.35	$22.29–$432.35	89% above	75%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB QUAL	$81.59	$81.59	$20.40–$81.59	—	—
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY QUAL	$432.35	$432.35	$108.09–$432.35	—	—
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRIPJ	$54.75	$219.00	$54.75–$219.00	59% below	75%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C RNA QUANT	$132.30	$529.20	$66.91–$529.20	1% below	75%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATIS C RNA BRANCH DNA	$176.90	$707.60	$66.91–$707.60	32% above	75%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C RNA QUANT	$176.90	$707.60	$66.91–$707.60	32% above	75%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA Detect/Quant S	$185.75	$742.98	$66.91–$742.98	38% above	75%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C REVRS TRNSCRIPJ	$219.00	$219.00	$54.75–$219.00	—	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C RNA QUANT	$529.20	$529.20	$132.30–$529.20	—	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C RNA QUANT	$707.60	$707.60	$176.90–$707.60	—	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATIS C RNA BRANCH DNA	$707.60	$707.60	$176.90–$707.60	—	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA Detect/Quant S	$742.98	$742.98	$185.75–$742.98	—	—
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 TEST	$9.50	$38.00	$9.50–$38.00	80% below	75%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMP1 AB QUAL	$18.19	$72.77	$18.19–$72.77	62% below	75%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES 1 AB 1GM	$49.21	$196.82	$20.60–$196.82	3% above	75%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IGG INDEX	$49.21	$196.82	$20.60–$196.82	3% above	75%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES 1 ANTIBODY IGG EACH	$51.67	$206.66	$20.60–$206.66	8% above	75%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE 1 TEST	$38.00	$38.00	$9.50–$38.00	—	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMP1 AB QUAL	$72.77	$72.77	$18.19–$72.77	—	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IGG INDEX	$196.82	$196.82	$49.20–$196.82	—	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES 1 AB 1GM	$196.82	$196.82	$49.20–$196.82	—	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES 1 ANTIBODY IGG EACH	$206.66	$206.66	$51.66–$206.66	—	—
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX 2 AB	$18.19	$72.77	$18.19–$72.77	69% below	75%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST	$22.25	$89.00	$22.25–$89.00	62% below	75%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IGG INDEX	$49.21	$196.82	$30.22–$196.82	15% below	75%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES 2 ANTIBODY IGG EACH	$51.67	$206.66	$30.22–$206.66	11% below	75%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX 2 AB	$72.77	$72.77	$18.19–$72.77	—	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE 2 TEST	$89.00	$89.00	$22.25–$89.00	—	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IGG INDEX	$196.82	$196.82	$49.20–$196.82	—	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES 2 ANTIBODY IGG EACH	$206.66	$206.66	$51.66–$206.66	—	—
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS	$16.75	$67.00	$16.75–$67.00	68% below	75%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HIGH SENS	$43.17	$172.67	$20.22–$172.67	16% below	75%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HS	$67.00	$67.00	$16.75–$67.00	—	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HIGH SENS	$172.67	$172.67	$43.17–$172.67	—	—
Homocysteine blood test CPT 83090 HOMOCYSTEINE TOTAL URINE	$63.09	$252.37	$27.99–$252.37	12% below	75%
Homocysteine blood test CPT 83090 HOMOCYSTEINE TOTAL	$63.09	$252.37	$27.99–$252.37	12% below	75%
Homocysteine blood test CPT 83090 HOMOCYSTEINE ULTRAQUANTITATIVE	$66.25	$264.99	$27.99–$264.99	8% below	75%
Homocysteine blood test CPT 83090 HOMOCYSTEINE	$66.25	$264.99	$27.99–$264.99	8% below	75%
Homocysteine blood test inpatient CPT 83090 ASSAY OF HOMOCYSTINE	$16.00	$16.00	$4.00–$16.00	—	—
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE TOTAL URINE	$252.37	$252.37	$63.09–$252.37	—	—
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE TOTAL	$252.37	$252.37	$63.09–$252.37	—	—
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE	$264.99	$264.99	$66.25–$264.99	—	—
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE ULTRAQUANTITATIVE	$264.99	$264.99	$66.25–$264.99	—	—
Insulin blood test CPT 83525 ASSAY OF INSULIN	$14.75	$59.00	$14.75–$59.00	68% below	75%
Insulin blood test CPT 83525 INSULIN TOTAL	$18.11	$72.45	$17.85–$72.45	60% below	75%
Insulin blood test CPT 83525 INSULIN-INHOUSE	$19.02	$76.07	$17.85–$76.07	58% below	75%
Insulin blood test inpatient CPT 83525 ASSAY OF INSULIN	$59.00	$59.00	$14.75–$59.00	—	—
Insulin blood test inpatient CPT 83525 INSULIN TOTAL	$72.45	$72.45	$18.11–$72.45	—	—
Insulin blood test inpatient CPT 83525 INSULIN-INHOUSE	$76.07	$76.07	$19.02–$76.07	—	—
Iron blood test (serum iron) CPT 83540 ASSAY OF IRON	$8.75	$35.00	$8.75–$35.00	76% below	75%
Iron blood test (serum iron) CPT 83540 IRON	$43.17	$172.67	$10.11–$172.67	18% above	75%
Iron blood test (serum iron) inpatient CPT 83540 ASSAY OF IRON	$35.00	$35.00	$8.75–$35.00	—	—
Iron blood test (serum iron) inpatient CPT 83540 IRON	$172.67	$172.67	$43.17–$172.67	—	—
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST	$11.75	$47.00	$11.75–$47.00	62% below	75%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY	$53.25	$213.00	$13.65–$213.00	71% above	75%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING TEST	$47.00	$47.00	$11.75–$47.00	—	—
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY	$213.00	$213.00	$53.25–$213.00	—	—
LH (luteinizing hormone) test CPT 83002 ASSAY OF GONADOTROPIN (LH)	$24.50	$98.00	$24.50–$98.00	63% below	75%
LH (luteinizing hormone) test CPT 83002 LUTENINIZING HORMONE SERUM	$50.72	$202.86	$28.92–$202.86	23% below	75%
LH (luteinizing hormone) test CPT 83002 LEUTENIZING HORMONE (LH)	$53.25	$213.00	$28.92–$213.00	20% below	75%
LH (luteinizing hormone) test inpatient CPT 83002 ASSAY OF GONADOTROPIN (LH)	$98.00	$98.00	$24.50–$98.00	—	—
LH (luteinizing hormone) test inpatient CPT 83002 LUTENINIZING HORMONE SERUM	$202.86	$202.86	$50.72–$202.86	—	—
LH (luteinizing hormone) test inpatient CPT 83002 LEUTENIZING HORMONE (LH)	$213.00	$213.00	$53.25–$213.00	—	—
Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE	$9.25	$37.00	$9.25–$37.00	76% below	75%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE BODY FLUID	$49.81	$199.24	$10.75–$199.24	30% above	75%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE RANDOM URINE	$49.81	$199.24	$10.75–$199.24	30% above	75%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$52.30	$209.20	$10.75–$209.20	37% above	75%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 ASSAY OF LIPASE	$37.00	$37.00	$9.25–$37.00	—	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE BODY FLUID	$199.24	$199.24	$49.81–$199.24	—	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE RANDOM URINE	$199.24	$199.24	$49.81–$199.24	—	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$209.20	$209.20	$52.30–$209.20	—	—
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$53.20	$212.78	$12.75–$212.78	40% below	75%
Liver function blood test panel CPT 80076 LIVER OUTREACH	$123.90	$495.60	$12.75–$495.60	39% above	75%
Liver function blood test panel CPT 80076 LIVER PROFILE	$123.90	$495.60	$12.75–$495.60	39% above	75%
Liver function blood test panel CPT 80076 LIVER PANEL	$123.90	$495.60	$12.75–$495.60	39% above	75%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$212.78	$212.78	$53.20–$212.78	—	—
Liver function blood test panel inpatient CPT 80076 LIVER PANEL	$495.60	$495.60	$123.90–$495.60	—	—
Liver function blood test panel inpatient CPT 80076 LIVER OUTREACH	$495.60	$495.60	$123.90–$495.60	—	—
Liver function blood test panel inpatient CPT 80076 LIVER PROFILE	$495.60	$495.60	$123.90–$495.60	—	—
Lyme disease antibody test CPT 86618 LYME DISEASE AB QL	$35.83	$143.33	$26.59–$143.33	56% below	75%
Lyme disease antibody test CPT 86618 LYME DISEASE ABY SENDOUT	$94.79	$379.16	$26.59–$379.16	16% above	75%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY	$94.79	$379.16	$26.59–$379.16	16% above	75%
Lyme disease antibody test CPT 86618 Lyme Disease Serology Eval	$94.79	$379.16	$26.59–$379.16	16% above	75%
Lyme disease antibody test CPT 86618 LYME DISEASE AB SCREEN CSF	$94.79	$379.16	$26.59–$379.16	16% above	75%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB QL	$143.33	$143.33	$35.83–$143.33	—	—
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB SCREEN CSF	$379.16	$379.16	$94.79–$379.16	—	—
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ABY SENDOUT	$379.16	$379.16	$94.79–$379.16	—	—
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY	$379.16	$379.16	$94.79–$379.16	—	—
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Serology Eval	$379.16	$379.16	$94.79–$379.16	—	—
Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM	$9.00	$36.00	$9.00–$36.00	71% below	75%
Magnesium blood test CPT 83735 MAGNESIUM RBC	$43.17	$172.67	$10.47–$172.67	39% above	75%
Magnesium blood test CPT 83735 MAGNESIUM	$43.17	$172.67	$10.47–$172.67	39% above	75%
Magnesium blood test CPT 83735 MAGNESIUM U	$43.17	$172.67	$10.47–$172.67	39% above	75%
Magnesium blood test CPT 83735 MAGNESIUM FECES	$43.17	$172.67	$10.47–$172.67	39% above	75%
Magnesium blood test CPT 83735 MAGNESIUM SERUM/URINE	$45.33	$181.30	$10.47–$181.30	46% above	75%
Magnesium blood test CPT 83735 MAGNESIUM,24 HR, U	$45.33	$181.30	$10.47–$181.30	46% above	75%
Magnesium blood test inpatient CPT 83735 ASSAY OF MAGNESIUM	$36.00	$36.00	$9.00–$36.00	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM RBC	$172.67	$172.67	$43.17–$172.67	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$172.67	$172.67	$43.17–$172.67	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM U	$172.67	$172.67	$43.17–$172.67	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM FECES	$172.67	$172.67	$43.17–$172.67	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM SERUM/URINE	$181.30	$181.30	$45.33–$181.30	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM,24 HR, U	$181.30	$181.30	$45.33–$181.30	—	—
Measles (rubeola) antibody test CPT 86765 RUBELLA AB IGG	$38.34	$153.35	$20.11–$153.35	9% below	75%
Measles (rubeola) antibody test CPT 86765 RUBEOLA AB IGG & IGM S	$38.34	$153.35	$20.11–$153.35	9% below	75%
Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY	$38.34	$153.35	$20.11–$153.35	9% below	75%
Measles (rubeola) antibody test CPT 86765 Rubeola Antibody	$38.34	$153.35	$20.11–$153.35	9% below	75%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ANTIBODY	$153.35	$153.35	$38.34–$153.35	—	—
Measles (rubeola) antibody test inpatient CPT 86765 RUBELLA AB IGG	$153.35	$153.35	$38.34–$153.35	—	—
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA AB IGG & IGM S	$153.35	$153.35	$38.34–$153.35	—	—
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola Antibody	$153.35	$153.35	$38.34–$153.35	—	—
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN	$7.00	$28.00	$7.00–$28.00	77% below	75%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SCREEN	$12.05	$48.18	$8.10–$48.18	61% below	75%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SCR (HETEROPHIL)	$18.19	$72.77	$8.10–$72.77	40% below	75%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODY SCREEN	$28.00	$28.00	$7.00–$28.00	—	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SCREEN	$48.18	$48.18	$12.04–$48.18	—	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SCR (HETEROPHIL)	$72.77	$72.77	$18.19–$72.77	—	—
Obstetric blood test panel CPT 80055 OBSTETRIC PANEL	$101.85	$407.40	$74.67–$407.40	21% below	75%
Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL	$407.40	$407.40	$101.85–$407.40	—	—
PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PSA FREE	$25.00	$100.00	$25.00–$100.00	66% below	75%
PSA (prostate-specific antigen) blood test, free CPT 84154 PROSTATE SPECIFIC ANTIGEN FREE	$45.28	$181.13	$28.72–$181.13	38% below	75%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 ASSAY OF PSA FREE	$100.00	$100.00	$25.00–$100.00	—	—
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PROSTATE SPECIFIC ANTIGEN FREE	$181.13	$181.13	$45.28–$181.13	—	—
PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL	$44.08	$176.30	$28.72–$176.30	34% below	75%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANTIGEN (PSA	$46.28	$185.12	$28.72–$185.12	31% below	75%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Ultrasensitive	$46.28	$185.12	$28.72–$185.12	31% below	75%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL	$176.30	$176.30	$44.08–$176.30	—	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN (PSA	$185.12	$185.12	$46.28–$185.12	—	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Ultrasensitive	$185.12	$185.12	$46.28–$185.12	—	—
Pap test (liquid-based, automated screening with review) CPT 88175 PAP	$20.12	$80.48	$20.12–$80.48	53% below	75%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATH C/V AUTO FLUID REDO	$33.75	$135.00	$33.75–$135.00	21% below	75%
Pap test (liquid-based, automated screening with review) CPT 88175 APA AUTOMATED THINPREP PAP	$89.84	$359.36	$41.57–$359.36	109% above	75%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP	$80.48	$80.48	$20.12–$80.48	—	—
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTOPATH C/V AUTO FLUID REDO	$135.00	$135.00	$33.75–$135.00	—	—
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 APA AUTOMATED THINPREP PAP	$359.36	$359.36	$89.84–$359.36	—	—
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 APA MANUAL THINPREP PAP	$7.89	$31.54	$7.88–$31.65	85% below	75%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 APA MANUAL THINPREP PAP	$31.54	$31.54	$7.88–$31.54	—	—
Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE	$54.75	$219.00	$54.75–$219.00	65% below	75%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE INTACT	$103.54	$414.17	$64.47–$414.17	35% below	75%
Parathyroid hormone (PTH) blood test CPT 83970 PTH C TERMINAL TOTAL CALCIUM	$103.54	$414.17	$64.47–$414.17	35% below	75%
Parathyroid hormone (PTH) blood test CPT 83970 PTH W/ MINERALS	$103.54	$414.17	$64.47–$414.17	35% below	75%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT WITH MINERALS	$103.54	$414.17	$64.47–$414.17	35% below	75%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT SERUM	$108.72	$434.88	$64.47–$434.88	31% below	75%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 ASSAY OF PARATHORMONE	$219.00	$219.00	$54.75–$219.00	—	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE INTACT	$414.17	$414.17	$103.54–$414.17	—	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH C TERMINAL TOTAL CALCIUM	$414.17	$414.17	$103.54–$414.17	—	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT WITH MINERALS	$414.17	$414.17	$103.54–$414.17	—	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH W/ MINERALS	$414.17	$414.17	$103.54–$414.17	—	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT SERUM	$434.88	$434.88	$108.72–$434.88	—	—
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBO TIME PARTIAL,PLASMA	$8.25	$33.00	$8.25–$33.00	76% below	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL; P	$14.33	$57.33	$9.38–$57.33	59% below	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBIN TIME (PTT)	$14.33	$57.33	$9.38–$57.33	59% below	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL	$15.70	$62.79	$9.38–$62.79	55% below	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 3000006517	$16.33	$65.33	$9.38–$65.33	53% below	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$26.74	$106.94	$9.38–$106.94	23% below	75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBO TIME PARTIAL,PLASMA	$33.00	$33.00	$8.25–$33.00	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL; P	$57.33	$57.33	$14.33–$57.33	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBIN TIME (PTT)	$57.33	$57.33	$14.33–$57.33	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL	$62.79	$62.79	$15.70–$62.79	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 3000006517	$65.33	$65.33	$16.33–$65.33	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$106.94	$106.94	$26.73–$106.94	—	—
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 NIPT with Microdeletions	$398.48	$1,593.90	$398.48–$1,593.90	70% below	75%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 MaterniT21 Plus	$398.48	$1,593.90	$398.48–$1,593.90	70% below	75%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 NIPT with Microdeletions	$1,593.90	$1,593.90	$398.48–$1,593.90	—	—
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 MaterniT21 Plus	$1,593.90	$1,593.90	$398.48–$1,593.90	—	—
Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE	$28.25	$113.00	$28.25–$113.00	55% below	75%
Progesterone blood test CPT 84144 PROGESTERONE FOLLICULAR PHASE	$38.64	$154.56	$32.58–$154.56	38% below	75%
Progesterone blood test CPT 84144 PROGESTERONE	$38.64	$154.56	$32.58–$154.56	38% below	75%
Progesterone blood test inpatient CPT 84144 ASSAY OF PROGESTERONE	$113.00	$113.00	$28.25–$113.00	—	—
Progesterone blood test inpatient CPT 84144 PROGESTERONE FOLLICULAR PHASE	$154.56	$154.56	$38.64–$154.56	—	—
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$154.56	$154.56	$38.64–$154.56	—	—
Prolactin blood test CPT 84146 ASSAY OF PROLACTIN	$24.75	$99.00	$24.75–$99.00	65% below	75%
Prolactin blood test CPT 84146 PROLACTIN	$46.29	$185.17	$30.26–$185.17	34% below	75%
Prolactin blood test CPT 84146 PROLACTIN SERUM	$46.29	$185.17	$30.26–$185.17	34% below	75%
Prolactin blood test inpatient CPT 84146 ASSAY OF PROLACTIN	$99.00	$99.00	$24.75–$99.00	—	—
Prolactin blood test inpatient CPT 84146 PROLACTIN	$185.17	$185.17	$46.29–$185.17	—	—
Prolactin blood test inpatient CPT 84146 PROLACTIN SERUM	$185.17	$185.17	$46.29–$185.17	—	—
Prothrombin time (PT/INR) clotting test CPT 85610 ANTITHROMBIN III TEST	$25.06	$100.22	$6.70–$100.22	10% below	75%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME	$26.74	$106.94	$6.70–$106.94	4% below	75%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$86.64	$346.55	$6.70–$346.55	210% above	75%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 ANTITHROMBIN III TEST	$100.22	$100.22	$25.05–$100.22	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME	$106.94	$106.94	$26.73–$106.94	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$346.55	$346.55	$86.64–$346.55	—	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN QUALITATE/MULTI	$9.50	$38.00	$9.50–$38.00	64% below	75%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 FENTANYL URINE (DRMC)	$15.40	$61.58	$15.39–$61.58	42% below	75%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN ALERE	$15.40	$61.58	$15.39–$61.58	42% below	75%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN QUALITATE/MULTI	$38.00	$38.00	$9.50–$38.00	—	—
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN ALERE	$61.58	$61.58	$15.39–$61.58	—	—
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 FENTANYL URINE (DRMC)	$61.58	$61.58	$15.39–$61.58	—	—
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/OPTIC	$12.00	$48.00	$12.00–$48.00	76% below	75%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA VIRUS A AG	$25.08	$100.33	$25.08–$100.33	51% below	75%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZAE A ANTIGEN	$43.11	$172.43	$25.85–$172.43	15% below	75%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA ASSAY W/OPTIC	$48.00	$48.00	$12.00–$48.00	—	—
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA VIRUS A AG	$100.33	$100.33	$25.08–$100.33	—	—
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZAE A ANTIGEN	$172.43	$172.43	$43.11–$172.43	—	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ASSAY W/OPTIC	$14.25	$57.00	$14.25–$57.00	60% below	75%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A OPTICAL IA	$25.08	$100.33	$25.08–$100.33	30% below	75%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP GROUP A EIA QUAL.	$36.77	$147.07	$25.81–$147.07	2% above	75%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A ASSAY W/OPTIC	$57.00	$57.00	$14.25–$57.00	—	—
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A OPTICAL IA	$100.33	$100.33	$25.08–$100.33	—	—
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP GROUP A EIA QUAL.	$147.07	$147.07	$36.77–$147.07	—	—
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT	$8.25	$33.00	$8.25–$33.00	75% below	75%
Rheumatoid factor (RF) test CPT 86431 RA QN	$18.19	$72.77	$8.85–$72.77	46% below	75%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor BF	$37.74	$150.94	$8.85–$150.94	12% above	75%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIV	$39.62	$158.49	$8.85–$158.49	18% above	75%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT	$33.00	$33.00	$8.25–$33.00	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 RA QN	$72.77	$72.77	$18.19–$72.77	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor BF	$150.94	$150.94	$37.73–$150.94	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTITATIV	$158.49	$158.49	$39.62–$158.49	—	—
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB IGM	$34.72	$138.86	$22.47–$138.86	20% below	75%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODIES IgM S	$34.72	$138.86	$22.47–$138.86	20% below	75%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibody	$34.72	$138.86	$22.47–$138.86	20% below	75%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibody IgG	$34.72	$138.86	$22.47–$138.86	20% below	75%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY	$36.45	$145.80	$22.47–$145.80	16% below	75%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibody	$138.86	$138.86	$34.72–$138.86	—	—
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODIES IgM S	$138.86	$138.86	$34.72–$138.86	—	—
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB IGM	$138.86	$138.86	$34.72–$138.86	—	—
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibody IgG	$138.86	$138.86	$34.72–$138.86	—	—
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODY	$145.80	$145.80	$36.45–$145.80	—	—
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESR (SED RATE)	$25.36	$101.43	$4.22–$101.43	at median	75%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESR (SED RATE)	$101.43	$101.43	$25.36–$101.43	—	—
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS COMPLETE	$50.14	$200.55	$19.22–$200.55	60% below	75%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANALYSIS COMPLETE	$200.55	$200.55	$50.14–$200.55	—	—
Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS	$11.75	$47.00	$11.75–$47.00	71% below	75%
Stool ova and parasites exam CPT 87177 PARASITOLOGY ID CONCENTRATE	$12.38	$49.51	$12.38–$49.51	69% below	75%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES SMEARS	$47.00	$47.00	$11.75–$47.00	—	—
Stool ova and parasites exam inpatient CPT 87177 PARASITOLOGY ID CONCENTRATE	$49.51	$49.51	$12.38–$49.51	—	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECES	$4.75	$19.00	$4.75–$19.00	78% below	75%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD	$10.57	$42.26	$6.84–$42.26	52% below	75%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD FECES	$19.00	$19.00	$4.75–$19.00	—	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD	$42.26	$42.26	$10.56–$42.26	—	—
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HEMOSURE IFOB	$22.05	$88.20	$22.05–$88.20	57% below	75%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD EIA GSDL	$48.00	$191.99	$24.87–$191.99	7% below	75%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HEMOSURE IFOB	$88.20	$88.20	$22.05–$88.20	—	—
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD EIA GSDL	$191.99	$191.99	$48.00–$191.99	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR QUAL	$16.26	$65.05	$6.67–$65.05	9% below	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL	$20.25	$81.00	$6.67–$81.00	14% above	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST QUAL EACH	$31.70	$126.79	$6.67–$126.79	78% above	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR QUAL	$65.05	$65.05	$16.26–$65.05	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREP QUAL	$81.00	$81.00	$20.25–$81.00	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST QUAL EACH	$126.79	$126.79	$31.70–$126.79	—	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB Test Cell Immun Measure	$103.02	$412.06	$96.80–$412.06	4% above	75%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB Test Cell Immun Measure	$412.06	$412.06	$103.02–$412.06	—	—
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$33.75	$135.00	$33.75–$135.00	57% below	75%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE URINE	$92.98	$371.91	$40.31–$371.91	17% above	75%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$92.98	$371.91	$40.31–$371.91	17% above	75%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE,TOTAL,MS	$92.98	$371.91	$40.31–$371.91	17% above	75%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE	$92.98	$371.91	$40.31–$371.91	17% above	75%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE,TOTAL,S	$97.63	$390.51	$40.31–$390.51	23% above	75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$135.00	$135.00	$33.75–$135.00	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE URINE	$371.91	$371.91	$92.98–$371.91	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE,TOTAL,MS	$371.91	$371.91	$92.98–$371.91	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL	$371.91	$371.91	$92.98–$371.91	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE	$371.91	$371.91	$92.98–$371.91	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE,TOTAL,S	$390.51	$390.51	$97.63–$390.51	—	—
Thyroid peroxidase (TPO) antibody test CPT 86376 THROID PEROXIDOSE ANTIBODY	$19.50	$78.00	$19.50–$78.00	53% below	75%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTI MICROSOMAL AB	$35.83	$143.33	$22.73–$143.33	14% below	75%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTI-TPO AB IGG	$75.77	$303.08	$22.73–$303.08	83% above	75%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER CYTOSOL AUTOANTIBODIES	$75.77	$303.08	$22.73–$303.08	83% above	75%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSOME ABS	$75.77	$303.08	$22.73–$303.08	83% above	75%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTI-MICROSOME/THYROGLOBULIN	$75.77	$303.08	$22.73–$303.08	83% above	75%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTITHYROID MICROSOMAL AB S	$75.77	$303.08	$22.73–$303.08	83% above	75%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AUTOAB	$79.56	$318.23	$22.73–$318.23	92% above	75%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THROID PEROXIDOSE ANTIBODY	$78.00	$78.00	$19.50–$78.00	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTI MICROSOMAL AB	$143.33	$143.33	$35.83–$143.33	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY MICROSOME ABS	$303.08	$303.08	$75.77–$303.08	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTI-TPO AB IGG	$303.08	$303.08	$75.77–$303.08	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER CYTOSOL AUTOANTIBODIES	$303.08	$303.08	$75.77–$303.08	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTI-MICROSOME/THYROGLOBULIN	$303.08	$303.08	$75.77–$303.08	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTITHYROID MICROSOMAL AB S	$303.08	$303.08	$75.77–$303.08	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AUTOAB	$318.23	$318.23	$79.56–$318.23	—	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE	$22.25	$89.00	$22.25–$89.00	65% below	75%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HYPERSENSITIVE TSH	$110.49	$441.95	$26.24–$441.95	74% above	75%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE	$110.49	$441.95	$26.24–$441.95	74% above	75%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID FUNCTION CASCADE S	$110.49	$441.95	$26.24–$441.95	74% above	75%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH SENDOFF	$110.49	$441.95	$26.24–$441.95	74% above	75%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE	$89.00	$89.00	$22.25–$89.00	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE	$441.95	$441.95	$110.49–$441.95	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID FUNCTION CASCADE S	$441.95	$441.95	$110.49–$441.95	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH SENDOFF	$441.95	$441.95	$110.49–$441.95	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HYPERSENSITIVE TSH	$441.95	$441.95	$110.49–$441.95	—	—
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$37.75	$151.00	$37.75–$151.00	52% below	75%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAG AMP PROBE	$51.67	$206.66	$51.66–$206.66	34% below	75%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS	$95.64	$382.57	$54.80–$382.57	22% above	75%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$151.00	$151.00	$37.75–$151.00	—	—
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAG AMP PROBE	$206.66	$206.66	$51.66–$206.66	—	—
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS	$382.57	$382.57	$95.64–$382.57	—	—
Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID	$6.25	$25.00	$6.25–$25.00	83% below	75%
Uric acid blood test CPT 84550 URIC ACID SERUM	$28.84	$115.37	$7.06–$115.37	20% below	75%
Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID	$25.00	$25.00	$6.25–$25.00	—	—
Uric acid blood test inpatient CPT 84550 URIC ACID SERUM	$115.37	$115.37	$28.84–$115.37	—	—
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$4.50	$18.00	$4.50–$18.00	85% below	75%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS W/MICROSCOPIC EXAM	$21.24	$84.95	$4.95–$84.95	28% below	75%
Urinalysis with microscope exam, automated CPT 81001 UA W MICRO AUTO	$26.74	$106.94	$4.95–$106.94	9% below	75%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE	$18.00	$18.00	$4.50–$18.00	—	—
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS W/MICROSCOPIC EXAM	$84.95	$84.95	$21.24–$84.95	—	—
Urinalysis with microscope exam, automated inpatient CPT 81001 UA W MICRO AUTO	$106.94	$106.94	$26.73–$106.94	—	—
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS NONAUTO W/SCOPE	$4.75	$19.00	$4.75–$19.00	69% below	75%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS NONAUTO W/SCOPE	$19.00	$19.00	$4.75–$19.00	—	—
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE	$3.50	$14.00	$3.50–$14.00	82% below	75%
Urinalysis without microscope exam, automated CPT 81003 KETONES UR AUTO	$6.34	$25.36	$3.52–$25.36	67% below	75%
Urinalysis without microscope exam, automated CPT 81003 UA W O MICRO AUTO	$6.34	$25.36	$3.52–$25.36	67% below	75%
Urinalysis without microscope exam, automated CPT 81003 PROTEIN; URINE QUALITATIVE	$7.55	$30.19	$3.52–$30.19	61% below	75%
Urinalysis without microscope exam, automated CPT 81003 UR CONSTIUENT AUTO EACH	$7.55	$30.19	$3.52–$30.19	61% below	75%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS NO MICRO EXAM	$7.93	$31.70	$3.52–$31.70	59% below	75%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O SCOPE	$14.00	$14.00	$3.50–$14.00	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 UA W O MICRO AUTO	$25.36	$25.36	$6.34–$25.36	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 KETONES UR AUTO	$25.36	$25.36	$6.34–$25.36	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 UR CONSTIUENT AUTO EACH	$30.19	$30.19	$7.55–$30.19	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 PROTEIN; URINE QUALITATIVE	$30.19	$30.19	$7.55–$30.19	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS NO MICRO EXAM	$31.70	$31.70	$7.92–$31.70	—	—
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$3.50	$14.00	$3.50–$14.00	78% below	75%
Urinalysis without microscope exam, manual CPT 81002 UR CONSTITUENT NON AUTO EACH	$9.36	$37.43	$5.44–$37.43	40% below	75%
Urinalysis without microscope exam, manual CPT 81002 SPECIFIC GRAVITY (URINE)	$9.36	$37.43	$5.44–$37.43	40% below	75%
Urinalysis without microscope exam, manual CPT 81002 ACETONE QUALITATIVE	$9.36	$37.43	$5.44–$37.43	40% below	75%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$14.00	$14.00	$3.50–$14.00	—	—
Urinalysis without microscope exam, manual inpatient CPT 81002 SPECIFIC GRAVITY (URINE)	$37.43	$37.43	$9.36–$37.43	—	—
Urinalysis without microscope exam, manual inpatient CPT 81002 UR CONSTITUENT NON AUTO EACH	$37.43	$37.43	$9.36–$37.43	—	—
Urinalysis without microscope exam, manual inpatient CPT 81002 ACETONE QUALITATIVE	$37.43	$37.43	$9.36–$37.43	—	—
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT	$11.25	$45.00	$11.25–$45.00	76% below	75%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE	$39.62	$158.49	$12.60–$158.49	14% below	75%
Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE/COLONY COUNT	$45.00	$45.00	$11.25–$45.00	—	—
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE	$158.49	$158.49	$39.62–$158.49	—	—
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$8.75	$35.00	$8.75–$35.00	85% below	75%
Urine pregnancy test, read by color change CPT 81025 PREG URINE QUAL	$22.05	$88.20	$13.45–$88.20	63% below	75%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY QUALITATIVE URINE	$35.82	$143.27	$13.45–$143.27	40% below	75%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST	$35.00	$35.00	$8.75–$35.00	—	—
Urine pregnancy test, read by color change inpatient CPT 81025 PREG URINE QUAL	$88.20	$88.20	$22.05–$88.20	—	—
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY QUALITATIVE URINE	$143.27	$143.27	$35.82–$143.27	—	—
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12	$19.75	$79.00	$19.75–$79.00	64% below	75%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 ASSAY	$92.56	$370.22	$23.55–$370.22	67% above	75%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12	$79.00	$79.00	$19.75–$79.00	—	—
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 ASSAY	$370.22	$370.22	$92.56–$370.22	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY	$39.00	$156.00	$39.00–$156.00	51% below	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D LEVEL (25-HYDROXY)	$92.56	$370.22	$46.22–$370.22	17% above	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY	$156.00	$156.00	$39.00–$156.00	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D LEVEL (25-HYDROXY)	$370.22	$370.22	$92.56–$370.22	—	—
Zinc blood test CPT 84630 ZINC LEVEL	$28.53	$114.11	$17.78–$114.11	35% below	75%
Zinc blood test CPT 84630 ZINC RBCs TEST	$28.53	$114.11	$17.78–$114.11	35% below	75%
Zinc blood test inpatient CPT 84630 ZINC RBCs TEST	$114.11	$114.11	$28.53–$114.11	—	—
Zinc blood test inpatient CPT 84630 ZINC LEVEL	$114.11	$114.11	$28.53–$114.11	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST	$19.50	$78.00	$19.50–$78.00	51% below	75%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUANTITATIVE/ALPHA EACH	$81.46	$325.85	$23.51–$325.85	105% above	75%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHORIONIC GONADOTROPIN TEST	$78.00	$78.00	$19.50–$78.00	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QUANTITATIVE/ALPHA EACH	$325.85	$325.85	$81.46–$325.85	—	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Arkansas	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 REMOVAL OF ADENOIDS	$2,416.96	$9,667.83	$2,416.96–$9,667.83	6% below	75%
Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 REMOVAL OF ADENOIDS	$9,667.83	$9,667.83	$2,416.96–$9,667.83	—	—
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTH ROTATOR CUFF REPAIR	$5,318.01	$21,272.04	$2,000.00–$21,272.04	32% below	75%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 ARTH ROTATOR CUFF REPAIR	$21,272.04	$21,272.04	$5,318.01–$21,272.04	—	—
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 ER CLS TX DIST FIBULA NO MANIP	$192.40	$769.60	$192.40–$769.60	49% below	75%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 ER CLS TX DIST FIBULA NO MANIP	$769.60	$769.60	$192.40–$769.60	—	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 ER TX METATARSAL FX NO MANIP	$192.40	$769.60	$192.40–$769.60	50% below	75%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 ER TX METATARSAL FX NO MANIP	$769.60	$769.60	$192.40–$769.60	—	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 ER CARDIOVERSION EXTERNAL	$488.05	$1,952.19	$488.05–$1,952.19	20% below	75%
Cardioversion, elective (restoring heart rhythm) CPT 92960 OIU CARDIOVERSION	$488.05	$1,952.19	$488.05–$1,952.19	20% below	75%
Cardioversion, elective (restoring heart rhythm) CPT 92960 MS CARDIOVERSION	$488.05	$1,952.19	$488.05–$1,952.19	20% below	75%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 MS CARDIOVERSION	$1,952.19	$1,952.19	$488.05–$1,952.19	—	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ER CARDIOVERSION EXTERNAL	$1,952.19	$1,952.19	$488.05–$1,952.19	—	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 OIU CARDIOVERSION	$1,952.19	$1,952.19	$488.05–$1,952.19	—	—
Carpal tunnel release, open surgery CPT 64721 WRIST CARPAL TUNNEL RELEASE	$1,459.64	$5,838.54	$915.00–$5,838.54	37% below	75%
Carpal tunnel release, open surgery inpatient CPT 64721 WRIST CARPAL TUNNEL RELEASE	$5,838.54	$5,838.54	$1,459.63–$5,838.54	—	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 ER CLSD TX DIS RAD FX W/O MIN	$192.40	$769.60	$192.40–$769.60	51% below	75%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 ER CLSD TX DIS RAD FX W/O MIN	$769.60	$769.60	$192.40–$769.60	—	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$11.00	$44.00	$11.00–$80.09	78% below	75%
Earwax removal by irrigation (rinsing), one ear CPT 69209 EAR IRRIGATION	$44.30	$177.21	$44.30–$177.21	13% below	75%
Earwax removal by irrigation (rinsing), one ear CPT 69209 ER REM IMP EARWAX W/IRRIG, UNI	$44.30	$177.21	$44.30–$177.21	13% below	75%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI	$44.00	$44.00	$11.00–$44.00	—	—
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ER REM IMP EARWAX W/IRRIG, UNI	$177.21	$177.21	$44.30–$177.21	—	—
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 EAR IRRIGATION	$177.21	$177.21	$44.30–$177.21	—	—
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI	$29.75	$119.00	$29.75–$119.00	50% below	75%
Earwax removal with instruments, one ear CPT 69210 MS REMOVE IMPACT EAR WAX UNI	$82.41	$329.65	$80.09–$329.65	37% above	75%
Earwax removal with instruments, one ear CPT 69210 ER REM IMP EARWAX W/INST, UNI	$82.41	$329.65	$80.09–$329.65	37% above	75%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR WAX UNI	$119.00	$119.00	$29.75–$119.00	—	—
Earwax removal with instruments, one ear inpatient CPT 69210 ER REM IMP EARWAX W/INST, UNI	$329.65	$329.65	$82.41–$329.65	—	—
Earwax removal with instruments, one ear inpatient CPT 69210 MS REMOVE IMPACT EAR WAX UNI	$329.65	$329.65	$82.41–$329.65	—	—
Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 NSL/SINS NDSC W/TOT ETHMDCT	$5,131.55	$20,526.21	$5,131.55–$20,526.21	at median	75%
Endoscopic sinus surgery: full ethmoid sinus opening inpatient CPT 31255 NSL/SINS NDSC W/TOT ETHMDCT	$20,526.21	$20,526.21	$5,131.55–$20,526.21	—	—
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 NSL/SINS NDSC FRNT TISS RMVL	$5,131.55	$20,526.21	$5,131.55–$20,526.21	29% below	75%
Endoscopic sinus surgery: opening the frontal sinus inpatient CPT 31276 NSL/SINS NDSC FRNT TISS RMVL	$20,526.21	$20,526.21	$5,131.55–$20,526.21	—	—
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 EXPLORATION MAXILLARY SINUS	$2,761.04	$11,044.14	$2,761.03–$11,044.14	47% below	75%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 EXPLORATION MAXILLARY SINUS	$11,044.14	$11,044.14	$2,761.03–$11,044.14	—	—
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 ENDOSCOPY MAXILLARY SINUS	$5,131.55	$20,526.21	$5,131.55–$20,526.21	at median	75%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 ENDOSCOPY MAXILLARY SINUS	$20,526.21	$20,526.21	$5,131.55–$20,526.21	—	—
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINER CRV/THRC	$522.54	$2,090.16	$522.54–$2,090.16	27% below	75%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 NJX INTERLAMINER CRV/THRC	$2,090.16	$2,090.16	$522.54–$2,090.16	—	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JOINT LUM 1 LEV	$739.17	$2,956.68	$739.17–$2,956.68	19% below	75%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERT F JOINT LUM 1 LEV	$2,956.68	$2,956.68	$739.17–$2,956.68	—	—
Incision and drainage of a simple or single skin abscess CPT 10060 I & D	$59.85	$239.40	$59.85–$251.61	68% below	75%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABCESS SIMPLE	$249.46	$997.82	$249.46–$997.82	33% above	75%
Incision and drainage of a simple or single skin abscess CPT 10060 ER I&D ABSCESS SIMPLE	$249.46	$997.82	$249.46–$997.82	33% above	75%
Incision and drainage of a simple or single skin abscess CPT 10060 MS DRAINAGE SKIN ABCESS	$249.46	$997.82	$249.46–$997.82	33% above	75%
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION/DRAINAGE SIMPLE	$249.46	$997.82	$249.46–$997.82	33% above	75%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D	$239.40	$239.40	$59.85–$239.40	—	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION/DRAINAGE SIMPLE	$997.82	$997.82	$249.46–$997.82	—	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 MS DRAINAGE SKIN ABCESS	$997.82	$997.82	$249.46–$997.82	—	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABCESS SIMPLE	$997.82	$997.82	$249.46–$997.82	—	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ER I&D ABSCESS SIMPLE	$997.82	$997.82	$249.46–$997.82	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ/ASP LG JOING SHL	$205.63	$822.51	$205.63–$822.51	19% above	75%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ER ASP/INJ MJ JNT SHLD/KNEE/HP	$226.23	$904.92	$226.23–$904.92	31% above	75%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJ/ASP LG JOING SHL	$822.51	$822.51	$205.63–$822.51	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ER ASP/INJ MJ JNT SHLD/KNEE/HP	$904.92	$904.92	$226.23–$904.92	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 MS ASP/INJ IM JNT/BURSA W/O US	$226.23	$904.92	$226.23–$904.92	28% above	75%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ER ASPI/INJ MD JNT WRST/ELB/AN	$226.23	$904.92	$226.23–$904.92	28% above	75%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ER ASPI/INJ MD JNT WRST/ELB/AN	$904.92	$904.92	$226.23–$904.92	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 MS ASP/INJ IM JNT/BURSA W/O US	$904.92	$904.92	$226.23–$904.92	—	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 MS ASP/INJ JOINT/BURSA W/O US	$226.23	$904.92	$226.23–$904.92	53% above	75%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ER ASPI/INJ SM JNT FINGER /TOE	$226.23	$904.92	$226.23–$904.92	53% above	75%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASPI/INJ SM JNT FINGER /TOE	$226.23	$904.92	$226.23–$904.92	53% above	75%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 MS ASP/INJ JOINT/BURSA W/O US	$904.92	$904.92	$226.23–$904.92	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ER ASPI/INJ SM JNT FINGER /TOE	$904.92	$904.92	$226.23–$904.92	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASPI/INJ SM JNT FINGER /TOE	$904.92	$904.92	$226.23–$904.92	—	—
Knee arthroscopy with meniscus trim CPT 29881 KNEE MENISECTOMY	$2,422.73	$9,690.90	$1,625.00–$9,690.90	47% below	75%
Knee arthroscopy with meniscus trim inpatient CPT 29881 KNEE MENISECTOMY	$9,690.90	$9,690.90	$2,422.72–$9,690.90	—	—
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 MENISCECTOMY MEDIAL & LATERAL	$2,422.73	$9,690.90	$1,625.00–$9,690.90	48% below	75%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 MENISCECTOMY MEDIAL & LATERAL	$9,690.90	$9,690.90	$2,422.72–$9,690.90	—	—
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 CHONDRAPLASTY....KNEE	$364.50	$1,458.00	$364.50–$4,147.48	90% below	75%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 CHONDRAPLASTY....KNEE	$1,458.00	$1,458.00	$364.50–$1,458.00	—	—
Laparoscopic sleeve gastrectomy for weight loss CPT 43775 LAPS GSTRC RSTRICTIV PX LONGIT	$1,032.50	$4,130.00	$999.22–$13,479.55	91% below	75%
Laparoscopic sleeve gastrectomy for weight loss inpatient CPT 43775 LAPS GSTRC RSTRICTIV PX LONGIT	$4,130.00	$4,130.00	$1,032.50–$4,130.00	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ER LSRP SCALP AXIL TRNK 2.5CM	$302.33	$1,209.33	$302.33–$1,209.33	6% below	75%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 ER LSRP SCALP AXIL TRNK 2.5CM	$1,209.33	$1,209.33	$302.33–$1,209.33	—	—
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC	$529.97	$2,119.89	$529.97–$2,119.89	28% below	75%
Lower-back epidural injection, with imaging guidance CPT 62323 CAUDAL BLOCK	$529.97	$2,119.89	$529.97–$2,119.89	28% below	75%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC	$2,119.89	$2,119.89	$529.97–$2,119.89	—	—
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 CAUDAL BLOCK	$2,119.89	$2,119.89	$529.97–$2,119.89	—	—
Lower-back epidural injection, without imaging guidance CPT 62322 DRMC LUMBAR ESI W/O IMAGING	$620.16	$2,480.64	$620.16–$2,480.64	at median	75%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC	$672.43	$2,689.71	$672.43–$2,689.71	8% above	75%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 DRMC LUMBAR ESI W/O IMAGING	$2,480.64	$2,480.64	$620.16–$2,480.64	—	—
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC	$2,689.71	$2,689.71	$672.43–$2,689.71	—	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+ MARG 0.5CM<	$499.01	$1,996.05	$499.01–$1,996.05	68% above	75%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+ MARG 0.5CM<	$1,996.05	$1,996.05	$499.01–$1,996.05	—	—
Nail removal (partial or complete), one nail CPT 11730 SPL AVULSE NPL; SGL	$153.41	$613.65	$153.41–$1,450.00	4% above	75%
Nail removal (partial or complete), one nail CPT 11730 ER AVUL NAIL PLT SIMPLE SINGLE	$153.41	$613.65	$153.41–$613.65	4% above	75%
Nail removal (partial or complete), one nail inpatient CPT 11730 SPL AVULSE NPL; SGL	$613.65	$613.65	$153.41–$613.65	—	—
Nail removal (partial or complete), one nail inpatient CPT 11730 ER AVUL NAIL PLT SIMPLE SINGLE	$613.65	$613.65	$153.41–$613.65	—	—
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS WITH IMAGING	$673.99	$2,695.95	$673.99–$2,695.95	4% above	75%
Paracentesis with imaging guidance CPT 49083 US PERIT/PARACENT IT	$673.99	$2,695.95	$673.99–$2,695.95	4% above	75%
Paracentesis with imaging guidance CPT 49083 ABDOM PARACENTISIS W/IMAG GUID	$698.52	$2,794.08	$698.52–$2,794.08	8% above	75%
Paracentesis with imaging guidance CPT 49083 ER PARACENTESIS W/IMAGING	$698.52	$2,794.08	$698.52–$2,794.08	8% above	75%
Paracentesis with imaging guidance inpatient CPT 49083 US PERIT/PARACENT IT	$2,695.95	$2,695.95	$673.99–$2,695.95	—	—
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS WITH IMAGING	$2,695.95	$2,695.95	$673.99–$2,695.95	—	—
Paracentesis with imaging guidance inpatient CPT 49083 ER PARACENTESIS W/IMAGING	$2,794.08	$2,794.08	$698.52–$2,794.08	—	—
Paracentesis with imaging guidance inpatient CPT 49083 ABDOM PARACENTISIS W/IMAG GUID	$2,794.08	$2,794.08	$698.52–$2,794.08	—	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 ER EXCISION NAIL AND MATRIX	$317.61	$1,270.42	$317.61–$1,270.42	9% below	75%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$317.61	$1,270.42	$317.61–$1,270.42	9% below	75%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 MS REMOVAL OF NAIL BED	$317.61	$1,270.42	$317.61–$1,270.42	9% below	75%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 ER EXCISION NAIL AND MATRIX	$1,270.42	$1,270.42	$317.61–$1,270.42	—	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 MS REMOVAL OF NAIL BED	$1,270.42	$1,270.42	$317.61–$1,270.42	—	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF NAIL BED	$1,270.42	$1,270.42	$317.61–$1,270.42	—	—
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY L/S FACET JNT	$1,459.64	$5,838.54	$1,450.00–$5,838.54	28% below	75%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DESTROY L/S FACET JNT	$5,838.54	$5,838.54	$1,459.63–$5,838.54	—	—
Removal of a foreign object under the skin, simple CPT 10120 ER FBR-SUBQ-SIMPLE	$278.31	$1,113.24	$278.31–$1,113.24	5% above	75%
Removal of a foreign object under the skin, simple inpatient CPT 10120 ER FBR-SUBQ-SIMPLE	$1,113.24	$1,113.24	$278.31–$1,113.24	—	—
Septoplasty to straighten the nasal septum CPT 30520 REPAIR OF NASAL SEPTUM	$2,416.96	$9,667.83	$2,416.96–$9,667.83	11% below	75%
Septoplasty to straighten the nasal septum inpatient CPT 30520 REPAIR OF NASAL SEPTUM	$9,667.83	$9,667.83	$2,416.96–$9,667.83	—	—
Short arm splint (forearm and hand) CPT 29125 ER APPL SHORT ARM SPLNT:STATIC	$95.99	$383.97	$95.99–$383.97	28% below	75%
Short arm splint (forearm and hand) inpatient CPT 29125 ER APPL SHORT ARM SPLNT:STATIC	$383.97	$383.97	$95.99–$383.97	—	—
Short leg cast (below the knee) CPT 29405 SHORT LEG CAST	$47.00	$188.00	$47.00–$334.28	65% below	75%
Short leg cast (below the knee) inpatient CPT 29405 SHORT LEG CAST	$188.00	$188.00	$47.00–$188.00	—	—
Short leg splint (calf to foot) CPT 29515 ER SPLINT SHORT LEG	$109.91	$439.65	$109.91–$439.65	18% below	75%
Short leg splint (calf to foot) inpatient CPT 29515 ER SPLINT SHORT LEG	$439.65	$439.65	$109.91–$439.65	—	—
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 ARTH DISTAL CLAVICLE EXCISION	$2,422.73	$9,690.90	$2,000.00–$9,690.90	57% below	75%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 ARTH DISTAL CLAVICLE EXCISION	$9,690.90	$9,690.90	$2,422.72–$9,690.90	—	—
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 ARTH SUBACROMIAL DECOMPRESSION	$525.00	$525.00	$131.25–$525.00	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ER SIM SURG REPAIR UP TO 2.5CM	$153.41	$613.65	$153.41–$613.65	36% below	75%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 MS REPR SUPERFIC WOUND <2.5CM	$153.41	$613.65	$153.41–$613.65	36% below	75%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SREP S/N/A/G/TR/E; 2.5CM/<	$153.41	$613.65	$153.41–$613.65	36% below	75%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 ER SIM SURG REPAIR UP TO 2.5CM	$613.65	$613.65	$153.41–$613.65	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 MS REPR SUPERFIC WOUND <2.5CM	$613.65	$613.65	$153.41–$613.65	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SREP S/N/A/G/TR/E; 2.5CM/<	$613.65	$613.65	$153.41–$613.65	—	—
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY, SINGLE LESION	$1,109.07	$4,436.29	$519.81–$4,436.29	394% above	75%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY, SINGLE LESION	$4,436.29	$4,436.29	$1,109.07–$4,436.29	—	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTR, LMBR DIAGNOSTIC	$85.50	$342.00	$85.50–$897.77	86% below	75%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE	$679.82	$2,719.29	$679.82–$2,719.29	14% above	75%
Spinal tap (lumbar puncture), diagnostic CPT 62270 ER LUMBAR PUNCTURE	$713.81	$2,855.25	$713.81–$2,855.25	19% above	75%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTR, LMBR DIAGNOSTIC	$342.00	$342.00	$85.50–$342.00	—	—
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE	$2,719.29	$2,719.29	$679.82–$2,719.29	—	—
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ER LUMBAR PUNCTURE	$2,855.25	$2,855.25	$713.81–$2,855.25	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ER SIM SURG REPAIR 2.6-7.5 CM	$171.48	$685.92	$171.48–$685.92	39% below	75%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 MS REPR SUPERFIC WOUND 2.6-7.5	$180.58	$722.31	$180.58–$722.31	36% below	75%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 ER SIM SURG REPAIR 2.6-7.5 CM	$685.92	$685.92	$171.48–$685.92	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 MS REPR SUPERFIC WOUND 2.6-7.5	$722.31	$722.31	$180.58–$722.31	—	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ER SIM SURG FACE < 2.5 CM	$153.41	$613.65	$153.41–$613.65	7% below	75%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 ER SIM SURG FACE < 2.5 CM	$613.65	$613.65	$153.41–$613.65	—	—
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENT BIOPSY SKIN, 1 LESION	$149.33	$597.30	$149.32–$597.30	6% below	75%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENT BIOPSY SKIN, 1 LESION	$597.30	$597.30	$149.32–$597.30	—	—
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS ND OR CATH W GDN	$172.75	$691.00	$172.75–$806.04	78% below	75%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS ND OR CATH W GDN	$691.00	$691.00	$172.75–$691.00	—	—
Tonsil and adenoid removal, age 12 or older CPT 42821 REMOVE TONSILS AND ADENOIDS	$2,416.96	$9,667.83	$2,416.96–$9,667.83	at median	75%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 REMOVE TONSILS AND ADENOIDS	$9,667.83	$9,667.83	$2,416.96–$9,667.83	—	—
Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS AND ADENOIDS	$4,411.88	$17,647.53	$4,411.88–$17,647.53	45% above	75%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 REMOVE TONSILS AND ADENOIDS	$17,647.53	$17,647.53	$4,411.88–$17,647.53	—	—
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS	$2,416.96	$9,667.83	$2,416.96–$9,667.83	at median	75%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 REMOVAL OF TONSILS	$9,667.83	$9,667.83	$2,416.96–$9,667.83	—	—
Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY	$9,566.69	$38,266.74	$1,450.00–$38,266.74	131% above	75%
Total hip replacement inpatient CPT 27130 TOTAL HIP ARTHROPLASTY	$38,266.74	$38,266.74	$9,566.68–$38,266.74	—	—
Total knee replacement CPT 27447 KNEE TOTAL KNEE	$9,566.69	$38,266.74	$1,450.00–$38,266.74	at median	75%
Total knee replacement inpatient CPT 27447 KNEE TOTAL KNEE	$38,266.74	$38,266.74	$9,566.68–$38,266.74	—	—
Trigger point injections, 1 or 2 muscles CPT 20552 ER INJECT TRIGGER POINT 1 OR 2	$180.67	$722.69	$180.67–$722.69	at median	75%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$205.63	$822.51	$205.63–$1,450.00	14% above	75%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCLE	$226.23	$904.92	$226.23–$1,450.00	26% above	75%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ER INJECT TRIGGER POINT 1 OR 2	$722.69	$722.69	$180.67–$722.69	—	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$822.51	$822.51	$205.63–$822.51	—	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCLE	$904.92	$904.92	$226.23–$904.92	—	—
Upper endoscopy (EGD) with injection into the lining CPT 43236 AMB EGD FLEX W/Direct INJ	$201.25	$805.00	$127.71–$1,150.22	89% below	75%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 AMB EGD FLEX W/Direct INJ	$805.00	$805.00	$201.25–$805.00	—	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 ER DBRIDEMENT-SKIN & SUBQ	$337.26	$1,349.02	$337.25–$1,349.02	17% below	75%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUB TISS 1st 20 SQ CM OR <	$337.26	$1,349.02	$337.25–$1,349.02	17% below	75%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 ER DBRIDEMENT-SKIN & SUBQ	$1,349.02	$1,349.02	$337.25–$1,349.02	—	—
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEB SUB TISS 1st 20 SQ CM OR <	$1,349.02	$1,349.02	$337.25–$1,349.02	—	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Arkansas	Off list
Blood transfusion (giving blood or blood components) CPT 36430 OIU BLOOD TRANSFUSION	$356.26	$1,425.04	$356.26–$1,425.04	28% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 ER BLOOD ADMINISTRATION >4 HRS	$390.19	$1,560.75	$390.19–$1,560.75	21% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 ER BLOOD ADMINISTRATION < 2HRS	$390.19	$1,560.75	$390.19–$1,560.75	21% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 ER BLOOD ADMINISTRATION 2-4HRS	$390.19	$1,560.75	$390.19–$1,560.75	21% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 DRMC MS BLOOD TRANSFUSION	$390.19	$1,560.75	$390.19–$1,560.75	21% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 DRMC TRANSFUSION (LAB)	$448.72	$1,794.86	$448.71–$1,794.86	10% below	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 OIU BLOOD TRANSFUSION	$1,425.04	$1,425.04	$356.26–$1,425.04	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ER BLOOD ADMINISTRATION >4 HRS	$1,560.75	$1,560.75	$390.19–$1,560.75	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 DRMC MS BLOOD TRANSFUSION	$1,560.75	$1,560.75	$390.19–$1,560.75	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ER BLOOD ADMINISTRATION 2-4HRS	$1,560.75	$1,560.75	$390.19–$1,560.75	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ER BLOOD ADMINISTRATION < 2HRS	$1,560.75	$1,560.75	$390.19–$1,560.75	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 DRMC TRANSFUSION (LAB)	$1,794.86	$1,794.86	$448.71–$1,794.86	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ASD UPDRAFT NEBUL SUB TX	$150.03	$600.12	$150.03–$600.12	41% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MET DOS INH TX INITIAL	$150.03	$600.12	$150.03–$600.12	41% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI INITIAL	$150.03	$600.12	$150.03–$600.12	41% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PEAK FLOW / VITAL CAPACITY	$150.03	$600.12	$150.03–$600.12	41% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI SUBSEQUENT	$150.03	$600.12	$150.03–$600.12	41% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ASD UPDRAFT NEBULIZ INTL TX	$150.03	$600.12	$150.03–$600.12	41% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 UPDRAFT NEBULIZATION INTL TX	$150.03	$600.12	$150.03–$600.12	41% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INTRAPULMONARY VENT INTL TX	$150.03	$600.12	$150.03–$600.12	41% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TMNT SUBSEQUENT	$150.03	$600.12	$150.03–$600.12	41% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM IND W/O ULTRASOUND	$150.03	$600.12	$150.03–$600.12	41% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER TREATMENT	$62.00	$62.00	$15.50–$62.00	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 UPDRAFT NEBULIZATION INTL TX	$600.12	$600.12	$150.03–$600.12	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM IND W/O ULTRASOUND	$600.12	$600.12	$150.03–$600.12	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ASD UPDRAFT NEBUL SUB TX	$600.12	$600.12	$150.03–$600.12	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL TMNT SUBSEQUENT	$600.12	$600.12	$150.03–$600.12	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI INITIAL	$600.12	$600.12	$150.03–$600.12	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI SUBSEQUENT	$600.12	$600.12	$150.03–$600.12	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MET DOS INH TX INITIAL	$600.12	$600.12	$150.03–$600.12	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PEAK FLOW / VITAL CAPACITY	$600.12	$600.12	$150.03–$600.12	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ASD UPDRAFT NEBULIZ INTL TX	$600.12	$600.12	$150.03–$600.12	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INTRAPULMONARY VENT INTL TX	$600.12	$600.12	$150.03–$600.12	—	—
Critical care, first 30 to 74 minutes CPT 99291 ER CRITICAL CARE Init (30-74M)	$795.54	$3,182.16	$511.74–$3,182.16	20% below	75%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ER CRITICAL CARE Init (30-74M)	$3,182.16	$3,182.16	$795.54–$3,182.16	—	—
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG	$12.75	$51.00	$12.75–$51.00	41% below	75%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG	$51.00	$51.00	$12.75–$51.00	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$52.65	$210.58	$52.65–$210.58	50% below	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING/OIU	$59.27	$237.09	$59.27–$237.09	44% below	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING	$59.27	$237.09	$59.27–$237.09	44% below	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG without Intrerp and report	$38.00	$38.00	$9.50–$38.00	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG	$210.58	$210.58	$52.65–$210.58	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM TRACING/OIU	$237.09	$237.09	$59.27–$237.09	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM TRACING	$237.09	$237.09	$59.27–$237.09	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL I	$104.67	$418.68	$104.67–$482.40	11% below	75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL I	$418.68	$418.68	$104.67–$418.68	—	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL II	$150.09	$600.35	$150.09–$600.35	25% below	75%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL II	$600.35	$600.35	$150.09–$600.35	—	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER NON-URG LEVEL III	$238.81	$955.25	$238.81–$955.25	42% below	75%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL III	$238.81	$955.25	$238.81–$955.25	42% below	75%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL III	$955.25	$955.25	$238.81–$955.25	—	—
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER NON-URG LEVEL III	$955.25	$955.25	$238.81–$955.25	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER NON-URG LEVEL IV	$373.05	$1,492.18	$373.05–$1,492.18	33% below	75%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 LEVEL IV-EXTENDED ASSESS &MGMT	$387.70	$1,550.78	$387.69–$1,550.78	31% below	75%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL IV	$387.70	$1,550.78	$387.69–$1,550.78	31% below	75%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER NON-URG LEVEL IV	$1,492.18	$1,492.18	$373.05–$1,492.18	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL IV	$1,550.78	$1,550.78	$387.69–$1,550.78	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 LEVEL IV-EXTENDED ASSESS &MGMT	$1,550.78	$1,550.78	$387.69–$1,550.78	—	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL V	$495.07	$1,980.28	$495.07–$1,980.28	33% below	75%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL V	$1,980.28	$1,980.28	$495.07–$1,980.28	—	—
Family therapy with the patient, 50 minutes CPT 90847 PF LCSW Family psytx w/pt 50 m	$62.57	$250.27	$62.57–$250.27	60% below	75%
Family therapy with the patient, 50 minutes CPT 90847 PF Family psytx w/pt 50 min	$65.60	$262.40	$65.60–$262.40	58% below	75%
Family therapy with the patient, 50 minutes CPT 90847 IOP FAMILY THERAPY	$232.08	$928.31	$189.48–$928.31	48% above	75%
Family therapy with the patient, 50 minutes inpatient CPT 90847 PF LCSW Family psytx w/pt 50 m	$250.27	$250.27	$62.57–$250.27	—	—
Family therapy with the patient, 50 minutes inpatient CPT 90847 PF Family psytx w/pt 50 min	$262.40	$262.40	$65.60–$262.40	—	—
Family therapy with the patient, 50 minutes inpatient CPT 90847 IOP FAMILY THERAPY	$928.31	$928.31	$232.08–$928.31	—	—
Family therapy without the patient, 50 minutes CPT 90846 PF LCSW Family psytx w/o pt 50	$50.44	$201.76	$50.44–$201.76	68% below	75%
Family therapy without the patient, 50 minutes CPT 90846 PF Family psytx w/o pt 50 min	$55.40	$221.60	$55.40–$221.60	65% below	75%
Family therapy without the patient, 50 minutes inpatient CPT 90846 PF LCSW Family psytx w/o pt 50	$201.76	$201.76	$50.44–$201.76	—	—
Family therapy without the patient, 50 minutes inpatient CPT 90846 PF Family psytx w/o pt 50 min	$221.60	$221.60	$55.40–$221.60	—	—
Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY PRFEE LCSW	$19.02	$76.07	$19.02–$98.64	82% below	75%
Group psychotherapy session CPT 90853 PSYCHOLOGIST PF GROUP THERAPY	$19.30	$77.18	$19.30–$98.64	81% below	75%
Group psychotherapy session CPT 90853 OHP PSYCHOTHERAPY GROUP	$64.43	$257.73	$64.43–$257.73	38% below	75%
Group psychotherapy session CPT 90853 IOP GROUP THERAPY	$67.57	$270.27	$67.57–$270.27	34% below	75%
Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY PRFEE LCSW	$76.07	$76.07	$19.02–$76.07	—	—
Group psychotherapy session inpatient CPT 90853 PSYCHOLOGIST PF GROUP THERAPY	$77.18	$77.18	$19.30–$77.18	—	—
Group psychotherapy session inpatient CPT 90853 OHP PSYCHOTHERAPY GROUP	$257.73	$257.73	$64.43–$257.73	—	—
Group psychotherapy session inpatient CPT 90853 IOP GROUP THERAPY	$270.27	$270.27	$67.57–$270.27	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ER HYDRATION IV INFUSION INIT	$146.76	$587.04	$146.76–$587.04	18% below	75%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 MS INITAL HYDRATION INFUSION	$146.78	$587.10	$146.78–$587.10	18% below	75%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ER HYDRATION IV INFUSION INIT	$587.04	$587.04	$146.76–$587.04	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 MS INITAL HYDRATION INFUSION	$587.10	$587.10	$146.78–$587.10	—	—
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT	$146.76	$587.04	$146.76–$587.04	25% below	75%
IV infusion of a medicine, first hour CPT 96365 MS THER/DIAG IV INF INITIAL	$146.78	$587.10	$146.78–$587.10	25% below	75%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION INIT HR TO 1 HOUR	$157.17	$628.68	$157.17–$628.68	19% below	75%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT	$587.04	$587.04	$146.76–$587.04	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 MS THER/DIAG IV INF INITIAL	$587.10	$587.10	$146.78–$587.10	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION INIT HR TO 1 HOUR	$628.68	$628.68	$157.17–$628.68	—	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ-SQ/IM (INCLUDES ANTIBIOTIC	$36.17	$144.67	$36.17–$144.67	53% below	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 MS ADMIN IN/SQ MED INJ	$36.17	$144.67	$36.17–$144.67	53% below	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM	$49.58	$198.30	$49.58–$198.30	35% below	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ED OVERFLW ADMIN IM/SQ MED INJ	$53.17	$212.67	$53.17–$212.67	30% below	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ-SQ/IM (INCLUDES ANTIBIOTIC	$144.67	$144.67	$36.17–$144.67	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 MS ADMIN IN/SQ MED INJ	$144.67	$144.67	$36.17–$144.67	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM	$198.30	$198.30	$49.58–$198.30	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ED OVERFLW ADMIN IM/SQ MED INJ	$212.67	$212.67	$53.17–$212.67	—	—
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PF PSYCHIATRIC DIAG EXAM	$105.57	$422.26	$105.56–$422.26	28% below	75%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 OP PSYCHIATRIC DIAG EXAM	$111.92	$447.69	$111.92–$447.69	24% below	75%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PF PSYCHIATRIC DIAG EXAM	$422.26	$422.26	$105.56–$422.26	—	—
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 OP PSYCHIATRIC DIAG EXAM	$447.69	$447.69	$111.92–$447.69	—	—
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSC ED 15 MIN	$29.27	$117.09	$29.27–$117.09	56% below	75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSC ED 15 MIN	$117.09	$117.09	$29.27–$117.09	—	—
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT LEVEL 3	$56.31	$225.25	$56.31–$225.25	31% below	75%
New patient office visit, about 30 minutes CPT 99203 NEW PT OUTPT 30-44 MIN	$63.50	$254.00	$63.50–$254.00	23% below	75%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT LEVEL 3	$225.25	$225.25	$56.31–$225.25	—	—
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PT OUTPT 30-44 MIN	$254.00	$254.00	$63.50–$254.00	—	—
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT LEVEL 4	$76.40	$305.61	$76.40–$305.61	25% below	75%
New patient office visit, about 45 minutes CPT 99204 NEW PT OUTPT 45-59 MIN	$96.75	$387.00	$96.75–$387.00	5% below	75%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT LEVEL 4	$305.61	$305.61	$76.40–$305.61	—	—
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PT OUTPT 45-59 MIN	$387.00	$387.00	$96.75–$387.00	—	—
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT LEVEL 5	$91.54	$366.15	$91.54–$366.15	49% below	75%
New patient office visit, about 60 minutes CPT 99205 NEW PT OUTPT 60-74 MIN	$121.75	$487.00	$121.75–$487.00	32% below	75%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT LEVEL 5	$366.15	$366.15	$91.54–$366.15	—	—
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PT OUTPT 60-74 MIN	$487.00	$487.00	$121.75–$487.00	—	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT LEVEL 2	$48.13	$192.50	$48.13–$192.50	19% below	75%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT LEVEL 2	$192.50	$192.50	$48.13–$192.50	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION INDV IN	$21.50	$86.00	$21.50–$86.00	50% below	75%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 CRHS MED NUTR THERAPY INDV 15M	$30.75	$122.99	$30.75–$122.99	28% below	75%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT-INITIAL PER 15 MIN	$30.75	$122.99	$30.75–$122.99	28% below	75%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MEDICAL NUTRITION INDV IN	$86.00	$86.00	$21.50–$86.00	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT-INITIAL PER 15 MIN	$122.99	$122.99	$30.75–$122.99	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 CRHS MED NUTR THERAPY INDV 15M	$122.99	$122.99	$30.75–$122.99	—	—
Occupational therapy evaluation, low complexity CPT 97165 OT 20 MINUTE EVAL	$54.10	$216.41	$54.10–$216.41	50% below	75%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT 20 MINUTE EVAL	$216.41	$216.41	$54.10–$216.41	—	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT 60 MINUTE EVAL	$63.00	$252.00	$63.00–$252.00	59% below	75%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT 60 MINUTE EVAL	$252.00	$252.00	$63.00–$252.00	—	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 DR PT, Cash, EVAL and TX visit	$37.50	$150.00	$37.50–$150.00	70% below	75%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT 20 MINUTE EVAL	$66.44	$265.74	$66.44–$265.74	46% below	75%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 DR PT, Cash, EVAL and TX visit	$150.00	$150.00	$37.50–$150.00	—	—
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT 20 MINUTE EVAL	$265.74	$265.74	$66.44–$265.74	—	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT 30 MINUTE EVAL	$66.48	$265.92	$66.48–$265.92	49% below	75%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT 30 MINUTE EVAL	$265.92	$265.92	$66.48–$265.92	—	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 15 MIN	$36.96	$147.85	$36.96–$147.85	42% below	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY 15 MIN	$147.85	$147.85	$36.96–$147.85	—	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXER 15 MIN	$36.71	$146.85	$36.71–$146.85	42% below	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAP PROC-THER EX (PT TREAT)	$36.71	$146.85	$36.71–$146.85	42% below	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 DR PT, Cash, 4 Visits	$90.00	$360.00	$41.54–$360.00	41% above	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 DR PT, Cash, 8 Visits	$127.50	$510.00	$41.54–$510.00	100% above	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 DR PT, Cash, 10 Visits	$200.00	$800.00	$41.54–$800.00	214% above	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 DR PT, Cash, 12 Visits	$225.00	$900.00	$41.54–$900.00	253% above	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 DR PT, Prefer Customer, 15 min	$10.00	$10.00	$2.50–$10.00	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 DR PT, Cash, Single Visit, 15	$25.00	$25.00	$6.25–$25.00	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAP PROC-THER EX (PT TREAT)	$146.85	$146.85	$36.71–$146.85	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXER 15 MIN	$146.85	$146.85	$36.71–$146.85	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 DR PT, Cash, 4 Visits	$360.00	$360.00	$90.00–$360.00	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 DR PT, Cash, 8 Visits	$510.00	$510.00	$127.50–$510.00	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 DR PT, Cash, 10 Visits	$800.00	$800.00	$200.00–$800.00	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 DR PT, Cash, 12 Visits	$900.00	$900.00	$225.00–$900.00	—	—
Psychiatric evaluation with medical services CPT 90792 PF PSYCHIATRIC DX INTERVIEW	$62.57	$250.27	$62.57–$250.27	66% below	75%
Psychiatric evaluation with medical services CPT 90792 PSYCH DIAGNOSTIC EVAL W/MED SR	$94.27	$377.06	$94.27–$377.06	48% below	75%
Psychiatric evaluation with medical services CPT 90792 OP PSCHIATRIC DX INTERVIEW	$115.84	$463.35	$115.84–$463.35	37% below	75%
Psychiatric evaluation with medical services inpatient CPT 90792 PF PSYCHIATRIC DX INTERVIEW	$250.27	$250.27	$62.57–$250.27	—	—
Psychiatric evaluation with medical services inpatient CPT 90792 PSYCH DIAGNOSTIC EVAL W/MED SR	$377.06	$377.06	$94.27–$377.06	—	—
Psychiatric evaluation with medical services inpatient CPT 90792 OP PSCHIATRIC DX INTERVIEW	$463.35	$463.35	$115.84–$463.35	—	—
Psychotherapy for crisis, first 60 minutes CPT 90839 PF PSYTX CRISIS INITIAL 60 MIN	$83.24	$332.96	$83.24–$332.96	at median	75%
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYTX CRISIS INITIAL 60 MIN	$115.84	$463.35	$115.84–$463.35	39% above	75%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PF PSYTX CRISIS INITIAL 60 MIN	$332.96	$332.96	$83.24–$332.96	—	—
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PSYTX CRISIS INITIAL 60 MIN	$463.35	$463.35	$115.84–$463.35	—	—
Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY 30 MINS	$41.07	$164.27	$41.07–$189.48	58% below	75%
Psychotherapy session, 30 minutes CPT 90832 IOP IND THERAPY 30 MIN	$111.92	$447.69	$111.92–$447.69	14% above	75%
Psychotherapy session, 30 minutes CPT 90832 Psytx w pt 30 minutes	$115.84	$463.35	$115.84–$463.35	18% above	75%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY 30 MINS	$164.27	$164.27	$41.07–$164.27	—	—
Psychotherapy session, 30 minutes inpatient CPT 90832 IOP IND THERAPY 30 MIN	$447.69	$447.69	$111.92–$447.69	—	—
Psychotherapy session, 30 minutes inpatient CPT 90832 Psytx w pt 30 minutes	$463.35	$463.35	$115.84–$463.35	—	—
Psychotherapy session, 45 minutes CPT 90834 PF Psytx w pt 45 minutes	$54.85	$219.40	$54.85–$219.40	55% below	75%
Psychotherapy session, 45 minutes CPT 90834 IOP IND THERAPY 45 MIN	$111.92	$447.69	$111.92–$447.69	9% below	75%
Psychotherapy session, 45 minutes CPT 90834 Psytx w pt 45 minutes	$115.84	$463.35	$115.84–$463.35	6% below	75%
Psychotherapy session, 45 minutes inpatient CPT 90834 PF Psytx w pt 45 minutes	$219.40	$219.40	$54.85–$219.40	—	—
Psychotherapy session, 45 minutes inpatient CPT 90834 IOP IND THERAPY 45 MIN	$447.69	$447.69	$111.92–$447.69	—	—
Psychotherapy session, 45 minutes inpatient CPT 90834 Psytx w pt 45 minutes	$463.35	$463.35	$115.84–$463.35	—	—
Psychotherapy session, 60 minutes CPT 90837 PF Psytx w pt 60 minutes	$83.24	$332.96	$83.24–$332.96	29% below	75%
Psychotherapy session, 60 minutes CPT 90837 IOP IND THERAPY 60 MIN	$111.92	$447.69	$111.92–$447.69	4% below	75%
Psychotherapy session, 60 minutes CPT 90837 Psytx w pt 60 minutes	$115.84	$463.35	$115.84–$463.35	1% below	75%
Psychotherapy session, 60 minutes inpatient CPT 90837 PF Psytx w pt 60 minutes	$332.96	$332.96	$83.24–$332.96	—	—
Psychotherapy session, 60 minutes inpatient CPT 90837 IOP IND THERAPY 60 MIN	$447.69	$447.69	$111.92–$447.69	—	—
Psychotherapy session, 60 minutes inpatient CPT 90837 Psytx w pt 60 minutes	$463.35	$463.35	$115.84–$463.35	—	—
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$36.22	$144.87	$36.22–$144.87	1% above	75%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION COUNSELING	$36.22	$144.87	$36.22–$144.87	1% above	75%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION COUNSELING	$144.87	$144.87	$36.22–$144.87	—	—
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$144.87	$144.87	$36.22–$144.87	—	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PF PSYCH E&M VISIT EST 45 MIN	$86.00	$343.98	$86.00–$343.98	33% below	75%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTABLISHED PATIENT LEVEL 5	$198.95	$795.78	$198.94–$795.78	54% above	75%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP PSYCH E&M VISIT EST 45 MIN	$198.95	$795.78	$198.94–$795.78	54% above	75%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PF PSYCH E&M VISIT EST 45 MIN	$343.98	$343.98	$86.00–$343.98	—	—
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OP PSYCH E&M VISIT EST 45 MIN	$795.78	$795.78	$198.94–$795.78	—	—
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ESTABLISHED PATIENT LEVEL 5	$795.78	$795.78	$198.94–$795.78	—	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP VISIT EST 15 MIN	$45.48	$181.91	$45.48–$181.91	46% below	75%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTABLISHED PATIENT LEVEL 3	$101.96	$407.82	$101.54–$407.82	20% above	75%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OUTPATIENT VISIT EST 14 MIN	$101.96	$407.82	$101.54–$407.82	20% above	75%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OP VISIT EST 15 MIN	$181.91	$181.91	$45.48–$181.91	—	—
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ESTABLISHED PATIENT LEVEL 3	$407.82	$407.82	$101.95–$407.82	—	—
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OUTPATIENT VISIT EST 14 MIN	$407.82	$407.82	$101.95–$407.82	—	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OUTPATIENT VISIT EST 25 MIN	$66.98	$267.91	$66.98–$267.91	33% below	75%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTABLISHED PATIENT LEVEL 4	$151.57	$606.27	$147.96–$606.27	52% above	75%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP VISIT EST 25 MIN NONMCR	$151.57	$606.27	$147.96–$606.27	52% above	75%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OUTPATIENT VISIT EST 25 MIN	$267.91	$267.91	$66.98–$267.91	—	—
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OP VISIT EST 25 MIN NONMCR	$606.27	$606.27	$151.57–$606.27	—	—
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ESTABLISHED PATIENT LEVEL 4	$606.27	$606.27	$151.57–$606.27	—	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTABLISHED PATIENT LEVEL 2	$81.37	$325.46	$60.90–$325.46	29% above	75%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ESTABLISHED PATIENT LEVEL 2	$325.46	$325.46	$81.36–$325.46	—	—
Specialist consultation, low complexity or 30+ minutes CPT 99243 Outpatient Consultation	$72.50	$290.00	$72.50–$290.00	at median	75%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Outpatient Consultation	$290.00	$290.00	$72.50–$290.00	—	—
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Outpatient Consultation	$101.75	$407.00	$101.75–$407.00	at median	75%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Outpatient Consultation	$407.00	$407.00	$101.75–$407.00	—	—
Speech and language evaluation CPT 92523 EVAL SPCH SOUND PROD & COMP	$155.00	$619.99	$155.00–$619.99	15% below	75%
Speech and language evaluation inpatient CPT 92523 EVAL SPCH SOUND PROD & COMP	$619.99	$619.99	$155.00–$619.99	—	—
Speech therapy session, individual CPT 92507 SPEECH/LANG THERAPY IND	$89.07	$356.28	$89.07–$356.28	35% below	75%
Speech therapy session, individual inpatient CPT 92507 SPEECH/LANG THERAPY IND	$356.28	$356.28	$89.07–$356.28	—	—
Spirometry (breathing test) CPT 94010 PF SPIROM W/VIT CAP/VOL LOOP	$116.60	$466.41	$116.60–$466.41	43% below	75%
Spirometry (breathing test) inpatient CPT 94010 PF SPIROM W/VIT CAP/VOL LOOP	$466.41	$466.41	$116.60–$466.41	—	—
Spirometry before and after a bronchodilator CPT 94060 Complete PFT w/Bronchodilator	$233.00	$931.98	$233.00–$931.98	38% below	75%
Spirometry before and after a bronchodilator inpatient CPT 94060 Complete PFT w/Bronchodilator	$931.98	$931.98	$233.00–$931.98	—	—
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVIES 15 MIN	$36.96	$147.85	$36.96–$147.85	46% below	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVIES 15 MIN	$147.85	$147.85	$36.96–$147.85	—	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEB	$95.99	$383.97	$95.99–$383.97	30% below	75%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEB	$383.97	$383.97	$95.99–$383.97	—	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Arkansas	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 INFLUENZA VAC 65+	$76.12	$304.46	$53.92–$304.46	6% above	75%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 INFLUENZA VAC 65+	$304.46	$304.46	$76.11–$304.46	—	—
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA	$40.75	$163.00	$40.75–$192.12	83% below	75%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA MASTER	$40.75	$163.00	$40.75–$192.12	83% below	75%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA	$163.00	$163.00	$40.75–$163.00	—	—
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA MASTER	$163.00	$163.00	$40.75–$163.00	—	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VACCINE 0.5ML IM	$23.73	$94.93	$21.90–$94.93	41% below	75%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VACCINE 0.5ML IM	$94.93	$94.93	$23.73–$94.93	—	—
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV	$69.00	$276.00	$69.00–$329.09	77% below	75%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV MASTER	$69.00	$276.00	$69.00–$329.09	77% below	75%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV MASTER	$276.00	$276.00	$69.00–$276.00	—	—
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV	$276.00	$276.00	$69.00–$276.00	—	—
Hepatitis A vaccine, adult dose CPT 90632 MS HEPA VACCINE ADULT IM	$16.26	$65.05	$16.26–$69.55	84% below	75%
Hepatitis A vaccine, adult dose inpatient CPT 90632 MS HEPA VACCINE ADULT IM	$65.05	$65.05	$16.26–$65.05	—	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 AMB HEPB VACCINE ADUL 3 DOSE	$53.00	$212.00	$53.00–$212.00	54% below	75%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B ADULT (3 DOSE) 20 MCG 1	$62.64	$250.55	$62.64–$250.55	46% below	75%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 AMB HEPB VACCINE ADUL 3 DOSE	$212.00	$212.00	$53.00–$212.00	—	—
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B ADULT (3 DOSE) 20 MCG 1	$250.55	$250.55	$62.64–$250.55	—	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza Immunization 65+	$19.00	$76.00	$19.00–$92.60	87% below	75%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Influenza Immunization 65+	$76.00	$76.00	$19.00–$76.00	—	—
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR	$25.00	$100.00	$25.00–$100.00	85% below	75%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR MASTER	$25.00	$100.00	$25.00–$100.00	85% below	75%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLESMUMPSRUBELLA VAC 0.5	$101.01	$404.05	$97.99–$404.05	40% below	75%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR	$100.00	$100.00	$25.00–$100.00	—	—
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR MASTER	$100.00	$100.00	$25.00–$100.00	—	—
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLESMUMPSRUBELLA VAC 0.5	$404.05	$404.05	$101.01–$404.05	—	—
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL CONJ MASTER	$89.25	$357.00	$89.25–$357.00	60% below	75%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL CONJ VACCINE	$89.25	$357.00	$89.25–$357.00	60% below	75%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Menacwyd/menacwycrm vacc im	$193.39	$773.56	$176.71–$773.56	13% below	75%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL CONJ MASTER	$357.00	$357.00	$89.25–$357.00	—	—
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL CONJ VACCINE	$357.00	$357.00	$89.25–$357.00	—	—
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Menacwyd/menacwycrm vacc im	$773.56	$773.56	$193.39–$773.56	—	—
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGCOCCAL CONJUGATE 2 DOSE	$100.25	$401.00	$100.25–$401.00	87% below	75%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGCOCCAL CONJUGATE MASTER	$100.25	$401.00	$100.25–$401.00	87% below	75%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal B vaccine	$206.38	$825.50	$206.38–$825.50	73% below	75%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGCOCCAL CONJUGATE 2 DOSE	$401.00	$401.00	$100.25–$401.00	—	—
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGCOCCAL CONJUGATE MASTER	$401.00	$401.00	$100.25–$401.00	—	—
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Meningococcal B vaccine	$825.50	$825.50	$206.38–$825.50	—	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Prevnar-20 Syringe	$295.61	$1,182.44	$295.19–$1,182.44	67% below	75%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Prevnar-20 Syringe	$1,182.44	$1,182.44	$295.61–$1,182.44	—	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV 23 VACC 2YR+ MASTER	$45.50	$182.00	$45.50–$182.00	71% below	75%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV 23 VACC 2 YRS+ SUBQ/IM	$45.50	$182.00	$45.50–$182.00	71% below	75%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACCINE	$144.01	$576.04	$107.30–$576.04	9% below	75%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PPSV 23 VACC 2YR+ MASTER	$182.00	$182.00	$45.50–$182.00	—	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PPSV 23 VACC 2 YRS+ SUBQ/IM	$182.00	$182.00	$45.50–$182.00	—	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACCINE	$576.04	$576.04	$144.01–$576.04	—	—
Rabies vaccine, one dose CPT 90675 RABIES 1ML I	$408.23	$1,632.91	$297.38–$1,632.91	56% below	75%
Rabies vaccine, one dose inpatient CPT 90675 RABIES 1ML I	$1,632.91	$1,632.91	$408.23–$1,632.91	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus/Diptheria TENIVAC 0.5m	$46.33	$185.32	$26.33–$185.32	28% below	75%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TET DIPTH I	$51.66	$206.62	$26.33–$206.62	20% below	75%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus/Diptheria TENIVAC 0.5m	$185.32	$185.32	$46.33–$185.32	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TET DIPTH I	$206.62	$206.62	$51.66–$206.62	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET TOX/DIPTH/PERTUS I	$49.23	$196.92	$35.35–$196.92	50% below	75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHT/TET/PERT BOOSTRIX 0.5ML	$51.64	$206.56	$35.35–$206.56	47% below	75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 VFC TDAP VACCINE 7YRS>IM	$17.00	$17.00	$4.25–$17.00	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET TOX/DIPTH/PERTUS I	$196.92	$196.92	$49.23–$196.92	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHT/TET/PERT BOOSTRIX 0.5ML	$206.56	$206.56	$51.64–$206.56	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN	$12.75	$51.00	$12.75–$87.73	61% below	75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADM OF IMMUNIZATION	$60.73	$242.90	$60.73–$242.90	84% above	75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ER IMM ADM DT TETANUS/RABIES	$67.47	$269.89	$67.47–$269.89	104% above	75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN	$51.00	$51.00	$12.75–$51.00	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADM OF IMMUNIZATION	$242.90	$242.90	$60.73–$242.90	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ER IMM ADM DT TETANUS/RABIES	$269.89	$269.89	$67.47–$269.89	—	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD	$8.25	$33.00	$8.25–$33.00	61% below	75%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 MS IMMUNIZATION EACH ADDL	$18.61	$74.42	$18.61–$74.42	12% below	75%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ED IMMUN ADMIN EACH ADD ON	$18.61	$74.42	$18.61–$74.42	12% below	75%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADM INJ EA ADD VAC	$18.61	$74.42	$18.61–$74.42	12% below	75%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EACH ADD	$33.00	$33.00	$8.25–$33.00	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADM INJ EA ADD VAC	$74.42	$74.42	$18.61–$74.42	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ED IMMUN ADMIN EACH ADD ON	$74.42	$74.42	$18.61–$74.42	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 MS IMMUNIZATION EACH ADDL	$74.42	$74.42	$18.61–$74.42	—	—

Source file: https://www.conwayregional.org/docs/default-source/dardanelle/834538290_dardanelle-regional-llc_standardcharges.csv