Columbia Memorial Hospital
Listed in its price file as “Columbia Lutheran Charities”.
Columbia Memorial Hospital in Astoria, OR publishes cash prices for 443 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Oregon median for 248 of 441 procedures and below it for 181. By typical cash price it ranks #29 of 47 Oregon hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
2111 Exchange Street, Astoria, OR 97103 Collected Sep 29, 2026 Source price file (503) 325-4321
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 381320 · CMS hospital register NPI 1134146939
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Oregon | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT Multiphase Upper Abdomen | $3,079.20 | $3,849.00 | $588.90–$3,849.00 | 88% above | 20% |
| Abdominal CT scan without and with contrast CPT 74170 CMH CT Abdomen w/ + w/o Cont | $3,079.20 | $3,849.00 | $588.90–$3,849.00 | 88% above | 20% |
| Abdominal CT scan without and with contrast CPT 74170 CMH CT Abdomen w/ + w/o Cont BCE | $3,079.20 | $3,849.00 | $588.90–$3,849.00 | 88% above | 20% |
| Abdominal CT scan without and with contrast CPT 74170 CT Abdomen w/ + w/o Cont | $3,079.20 | $3,849.00 | $588.90–$3,849.00 | 88% above | 20% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CMH CT Abdomen w/ + w/o Cont | $3,079.20 | $3,849.00 | $588.90–$3,849.00 | — | 20% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen w/ + w/o Cont | $3,079.20 | $3,849.00 | $588.90–$3,849.00 | — | 20% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CMH CT Abdomen w/ + w/o Cont BCE | $3,079.20 | $3,849.00 | $588.90–$3,849.00 | — | 20% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT Multiphase Upper Abdomen | $3,079.20 | $3,849.00 | $588.90–$3,849.00 | — | 20% |
| Abdominal X-ray, 2 views CPT 74019 XR Abdomen 2 Views | $367.20 | $459.00 | $70.23–$459.00 | 23% above | 20% |
| Abdominal X-ray, 2 views inpatient CPT 74019 XR Abdomen 2 Views | $367.20 | $459.00 | $70.23–$459.00 | — | 20% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Comp Min 3 Views Rt | $370.40 | $463.00 | $70.84–$463.00 | 48% above | 20% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Comp Min 3 Views Lt | $370.40 | $463.00 | $70.84–$463.00 | 48% above | 20% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Comp Min 3 Views Rt | $370.40 | $463.00 | $70.84–$463.00 | — | 20% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Comp Min 3 Views Lt | $370.40 | $463.00 | $70.84–$463.00 | — | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABI w/ Upper OR Lower EO | $878.40 | $1,098.00 | $167.99–$1,098.00 | 74% above | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US UE Art Doppler Single Level Bil | $878.40 | $1,098.00 | $167.99–$1,098.00 | 74% above | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US LE Art Doppler Single Level Bil | $878.40 | $1,098.00 | $167.99–$1,098.00 | 74% above | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABI w/ Upper AND Lower EO | $878.40 | $1,098.00 | $167.99–$1,098.00 | 74% above | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US UE Art Doppler Single Level Bil | $878.40 | $1,098.00 | $167.99–$1,098.00 | — | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US LE Art Doppler Single Level Bil | $878.40 | $1,098.00 | $167.99–$1,098.00 | — | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ABI w/ Upper AND Lower EO | $878.40 | $1,098.00 | $167.99–$1,098.00 | — | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ABI w/ Upper OR Lower EO | $878.40 | $1,098.00 | $167.99–$1,098.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Fingers w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UE w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UE w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder Surgical Planning Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder Surgical Planning Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Fingers w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 71% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder Surgical Planning Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder Surgical Planning Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Forearm w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Forearm w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Fingers w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Fingers w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Humerus w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UE w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Humerus w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder w/o Cont Rt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UE w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder w/o Cont Lt | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus | $708.00 | $885.00 | $135.41–$885.00 | 27% above | 20% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus | $708.00 | $885.00 | $135.41–$885.00 | — | 20% |
| Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Whole Body | $1,799.20 | $2,249.00 | $344.10–$2,249.00 | 35% above | 20% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Whole Body | $1,799.20 | $2,249.00 | $344.10–$2,249.00 | — | 20% |
| Breast ultrasound, complete, one breast both sides CPT 76641 76641 US BREAST COMP BI-LAT BCE | $484.00 | $605.00 | $92.57–$605.00 | — | 20% |
| Breast ultrasound, complete, one breast CPT 76641 US Breast Comp Bil. | $484.00 | $605.00 | $92.57–$605.00 | 34% above | 20% |
| Breast ultrasound, complete, one breast one side CPT 76641 US Breast Comp Rt. | $431.20 | $539.00 | $82.47–$539.00 | 20% above | 20% |
| Breast ultrasound, complete, one breast one side CPT 76641 76641 US BREAST COMP LT BCE | $431.20 | $539.00 | $82.47–$539.00 | 20% above | 20% |
| Breast ultrasound, complete, one breast one side CPT 76641 US Breast Comp Lt. | $431.20 | $539.00 | $82.47–$539.00 | 20% above | 20% |
| Breast ultrasound, complete, one breast one side CPT 76641 76641 US BREAST COMP RT BCE | $431.20 | $539.00 | $82.47–$539.00 | 20% above | 20% |
| Breast ultrasound, complete, one breast inpatient both sides CPT 76641 76641 US BREAST COMP BI-LAT BCE | $484.00 | $605.00 | $92.57–$605.00 | — | 20% |
| Breast ultrasound, complete, one breast inpatient CPT 76641 US Breast Comp Bil. | $484.00 | $605.00 | $92.57–$605.00 | — | 20% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Comp Rt. | $431.20 | $539.00 | $82.47–$539.00 | — | 20% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 76641 US BREAST COMP LT BCE | $431.20 | $539.00 | $82.47–$539.00 | — | 20% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Comp Lt. | $431.20 | $539.00 | $82.47–$539.00 | — | 20% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 76641 US BREAST COMP RT BCE | $431.20 | $539.00 | $82.47–$539.00 | — | 20% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 US Breast Ltd Bil. | $621.60 | $777.00 | $118.88–$777.00 | 104% above | 20% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 76642 US Breast Ltd Bil BCE | $621.60 | $777.00 | $118.88–$777.00 | 104% above | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 76642 US Breast Ltd Lt BCE | $412.80 | $516.00 | $78.95–$516.00 | 36% above | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Ltd Rt. | $412.80 | $516.00 | $78.95–$516.00 | 36% above | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 76642 US Breast Ltd RT BCE | $412.80 | $516.00 | $78.95–$516.00 | 36% above | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Ltd Lt. | $412.80 | $516.00 | $78.95–$516.00 | 36% above | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Left w/o BIRAD | $412.80 | $516.00 | $78.95–$516.00 | 36% above | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Right w/o BIRAD | $412.80 | $516.00 | $78.95–$516.00 | 36% above | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 76642 US Breast Ltd Bil BCE | $621.60 | $777.00 | $118.88–$777.00 | — | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US Breast Ltd Bil. | $621.60 | $777.00 | $118.88–$777.00 | — | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 76642 US Breast Ltd Lt BCE | $412.80 | $516.00 | $78.95–$516.00 | — | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 76642 US Breast Ltd RT BCE | $412.80 | $516.00 | $78.95–$516.00 | — | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Ltd Rt. | $412.80 | $516.00 | $78.95–$516.00 | — | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Ltd Lt. | $412.80 | $516.00 | $78.95–$516.00 | — | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Right w/o BIRAD | $412.80 | $516.00 | $78.95–$516.00 | — | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Left w/o BIRAD | $412.80 | $516.00 | $78.95–$516.00 | — | 20% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Venogram Abdomen+Pelvis w/ + w/o Cont | $4,397.60 | $5,497.00 | $841.04–$5,497.00 | 78% above | 20% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Angio Abdomen +Pelvis w/ Cont | $4,397.60 | $5,497.00 | $841.04–$5,497.00 | 78% above | 20% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Venogram Abdomen+Pelvis w/ Cont | $4,397.60 | $5,497.00 | $841.04–$5,497.00 | 78% above | 20% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Angio Abdomen +Pelvis w/ + w/o Cont | $4,397.60 | $5,497.00 | $841.04–$5,497.00 | 78% above | 20% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Angio Abdomen +Pelvis w/ Cont | $4,397.60 | $5,497.00 | $841.04–$5,497.00 | — | 20% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Venogram Abdomen+Pelvis w/ + w/o Cont | $4,397.60 | $5,497.00 | $841.04–$5,497.00 | — | 20% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Angio Abdomen +Pelvis w/ + w/o Cont | $4,397.60 | $5,497.00 | $841.04–$5,497.00 | — | 20% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Venogram Abdomen+Pelvis w/ Cont | $4,397.60 | $5,497.00 | $841.04–$5,497.00 | — | 20% |
| CT angiography (CTA) of the head CPT 70496 CT Angio Head | $3,094.40 | $3,868.00 | $591.80–$3,868.00 | 66% above | 20% |
| CT angiography (CTA) of the head CPT 70496 CT Angio Head w/ + w/o Cont | $3,094.40 | $3,868.00 | $591.80–$3,868.00 | 66% above | 20% |
| CT angiography (CTA) of the head CPT 70496 CT Venogram Head w/ Contrast | $3,094.40 | $3,868.00 | $591.80–$3,868.00 | 66% above | 20% |
| CT angiography (CTA) of the head CPT 70496 CT Venogram Head w/ + w/o Contrast | $3,094.40 | $3,868.00 | $591.80–$3,868.00 | 66% above | 20% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT Venogram Head w/ Contrast | $3,094.40 | $3,868.00 | $591.80–$3,868.00 | — | 20% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Head | $3,094.40 | $3,868.00 | $591.80–$3,868.00 | — | 20% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT Venogram Head w/ + w/o Contrast | $3,094.40 | $3,868.00 | $591.80–$3,868.00 | — | 20% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Head w/ + w/o Cont | $3,094.40 | $3,868.00 | $591.80–$3,868.00 | — | 20% |
| CT angiography (CTA) of the neck CPT 70498 CT Angio Neck w/ Cont | $3,089.60 | $3,862.00 | $590.89–$3,862.00 | 66% above | 20% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CT Angio Neck w/ Cont | $3,089.60 | $3,862.00 | $590.89–$3,862.00 | — | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest w/ + w/out contrast | $3,125.60 | $3,907.00 | $597.77–$3,907.00 | 78% above | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest w/ Cont | $3,125.60 | $3,907.00 | $597.77–$3,907.00 | 78% above | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest w/ Cont | $3,125.60 | $3,907.00 | $597.77–$3,907.00 | — | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest w/ + w/out contrast | $3,125.60 | $3,907.00 | $597.77–$3,907.00 | — | 20% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Cardiac Calcium Score | $164.00 | $205.00 | $31.37–$205.00 | 5% above | 20% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Cardiac Calcium Score | $164.00 | $205.00 | $31.37–$205.00 | — | 20% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CMH CT Abdomen +Pelvis w/o Cont BCE | $1,630.40 | $2,038.00 | $311.81–$2,038.00 | 23% below | 20% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CMH CT Abdomen +Pelvis w/o Cont | $1,630.40 | $2,038.00 | $311.81–$2,038.00 | 23% below | 20% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen +Pelvis w/o Cont | $1,630.40 | $2,038.00 | $311.81–$2,038.00 | 23% below | 20% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CMH CT Abdomen +Pelvis w/o Cont | $1,630.40 | $2,038.00 | $311.81–$2,038.00 | — | 20% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen +Pelvis w/o Cont | $1,630.40 | $2,038.00 | $311.81–$2,038.00 | — | 20% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CMH CT Abdomen +Pelvis w/o Cont BCE | $1,630.40 | $2,038.00 | $311.81–$2,038.00 | — | 20% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CMH CT Abdomen +Pelvis w/ Cont | $3,432.00 | $4,290.00 | $656.37–$4,290.00 | 42% above | 20% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Enterography w/ Cont | $3,432.00 | $4,290.00 | $656.37–$4,290.00 | 42% above | 20% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen +Pelvis w/contrast | $3,432.00 | $4,290.00 | $656.37–$4,290.00 | 42% above | 20% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CMH CT Abdomen +Pelvis w/ Cont BCE | $3,432.00 | $4,290.00 | $656.37–$4,290.00 | 42% above | 20% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Enterography w/ Cont | $3,432.00 | $4,290.00 | $656.37–$4,290.00 | — | 20% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CMH CT Abdomen +Pelvis w/ Cont BCE | $3,432.00 | $4,290.00 | $656.37–$4,290.00 | — | 20% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CMH CT Abdomen +Pelvis w/ Cont | $3,432.00 | $4,290.00 | $656.37–$4,290.00 | — | 20% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen +Pelvis w/contrast | $3,432.00 | $4,290.00 | $656.37–$4,290.00 | — | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen +Pelvis w/ + w/o Cont | $3,873.60 | $4,842.00 | $740.83–$4,842.00 | 30% above | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Urogram | $3,873.60 | $4,842.00 | $740.83–$4,842.00 | 30% above | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Multiphase Upper Abdomen + Pelvis | $3,873.60 | $4,842.00 | $740.83–$4,842.00 | 30% above | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CMH CT Abd +Pelvis w/ + w/o Cont BCE | $3,873.60 | $4,842.00 | $740.83–$4,842.00 | 30% above | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CMH CT Abd +Pelvis w/ + w/o Cont | $3,873.60 | $4,842.00 | $740.83–$4,842.00 | 30% above | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen +Pelvis w/ + w/o Cont | $3,873.60 | $4,842.00 | $740.83–$4,842.00 | — | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Multiphase Upper Abdomen + Pelvis | $3,873.60 | $4,842.00 | $740.83–$4,842.00 | — | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CMH CT Abd +Pelvis w/ + w/o Cont BCE | $3,873.60 | $4,842.00 | $740.83–$4,842.00 | — | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Urogram | $3,873.60 | $4,842.00 | $740.83–$4,842.00 | — | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CMH CT Abd +Pelvis w/ + w/o Cont | $3,873.60 | $4,842.00 | $740.83–$4,842.00 | — | 20% |
| CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Cont | $2,715.20 | $3,394.00 | $519.28–$3,394.00 | 88% above | 20% |
| CT scan of the abdomen with contrast CPT 74160 CMH CT Abdomen w/ Cont | $2,715.20 | $3,394.00 | $519.28–$3,394.00 | 88% above | 20% |
| CT scan of the abdomen with contrast CPT 74160 CMH CT Abdomen w/ Cont BCE | $2,715.20 | $3,394.00 | $519.28–$3,394.00 | 88% above | 20% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CMH CT Abdomen w/ Cont BCE | $2,715.20 | $3,394.00 | $519.28–$3,394.00 | — | 20% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Cont | $2,715.20 | $3,394.00 | $519.28–$3,394.00 | — | 20% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CMH CT Abdomen w/ Cont | $2,715.20 | $3,394.00 | $519.28–$3,394.00 | — | 20% |
| CT scan of the abdomen without contrast CPT 74150 CMH CT Abdomen w/o Cont BCE | $1,288.00 | $1,610.00 | $246.33–$1,610.00 | 17% above | 20% |
| CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Cont | $1,288.00 | $1,610.00 | $246.33–$1,610.00 | 17% above | 20% |
| CT scan of the abdomen without contrast CPT 74150 CMH CT Abdomen w/o Cont | $1,288.00 | $1,610.00 | $246.33–$1,610.00 | 17% above | 20% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CMH CT Abdomen w/o Cont BCE | $1,288.00 | $1,610.00 | $246.33–$1,610.00 | — | 20% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CMH CT Abdomen w/o Cont | $1,288.00 | $1,610.00 | $246.33–$1,610.00 | — | 20% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Cont | $1,288.00 | $1,610.00 | $246.33–$1,610.00 | — | 20% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Cont | $1,396.80 | $1,746.00 | $267.14–$1,746.00 | 29% above | 20% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus or Facial w/o Cont | $1,396.80 | $1,746.00 | $267.14–$1,746.00 | 29% above | 20% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT Mandible Ltd Dental Plan | $1,396.80 | $1,746.00 | $267.14–$1,746.00 | 29% above | 20% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Cont | $1,396.80 | $1,746.00 | $267.14–$1,746.00 | — | 20% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus or Facial w/o Cont | $1,396.80 | $1,746.00 | $267.14–$1,746.00 | — | 20% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Mandible Ltd Dental Plan | $1,396.80 | $1,746.00 | $267.14–$1,746.00 | — | 20% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Cont BCE | $1,064.00 | $1,330.00 | $203.49–$1,330.00 | 6% above | 20% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Cont | $1,064.00 | $1,330.00 | $203.49–$1,330.00 | 6% above | 20% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Cont | $1,064.00 | $1,330.00 | $203.49–$1,330.00 | — | 20% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Cont BCE | $1,064.00 | $1,330.00 | $203.49–$1,330.00 | — | 20% |
| CT scan of the head with contrast CPT 70460 CT Head or Brain w/ Cont | $1,521.60 | $1,902.00 | $291.01–$1,902.00 | 18% above | 20% |
| CT scan of the head with contrast inpatient CPT 70460 CT Head or Brain w/ Cont | $1,521.60 | $1,902.00 | $291.01–$1,902.00 | — | 20% |
| CT scan of the head without and with contrast CPT 70470 CT Head or Brain w/ + w/o Cont | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | 17% above | 20% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT Head or Brain w/ + w/o Cont | $1,812.00 | $2,265.00 | $346.55–$2,265.00 | — | 20% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Cont | $1,318.40 | $1,648.00 | $252.14–$1,648.00 | 5% above | 20% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Cont | $1,318.40 | $1,648.00 | $252.14–$1,648.00 | — | 20% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Cont | $1,328.80 | $1,661.00 | $254.13–$1,661.00 | 10% above | 20% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Cont | $1,328.80 | $1,661.00 | $254.13–$1,661.00 | — | 20% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Angio Pelvis w/ Cont | $2,736.00 | $3,420.00 | $523.26–$3,420.00 | 85% above | 20% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Cont | $2,736.00 | $3,420.00 | $523.26–$3,420.00 | 85% above | 20% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Angio Pelvis w/ Cont | $2,736.00 | $3,420.00 | $523.26–$3,420.00 | — | 20% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Cont | $2,736.00 | $3,420.00 | $523.26–$3,420.00 | — | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US Carotid Duplex Bil | $1,162.40 | $1,453.00 | $222.31–$1,453.00 | 12% above | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US Carotid Duplex Bil | $1,162.40 | $1,453.00 | $222.31–$1,453.00 | — | 20% |
| Chest CT scan without and with contrast CPT 71270 CT Chest w/ + w/o Cont | $2,185.60 | $2,732.00 | $418.00–$2,732.00 | 25% above | 20% |
| Chest CT scan without and with contrast CPT 71270 CT Chest +Abdomen w/ + w/o Cont | $2,185.60 | $2,732.00 | $418.00–$2,732.00 | 25% above | 20% |
| Chest CT scan without and with contrast CPT 71270 CT Chest +Abdomen +Pelvis w/ + w/o Cont | $2,185.60 | $2,732.00 | $418.00–$2,732.00 | 25% above | 20% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT Chest +Abdomen w/ + w/o Cont | $2,185.60 | $2,732.00 | $418.00–$2,732.00 | — | 20% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT Chest +Abdomen +Pelvis w/ + w/o Cont | $2,185.60 | $2,732.00 | $418.00–$2,732.00 | — | 20% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT Chest w/ + w/o Cont | $2,185.60 | $2,732.00 | $418.00–$2,732.00 | — | 20% |
| Chest X-ray, 2 views CPT 71046 XR Chest 2 Views w/ Obl | $274.40 | $343.00 | $52.48–$343.00 | 2% above | 20% |
| Chest X-ray, 2 views CPT 71046 XR Chest 2 Views BCE | $274.40 | $343.00 | $52.48–$343.00 | 2% above | 20% |
| Chest X-ray, 2 views CPT 71046 XR Chest 2 Views w/ Fluoro | $274.40 | $343.00 | $52.48–$343.00 | 2% above | 20% |
| Chest X-ray, 2 views CPT 71046 XR Chest 2 Views | $274.40 | $343.00 | $52.48–$343.00 | 2% above | 20% |
| Chest X-ray, 2 views CPT 71046 XR Chest 2 Views w/ Apical Lordotic | $274.40 | $343.00 | $52.48–$343.00 | 2% above | 20% |
| Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views w/ Apical Lordotic | $274.40 | $343.00 | $52.48–$343.00 | — | 20% |
| Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views | $274.40 | $343.00 | $52.48–$343.00 | — | 20% |
| Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views w/ Obl | $274.40 | $343.00 | $52.48–$343.00 | — | 20% |
| Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views w/ Fluoro | $274.40 | $343.00 | $52.48–$343.00 | — | 20% |
| Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views BCE | $274.40 | $343.00 | $52.48–$343.00 | — | 20% |
| Chest X-ray, single view CPT 71045 XR Chest 1 View Portable | $370.40 | $463.00 | $70.84–$463.00 | 46% above | 20% |
| Chest X-ray, single view CPT 71045 XR Chest 1 View | $370.40 | $463.00 | $70.84–$463.00 | 46% above | 20% |
| Chest X-ray, single view CPT 71045 XR Chest 1 View Discount | $370.40 | $463.00 | $70.84–$463.00 | 46% above | 20% |
| Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View Portable | $370.40 | $463.00 | $70.84–$463.00 | — | 20% |
| Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View Discount | $370.40 | $463.00 | $70.84–$463.00 | — | 20% |
| Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View | $370.40 | $463.00 | $70.84–$463.00 | — | 20% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Comp Lt | $295.20 | $369.00 | $56.46–$369.00 | 37% above | 20% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Comp Rt | $295.20 | $369.00 | $56.46–$369.00 | 37% above | 20% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Comp Rt | $295.20 | $369.00 | $56.46–$369.00 | — | 20% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Comp Lt | $295.20 | $369.00 | $56.46–$369.00 | — | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 CMH US Retroperitoneal Comp | $606.40 | $758.00 | $115.97–$758.00 | 10% above | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Comp | $606.40 | $758.00 | $115.97–$758.00 | 10% above | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 CMH US Retroperitoneal Comp | $606.40 | $758.00 | $115.97–$758.00 | — | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Comp | $606.40 | $758.00 | $115.97–$758.00 | — | 20% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD DEXA Axial Skeleton | $392.00 | $490.00 | $74.97–$490.00 | 2% above | 20% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD DEXA Axial Skeleton | $392.00 | $490.00 | $74.97–$490.00 | — | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD DEXA Appendicular Skeleton | $296.00 | $370.00 | $56.61–$370.00 | 21% above | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 CMH BD DEXA Appendicular Skeleton | $296.00 | $370.00 | $56.61–$370.00 | 21% above | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD DEXA Appendicular Skeleton | $296.00 | $370.00 | $56.61–$370.00 | — | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 CMH BD DEXA Appendicular Skeleton | $296.00 | $370.00 | $56.61–$370.00 | — | 20% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US Pregnant Detailed 1st Gest | $632.00 | $790.00 | $120.87–$790.00 | at median | 20% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US Pregnant Detailed 1st Gest | $632.00 | $790.00 | $120.87–$790.00 | — | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest Low Dose Screen F/U w/o Cont | $1,288.80 | $1,611.00 | $246.48–$1,611.00 | 7% above | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest Hi-Res w/o Contrast | $1,313.60 | $1,642.00 | $251.23–$1,642.00 | 9% above | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Cont | $1,313.60 | $1,642.00 | $251.23–$1,642.00 | 9% above | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest +Abdomen +Pelvis w/o Cont | $1,313.60 | $1,642.00 | $251.23–$1,642.00 | 9% above | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest +Abdomen w/o Cont | $1,313.60 | $1,642.00 | $251.23–$1,642.00 | 9% above | 20% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest Low Dose Screen F/U w/o Cont | $1,288.80 | $1,611.00 | $246.48–$1,611.00 | — | 20% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Cont | $1,313.60 | $1,642.00 | $251.23–$1,642.00 | — | 20% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest +Abdomen +Pelvis w/o Cont | $1,313.60 | $1,642.00 | $251.23–$1,642.00 | — | 20% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest +Abdomen w/o Cont | $1,313.60 | $1,642.00 | $251.23–$1,642.00 | — | 20% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest Hi-Res w/o Contrast | $1,313.60 | $1,642.00 | $251.23–$1,642.00 | — | 20% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Thorax w/Contrast - (Chest w/Contrast) | $1,786.40 | $2,233.00 | $341.65–$2,233.00 | 20% above | 20% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest +Abdomen w/ Cont | $1,786.40 | $2,233.00 | $341.65–$2,233.00 | 20% above | 20% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest +Abdomen +Pelvis w/ Cont | $1,786.40 | $2,233.00 | $341.65–$2,233.00 | 20% above | 20% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Thorax w/Contrast - (Chest w/Contrast) | $1,786.40 | $2,233.00 | $341.65–$2,233.00 | — | 20% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest +Abdomen w/ Cont | $1,786.40 | $2,233.00 | $341.65–$2,233.00 | — | 20% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest +Abdomen +Pelvis w/ Cont | $1,786.40 | $2,233.00 | $341.65–$2,233.00 | — | 20% |
| Diagnostic mammogram, both breasts CPT 77066 CMH MA Diag Implant Bil. | $385.60 | $482.00 | $73.75–$482.00 | 7% below | 20% |
| Diagnostic mammogram, both breasts CPT 77066 MA Diag Bil. | $385.60 | $482.00 | $73.75–$482.00 | 7% below | 20% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA Diag Bil. | $385.60 | $482.00 | $73.75–$482.00 | — | 20% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 CMH MA Diag Implant Bil. | $385.60 | $482.00 | $73.75–$482.00 | — | 20% |
| Diagnostic mammogram, one breast CPT 77065 CMH MA Diag Ltd Mrker Plcmnt | $303.20 | $379.00 | $57.99–$379.00 | 3% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA Diag Rt. | $303.20 | $379.00 | $57.99–$379.00 | 3% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 CMH MA Diag Implant Lt. | $303.20 | $379.00 | $57.99–$379.00 | 3% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA Diag Lt. | $303.20 | $379.00 | $57.99–$379.00 | 3% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA Diag Ltd Marker Placement Lt | $303.20 | $379.00 | $57.99–$379.00 | 3% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 CMH MA Diag Implant Rt. | $303.20 | $379.00 | $57.99–$379.00 | 3% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA Diag Ltd Marker Placement Rt | $303.20 | $379.00 | $57.99–$379.00 | 3% below | 20% |
| Diagnostic mammogram, one breast inpatient CPT 77065 CMH MA Diag Ltd Mrker Plcmnt | $303.20 | $379.00 | $57.99–$379.00 | — | 20% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Lt. | $303.20 | $379.00 | $57.99–$379.00 | — | 20% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 CMH MA Diag Implant Rt. | $303.20 | $379.00 | $57.99–$379.00 | — | 20% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Ltd Marker Placement Rt | $303.20 | $379.00 | $57.99–$379.00 | — | 20% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 CMH MA Diag Implant Lt. | $303.20 | $379.00 | $57.99–$379.00 | — | 20% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Rt. | $303.20 | $379.00 | $57.99–$379.00 | — | 20% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Ltd Marker Placement Lt | $303.20 | $379.00 | $57.99–$379.00 | — | 20% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 US LE Art Duplex Bil | $2,519.20 | $3,149.00 | $481.80–$3,149.00 | 139% above | 20% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US LE Art Duplex Bil | $2,519.20 | $3,149.00 | $481.80–$3,149.00 | — | 20% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Venous Insufficiency Bilateral | $1,479.20 | $1,849.00 | $282.90–$1,849.00 | — | 20% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 US UE Venous Mapping Bil | $1,479.20 | $1,849.00 | $282.90–$1,849.00 | 36% above | 20% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 US LE Veins Duplex Bil | $1,479.20 | $1,849.00 | $282.90–$1,849.00 | 36% above | 20% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 US UE Veins Duplex Bil | $1,479.20 | $1,849.00 | $282.90–$1,849.00 | 36% above | 20% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Venous Insufficiency Bilateral | $1,479.20 | $1,849.00 | $282.90–$1,849.00 | — | 20% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US UE Venous Mapping Bil | $1,479.20 | $1,849.00 | $282.90–$1,849.00 | — | 20% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US UE Veins Duplex Bil | $1,479.20 | $1,849.00 | $282.90–$1,849.00 | — | 20% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US LE Veins Duplex Bil | $1,479.20 | $1,849.00 | $282.90–$1,849.00 | — | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo 2D Comp | $1,424.00 | $1,780.00 | $272.34–$1,780.00 | 7% below | 20% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo 2D Comp | $1,424.00 | $1,780.00 | $272.34–$1,780.00 | — | 20% |
| Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Lt | $295.20 | $369.00 | $56.46–$369.00 | 22% above | 20% |
| Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Rt | $295.20 | $369.00 | $56.46–$369.00 | 22% above | 20% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Rt | $295.20 | $369.00 | $56.46–$369.00 | — | 20% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Lt | $295.20 | $369.00 | $56.46–$369.00 | — | 20% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Comp Min 3 Views Lt | $344.80 | $431.00 | $65.94–$431.00 | 41% above | 20% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Comp Min 3 Views Rt | $344.80 | $431.00 | $65.94–$431.00 | 41% above | 20% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Comp Min 3 Views Lt | $344.80 | $431.00 | $65.94–$431.00 | — | 20% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Comp Min 3 Views Rt | $344.80 | $431.00 | $65.94–$431.00 | — | 20% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT Orbit Sella etc. w/o Cont | $1,572.80 | $1,966.00 | $300.80–$1,966.00 | 56% above | 20% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT IAC w/o Cont | $1,572.80 | $1,966.00 | $300.80–$1,966.00 | 56% above | 20% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT IAC w/o Cont | $1,572.80 | $1,966.00 | $300.80–$1,966.00 | — | 20% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Orbit Sella etc. w/o Cont | $1,572.80 | $1,966.00 | $300.80–$1,966.00 | — | 20% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 XR Facial Bones Comp Min 3 Views | $433.60 | $542.00 | $82.93–$542.00 | 30% above | 20% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR Facial Bones Comp Min 3 Views | $433.60 | $542.00 | $82.93–$542.00 | — | 20% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Rt | $267.20 | $334.00 | $51.10–$334.00 | 12% above | 20% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Lt | $267.20 | $334.00 | $51.10–$334.00 | 12% above | 20% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Lt | $267.20 | $334.00 | $51.10–$334.00 | — | 20% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Rt | $267.20 | $334.00 | $51.10–$334.00 | — | 20% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepa Duct System | $3,159.20 | $3,949.00 | $604.20–$3,949.00 | 139% above | 20% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepa Duct System w/o Pharm | $3,159.20 | $3,949.00 | $604.20–$3,949.00 | 139% above | 20% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepa Duct System w/o Pharm | $3,159.20 | $3,949.00 | $604.20–$3,949.00 | — | 20% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepa Duct System | $3,159.20 | $3,949.00 | $604.20–$3,949.00 | — | 20% |
| Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Lt | $272.00 | $340.00 | $52.02–$340.00 | 11% above | 20% |
| Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Rt | $272.00 | $340.00 | $52.02–$340.00 | 11% above | 20% |
| Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Rt | $272.00 | $340.00 | $52.02–$340.00 | — | 20% |
| Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Lt | $272.00 | $340.00 | $52.02–$340.00 | — | 20% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Heel Min 2 Views Lt | $245.60 | $307.00 | $46.97–$307.00 | 19% above | 20% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Heel Min 2 Views Rt | $245.60 | $307.00 | $46.97–$307.00 | 19% above | 20% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Heel Min 2 Views Lt | $245.60 | $307.00 | $46.97–$307.00 | — | 20% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Heel Min 2 Views Rt | $245.60 | $307.00 | $46.97–$307.00 | — | 20% |
| Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Lt | $390.40 | $488.00 | $74.66–$488.00 | 38% above | 20% |
| Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Rt | $390.40 | $488.00 | $74.66–$488.00 | 38% above | 20% |
| Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Lt | $390.40 | $488.00 | $74.66–$488.00 | — | 20% |
| Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Rt | $390.40 | $488.00 | $74.66–$488.00 | — | 20% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Comp Min 4 Views Rt | $454.40 | $568.00 | $86.90–$568.00 | 28% above | 20% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Comp Min 4 Views Lt | $454.40 | $568.00 | $86.90–$568.00 | 28% above | 20% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Comp Min 4 Views Rt | $454.40 | $568.00 | $86.90–$568.00 | — | 20% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Comp Min 4 Views Lt | $454.40 | $568.00 | $86.90–$568.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LE w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LE w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle Surgical Planning Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle Surgical Planning Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee Robotic Planning Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee Robotic Planning Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Heel w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Heel w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia/Fibula w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia/Fibula w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Toes w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Toes w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 31% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LE w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Heel w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Heel w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee Robotic Planning Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee Robotic Planning Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle Surgical Planning Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle Surgical Planning Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LE w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Femur w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Femur w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Toes w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Toes w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Tibia/Fibula w/o Cont Lt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Tibia/Fibula w/o Cont Rt | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Ltd | $588.00 | $735.00 | $112.46–$735.00 | 23% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Ltd | $588.00 | $735.00 | $112.46–$735.00 | — | 20% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Nonvascular Ltd Rt | $236.80 | $296.00 | $45.29–$296.00 | 20% below | 20% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Nonvascular Ltd Lt | $236.80 | $296.00 | $45.29–$296.00 | 20% below | 20% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Nonvascular Ltd Rt | $236.80 | $296.00 | $45.29–$296.00 | — | 20% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Nonvascular Ltd Lt | $236.80 | $296.00 | $45.29–$296.00 | — | 20% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Chest Low Dose Screen w/o Cont | $1,386.40 | $1,733.00 | $265.15–$1,733.00 | 411% above | 20% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Chest Low Dose Screen w/o Cont | $1,386.40 | $1,733.00 | $265.15–$1,733.00 | — | 20% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia +Fibula 2 Views Lt | $272.00 | $340.00 | $52.02–$340.00 | 9% above | 20% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia +Fibula 2 Views Rt | $272.00 | $340.00 | $52.02–$340.00 | 9% above | 20% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia +Fibula 2 Views Rt | $272.00 | $340.00 | $52.02–$340.00 | — | 20% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia +Fibula 2 Views Lt | $272.00 | $340.00 | $52.02–$340.00 | — | 20% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA Head w/o Cont | $3,471.20 | $4,339.00 | $663.87–$4,339.00 | 85% above | 20% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRV Head w/o Cont | $3,471.20 | $4,339.00 | $663.87–$4,339.00 | 85% above | 20% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA Head w/o Cont | $3,471.20 | $4,339.00 | $663.87–$4,339.00 | — | 20% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV Head w/o Cont | $3,471.20 | $4,339.00 | $663.87–$4,339.00 | — | 20% |
| MRI of both breasts, without and then with contrast dye CPT 77049 MRI Breast w/ + w/o Cont Bil. | $4,741.60 | $5,927.00 | $906.83–$5,927.00 | 109% above | 20% |
| MRI of both breasts, without and then with contrast dye inpatient CPT 77049 MRI Breast w/ + w/o Cont Bil. | $4,741.60 | $5,927.00 | $906.83–$5,927.00 | — | 20% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Cont Lt | $1,919.20 | $2,399.00 | $367.05–$2,399.00 | 8% above | 20% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Cont Rt | $1,919.20 | $2,399.00 | $367.05–$2,399.00 | 8% above | 20% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Cont Rt | $1,919.20 | $2,399.00 | $367.05–$2,399.00 | 8% above | 20% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Cont Lt | $1,919.20 | $2,399.00 | $367.05–$2,399.00 | 8% above | 20% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Cont Rt | $1,988.80 | $2,486.00 | $380.36–$2,486.00 | 12% above | 20% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Cont Lt | $1,988.80 | $2,486.00 | $380.36–$2,486.00 | 12% above | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Cont Lt | $1,919.20 | $2,399.00 | $367.05–$2,399.00 | — | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Cont Rt | $1,919.20 | $2,399.00 | $367.05–$2,399.00 | — | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Cont Lt | $1,919.20 | $2,399.00 | $367.05–$2,399.00 | — | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Cont Rt | $1,919.20 | $2,399.00 | $367.05–$2,399.00 | — | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Cont Rt | $1,988.80 | $2,486.00 | $380.36–$2,486.00 | — | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Cont Lt | $1,988.80 | $2,486.00 | $380.36–$2,486.00 | — | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Cont Rt | $3,789.60 | $4,737.00 | $724.76–$4,737.00 | 42% above | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Cont Lt | $3,789.60 | $4,737.00 | $724.76–$4,737.00 | 42% above | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Cont Rt | $3,789.60 | $4,737.00 | $724.76–$4,737.00 | 42% above | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Cont Rt | $3,789.60 | $4,737.00 | $724.76–$4,737.00 | 42% above | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Cont Lt | $3,789.60 | $4,737.00 | $724.76–$4,737.00 | 42% above | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Cont Lt | $3,789.60 | $4,737.00 | $724.76–$4,737.00 | 42% above | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Cont Lt | $3,789.60 | $4,737.00 | $724.76–$4,737.00 | — | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Cont Rt | $3,789.60 | $4,737.00 | $724.76–$4,737.00 | — | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Cont Rt | $3,789.60 | $4,737.00 | $724.76–$4,737.00 | — | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Cont Lt | $3,789.60 | $4,737.00 | $724.76–$4,737.00 | — | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Cont Lt | $3,789.60 | $4,737.00 | $724.76–$4,737.00 | — | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Cont Rt | $3,789.60 | $4,737.00 | $724.76–$4,737.00 | — | 20% |
| MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Cont | $3,143.20 | $3,929.00 | $601.14–$3,929.00 | 75% above | 20% |
| MRI of the abdomen without contrast CPT 74181 MRI MRCP | $3,143.20 | $3,929.00 | $601.14–$3,929.00 | 75% above | 20% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Cont | $3,143.20 | $3,929.00 | $601.14–$3,929.00 | — | 20% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP | $3,143.20 | $3,929.00 | $601.14–$3,929.00 | — | 20% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Cont | $3,402.40 | $4,253.00 | $650.71–$4,253.00 | 19% above | 20% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Enterography | $3,402.40 | $4,253.00 | $650.71–$4,253.00 | 19% above | 20% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Enterography | $3,402.40 | $4,253.00 | $650.71–$4,253.00 | — | 20% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Cont | $3,402.40 | $4,253.00 | $650.71–$4,253.00 | — | 20% |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Cont | $1,974.40 | $2,468.00 | $377.60–$2,468.00 | 8% above | 20% |
| MRI of the brain, no contrast dye CPT 70551 MRI IAC w/o Cont | $1,974.40 | $2,468.00 | $377.60–$2,468.00 | 8% above | 20% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI IAC w/o Cont | $1,974.40 | $2,468.00 | $377.60–$2,468.00 | — | 20% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Cont | $1,974.40 | $2,468.00 | $377.60–$2,468.00 | — | 20% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Cont | $3,331.20 | $4,164.00 | $637.09–$4,164.00 | 7% above | 20% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI IAC w/ + w/o Cont | $3,331.20 | $4,164.00 | $637.09–$4,164.00 | 7% above | 20% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI IAC w/ + w/o Cont | $3,331.20 | $4,164.00 | $637.09–$4,164.00 | — | 20% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Cont | $3,331.20 | $4,164.00 | $637.09–$4,164.00 | — | 20% |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Cont | $2,322.40 | $2,903.00 | $444.16–$2,903.00 | 28% above | 20% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Cont | $2,322.40 | $2,903.00 | $444.16–$2,903.00 | — | 20% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Cont | $3,861.60 | $4,827.00 | $738.53–$4,827.00 | 27% above | 20% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Cont | $3,861.60 | $4,827.00 | $738.53–$4,827.00 | — | 20% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Cont | $1,798.40 | $2,248.00 | $343.94–$2,248.00 | 2% below | 20% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Cont | $1,798.40 | $2,248.00 | $343.94–$2,248.00 | — | 20% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Cont | $3,112.80 | $3,891.00 | $595.32–$3,891.00 | 9% above | 20% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Cont | $3,112.80 | $3,891.00 | $595.32–$3,891.00 | — | 20% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Cont | $2,075.20 | $2,594.00 | $396.88–$2,594.00 | 17% above | 20% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Cont | $2,075.20 | $2,594.00 | $396.88–$2,594.00 | — | 20% |
| MRI of the pelvis without and with contrast CPT 72197 CMH MRI Pelvis w/ + w/o Cont | $4,092.80 | $5,116.00 | $782.75–$5,116.00 | 53% above | 20% |
| MRI of the pelvis without and with contrast CPT 72197 MRI Rectum w/ + w/o Cont | $4,092.80 | $5,116.00 | $782.75–$5,116.00 | 53% above | 20% |
| MRI of the pelvis without and with contrast CPT 72197 MRI Prostate w/ + w/o Cont | $4,092.80 | $5,116.00 | $782.75–$5,116.00 | 53% above | 20% |
| MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Cont | $4,092.80 | $5,116.00 | $782.75–$5,116.00 | 53% above | 20% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Prostate w/ + w/o Cont | $4,092.80 | $5,116.00 | $782.75–$5,116.00 | — | 20% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 CMH MRI Pelvis w/ + w/o Cont | $4,092.80 | $5,116.00 | $782.75–$5,116.00 | — | 20% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Rectum w/ + w/o Cont | $4,092.80 | $5,116.00 | $782.75–$5,116.00 | — | 20% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Cont | $4,092.80 | $5,116.00 | $782.75–$5,116.00 | — | 20% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Cont | $3,159.20 | $3,949.00 | $604.20–$3,949.00 | 78% above | 20% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI Rectum w/o Cont | $3,159.20 | $3,949.00 | $604.20–$3,949.00 | 78% above | 20% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI Prostate w/o Cont | $3,159.20 | $3,949.00 | $604.20–$3,949.00 | 78% above | 20% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Cont | $3,159.20 | $3,949.00 | $604.20–$3,949.00 | — | 20% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Rectum w/o Cont | $3,159.20 | $3,949.00 | $604.20–$3,949.00 | — | 20% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Prostate w/o Cont | $3,159.20 | $3,949.00 | $604.20–$3,949.00 | — | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Cont Lt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | 25% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Cont Lt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | 25% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Clavicle w/o Cont Lt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | 25% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Cont Rt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | 25% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Cont Lt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | 25% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Cont Rt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | 25% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Cont Rt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | 25% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Clavicle w/o Cont Rt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | 25% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Clavicle w/o Cont Rt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | — | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Cont Lt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | — | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Cont Rt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | — | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Cont Lt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | — | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Cont Rt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | — | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Cont Lt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | — | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Cont Rt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | — | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Clavicle w/o Cont Lt | $2,211.20 | $2,764.00 | $422.89–$2,764.00 | — | 20% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR Spine Cerv Min 4 Views | $444.00 | $555.00 | $84.92–$555.00 | 18% above | 20% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR Spine Cerv Min 4 Views | $444.00 | $555.00 | $84.92–$555.00 | — | 20% |
| Neck soft tissue CT scan with contrast CPT 70491 CT Neck Soft Tissue w/ Cont | $1,900.00 | $2,375.00 | $363.38–$2,375.00 | 32% above | 20% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Neck Soft Tissue w/ Cont | $1,900.00 | $2,375.00 | $363.38–$2,375.00 | — | 20% |
| Neck soft tissue CT scan without contrast CPT 70490 CT Neck Soft Tissue w/o Cont | $1,432.80 | $1,791.00 | $274.02–$1,791.00 | 38% above | 20% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Neck Soft Tissue w/o Cont | $1,432.80 | $1,791.00 | $274.02–$1,791.00 | — | 20% |
| Neck soft tissue X-ray CPT 70360 XR Neck Soft Tissue | $300.00 | $375.00 | $57.38–$375.00 | 24% above | 20% |
| Neck soft tissue X-ray inpatient CPT 70360 XR Neck Soft Tissue | $300.00 | $375.00 | $57.38–$375.00 | — | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocard Perf Spect Mult | $4,224.00 | $5,280.00 | $807.84–$5,280.00 | 23% above | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocard Perf Spect Rest+Pharm Stress | $4,224.00 | $5,280.00 | $807.84–$5,280.00 | 23% above | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocard Perf Spect Rest+Tread Stress | $4,224.00 | $5,280.00 | $807.84–$5,280.00 | 23% above | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocard Perf Spect Rest+Tread Stress | $4,224.00 | $5,280.00 | $807.84–$5,280.00 | — | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocard Perf Spect Rest+Pharm Stress | $4,224.00 | $5,280.00 | $807.84–$5,280.00 | — | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocard Perf Spect Mult | $4,224.00 | $5,280.00 | $807.84–$5,280.00 | — | 20% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET PSMA w/ CT Scan | $4,876.80 | $6,096.00 | $932.69–$6,096.00 | 3% above | 20% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET Skull Base to Midthigh w/ CT Scan | $4,876.80 | $6,096.00 | $932.69–$6,096.00 | 3% above | 20% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET Skull Base to Midthigh w/ CT Scan | $4,876.80 | $6,096.00 | $932.69–$6,096.00 | — | 20% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET PSMA w/ CT Scan | $4,876.80 | $6,096.00 | $932.69–$6,096.00 | — | 20% |
| Pelvic CT scan without contrast CPT 72192 CT Pelvis w/o Cont | $1,308.00 | $1,635.00 | $250.16–$1,635.00 | 15% above | 20% |
| Pelvic CT scan without contrast one side CPT 72192 CT Pelvis Robotic Hip Planning Lt | $1,308.00 | $1,635.00 | $250.16–$1,635.00 | 15% above | 20% |
| Pelvic CT scan without contrast one side CPT 72192 CT Pelvis Robotic Hip Planning Rt | $1,308.00 | $1,635.00 | $250.16–$1,635.00 | 15% above | 20% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis w/o Cont | $1,308.00 | $1,635.00 | $250.16–$1,635.00 | — | 20% |
| Pelvic CT scan without contrast inpatient one side CPT 72192 CT Pelvis Robotic Hip Planning Lt | $1,308.00 | $1,635.00 | $250.16–$1,635.00 | — | 20% |
| Pelvic CT scan without contrast inpatient one side CPT 72192 CT Pelvis Robotic Hip Planning Rt | $1,308.00 | $1,635.00 | $250.16–$1,635.00 | — | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 76857 US Pelvic Non-OB Ltd Clinic EO | $156.00 | $195.00 | $29.84–$195.00 | 51% below | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic Non-OB Ltd | $172.00 | $215.00 | $32.90–$215.00 | 46% below | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 76857 US Pelvic Non-OB Ltd Clinic EO | $156.00 | $195.00 | $29.84–$195.00 | — | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic Non-OB Ltd | $172.00 | $215.00 | $32.90–$215.00 | — | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 CMH US PELVIC NON OB | $644.00 | $805.00 | $123.17–$805.00 | 23% above | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Non-OB Comp | $644.00 | $805.00 | $123.17–$805.00 | 23% above | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Non-OB Comp | $644.00 | $805.00 | $123.17–$805.00 | — | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 CMH US PELVIC NON OB | $644.00 | $805.00 | $123.17–$805.00 | — | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pregnant > 14 Weeks 1st Gest | $692.80 | $866.00 | $132.50–$866.00 | 34% above | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pregnant > 14 Weeks 1st Gest WC | $692.80 | $866.00 | $132.50–$866.00 | 34% above | 20% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pregnant > 14 Weeks 1st Gest WC | $692.80 | $866.00 | $132.50–$866.00 | — | 20% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pregnant > 14 Weeks 1st Gest | $692.80 | $866.00 | $132.50–$866.00 | — | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Pregnant < 14 Weeks 1st Gest WC | $552.00 | $690.00 | $105.57–$690.00 | 21% above | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Pregnant < 14 Weeks 1st Gest | $552.00 | $690.00 | $105.57–$690.00 | 21% above | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Pregnant < 14 Weeks 1st Gest | $552.00 | $690.00 | $105.57–$690.00 | — | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Pregnant < 14 Weeks 1st Gest WC | $552.00 | $690.00 | $105.57–$690.00 | — | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 76815 US Pregnant Ltd Clinic EO | $269.60 | $337.00 | $51.56–$337.00 | 24% below | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pregnant Ltd | $388.80 | $486.00 | $74.36–$486.00 | 10% above | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pregnant Ltd WC | $388.80 | $486.00 | $74.36–$486.00 | 10% above | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 76815 US Pregnant Ltd Clinic EO | $269.60 | $337.00 | $51.56–$337.00 | — | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Pregnant Ltd WC | $388.80 | $486.00 | $74.36–$486.00 | — | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Pregnant Ltd | $388.80 | $486.00 | $74.36–$486.00 | — | 20% |
| Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 Views Lt | $295.20 | $369.00 | $56.46–$369.00 | 12% above | 20% |
| Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 Views Rt | $295.20 | $369.00 | $56.46–$369.00 | 12% above | 20% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 Views Rt | $295.20 | $369.00 | $56.46–$369.00 | — | 20% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 Views Lt | $295.20 | $369.00 | $56.46–$369.00 | — | 20% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs Min 3 Views Lt w/ AP Chest | $351.20 | $439.00 | $67.17–$439.00 | 8% above | 20% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs Min 3 Views Rt w/ AP Chest | $351.20 | $439.00 | $67.17–$439.00 | 8% above | 20% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs Min 3 Views Rt w/ AP Chest | $351.20 | $439.00 | $67.17–$439.00 | — | 20% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs Min 3 Views Lt w/ AP Chest | $351.20 | $439.00 | $67.17–$439.00 | — | 20% |
| Screening mammogram, both breasts CPT 77067 CMH MA Routine Screen Implant Bil. | $319.20 | $399.00 | $61.05–$399.00 | 4% below | 20% |
| Screening mammogram, both breasts CPT 77067 MA Routine Screen Bil. | $319.20 | $399.00 | $61.05–$399.00 | 4% below | 20% |
| Screening mammogram, both breasts inpatient CPT 77067 MA Routine Screen Bil. | $319.20 | $399.00 | $61.05–$399.00 | — | 20% |
| Screening mammogram, both breasts inpatient CPT 77067 CMH MA Routine Screen Implant Bil. | $319.20 | $399.00 | $61.05–$399.00 | — | 20% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Comp Min 2 Views Lt | $324.00 | $405.00 | $61.97–$405.00 | 16% above | 20% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Comp Min 2 Views Rt | $324.00 | $405.00 | $61.97–$405.00 | 16% above | 20% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Comp Min 2 Views Lt | $324.00 | $405.00 | $61.97–$405.00 | — | 20% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Comp Min 2 Views Rt | $324.00 | $405.00 | $61.97–$405.00 | — | 20% |
| Sinus X-ray, complete, 3 or more views CPT 70220 XR Sinuses Paranasal Comp Min 3 Views | $380.80 | $476.00 | $72.83–$476.00 | 32% above | 20% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR Sinuses Paranasal Comp Min 3 Views | $380.80 | $476.00 | $72.83–$476.00 | — | 20% |
| Skull X-ray, fewer than 4 views CPT 70250 XR Skull < 4 Views | $356.00 | $445.00 | $68.09–$445.00 | 27% above | 20% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 XR Skull < 4 Views | $356.00 | $445.00 | $68.09–$445.00 | — | 20% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 US Echo Stress Dobutamine | $1,784.00 | $2,230.00 | $341.19–$2,230.00 | 20% above | 20% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 US Echo Exercise Stress | $1,784.00 | $2,230.00 | $341.19–$2,230.00 | 20% above | 20% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 US Echo Stress Dobutamine | $1,784.00 | $2,230.00 | $341.19–$2,230.00 | — | 20% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 US Echo Exercise Stress | $1,784.00 | $2,230.00 | $341.19–$2,230.00 | — | 20% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Swallowing Funct w/ Video | $1,581.60 | $1,977.00 | $302.48–$1,977.00 | 191% above | 20% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Swallowing Funct w/ Video | $1,581.60 | $1,977.00 | $302.48–$1,977.00 | — | 20% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur 2 Views Lt | $277.60 | $347.00 | $53.09–$347.00 | 9% above | 20% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur 2 Views Rt | $277.60 | $347.00 | $53.09–$347.00 | 9% above | 20% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur 2 Views Rt | $277.60 | $347.00 | $53.09–$347.00 | — | 20% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur 2 Views Lt | $277.60 | $347.00 | $53.09–$347.00 | — | 20% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Spine Thoracic w/o Cont | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | 10% above | 20% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Spine Thoracic w/o Cont | $1,324.00 | $1,655.00 | $253.22–$1,655.00 | — | 20% |
| Toe X-ray, 2 or more views one side CPT 73660 XR Toe(s) Min 2 Views Rt | $279.20 | $349.00 | $53.40–$349.00 | 39% above | 20% |
| Toe X-ray, 2 or more views one side CPT 73660 XR Toe(s) Min 2 Views Lt | $279.20 | $349.00 | $53.40–$349.00 | 39% above | 20% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toe(s) Min 2 Views Lt | $279.20 | $349.00 | $53.40–$349.00 | — | 20% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toe(s) Min 2 Views Rt | $279.20 | $349.00 | $53.40–$349.00 | — | 20% |
| Transvaginal pelvic ultrasound CPT 76830 76830 US Transvaginal Non-OB Clinic EO | $319.20 | $399.00 | $61.05–$399.00 | 32% below | 20% |
| Transvaginal pelvic ultrasound CPT 76830 CMH US TRANSVAGINAL | $547.20 | $684.00 | $104.65–$684.00 | 17% above | 20% |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal | $547.20 | $684.00 | $104.65–$684.00 | 17% above | 20% |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Ltd WC | $547.20 | $684.00 | $104.65–$684.00 | 17% above | 20% |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Ltd | $547.20 | $684.00 | $104.65–$684.00 | 17% above | 20% |
| Transvaginal pelvic ultrasound CPT 76830 US Pelvis Transvaginal | $547.20 | $684.00 | $104.65–$684.00 | 17% above | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 76830 US Transvaginal Non-OB Clinic EO | $319.20 | $399.00 | $61.05–$399.00 | — | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Pelvis Transvaginal | $547.20 | $684.00 | $104.65–$684.00 | — | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 CMH US TRANSVAGINAL | $547.20 | $684.00 | $104.65–$684.00 | — | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Ltd WC | $547.20 | $684.00 | $104.65–$684.00 | — | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Ltd | $547.20 | $684.00 | $104.65–$684.00 | — | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal | $547.20 | $684.00 | $104.65–$684.00 | — | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 US Pregnant Transvaginal | $444.00 | $555.00 | $84.92–$555.00 | 23% above | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 CMH US Pregnant Transvaginal | $444.00 | $555.00 | $84.92–$555.00 | 23% above | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 US Pregnant Transvaginal WC | $444.00 | $555.00 | $84.92–$555.00 | 23% above | 20% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Pregnant Transvaginal WC | $444.00 | $555.00 | $84.92–$555.00 | — | 20% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Pregnant Transvaginal | $444.00 | $555.00 | $84.92–$555.00 | — | 20% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 CMH US Pregnant Transvaginal | $444.00 | $555.00 | $84.92–$555.00 | — | 20% |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Comp | $654.40 | $818.00 | $125.15–$818.00 | 9% above | 20% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Comp | $654.40 | $818.00 | $125.15–$818.00 | — | 20% |
| Ultrasound of the scrotum and testicles CPT 76870 US Scrotum +Contents | $280.00 | $350.00 | $53.55–$350.00 | 47% below | 20% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum +Contents | $280.00 | $350.00 | $53.55–$350.00 | — | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head +Neck Soft Tissue | $636.00 | $795.00 | $121.64–$795.00 | 33% above | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head +Neck Soft Tissue | $636.00 | $795.00 | $121.64–$795.00 | — | 20% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper Gi + Ba Swallow | $1,136.00 | $1,420.00 | $217.26–$1,420.00 | 99% above | 20% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI w/ Small Bowel | $1,136.00 | $1,420.00 | $217.26–$1,420.00 | 99% above | 20% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI | $1,136.00 | $1,420.00 | $217.26–$1,420.00 | 99% above | 20% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI | $1,136.00 | $1,420.00 | $217.26–$1,420.00 | — | 20% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI w/ Small Bowel | $1,136.00 | $1,420.00 | $217.26–$1,420.00 | — | 20% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper Gi + Ba Swallow | $1,136.00 | $1,420.00 | $217.26–$1,420.00 | — | 20% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Min 2 Views Lt | $272.00 | $340.00 | $52.02–$340.00 | 14% above | 20% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Min 2 Views Rt | $272.00 | $340.00 | $52.02–$340.00 | 14% above | 20% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Min 2 Views Rt | $272.00 | $340.00 | $52.02–$340.00 | — | 20% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Min 2 Views Lt | $272.00 | $340.00 | $52.02–$340.00 | — | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Veins Duplex Rt | $788.00 | $985.00 | $150.71–$985.00 | 24% above | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Veins Duplex Lt | $788.00 | $985.00 | $150.71–$985.00 | 24% above | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Veins Duplex Lt | $788.00 | $985.00 | $150.71–$985.00 | 24% above | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Insufficiency Left | $788.00 | $985.00 | $150.71–$985.00 | 24% above | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Insufficiency Right | $788.00 | $985.00 | $150.71–$985.00 | 24% above | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Venous Mapping Lt | $788.00 | $985.00 | $150.71–$985.00 | 24% above | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Venous Mapping Rt | $788.00 | $985.00 | $150.71–$985.00 | 24% above | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Veins Duplex Rt | $788.00 | $985.00 | $150.71–$985.00 | 24% above | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Veins Duplex Lt | $788.00 | $985.00 | $150.71–$985.00 | — | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Veins Duplex Rt | $788.00 | $985.00 | $150.71–$985.00 | — | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Veins Duplex Rt | $788.00 | $985.00 | $150.71–$985.00 | — | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Veins Duplex Lt | $788.00 | $985.00 | $150.71–$985.00 | — | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Insufficiency Left | $788.00 | $985.00 | $150.71–$985.00 | — | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Insufficiency Right | $788.00 | $985.00 | $150.71–$985.00 | — | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Venous Mapping Rt | $788.00 | $985.00 | $150.71–$985.00 | — | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Venous Mapping Lt | $788.00 | $985.00 | $150.71–$985.00 | — | 20% |
| Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Rt | $316.80 | $396.00 | $60.59–$396.00 | 40% above | 20% |
| Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Lt | $316.80 | $396.00 | $60.59–$396.00 | 40% above | 20% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Lt | $316.80 | $396.00 | $60.59–$396.00 | — | 20% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Rt | $316.80 | $396.00 | $60.59–$396.00 | — | 20% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Comp Min 3 Views Rt | $346.40 | $433.00 | $66.25–$433.00 | 36% above | 20% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Comp Min 3 Views Lt | $346.40 | $433.00 | $66.25–$433.00 | 36% above | 20% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Comp Min 3 Views Rt | $346.40 | $433.00 | $66.25–$433.00 | — | 20% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Comp Min 3 Views Lt | $346.40 | $433.00 | $66.25–$433.00 | — | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 XR Pelvis +Hip Infant Min 2 Views | $281.60 | $352.00 | $53.86–$352.00 | 4% above | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Comp Min 2 Views Lt | $281.60 | $352.00 | $53.86–$352.00 | 4% above | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Comp Min 2 Views Rt BCE | $281.60 | $352.00 | $53.86–$352.00 | 4% above | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Comp Min 2 Views Lt +Pelvis | $281.60 | $352.00 | $53.86–$352.00 | 4% above | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Comp Min 2 Views Rt +Pelvis | $281.60 | $352.00 | $53.86–$352.00 | 4% above | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Comp Min 2 Views Rt | $281.60 | $352.00 | $53.86–$352.00 | 4% above | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Comp Min 2 Views Lt BCE | $281.60 | $352.00 | $53.86–$352.00 | 4% above | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 XR Pelvis +Hip Infant Min 2 Views | $281.60 | $352.00 | $53.86–$352.00 | — | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Comp Min 2 Views Lt | $281.60 | $352.00 | $53.86–$352.00 | — | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Comp Min 2 Views Rt BCE | $281.60 | $352.00 | $53.86–$352.00 | — | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Comp Min 2 Views Rt | $281.60 | $352.00 | $53.86–$352.00 | — | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Comp Min 2 Views Rt +Pelvis | $281.60 | $352.00 | $53.86–$352.00 | — | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Comp Min 2 Views Lt +Pelvis | $281.60 | $352.00 | $53.86–$352.00 | — | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Comp Min 2 Views Lt BCE | $281.60 | $352.00 | $53.86–$352.00 | — | 20% |
| X-ray of the abdomen, 1 view CPT 74018 XR Abdomen Sitzmark Study | $234.40 | $293.00 | $44.83–$293.00 | 6% below | 20% |
| X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View | $234.40 | $293.00 | $44.83–$293.00 | 6% below | 20% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen Sitzmark Study | $234.40 | $293.00 | $44.83–$293.00 | — | 20% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View | $234.40 | $293.00 | $44.83–$293.00 | — | 20% |
| X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Rt | $289.60 | $362.00 | $55.39–$362.00 | 17% above | 20% |
| X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Lt | $289.60 | $362.00 | $55.39–$362.00 | 17% above | 20% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Lt | $289.60 | $362.00 | $55.39–$362.00 | — | 20% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Rt | $289.60 | $362.00 | $55.39–$362.00 | — | 20% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views Rt | $334.40 | $418.00 | $63.95–$418.00 | 53% above | 20% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views Lt | $334.40 | $418.00 | $63.95–$418.00 | 53% above | 20% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views Lt | $334.40 | $418.00 | $63.95–$418.00 | — | 20% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views Rt | $334.40 | $418.00 | $63.95–$418.00 | — | 20% |
| X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Lt | $277.60 | $347.00 | $53.09–$347.00 | 24% above | 20% |
| X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Rt | $277.60 | $347.00 | $53.09–$347.00 | 24% above | 20% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Rt | $277.60 | $347.00 | $53.09–$347.00 | — | 20% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Lt | $277.60 | $347.00 | $53.09–$347.00 | — | 20% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Comp Min 3 Views Rt | $328.80 | $411.00 | $62.88–$411.00 | 29% above | 20% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Comp Min 3 Views Lt | $328.80 | $411.00 | $62.88–$411.00 | 29% above | 20% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Comp Min 3 Views Lt | $328.80 | $411.00 | $62.88–$411.00 | — | 20% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Comp Min 3 Views Rt | $328.80 | $411.00 | $62.88–$411.00 | — | 20% |
| X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Min 3 Views Rt | $350.40 | $438.00 | $67.01–$438.00 | 23% above | 20% |
| X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Min 3 Views Lt | $350.40 | $438.00 | $67.01–$438.00 | 23% above | 20% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Min 3 Views Lt | $350.40 | $438.00 | $67.01–$438.00 | — | 20% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Min 3 Views Rt | $350.40 | $438.00 | $67.01–$438.00 | — | 20% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Lt | $289.60 | $362.00 | $55.39–$362.00 | 18% above | 20% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Rt | $289.60 | $362.00 | $55.39–$362.00 | 18% above | 20% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Rt | $289.60 | $362.00 | $55.39–$362.00 | — | 20% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Lt | $289.60 | $362.00 | $55.39–$362.00 | — | 20% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views | $362.40 | $453.00 | $69.31–$453.00 | 16% above | 20% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views | $362.40 | $453.00 | $69.31–$453.00 | — | 20% |
| X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Min 4 Views | $508.80 | $636.00 | $97.31–$636.00 | 27% above | 20% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Min 4 Views | $508.80 | $636.00 | $97.31–$636.00 | — | 20% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views | $305.60 | $382.00 | $58.45–$382.00 | 6% above | 20% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views | $305.60 | $382.00 | $58.45–$382.00 | — | 20% |
| X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Comp Min 3 Views | $367.20 | $459.00 | $70.23–$459.00 | 66% above | 20% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones Comp Min 3 Views | $367.20 | $459.00 | $70.23–$459.00 | — | 20% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cerv 2 or 3 Views | $334.40 | $418.00 | $63.95–$418.00 | 29% above | 20% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cerv 2 or 3 Views | $334.40 | $418.00 | $63.95–$418.00 | — | 20% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views | $283.20 | $354.00 | $54.16–$354.00 | 4% above | 20% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views | $283.20 | $354.00 | $54.16–$354.00 | — | 20% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum +Coccyx Min 2 Views | $295.20 | $369.00 | $56.46–$369.00 | 18% above | 20% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum +Coccyx Min 2 Views | $295.20 | $369.00 | $56.46–$369.00 | — | 20% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Oregon | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ACTH Hormone LLS | $458.40 | $573.00 | $87.67–$573.00 | 262% above | 20% |
| ACTH blood test CPT 82024 ACTH Plasma LC | $458.40 | $573.00 | $87.67–$573.00 | 262% above | 20% |
| ACTH blood test inpatient CPT 82024 ACTH Plasma LC | $458.40 | $573.00 | $87.67–$573.00 | — | 20% |
| ACTH blood test inpatient CPT 82024 ACTH Hormone LLS | $458.40 | $573.00 | $87.67–$573.00 | — | 20% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase | $61.60 | $77.00 | $11.78–$77.00 | 157% above | 20% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 84460 Liver Fibrosis Panel LLS | $61.60 | $77.00 | $11.78–$77.00 | 157% above | 20% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine Aminotransferase | $61.60 | $77.00 | $11.78–$77.00 | — | 20% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 84460 Liver Fibrosis Panel LLS | $61.60 | $77.00 | $11.78–$77.00 | — | 20% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate Aminotransferase | $60.80 | $76.00 | $11.63–$76.00 | 113% above | 20% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Aspartate Aminotransferase | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Acute Panel LLS | $567.20 | $709.00 | $108.48–$709.00 | 155% above | 20% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Acute LC | $567.20 | $709.00 | $108.48–$709.00 | 155% above | 20% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Acute LC | $567.20 | $709.00 | $108.48–$709.00 | — | 20% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Acute Panel LLS | $567.20 | $709.00 | $108.48–$709.00 | — | 20% |
| Albumin blood test CPT 82040 Albumin Level | $57.60 | $72.00 | $11.02–$72.00 | 126% above | 20% |
| Albumin blood test inpatient CPT 82040 Albumin Level | $57.60 | $72.00 | $11.02–$72.00 | — | 20% |
| Aldosterone blood test CPT 82088 Aldosterone Urine LLS | $86.40 | $108.00 | $16.52–$108.00 | at median | 20% |
| Aldosterone blood test CPT 82088 Aldosterone/Renin Ratio LC | $296.00 | $370.00 | $56.61–$370.00 | 243% above | 20% |
| Aldosterone blood test CPT 82088 Aldosterone Activity Ratio LLS | $296.00 | $370.00 | $56.61–$370.00 | 243% above | 20% |
| Aldosterone blood test CPT 82088 Aldosterone LLS | $484.00 | $605.00 | $92.57–$605.00 | 460% above | 20% |
| Aldosterone blood test CPT 82088 Aldosterone LLS serum from peripheral blood | $484.00 | $605.00 | $92.57–$605.00 | 460% above | 20% |
| Aldosterone blood test one side CPT 82088 Aldosterone LLS serum from the Left Adrenal Vein | $484.00 | $605.00 | $92.57–$605.00 | 460% above | 20% |
| Aldosterone blood test one side CPT 82088 Aldosterone LLS serum from the Right Adrenal Vein | $484.00 | $605.00 | $92.57–$605.00 | 460% above | 20% |
| Aldosterone blood test inpatient CPT 82088 Aldosterone Urine LLS | $86.40 | $108.00 | $16.52–$108.00 | — | 20% |
| Aldosterone blood test inpatient CPT 82088 Aldosterone Activity Ratio LLS | $296.00 | $370.00 | $56.61–$370.00 | — | 20% |
| Aldosterone blood test inpatient CPT 82088 Aldosterone/Renin Ratio LC | $296.00 | $370.00 | $56.61–$370.00 | — | 20% |
| Aldosterone blood test inpatient CPT 82088 Aldosterone LLS serum from peripheral blood | $484.00 | $605.00 | $92.57–$605.00 | — | 20% |
| Aldosterone blood test inpatient CPT 82088 Aldosterone LLS | $484.00 | $605.00 | $92.57–$605.00 | — | 20% |
| Aldosterone blood test inpatient one side CPT 82088 Aldosterone LLS serum from the Left Adrenal Vein | $484.00 | $605.00 | $92.57–$605.00 | — | 20% |
| Aldosterone blood test inpatient one side CPT 82088 Aldosterone LLS serum from the Right Adrenal Vein | $484.00 | $605.00 | $92.57–$605.00 | — | 20% |
| Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase | $60.80 | $76.00 | $11.63–$76.00 | 165% above | 20% |
| Alkaline phosphatase (ALP) blood test CPT 84075 Alk Phos Isoenzyme LC | $60.80 | $76.00 | $11.63–$76.00 | 165% above | 20% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alk Phos Isoenzyme LC | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Monterey Pine IgE | $13.60 | $17.00 | $2.60–$17.00 | 7% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE SOYBEAN | $13.60 | $17.00 | $2.60–$17.00 | 7% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 86003 Aspergillus Fumigatus 6 | $17.60 | $22.00 | $3.37–$22.00 | 38% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE TOMATO | $28.00 | $35.00 | $5.36–$35.00 | 120% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Milk LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Orange LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Maize Corn LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE CHICKEN LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE EGG WHITE LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 86003 Allergen Specific IgE each LC | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Whey LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Bill Allergen Casein RAST LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 IgE Milk LC | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 IgE Egg White LC | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 IgE Egg (Yolk) LC | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 IgE Wheat LC | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Crab LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Hazelnut LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE EGG YOLK LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE WHEAT LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen IgE Pecan LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Bill Allergen Macadamia Nut LLS | $36.00 | $45.00 | $6.89–$45.00 | 182% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Bronch ABPA Panel LLS | $39.20 | $49.00 | $7.50–$49.00 | 207% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Clam LLS | $40.80 | $51.00 | $7.80–$51.00 | 220% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Strawberry LLS | $40.80 | $51.00 | $7.80–$51.00 | 220% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Penicillium Notatum LLS | $40.80 | $51.00 | $7.80–$51.00 | 220% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Lobster LLS | $40.80 | $51.00 | $7.80–$51.00 | 220% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Scallop LLS | $40.80 | $51.00 | $7.80–$51.00 | 220% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Shrimp LLS | $40.80 | $51.00 | $7.80–$51.00 | 220% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Oyster LLS | $40.80 | $51.00 | $7.80–$51.00 | 220% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Peanut LLS | $42.40 | $53.00 | $8.11–$53.00 | 233% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Walnut LLS | $42.40 | $53.00 | $8.11–$53.00 | 233% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 GRAPE IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 EGGWHITE IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 WHEAT IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SHRIMP IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SOYBEAN IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 WALNUT IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SCALLOP IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CORN/MAIZE IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SESAME SEED IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 OAT IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 RICE IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MILK COWS IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CRAB IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 BEEF IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 BARLEY IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ORANGE (F33) IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CLAM IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CODFISH IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CHICKEN MEAT IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | 377% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Latex LLS | $108.00 | $135.00 | $20.66–$135.00 | 747% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Bee Venom Profile LLS | $117.60 | $147.00 | $22.49–$147.00 | 822% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Mold Allergy Profile LLS | $152.00 | $190.00 | $29.07–$190.00 | 1092% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PANEL IGE PEDIATRIC ALLERGY II | $216.80 | $271.00 | $41.46–$271.00 | 1600% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen NW Food Profile LLS | $272.80 | $341.00 | $52.17–$341.00 | 2040% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Inhalant Profile LLS | $278.40 | $348.00 | $53.24–$348.00 | 2084% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Region 17 Allergy Panel LLS | $866.40 | $1,083.00 | $165.70–$1,083.00 | 6695% above | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE SOYBEAN | $13.60 | $17.00 | $2.60–$17.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Monterey Pine IgE | $13.60 | $17.00 | $2.60–$17.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003 Aspergillus Fumigatus 6 | $17.60 | $22.00 | $3.37–$22.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE TOMATO | $28.00 | $35.00 | $5.36–$35.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 IgE Milk LC | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003 Allergen Specific IgE each LC | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 IgE Wheat LC | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 IgE Egg (Yolk) LC | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 IgE Egg White LC | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Hazelnut LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bill Allergen Casein RAST LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Whey LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bill Allergen Macadamia Nut LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen IgE Pecan LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE WHEAT LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE EGG YOLK LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE EGG WHITE LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE CHICKEN LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Orange LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Crab LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Milk LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Maize Corn LLS | $36.00 | $45.00 | $6.89–$45.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Bronch ABPA Panel LLS | $39.20 | $49.00 | $7.50–$49.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Oyster LLS | $40.80 | $51.00 | $7.80–$51.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Lobster LLS | $40.80 | $51.00 | $7.80–$51.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Scallop LLS | $40.80 | $51.00 | $7.80–$51.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Strawberry LLS | $40.80 | $51.00 | $7.80–$51.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Shrimp LLS | $40.80 | $51.00 | $7.80–$51.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Clam LLS | $40.80 | $51.00 | $7.80–$51.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Penicillium Notatum LLS | $40.80 | $51.00 | $7.80–$51.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Walnut LLS | $42.40 | $53.00 | $8.11–$53.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Peanut LLS | $42.40 | $53.00 | $8.11–$53.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WALNUT IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BEEF IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ORANGE (F33) IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RICE IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CORN/MAIZE IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 EGGWHITE IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WHEAT IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GRAPE IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BARLEY IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 OAT IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SHRIMP IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SOYBEAN IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CODFISH IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PEANUT IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CLAM IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CRAB IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SESAME SEED IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MILK COWS IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHICKEN MEAT IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SCALLOP IGE LLS | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Latex LLS | $108.00 | $135.00 | $20.66–$135.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Bee Venom Profile LLS | $117.60 | $147.00 | $22.49–$147.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Mold Allergy Profile LLS | $152.00 | $190.00 | $29.07–$190.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PANEL IGE PEDIATRIC ALLERGY II | $216.80 | $271.00 | $41.46–$271.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen NW Food Profile LLS | $272.80 | $341.00 | $52.17–$341.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Inhalant Profile LLS | $278.40 | $348.00 | $53.24–$348.00 | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Region 17 Allergy Panel LLS | $866.40 | $1,083.00 | $165.70–$1,083.00 | — | 20% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 Maternal Screen Prenatal AFP LLS | $80.00 | $100.00 | $15.30–$100.00 | 10% above | 20% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-1-Fetoprotein LLS | $104.80 | $131.00 | $20.04–$131.00 | 44% above | 20% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFP Tetra LC | $104.80 | $131.00 | $20.04–$131.00 | 44% above | 20% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFP Serum Tumor Marker LC | $104.80 | $131.00 | $20.04–$131.00 | 44% above | 20% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Maternal Screen Prenatal AFP LLS | $80.00 | $100.00 | $15.30–$100.00 | — | 20% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP Tetra LC | $104.80 | $131.00 | $20.04–$131.00 | — | 20% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha-1-Fetoprotein LLS | $104.80 | $131.00 | $20.04–$131.00 | — | 20% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP Serum Tumor Marker LC | $104.80 | $131.00 | $20.04–$131.00 | — | 20% |
| Ammonia blood test CPT 82140 Ammonia Level | $172.80 | $216.00 | $33.05–$216.00 | 98% above | 20% |
| Ammonia blood test CPT 82140 Ammonia Lvl | $172.80 | $216.00 | $33.05–$216.00 | 98% above | 20% |
| Ammonia blood test inpatient CPT 82140 Ammonia Level | $172.80 | $216.00 | $33.05–$216.00 | — | 20% |
| Ammonia blood test inpatient CPT 82140 Ammonia Lvl | $172.80 | $216.00 | $33.05–$216.00 | — | 20% |
| Amylase blood test CPT 82150 Body Fluid Amylase LLS | $52.80 | $66.00 | $10.10–$66.00 | 10% above | 20% |
| Amylase blood test CPT 82150 Amylase Body Fluid LC | $52.80 | $66.00 | $10.10–$66.00 | 10% above | 20% |
| Amylase blood test CPT 82150 Amylase Level | $77.60 | $97.00 | $14.84–$97.00 | 62% above | 20% |
| Amylase blood test CPT 82150 Urine Amylase 24 Hour | $77.60 | $97.00 | $14.84–$97.00 | 62% above | 20% |
| Amylase blood test inpatient CPT 82150 Amylase Body Fluid LC | $52.80 | $66.00 | $10.10–$66.00 | — | 20% |
| Amylase blood test inpatient CPT 82150 Body Fluid Amylase LLS | $52.80 | $66.00 | $10.10–$66.00 | — | 20% |
| Amylase blood test inpatient CPT 82150 Urine Amylase 24 Hour | $77.60 | $97.00 | $14.84–$97.00 | — | 20% |
| Amylase blood test inpatient CPT 82150 Amylase Level | $77.60 | $97.00 | $14.84–$97.00 | — | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Antibodies IgG/IgA LC | $152.80 | $191.00 | $29.22–$191.00 | 189% above | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide Abs LLS | $152.80 | $191.00 | $29.22–$191.00 | 189% above | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 86200 Ccp Antibody LC | $420.00 | $525.00 | $80.33–$525.00 | 694% above | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP Antibodies IgG/IgA LC | $152.80 | $191.00 | $29.22–$191.00 | — | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrullinated Peptide Abs LLS | $152.80 | $191.00 | $29.22–$191.00 | — | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 86200 Ccp Antibody LC | $420.00 | $525.00 | $80.33–$525.00 | — | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA ELISA Screen Reflex Cascade LLS | $23.20 | $29.00 | $4.44–$29.00 | 60% below | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA by IFA Reflex LC | $23.20 | $29.00 | $4.44–$29.00 | 60% below | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibodies IFA LC | $23.20 | $29.00 | $4.44–$29.00 | 60% below | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibodies Direct LC | $23.20 | $29.00 | $4.44–$29.00 | 60% below | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA IFA LLS | $133.60 | $167.00 | $25.55–$167.00 | 131% above | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA ELISA Scrn Rflx IFA LLS | $143.20 | $179.00 | $27.39–$179.00 | 147% above | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Anti-Nuclear Ab by IFA (RDL) LC | $143.20 | $179.00 | $27.39–$179.00 | 147% above | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA by IFA Reflex LC | $23.20 | $29.00 | $4.44–$29.00 | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA ELISA Screen Reflex Cascade LLS | $23.20 | $29.00 | $4.44–$29.00 | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Antibodies Direct LC | $23.20 | $29.00 | $4.44–$29.00 | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Antibodies IFA LC | $23.20 | $29.00 | $4.44–$29.00 | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA IFA LLS | $133.60 | $167.00 | $25.55–$167.00 | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA ELISA Scrn Rflx IFA LLS | $143.20 | $179.00 | $27.39–$179.00 | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Anti-Nuclear Ab by IFA (RDL) LC | $143.20 | $179.00 | $27.39–$179.00 | — | 20% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-ProBNP II | $94.40 | $118.00 | $18.05–$118.00 | 40% below | 20% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT Pro-BNP | $94.40 | $118.00 | $18.05–$118.00 | 40% below | 20% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-ProBNP II | $94.40 | $118.00 | $18.05–$118.00 | — | 20% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT Pro-BNP | $94.40 | $118.00 | $18.05–$118.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Exudate Abscess Deep Wound LLS | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 GC Culture | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Environmental Culture | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bone Culture | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Respiratory LLS | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Skin Superficial LLS | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Throat LLS | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Body Fluid LLS | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Eye Culture | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Ear Culture | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture, Cerebrospinal Fluid CSF LLS | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Blood Unit Culture | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 .Sputum Culture MB LC | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Aerobic Culture+Gram Stain MB LC | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture+Gram Stain MB LC | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Gram Stain/Body Fluid Culture MB LC | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Gram S+Lower Resp Cult(Non-Sp) MB LC | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Upper Respiratory Culture MB LC | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 Aerobic Culture LC | $106.40 | $133.00 | $20.35–$133.00 | 103% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture Routine MB LC | $164.80 | $206.00 | $31.52–$206.00 | 215% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Tissue Culture + Gram Stain MB LC | $200.80 | $251.00 | $38.40–$251.00 | 283% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Eye Culture | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 87070 Aerobic Culture LC | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Ear Culture | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Upper Respiratory Culture MB LC | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Throat LLS | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Body Fluid LLS | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Blood Unit Culture | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Gram Stain/Body Fluid Culture MB LC | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture, Cerebrospinal Fluid CSF LLS | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 .Sputum Culture MB LC | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Gram S+Lower Resp Cult(Non-Sp) MB LC | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Aerobic Culture+Gram Stain MB LC | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Environmental Culture | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 GC Culture | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bone Culture | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Respiratory LLS | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Exudate Abscess Deep Wound LLS | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Skin Superficial LLS | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Genital Culture+Gram Stain MB LC | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Genital Culture | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Genital Culture Routine MB LC | $164.80 | $206.00 | $31.52–$206.00 | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Tissue Culture + Gram Stain MB LC | $200.80 | $251.00 | $38.40–$251.00 | — | 20% |
| Basic metabolic panel (blood test) CPT 80048 ONC BMP | $38.40 | $48.00 | $7.34–$48.00 | 20% below | 20% |
| Basic metabolic panel (blood test) CPT 80048 BMP 3 | $100.00 | $125.00 | $7.04–$125.00 | 108% above | 20% |
| Basic metabolic panel (blood test) inpatient CPT 80048 ONC BMP | $38.40 | $48.00 | $7.34–$48.00 | — | 20% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BMP 3 | $100.00 | $125.00 | $7.04–$125.00 | — | 20% |
| Bilirubin blood test, total CPT 82247 Bilirubin Total | $59.20 | $74.00 | $11.32–$74.00 | 132% above | 20% |
| Bilirubin blood test, total CPT 82247 82247 Liver Fibrosis Panel LLS | $59.20 | $74.00 | $11.32–$74.00 | 132% above | 20% |
| Bilirubin blood test, total CPT 82247 Neonatal Bilirubin | $59.20 | $74.00 | $11.32–$74.00 | 132% above | 20% |
| Bilirubin blood test, total inpatient CPT 82247 82247 Liver Fibrosis Panel LLS | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| Bilirubin blood test, total inpatient CPT 82247 Neonatal Bilirubin | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bill Surg Level IV 88305 | $204.00 | $255.00 | $39.02–$255.00 | 4% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Bill Surg Level IV 88305 | $204.00 | $255.00 | $39.02–$255.00 | — | 20% |
| Blood culture for bacteria CPT 87040 Blood Culture | $166.40 | $208.00 | $31.82–$208.00 | 51% above | 20% |
| Blood culture for bacteria CPT 87040 Blood Culture, Routine MB LC | $189.60 | $237.00 | $36.26–$237.00 | 72% above | 20% |
| Blood culture for bacteria inpatient CPT 87040 Blood Culture | $166.40 | $208.00 | $31.82–$208.00 | — | 20% |
| Blood culture for bacteria inpatient CPT 87040 Blood Culture, Routine MB LC | $189.60 | $237.00 | $36.26–$237.00 | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw | $28.00 | $35.00 | $5.36–$35.00 | 39% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 ROUTINE VENIPUNCTURE | $28.00 | $35.00 | $5.36–$35.00 | 39% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture Only Charge | $28.00 | $35.00 | $5.36–$35.00 | 39% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 Routine Venipuncture | $28.00 | $35.00 | $5.36–$35.00 | 39% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 Venipuncture | $28.00 | $35.00 | $5.36–$35.00 | 39% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Special Collection Lab | $28.00 | $35.00 | $5.36–$35.00 | 39% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 36415 ROUTINE VENIPUNCTURE | $28.00 | $35.00 | $5.36–$35.00 | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 36415 Venipuncture | $28.00 | $35.00 | $5.36–$35.00 | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 36415 Routine Venipuncture | $28.00 | $35.00 | $5.36–$35.00 | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw | $28.00 | $35.00 | $5.36–$35.00 | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture Only Charge | $28.00 | $35.00 | $5.36–$35.00 | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Special Collection Lab | $28.00 | $35.00 | $5.36–$35.00 | — | 20% |
| Blood glucose (sugar) test CPT 82947 Glucose Level | $48.00 | $60.00 | $3.37–$60.00 | 114% above | 20% |
| Blood glucose (sugar) test CPT 82947 .GTT Fasting Glucose 1 | $48.00 | $60.00 | $9.18–$60.00 | 114% above | 20% |
| Blood glucose (sugar) test CPT 82947 Rapid Glucose | $48.00 | $60.00 | $3.37–$60.00 | 114% above | 20% |
| Blood glucose (sugar) test CPT 82947 .GTT Fasting Glucose | $48.00 | $60.00 | $9.18–$60.00 | 114% above | 20% |
| Blood glucose (sugar) test inpatient CPT 82947 Glucose Level | $48.00 | $60.00 | $3.37–$60.00 | — | 20% |
| Blood glucose (sugar) test inpatient CPT 82947 Rapid Glucose | $48.00 | $60.00 | $3.37–$60.00 | — | 20% |
| Blood glucose (sugar) test inpatient CPT 82947 .GTT Fasting Glucose 1 | $48.00 | $60.00 | $9.18–$60.00 | — | 20% |
| Blood glucose (sugar) test inpatient CPT 82947 .GTT Fasting Glucose | $48.00 | $60.00 | $9.18–$60.00 | — | 20% |
| Blood lead test CPT 83655 LEAD, Capillary POC | $16.80 | $21.00 | $3.21–$21.00 | 54% below | 20% |
| Blood lead test CPT 83655 Lead (Pediatric) LC | $143.20 | $179.00 | $27.39–$179.00 | 293% above | 20% |
| Blood lead test CPT 83655 Lead Blood (Adult) LC | $143.20 | $179.00 | $27.39–$179.00 | 293% above | 20% |
| Blood lead test CPT 83655 Lead Whole Blood LLS | $143.20 | $179.00 | $27.39–$179.00 | 293% above | 20% |
| Blood lead test CPT 83655 Lead LLS | $143.20 | $179.00 | $27.39–$179.00 | 293% above | 20% |
| Blood lead test inpatient CPT 83655 LEAD, Capillary POC | $16.80 | $21.00 | $3.21–$21.00 | — | 20% |
| Blood lead test inpatient CPT 83655 Lead Whole Blood LLS | $143.20 | $179.00 | $27.39–$179.00 | — | 20% |
| Blood lead test inpatient CPT 83655 Lead Blood (Adult) LC | $143.20 | $179.00 | $27.39–$179.00 | — | 20% |
| Blood lead test inpatient CPT 83655 Lead (Pediatric) LC | $143.20 | $179.00 | $27.39–$179.00 | — | 20% |
| Blood lead test inpatient CPT 83655 Lead LLS | $143.20 | $179.00 | $27.39–$179.00 | — | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 hCG Qual Serum w/reflex to hCG Quant | $94.40 | $118.00 | $18.05–$118.00 | 36% above | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Pregnancy Test Serum | $94.40 | $118.00 | $18.05–$118.00 | 36% above | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 hCG Qual Serum w/reflex to hCG Quant | $94.40 | $118.00 | $18.05–$118.00 | — | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Pregnancy Test Serum | $94.40 | $118.00 | $18.05–$118.00 | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh3 Interp | $35.20 | $44.00 | $6.73–$44.00 | 37% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO 3 | $35.20 | $44.00 | $6.73–$44.00 | 37% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO | $35.20 | $44.00 | $6.73–$44.00 | 37% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord Blood Interp | $35.20 | $44.00 | $6.73–$44.00 | 37% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Reference ABO/Rh | $35.20 | $44.00 | $6.73–$44.00 | 37% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bill ABO Typing | $35.20 | $44.00 | $6.73–$44.00 | 37% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood typing; ABO | $35.20 | $44.00 | $6.73–$44.00 | 37% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Typing ABO Echo | $35.20 | $44.00 | $6.73–$44.00 | 37% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Typing Cord ABO Echo | $35.20 | $44.00 | $6.73–$44.00 | 37% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh3 Interp | $35.20 | $44.00 | $6.73–$44.00 | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO | $35.20 | $44.00 | $6.73–$44.00 | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO 3 | $35.20 | $44.00 | $6.73–$44.00 | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Bill ABO Typing | $35.20 | $44.00 | $6.73–$44.00 | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood Typing ABO Echo | $35.20 | $44.00 | $6.73–$44.00 | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood typing; ABO | $35.20 | $44.00 | $6.73–$44.00 | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood Typing Cord ABO Echo | $35.20 | $44.00 | $6.73–$44.00 | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Cord Blood Interp | $35.20 | $44.00 | $6.73–$44.00 | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Reference ABO/Rh | $35.20 | $44.00 | $6.73–$44.00 | — | 20% |
| Blood urea nitrogen (BUN) test CPT 84520 Blood Urea Nitrogen | $46.40 | $58.00 | $3.37–$58.00 | 82% above | 20% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 Blood Urea Nitrogen | $46.40 | $58.00 | $3.37–$58.00 | — | 20% |
| C-peptide blood test CPT 84681 C Peptide LLS | $246.40 | $308.00 | $47.12–$308.00 | 174% above | 20% |
| C-peptide blood test CPT 84681 C-Peptide LC | $246.40 | $308.00 | $47.12–$308.00 | 174% above | 20% |
| C-peptide blood test inpatient CPT 84681 C Peptide LLS | $246.40 | $308.00 | $47.12–$308.00 | — | 20% |
| C-peptide blood test inpatient CPT 84681 C-Peptide LC | $246.40 | $308.00 | $47.12–$308.00 | — | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Wide-Range CRP | $59.20 | $74.00 | $11.32–$74.00 | 57% above | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C Reactive Protein LLS | $59.20 | $74.00 | $11.32–$74.00 | 57% above | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 Wide-Range CRP | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C Reactive Protein LLS | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C Diff 027 | $45.60 | $57.00 | $8.72–$57.00 | 70% below | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C Diff PCR | $47.20 | $59.00 | $9.03–$59.00 | 69% below | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium Difficle Molecular | $89.60 | $112.00 | $17.14–$112.00 | 42% below | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 Toxigenic C. Diff | $89.60 | $112.00 | $17.14–$112.00 | 42% below | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 027 Presumptive | $89.60 | $112.00 | $17.14–$112.00 | 42% below | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C Diff Toxin | $89.60 | $112.00 | $17.14–$112.00 | 42% below | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C. Difficile Toxin by PCR LLS | $256.00 | $320.00 | $48.96–$320.00 | 67% above | 20% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C Diff 027 | $45.60 | $57.00 | $8.72–$57.00 | — | 20% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C Diff PCR | $47.20 | $59.00 | $9.03–$59.00 | — | 20% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C Diff Toxin | $89.60 | $112.00 | $17.14–$112.00 | — | 20% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Toxigenic C. Diff | $89.60 | $112.00 | $17.14–$112.00 | — | 20% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 027 Presumptive | $89.60 | $112.00 | $17.14–$112.00 | — | 20% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Clostridium Difficle Molecular | $89.60 | $112.00 | $17.14–$112.00 | — | 20% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C. Difficile Toxin by PCR LLS | $256.00 | $320.00 | $48.96–$320.00 | — | 20% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 LLS | $232.00 | $290.00 | $44.37–$290.00 | 148% above | 20% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 LC | $232.00 | $290.00 | $44.37–$290.00 | 148% above | 20% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 LLS | $232.00 | $290.00 | $44.37–$290.00 | — | 20% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 LC | $232.00 | $290.00 | $44.37–$290.00 | — | 20% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 LLS | $232.00 | $290.00 | $44.37–$290.00 | 113% above | 20% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Cancer Antigen (CA) 125 LC | $232.00 | $290.00 | $44.37–$290.00 | 113% above | 20% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 LLS | $232.00 | $290.00 | $44.37–$290.00 | — | 20% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Cancer Antigen (CA) 125 LC | $232.00 | $290.00 | $44.37–$290.00 | — | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Abbott ID NOW COVID-19 POC | $111.20 | $139.00 | $19.58–$139.00 | 8% below | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 GeneXpert Plus | $225.60 | $282.00 | $43.15–$282.00 | 88% above | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 GeneXpert | $225.60 | $282.00 | $43.15–$282.00 | 88% above | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Coronavirus SARS-CoV-2 by PCR LLS | $225.60 | $282.00 | $43.15–$282.00 | 88% above | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Abbott ID NOW COVID-19 POC | $111.20 | $139.00 | $19.58–$139.00 | — | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 GeneXpert | $225.60 | $282.00 | $43.15–$282.00 | — | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Coronavirus SARS-CoV-2 by PCR LLS | $225.60 | $282.00 | $43.15–$282.00 | — | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 GeneXpert Plus | $225.60 | $282.00 | $43.15–$282.00 | — | 20% |
| Calcium blood test, total CPT 82310 Calcium Level LLS 82310 | $21.60 | $27.00 | $4.13–$27.00 | 15% below | 20% |
| Calcium blood test, total CPT 82310 Ca+PTH Intact LC | $21.60 | $27.00 | $4.13–$27.00 | 15% below | 20% |
| Calcium blood test, total CPT 82310 Calcium Level LLS | $21.60 | $27.00 | $4.13–$27.00 | 15% below | 20% |
| Calcium blood test, total CPT 82310 Calcium Level | $60.80 | $76.00 | $11.63–$76.00 | 139% above | 20% |
| Calcium blood test, total inpatient CPT 82310 Calcium Level LLS | $21.60 | $27.00 | $4.13–$27.00 | — | 20% |
| Calcium blood test, total inpatient CPT 82310 Calcium Level LLS 82310 | $21.60 | $27.00 | $4.13–$27.00 | — | 20% |
| Calcium blood test, total inpatient CPT 82310 Ca+PTH Intact LC | $21.60 | $27.00 | $4.13–$27.00 | — | 20% |
| Calcium blood test, total inpatient CPT 82310 Calcium Level | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CEA LC | $224.80 | $281.00 | $42.99–$281.00 | 175% above | 20% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CEA LLS | $224.80 | $281.00 | $42.99–$281.00 | 175% above | 20% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA LLS | $224.80 | $281.00 | $42.99–$281.00 | — | 20% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA LC | $224.80 | $281.00 | $42.99–$281.00 | — | 20% |
| Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster Antibodies IgG and IgM LLS | $60.00 | $75.00 | $11.48–$75.00 | 1% below | 20% |
| Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster IgG Ab LLS | $126.40 | $158.00 | $24.17–$158.00 | 108% above | 20% |
| Chickenpox (varicella) immunity blood test CPT 86787 86787 Varicella Zoster Abs IgM LC | $126.40 | $158.00 | $24.17–$158.00 | 108% above | 20% |
| Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Abs IgG/IgM LC | $126.40 | $158.00 | $24.17–$158.00 | 108% above | 20% |
| Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster V Ab IgG LC | $126.40 | $158.00 | $24.17–$158.00 | 108% above | 20% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella-Zoster Antibodies IgG and IgM LLS | $60.00 | $75.00 | $11.48–$75.00 | — | 20% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 86787 Varicella Zoster Abs IgM LC | $126.40 | $158.00 | $24.17–$158.00 | — | 20% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster IgG Ab LLS | $126.40 | $158.00 | $24.17–$158.00 | — | 20% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella-Zoster V Ab IgG LC | $126.40 | $158.00 | $24.17–$158.00 | — | 20% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Abs IgG/IgM LC | $126.40 | $158.00 | $24.17–$158.00 | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA DNA (SDA) LLS | $140.80 | $176.00 | $26.93–$176.00 | 50% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Urine/Swab by Xpert | $140.80 | $176.00 | $26.93–$176.00 | 50% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis by BD QX LLS | $140.80 | $176.00 | $26.93–$176.00 | 50% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/GC Amplification LC | $140.80 | $176.00 | $26.93–$176.00 | 50% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 87491 Chlamydia Trach LC | $276.00 | $345.00 | $52.79–$345.00 | 193% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Trachomatis by BD QX LLS | $140.80 | $176.00 | $26.93–$176.00 | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/GC Amplification LC | $140.80 | $176.00 | $26.93–$176.00 | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Urine/Swab by Xpert | $140.80 | $176.00 | $26.93–$176.00 | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA DNA (SDA) LLS | $140.80 | $176.00 | $26.93–$176.00 | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 87491 Chlamydia Trach LC | $276.00 | $345.00 | $52.79–$345.00 | — | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 80061 Lipid Panel LC | $109.60 | $137.00 | $20.96–$137.00 | 90% above | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel 7 | $109.60 | $137.00 | $11.93–$137.00 | 90% above | 20% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel 7 | $109.60 | $137.00 | $11.93–$137.00 | — | 20% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 80061 Lipid Panel LC | $109.60 | $137.00 | $20.96–$137.00 | — | 20% |
| Complete blood count (CBC) with differential CPT 85025 Blood Count complete CBC | $91.20 | $114.00 | $17.44–$114.00 | 121% above | 20% |
| Complete blood count (CBC) with differential CPT 85025 Bill CBC w/Auto Diff 4 No Manual | $91.20 | $114.00 | $6.58–$114.00 | 121% above | 20% |
| Complete blood count (CBC) with differential CPT 85025 Blood Count Complete CBC | $91.20 | $114.00 | $17.44–$114.00 | 121% above | 20% |
| Complete blood count (CBC) with differential CPT 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC a | $91.20 | $114.00 | $6.27–$114.00 | 121% above | 20% |
| Complete blood count (CBC) with differential CPT 85025 No CBC Blood Count | $91.20 | $114.00 | $17.44–$114.00 | 121% above | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Blood Count complete CBC | $91.20 | $114.00 | $17.44–$114.00 | — | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Blood Count Complete CBC | $91.20 | $114.00 | $17.44–$114.00 | — | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC a | $91.20 | $114.00 | $6.27–$114.00 | — | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 No CBC Blood Count | $91.20 | $114.00 | $17.44–$114.00 | — | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Bill CBC w/Auto Diff 4 No Manual | $91.20 | $114.00 | $6.58–$114.00 | — | 20% |
| Complete blood count (CBC), no differential CPT 85027 Complete Blood Count with Manual Diff | $49.60 | $62.00 | $9.49–$62.00 | 61% above | 20% |
| Complete blood count (CBC), no differential CPT 85027 Hemogram | $49.60 | $62.00 | $9.49–$62.00 | 61% above | 20% |
| Complete blood count (CBC), no differential CPT 85027 Hemogram 3 | $49.60 | $62.00 | $5.51–$62.00 | 61% above | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Complete Blood Count with Manual Diff | $49.60 | $62.00 | $9.49–$62.00 | — | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram | $49.60 | $62.00 | $9.49–$62.00 | — | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram 3 | $49.60 | $62.00 | $5.51–$62.00 | — | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 CMH ONC CMP | $59.20 | $74.00 | $11.32–$74.00 | 18% above | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 CMP 3 | $123.20 | $154.00 | $9.03–$154.00 | 146% above | 20% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMH ONC CMP | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP 3 | $123.20 | $154.00 | $9.03–$154.00 | — | 20% |
| Cortisol blood test, total CPT 82533 ACTH Stimulation Cortisol 60 Minutes LLS | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total CPT 82533 ACTH Stimulation Cortisol 30 Minutes LLS | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total CPT 82533 ACTH Stimulation Cortisol 0 Minutes LLS | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total CPT 82533 BF Cortisol Saliva LLS | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total CPT 82533 Cortisol LC | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total CPT 82533 Cortisol 60 Minutes LC | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total CPT 82533 Cortisol 30 Minutes LC | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total CPT 82533 Cortisol LLS serum from peripheral blood | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total CPT 82533 Cortisol LLS | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total CPT 82533 Cortisol AM LC | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total CPT 82533 Salivary Cortisol LC | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total CPT 82533 Cortisol Baseline LC | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total one side CPT 82533 Cortisol LLS serum from the Left Adrenal Vein | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total one side CPT 82533 Cortisol LLS serum from the Right Adrenal Vein | $116.80 | $146.00 | $22.34–$146.00 | 41% above | 20% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol Baseline LC | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol LLS | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol LLS serum from peripheral blood | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 ACTH Stimulation Cortisol 0 Minutes LLS | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 ACTH Stimulation Cortisol 30 Minutes LLS | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 ACTH Stimulation Cortisol 60 Minutes LLS | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 BF Cortisol Saliva LLS | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol LC | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol 30 Minutes LC | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol 60 Minutes LC | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 Salivary Cortisol LC | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol AM LC | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient one side CPT 82533 Cortisol LLS serum from the Left Adrenal Vein | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Cortisol blood test, total inpatient one side CPT 82533 Cortisol LLS serum from the Right Adrenal Vein | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase | $77.60 | $97.00 | $14.84–$97.00 | 91% above | 20% |
| Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase (CK) MB/Total LC | $77.60 | $97.00 | $14.84–$97.00 | 91% above | 20% |
| Creatine kinase (CK) blood test, total CPT 82550 CK/MB LLS | $136.80 | $171.00 | $26.16–$171.00 | 236% above | 20% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase (CK) MB/Total LC | $77.60 | $97.00 | $14.84–$97.00 | — | 20% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase | $77.60 | $97.00 | $14.84–$97.00 | — | 20% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CK/MB LLS | $136.80 | $171.00 | $26.16–$171.00 | — | 20% |
| Creatinine blood test CPT 82565 Rapid Point Ca+ | $60.00 | $75.00 | $11.48–$75.00 | 143% above | 20% |
| Creatinine blood test CPT 82565 Creatinine Level | $60.00 | $75.00 | $4.13–$75.00 | 143% above | 20% |
| Creatinine blood test CPT 82565 Ionized Calcium Level | $60.00 | $75.00 | $11.48–$75.00 | 143% above | 20% |
| Creatinine blood test inpatient CPT 82565 Creatinine Level | $60.00 | $75.00 | $4.13–$75.00 | — | 20% |
| Creatinine blood test inpatient CPT 82565 Ionized Calcium Level | $60.00 | $75.00 | $11.48–$75.00 | — | 20% |
| Creatinine blood test inpatient CPT 82565 Rapid Point Ca+ | $60.00 | $75.00 | $11.48–$75.00 | — | 20% |
| Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus IgG Ab, LLS | $30.40 | $38.00 | $5.81–$38.00 | 48% below | 20% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus IgG Ab, LLS | $30.40 | $38.00 | $5.81–$38.00 | — | 20% |
| D-dimer blood test (blood clot marker) CPT 85379 D-Dimer | $120.00 | $150.00 | $22.95–$150.00 | 7% below | 20% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer | $120.00 | $150.00 | $22.95–$150.00 | — | 20% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA Serum by TMS LLS | $82.40 | $103.00 | $15.76–$103.00 | 2% below | 20% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA Sulfate LLS | $111.20 | $139.00 | $21.27–$139.00 | 33% above | 20% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-Sulfate LC | $111.20 | $139.00 | $21.27–$139.00 | 33% above | 20% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA Serum by TMS LLS | $82.40 | $103.00 | $15.76–$103.00 | — | 20% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA Sulfate LLS | $111.20 | $139.00 | $21.27–$139.00 | — | 20% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-Sulfate LC | $111.20 | $139.00 | $21.27–$139.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Urine Ethylglucuronide Screen LLS | $54.40 | $68.00 | $10.40–$68.00 | 6% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 U Tramadol Scn | $54.40 | $68.00 | $10.40–$68.00 | 6% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Buprenorphine Presumptive Urine Screen ( Suboxone ) LLS | $54.40 | $68.00 | $10.40–$68.00 | 6% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 METHADONE MECONIUM LLS | $54.40 | $68.00 | $10.40–$68.00 | 6% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 OPIATES MECONIUM LLS | $54.40 | $68.00 | $10.40–$68.00 | 6% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MARIJUANA MECONIUM LLS | $54.40 | $68.00 | $10.40–$68.00 | 6% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 COCAINE MECONIUM LLS | $54.40 | $68.00 | $10.40–$68.00 | 6% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 AMPHETAMINE MECONIUM LLS | $54.40 | $68.00 | $10.40–$68.00 | 6% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Acetaminophen Level | $54.40 | $68.00 | $10.40–$68.00 | 6% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Alcohol Screen Urine LLS | $66.40 | $83.00 | $12.70–$83.00 | 15% above | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 U Fentanyl Scrn LLS | $69.60 | $87.00 | $13.31–$87.00 | 21% above | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Ethyl Glucuronide Urine LC | $99.20 | $124.00 | $18.97–$124.00 | 72% above | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Buprenorphine Screen Only Urine LC | $99.20 | $124.00 | $18.97–$124.00 | 72% above | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Ethanol Urine LC | $99.20 | $124.00 | $18.97–$124.00 | 72% above | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Fentanyl/Norfentanyl Screen Only Urine LC | $99.20 | $124.00 | $18.97–$124.00 | 72% above | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Nicotine Metabolite, Serum LC | $99.20 | $124.00 | $18.97–$124.00 | 72% above | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cotinine LC | $99.20 | $124.00 | $18.97–$124.00 | 72% above | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 PROPOXPHENE MECONIUM LLS | $110.40 | $138.00 | $21.11–$138.00 | 91% above | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Meconium Drug Panel LLS | $117.60 | $147.00 | $22.49–$147.00 | 104% above | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Salicylate Level | $220.80 | $276.00 | $42.23–$276.00 | 282% above | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Meconium 5 Panel LC | $241.60 | $302.00 | $46.21–$302.00 | 318% above | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 COCAINE MECONIUM LLS | $54.40 | $68.00 | $10.40–$68.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Buprenorphine Presumptive Urine Screen ( Suboxone ) LLS | $54.40 | $68.00 | $10.40–$68.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 U Tramadol Scn | $54.40 | $68.00 | $10.40–$68.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 AMPHETAMINE MECONIUM LLS | $54.40 | $68.00 | $10.40–$68.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 OPIATES MECONIUM LLS | $54.40 | $68.00 | $10.40–$68.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 METHADONE MECONIUM LLS | $54.40 | $68.00 | $10.40–$68.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MARIJUANA MECONIUM LLS | $54.40 | $68.00 | $10.40–$68.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Urine Ethylglucuronide Screen LLS | $54.40 | $68.00 | $10.40–$68.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Acetaminophen Level | $54.40 | $68.00 | $10.40–$68.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Alcohol Screen Urine LLS | $66.40 | $83.00 | $12.70–$83.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 U Fentanyl Scrn LLS | $69.60 | $87.00 | $13.31–$87.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Buprenorphine Screen Only Urine LC | $99.20 | $124.00 | $18.97–$124.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cotinine LC | $99.20 | $124.00 | $18.97–$124.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Fentanyl/Norfentanyl Screen Only Urine LC | $99.20 | $124.00 | $18.97–$124.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Ethyl Glucuronide Urine LC | $99.20 | $124.00 | $18.97–$124.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Nicotine Metabolite, Serum LC | $99.20 | $124.00 | $18.97–$124.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Ethanol Urine LC | $99.20 | $124.00 | $18.97–$124.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 PROPOXPHENE MECONIUM LLS | $110.40 | $138.00 | $21.11–$138.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Meconium Drug Panel LLS | $117.60 | $147.00 | $22.49–$147.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Salicylate Level | $220.80 | $276.00 | $42.23–$276.00 | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Meconium 5 Panel LC | $241.60 | $302.00 | $46.21–$302.00 | — | 20% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolytes-Rapid | $82.40 | $103.00 | $15.76–$103.00 | 130% above | 20% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolytes 3 | $82.40 | $103.00 | $15.76–$103.00 | 130% above | 20% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolytes-Rapid | $82.40 | $103.00 | $15.76–$103.00 | — | 20% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolytes 3 | $82.40 | $103.00 | $15.76–$103.00 | — | 20% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 86665 Epstein Barr Viral Capsid LC | $98.40 | $123.00 | $18.82–$123.00 | 33% above | 20% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN BARR IGG AB LLS | $98.40 | $123.00 | $18.82–$123.00 | 33% above | 20% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN BARR IGM AB LLS | $98.40 | $123.00 | $18.82–$123.00 | 33% above | 20% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN BARR IGG AB LLS | $98.40 | $123.00 | $18.82–$123.00 | — | 20% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 86665 Epstein Barr Viral Capsid LC | $98.40 | $123.00 | $18.82–$123.00 | — | 20% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN BARR IGM AB LLS | $98.40 | $123.00 | $18.82–$123.00 | — | 20% |
| Estradiol blood test CPT 82670 Estradiol Sensitive LC | $140.00 | $175.00 | $26.78–$175.00 | 31% above | 20% |
| Estradiol blood test CPT 82670 Estradio 17-Beta LLS | $140.00 | $175.00 | $26.78–$175.00 | 31% above | 20% |
| Estradiol blood test CPT 82670 Estradiol LC | $140.00 | $175.00 | $26.78–$175.00 | 31% above | 20% |
| Estradiol blood test CPT 82670 Estradiol, LC/MS LC | $140.00 | $175.00 | $26.78–$175.00 | 31% above | 20% |
| Estradiol blood test inpatient CPT 82670 Estradiol, LC/MS LC | $140.00 | $175.00 | $26.78–$175.00 | — | 20% |
| Estradiol blood test inpatient CPT 82670 Estradiol LC | $140.00 | $175.00 | $26.78–$175.00 | — | 20% |
| Estradiol blood test inpatient CPT 82670 Estradio 17-Beta LLS | $140.00 | $175.00 | $26.78–$175.00 | — | 20% |
| Estradiol blood test inpatient CPT 82670 Estradiol Sensitive LC | $140.00 | $175.00 | $26.78–$175.00 | — | 20% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH LLS | $56.80 | $71.00 | $10.86–$71.00 | 27% below | 20% |
| FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone | $56.80 | $71.00 | $10.86–$71.00 | 27% below | 20% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH and LH LC | $56.80 | $71.00 | $10.86–$71.00 | 27% below | 20% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH LC | $56.80 | $71.00 | $10.86–$71.00 | 27% below | 20% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH LC | $56.80 | $71.00 | $10.86–$71.00 | — | 20% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH LLS | $56.80 | $71.00 | $10.86–$71.00 | — | 20% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stimulating Hormone | $56.80 | $71.00 | $10.86–$71.00 | — | 20% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH and LH LC | $56.80 | $71.00 | $10.86–$71.00 | — | 20% |
| Fecal calprotectin (stool inflammation test) CPT 83993 Fecal Calprotectin LLS | $232.80 | $291.00 | $44.52–$291.00 | 140% above | 20% |
| Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin Fecal LC | $240.80 | $301.00 | $46.05–$301.00 | 149% above | 20% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Fecal Calprotectin LLS | $232.80 | $291.00 | $44.52–$291.00 | — | 20% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin Fecal LC | $240.80 | $301.00 | $46.05–$301.00 | — | 20% |
| Ferritin blood test (iron stores) CPT 82728 Ferritin LLS | $109.60 | $137.00 | $20.96–$137.00 | 97% above | 20% |
| Ferritin blood test (iron stores) CPT 82728 Ferritin Level | $109.60 | $137.00 | $20.96–$137.00 | 97% above | 20% |
| Ferritin blood test (iron stores) CPT 82728 Fe+TIBC+Fer LC | $109.60 | $137.00 | $20.96–$137.00 | 97% above | 20% |
| Ferritin blood test (iron stores) inpatient CPT 82728 Fe+TIBC+Fer LC | $109.60 | $137.00 | $20.96–$137.00 | — | 20% |
| Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin LLS | $109.60 | $137.00 | $20.96–$137.00 | — | 20% |
| Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin Level | $109.60 | $137.00 | $20.96–$137.00 | — | 20% |
| Fibrinogen blood test CPT 85384 Fibrinogen | $101.60 | $127.00 | $19.43–$127.00 | 60% above | 20% |
| Fibrinogen blood test CPT 85384 85384 Fibrinogen LLS | $101.60 | $127.00 | $19.43–$127.00 | 60% above | 20% |
| Fibrinogen blood test CPT 85384 85384 Fibrinogen Activity LC | $260.00 | $325.00 | $49.73–$325.00 | 309% above | 20% |
| Fibrinogen blood test inpatient CPT 85384 85384 Fibrinogen LLS | $101.60 | $127.00 | $19.43–$127.00 | — | 20% |
| Fibrinogen blood test inpatient CPT 85384 Fibrinogen | $101.60 | $127.00 | $19.43–$127.00 | — | 20% |
| Fibrinogen blood test inpatient CPT 85384 85384 Fibrinogen Activity LC | $260.00 | $325.00 | $49.73–$325.00 | — | 20% |
| Folate (folic acid) blood test CPT 82746 Folate | $173.60 | $217.00 | $33.20–$217.00 | 98% above | 20% |
| Folate (folic acid) blood test CPT 82746 Folic Acid LLS | $173.60 | $217.00 | $33.20–$217.00 | 98% above | 20% |
| Folate (folic acid) blood test inpatient CPT 82746 Folate | $173.60 | $217.00 | $33.20–$217.00 | — | 20% |
| Folate (folic acid) blood test inpatient CPT 82746 Folic Acid LLS | $173.60 | $217.00 | $33.20–$217.00 | — | 20% |
| Free T3 thyroid hormone test CPT 84481 Free T3 | $200.80 | $251.00 | $38.40–$251.00 | 182% above | 20% |
| Free T3 thyroid hormone test inpatient CPT 84481 Free T3 | $200.80 | $251.00 | $38.40–$251.00 | — | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 | $106.40 | $133.00 | $20.35–$133.00 | 133% above | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine Free by Equilibrium Dialysis LLS | $212.00 | $265.00 | $40.55–$265.00 | 363% above | 20% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4 | $106.40 | $133.00 | $20.35–$133.00 | — | 20% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Thyroxine Free by Equilibrium Dialysis LLS | $212.00 | $265.00 | $40.55–$265.00 | — | 20% |
| Free testosterone test CPT 84402 Testosterone,Free and Total LC | $335.20 | $419.00 | $64.11–$419.00 | 478% above | 20% |
| Free testosterone test CPT 84402 84402 Testosterone Free LC | $335.20 | $419.00 | $64.11–$419.00 | 478% above | 20% |
| Free testosterone test CPT 84402 Testosterone Free Only Adult Males LLS | $335.20 | $419.00 | $64.11–$419.00 | 478% above | 20% |
| Free testosterone test CPT 84402 Testosterone Free Only FemaleChild LLS | $335.20 | $419.00 | $64.11–$419.00 | 478% above | 20% |
| Free testosterone test CPT 84402 Testosterone Free CIA LLS | $335.20 | $419.00 | $64.11–$419.00 | 478% above | 20% |
| Free testosterone test CPT 84402 Testosterone Free Adult Males by ED/LC-MS/MS LLS | $335.20 | $419.00 | $64.11–$419.00 | 478% above | 20% |
| Free testosterone test CPT 84402 Testosterone Free LCMSMS LLS | $335.20 | $419.00 | $64.11–$419.00 | 478% above | 20% |
| Free testosterone test CPT 84402 Testosterone Free Direct LC | $335.20 | $419.00 | $64.11–$419.00 | 478% above | 20% |
| Free testosterone test CPT 84402 Testosterone Free MS/Dialysis LC | $335.20 | $419.00 | $64.11–$419.00 | 478% above | 20% |
| Free testosterone test inpatient CPT 84402 Testosterone Free Only Adult Males LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Free testosterone test inpatient CPT 84402 Testosterone Free Adult Males by ED/LC-MS/MS LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Free testosterone test inpatient CPT 84402 Testosterone Free Only FemaleChild LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Free testosterone test inpatient CPT 84402 Testosterone Free CIA LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Free testosterone test inpatient CPT 84402 Testosterone Free LCMSMS LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Free testosterone test inpatient CPT 84402 Testosterone Free Direct LC | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Free testosterone test inpatient CPT 84402 84402 Testosterone Free LC | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Free testosterone test inpatient CPT 84402 Testosterone Free MS/Dialysis LC | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Free testosterone test inpatient CPT 84402 Testosterone,Free and Total LC | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase LLS | $21.60 | $27.00 | $4.13–$27.00 | 27% below | 20% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 82977 Liver Fibrosis Panel LLS | $21.60 | $27.00 | $4.13–$27.00 | 27% below | 20% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT LC | $21.60 | $27.00 | $4.13–$27.00 | 27% below | 20% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT LC | $21.60 | $27.00 | $4.13–$27.00 | — | 20% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 82977 Liver Fibrosis Panel LLS | $21.60 | $27.00 | $4.13–$27.00 | — | 20% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Gamma Glutamyl Transferase LLS | $21.60 | $27.00 | $4.13–$27.00 | — | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 .GTT-2 Hr | $48.00 | $60.00 | $9.18–$60.00 | 39% above | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 .GTT-3 Hr | $48.00 | $60.00 | $9.18–$60.00 | 39% above | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 .GTT-1 Hr | $48.00 | $60.00 | $9.18–$60.00 | 39% above | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 .GTT-2 Hr | $48.00 | $60.00 | $9.18–$60.00 | — | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 .GTT-1 Hr | $48.00 | $60.00 | $9.18–$60.00 | — | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 .GTT-3 Hr | $48.00 | $60.00 | $9.18–$60.00 | — | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC Urine/Swab by Xpert | $112.80 | $141.00 | $21.57–$141.00 | 20% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591 GC Amplification LC | $112.80 | $141.00 | $21.57–$141.00 | 20% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC DNA (SDA) LLS | $112.80 | $141.00 | $21.57–$141.00 | 20% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591 N. Gonorrhoeae LC | $276.00 | $345.00 | $52.79–$345.00 | 194% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC DNA (SDA) LLS | $112.80 | $141.00 | $21.57–$141.00 | — | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC Urine/Swab by Xpert | $112.80 | $141.00 | $21.57–$141.00 | — | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591 GC Amplification LC | $112.80 | $141.00 | $21.57–$141.00 | — | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591 N. Gonorrhoeae LC | $276.00 | $345.00 | $52.79–$345.00 | — | 20% |
| H. pylori antibody blood test CPT 86677 H pylori Ab - IgA LLS | $68.80 | $86.00 | $13.16–$86.00 | 5% below | 20% |
| H. pylori antibody blood test CPT 86677 Helicobacter pylori IgG Ab LLS | $170.40 | $213.00 | $32.59–$213.00 | 136% above | 20% |
| H. pylori antibody blood test inpatient CPT 86677 H pylori Ab - IgA LLS | $68.80 | $86.00 | $13.16–$86.00 | — | 20% |
| H. pylori antibody blood test inpatient CPT 86677 Helicobacter pylori IgG Ab LLS | $170.40 | $213.00 | $32.59–$213.00 | — | 20% |
| H. pylori stool antigen test CPT 87338 Helicobacter Pylori Stool Ag LLS | $141.60 | $177.00 | $27.08–$177.00 | 114% above | 20% |
| H. pylori stool antigen test CPT 87338 H pylori Stool Ag EIA MB LC | $141.60 | $177.00 | $27.08–$177.00 | 114% above | 20% |
| H. pylori stool antigen test inpatient CPT 87338 Helicobacter Pylori Stool Ag LLS | $141.60 | $177.00 | $27.08–$177.00 | — | 20% |
| H. pylori stool antigen test inpatient CPT 87338 H pylori Stool Ag EIA MB LC | $141.60 | $177.00 | $27.08–$177.00 | — | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV RNA Quant by PCR LLS | $263.20 | $329.00 | $50.34–$329.00 | 5% below | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV RNA Real Time PCR (Non-Graph) LC | $263.20 | $329.00 | $50.34–$329.00 | 5% below | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV RNA Real Time PCR (Non-Graph) LC | $263.20 | $329.00 | $50.34–$329.00 | — | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV RNA Quant by PCR LLS | $263.20 | $329.00 | $50.34–$329.00 | — | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 Antibody and p24 Antigen Screen w/ Reflex | $35.20 | $44.00 | $6.73–$44.00 | 56% below | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIVc (HIV combo) | $47.20 | $59.00 | $9.03–$59.00 | 41% below | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV Ag/Ab with Reflex LC | $47.20 | $59.00 | $9.03–$59.00 | 41% below | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1 and 2 Antibody and P24 Antigen Screen w/Reflex All Ages | $47.20 | $59.00 | $9.03–$59.00 | 41% below | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 Antibody and p24 Antigen Screen w/ Reflex | $35.20 | $44.00 | $6.73–$44.00 | — | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIVc (HIV combo) | $47.20 | $59.00 | $9.03–$59.00 | — | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV Ag/Ab with Reflex LC | $47.20 | $59.00 | $9.03–$59.00 | — | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1 and 2 Antibody and P24 Antigen Screen w/Reflex All Ages | $47.20 | $59.00 | $9.03–$59.00 | — | 20% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPVG Genotyping Only LLS | $59.20 | $74.00 | $11.32–$74.00 | 33% below | 20% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 _Human Papillomavirus (HPV) ThinPrep LLS | $59.20 | $74.00 | $11.32–$74.00 | 33% below | 20% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 _Human Papillomavirus (HPV) SurePath LLS | $59.20 | $74.00 | $11.32–$74.00 | 33% below | 20% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 .HPV (Aptima) LC | $133.60 | $167.00 | $25.55–$167.00 | 51% above | 20% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV Aptima LC | $472.80 | $591.00 | $90.42–$591.00 | 435% above | 20% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 87624 HPV Aptima LC | $472.80 | $591.00 | $90.42–$591.00 | 435% above | 20% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 _Human Papillomavirus (HPV) SurePath LLS | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 _Human Papillomavirus (HPV) ThinPrep LLS | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPVG Genotyping Only LLS | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 .HPV (Aptima) LC | $133.60 | $167.00 | $25.55–$167.00 | — | 20% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 87624 HPV Aptima LC | $472.80 | $591.00 | $90.42–$591.00 | — | 20% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV Aptima LC | $472.80 | $591.00 | $90.42–$591.00 | — | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c | $65.60 | $82.00 | $8.26–$82.00 | 37% above | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C Whole Blood LLS | $65.60 | $82.00 | $12.55–$82.00 | 37% above | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hgb A1c with eAG Estimation LC | $65.60 | $82.00 | $12.55–$82.00 | 37% above | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c POC | $103.20 | $129.00 | $19.74–$129.00 | 115% above | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c | $65.60 | $82.00 | $8.26–$82.00 | — | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C Whole Blood LLS | $65.60 | $82.00 | $12.55–$82.00 | — | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hgb A1c with eAG Estimation LC | $65.60 | $82.00 | $12.55–$82.00 | — | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c POC | $103.20 | $129.00 | $19.74–$129.00 | — | 20% |
| Hemoglobin blood test CPT 85018 Hemoglobin POC- PEDS | $24.00 | $30.00 | $4.59–$30.00 | 39% above | 20% |
| Hemoglobin blood test CPT 85018 85018 Hemoglobin LC | $28.00 | $35.00 | $5.36–$35.00 | 62% above | 20% |
| Hemoglobin blood test CPT 85018 Hemoglobin | $28.00 | $35.00 | $5.36–$35.00 | 62% above | 20% |
| Hemoglobin blood test inpatient CPT 85018 Hemoglobin POC- PEDS | $24.00 | $30.00 | $4.59–$30.00 | — | 20% |
| Hemoglobin blood test inpatient CPT 85018 Hemoglobin | $28.00 | $35.00 | $5.36–$35.00 | — | 20% |
| Hemoglobin blood test inpatient CPT 85018 85018 Hemoglobin LC | $28.00 | $35.00 | $5.36–$35.00 | — | 20% |
| Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Ab LC | $118.40 | $148.00 | $22.64–$148.00 | 77% above | 20% |
| Hepatitis B core antibody test (total) CPT 86704 86704 Hep B Core Ab Total LC | $118.40 | $148.00 | $22.64–$148.00 | 77% above | 20% |
| Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Ab LLS | $118.40 | $148.00 | $22.64–$148.00 | 77% above | 20% |
| Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE AB LLS | $118.40 | $148.00 | $22.64–$148.00 | 77% above | 20% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE AB LLS | $118.40 | $148.00 | $22.64–$148.00 | — | 20% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Ab LLS | $118.40 | $148.00 | $22.64–$148.00 | — | 20% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 86704 Hep B Core Ab Total LC | $118.40 | $148.00 | $22.64–$148.00 | — | 20% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Ab LC | $118.40 | $148.00 | $22.64–$148.00 | — | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody. | $127.20 | $159.00 | $24.33–$159.00 | 102% above | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Virus Screen and Diagnosis LC | $127.20 | $159.00 | $24.33–$159.00 | 102% above | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab LLS | $127.20 | $159.00 | $24.33–$159.00 | 102% above | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Antibody. | $127.20 | $159.00 | $24.33–$159.00 | — | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Virus Screen and Diagnosis LC | $127.20 | $159.00 | $24.33–$159.00 | — | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Ab LLS | $127.20 | $159.00 | $24.33–$159.00 | — | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen. | $121.60 | $152.00 | $8.72–$152.00 | 120% above | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HBsAg Screen LC | $121.60 | $152.00 | $23.26–$152.00 | 120% above | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 87340 HBsAg Screen LC | $121.60 | $152.00 | $23.26–$152.00 | 120% above | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURF ANTIGEN LLS | $121.60 | $152.00 | $23.26–$152.00 | 120% above | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag LLS | $121.60 | $152.00 | $23.26–$152.00 | 120% above | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen | $121.60 | $152.00 | $8.72–$152.00 | 120% above | 20% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 87340 HBsAg Screen LC | $121.60 | $152.00 | $23.26–$152.00 | — | 20% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen. | $121.60 | $152.00 | $8.72–$152.00 | — | 20% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURF ANTIGEN LLS | $121.60 | $152.00 | $23.26–$152.00 | — | 20% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Ag LLS | $121.60 | $152.00 | $23.26–$152.00 | — | 20% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen | $121.60 | $152.00 | $8.72–$152.00 | — | 20% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HBsAg Screen LC | $121.60 | $152.00 | $23.26–$152.00 | — | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY LLS | $94.40 | $118.00 | $18.05–$118.00 | 24% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HCV Antibody RFX to Quant PCR LC | $94.40 | $118.00 | $18.05–$118.00 | 24% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 86803 Hep C Antibody LC | $94.40 | $118.00 | $18.05–$118.00 | 24% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HCV Antibody LC | $94.40 | $118.00 | $18.05–$118.00 | 24% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody Diagnostic | $94.40 | $118.00 | $18.05–$118.00 | 24% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab LLS | $94.40 | $118.00 | $18.05–$118.00 | 24% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HCV Antibody Cascade(PCR/Geno) LC | $269.60 | $337.00 | $51.56–$337.00 | 255% above | 20% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV Antibody RFX to Quant PCR LC | $94.40 | $118.00 | $18.05–$118.00 | — | 20% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY LLS | $94.40 | $118.00 | $18.05–$118.00 | — | 20% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Antibody Diagnostic | $94.40 | $118.00 | $18.05–$118.00 | — | 20% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV Antibody LC | $94.40 | $118.00 | $18.05–$118.00 | — | 20% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Ab LLS | $94.40 | $118.00 | $18.05–$118.00 | — | 20% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 86803 Hep C Antibody LC | $94.40 | $118.00 | $18.05–$118.00 | — | 20% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV Antibody Cascade(PCR/Geno) LC | $269.60 | $337.00 | $51.56–$337.00 | — | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C RNA Quant by PCR LLS | $401.60 | $502.00 | $76.81–$502.00 | 105% above | 20% |
| Hepatitis C viral load (HCV RNA) test one side CPT 87522 HCV RT-PCR Quant (Non-Graph) LC | $401.60 | $502.00 | $76.81–$502.00 | 105% above | 20% |
| Hepatitis C viral load (HCV RNA) test one side CPT 87522 .HCV RT-PCR, Quant (Non-Graph) LC | $401.60 | $502.00 | $76.81–$502.00 | 105% above | 20% |
| Hepatitis C viral load (HCV RNA) test one side CPT 87522 .HCV RT-PCR, Quantitative (Non-Graph) LC | $1,071.20 | $1,339.00 | $204.87–$1,339.00 | 446% above | 20% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C RNA Quant by PCR LLS | $401.60 | $502.00 | $76.81–$502.00 | — | 20% |
| Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 HCV RT-PCR Quant (Non-Graph) LC | $401.60 | $502.00 | $76.81–$502.00 | — | 20% |
| Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 .HCV RT-PCR, Quant (Non-Graph) LC | $401.60 | $502.00 | $76.81–$502.00 | — | 20% |
| Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 .HCV RT-PCR, Quantitative (Non-Graph) LC | $1,071.20 | $1,339.00 | $204.87–$1,339.00 | — | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 Glycoprotein G Ab IgG LLS | $79.20 | $99.00 | $15.15–$99.00 | 32% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 HSV Type 1-Specific Ab IgG LC | $79.20 | $99.00 | $15.15–$99.00 | 32% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 Glycoprotein G Ab IgG ARUP | $87.20 | $109.00 | $16.68–$109.00 | 46% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES 1 IGG LLS | $155.20 | $194.00 | $29.68–$194.00 | 160% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Virus 1 Glycoprotein G-Sp IgG LLS | $155.20 | $194.00 | $29.68–$194.00 | 160% above | 20% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV Type 1-Specific Ab IgG LC | $79.20 | $99.00 | $15.15–$99.00 | — | 20% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 Glycoprotein G Ab IgG LLS | $79.20 | $99.00 | $15.15–$99.00 | — | 20% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 Glycoprotein G Ab IgG ARUP | $87.20 | $109.00 | $16.68–$109.00 | — | 20% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex Virus 1 Glycoprotein G-Sp IgG LLS | $155.20 | $194.00 | $29.68–$194.00 | — | 20% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES 1 IGG LLS | $155.20 | $194.00 | $29.68–$194.00 | — | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 Glycoprotein G Ab IgG LLS | $79.20 | $99.00 | $15.15–$99.00 | 9% above | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 Glycoprotein G Ab IgG ARUP | $87.20 | $109.00 | $16.68–$109.00 | 20% above | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Virus 2 Glycoprotein G-Sp IgG LLS | $183.20 | $229.00 | $35.04–$229.00 | 152% above | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HSV Type 2-Specific Antibodies IgG LC | $183.20 | $229.00 | $35.04–$229.00 | 152% above | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IGG #3640 LLS | $230.40 | $288.00 | $44.06–$288.00 | 217% above | 20% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 Glycoprotein G Ab IgG LLS | $79.20 | $99.00 | $15.15–$99.00 | — | 20% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 Glycoprotein G Ab IgG ARUP | $87.20 | $109.00 | $16.68–$109.00 | — | 20% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV Type 2-Specific Antibodies IgG LC | $183.20 | $229.00 | $35.04–$229.00 | — | 20% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex Virus 2 Glycoprotein G-Sp IgG LLS | $183.20 | $229.00 | $35.04–$229.00 | — | 20% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IGG #3640 LLS | $230.40 | $288.00 | $44.06–$288.00 | — | 20% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein High Sensitivity LLS | $152.80 | $191.00 | $29.22–$191.00 | 152% above | 20% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein Cardiac LC | $152.80 | $191.00 | $29.22–$191.00 | 152% above | 20% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein Cardiac LC | $152.80 | $191.00 | $29.22–$191.00 | — | 20% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein High Sensitivity LLS | $152.80 | $191.00 | $29.22–$191.00 | — | 20% |
| Homocysteine blood test CPT 83090 Homocysteine Quant LLS | $164.80 | $206.00 | $31.52–$206.00 | 95% above | 20% |
| Homocysteine blood test CPT 83090 Homocysteine LC | $164.80 | $206.00 | $31.52–$206.00 | 95% above | 20% |
| Homocysteine blood test inpatient CPT 83090 Homocysteine Quant LLS | $164.80 | $206.00 | $31.52–$206.00 | — | 20% |
| Homocysteine blood test inpatient CPT 83090 Homocysteine LC | $164.80 | $206.00 | $31.52–$206.00 | — | 20% |
| Insulin blood test CPT 83525 Insulin Random Level LLS | $82.40 | $103.00 | $15.76–$103.00 | 52% above | 20% |
| Insulin blood test CPT 83525 Insulin LC | $82.40 | $103.00 | $15.76–$103.00 | 52% above | 20% |
| Insulin blood test CPT 83525 Insulin Fasting Level LLS | $82.40 | $103.00 | $15.76–$103.00 | 52% above | 20% |
| Insulin blood test inpatient CPT 83525 Insulin Fasting Level LLS | $82.40 | $103.00 | $15.76–$103.00 | — | 20% |
| Insulin blood test inpatient CPT 83525 Insulin LC | $82.40 | $103.00 | $15.76–$103.00 | — | 20% |
| Insulin blood test inpatient CPT 83525 Insulin Random Level LLS | $82.40 | $103.00 | $15.76–$103.00 | — | 20% |
| Iron blood test (serum iron) CPT 83540 Iron LLS | $45.60 | $57.00 | $8.72–$57.00 | 30% above | 20% |
| Iron blood test (serum iron) CPT 83540 Iron Level 1 | $77.60 | $97.00 | $14.84–$97.00 | 122% above | 20% |
| Iron blood test (serum iron) CPT 83540 83540 Iron LLS | $77.60 | $97.00 | $14.84–$97.00 | 122% above | 20% |
| Iron blood test (serum iron) CPT 83540 83540 Iron LC | $77.60 | $97.00 | $14.84–$97.00 | 122% above | 20% |
| Iron blood test (serum iron) CPT 83540 Iron Level | $77.60 | $97.00 | $14.84–$97.00 | 122% above | 20% |
| Iron blood test (serum iron) CPT 83540 Iron and TIBC LC | $77.60 | $97.00 | $14.84–$97.00 | 122% above | 20% |
| Iron blood test (serum iron) CPT 83540 Iron TIBC 1 | $77.60 | $97.00 | $14.84–$97.00 | 122% above | 20% |
| Iron blood test (serum iron) inpatient CPT 83540 Iron LLS | $45.60 | $57.00 | $8.72–$57.00 | — | 20% |
| Iron blood test (serum iron) inpatient CPT 83540 Iron and TIBC LC | $77.60 | $97.00 | $14.84–$97.00 | — | 20% |
| Iron blood test (serum iron) inpatient CPT 83540 Iron TIBC 1 | $77.60 | $97.00 | $14.84–$97.00 | — | 20% |
| Iron blood test (serum iron) inpatient CPT 83540 Iron Level 1 | $77.60 | $97.00 | $14.84–$97.00 | — | 20% |
| Iron blood test (serum iron) inpatient CPT 83540 Iron Level | $77.60 | $97.00 | $14.84–$97.00 | — | 20% |
| Iron blood test (serum iron) inpatient CPT 83540 83540 Iron LC | $77.60 | $97.00 | $14.84–$97.00 | — | 20% |
| Iron blood test (serum iron) inpatient CPT 83540 83540 Iron LLS | $77.60 | $97.00 | $14.84–$97.00 | — | 20% |
| Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity Unsaturated (UIBC) LLS | $82.40 | $103.00 | $15.76–$103.00 | 93% above | 20% |
| Iron-binding capacity (TIBC) test CPT 83550 83550 Iron Binding Capacity LC | $104.00 | $130.00 | $19.89–$130.00 | 143% above | 20% |
| Iron-binding capacity (TIBC) test CPT 83550 dTIBC | $104.00 | $130.00 | $19.89–$130.00 | 143% above | 20% |
| Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity Total | $104.00 | $130.00 | $19.89–$130.00 | 143% above | 20% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity Unsaturated (UIBC) LLS | $82.40 | $103.00 | $15.76–$103.00 | — | 20% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 83550 Iron Binding Capacity LC | $104.00 | $130.00 | $19.89–$130.00 | — | 20% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity Total | $104.00 | $130.00 | $19.89–$130.00 | — | 20% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 dTIBC | $104.00 | $130.00 | $19.89–$130.00 | — | 20% |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $103.20 | $129.00 | $19.74–$129.00 | 115% above | 20% |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $103.20 | $129.00 | $19.74–$129.00 | — | 20% |
| LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone | $104.80 | $131.00 | $20.04–$131.00 | 29% above | 20% |
| LH (luteinizing hormone) test CPT 83002 83002 Luteinizing Hormone LC | $104.80 | $131.00 | $20.04–$131.00 | 29% above | 20% |
| LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone LLS | $104.80 | $131.00 | $20.04–$131.00 | 29% above | 20% |
| LH (luteinizing hormone) test inpatient CPT 83002 83002 Luteinizing Hormone LC | $104.80 | $131.00 | $20.04–$131.00 | — | 20% |
| LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone LLS | $104.80 | $131.00 | $20.04–$131.00 | — | 20% |
| LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone | $104.80 | $131.00 | $20.04–$131.00 | — | 20% |
| Lactate (lactic acid) blood test CPT 83605 Lactic Acid 2 | $126.40 | $158.00 | $24.17–$158.00 | 83% above | 20% |
| Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid 2 | $126.40 | $158.00 | $24.17–$158.00 | — | 20% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LD Body Fluid LC | $13.60 | $17.00 | $2.60–$17.00 | 56% below | 20% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 83615 LD Isoenzyme w/ total LD LLS | $13.60 | $17.00 | $2.60–$17.00 | 56% below | 20% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Body Fluid LDH LLS | $71.20 | $89.00 | $13.62–$89.00 | 132% above | 20% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase | $71.20 | $89.00 | $13.62–$89.00 | 132% above | 20% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LD Body Fluid LC | $13.60 | $17.00 | $2.60–$17.00 | — | 20% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 83615 LD Isoenzyme w/ total LD LLS | $13.60 | $17.00 | $2.60–$17.00 | — | 20% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Body Fluid LDH LLS | $71.20 | $89.00 | $13.62–$89.00 | — | 20% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase | $71.20 | $89.00 | $13.62–$89.00 | — | 20% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase LC | $11.20 | $14.00 | $2.14–$14.00 | 82% below | 20% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level | $85.60 | $107.00 | $16.37–$107.00 | 34% above | 20% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase LC | $11.20 | $14.00 | $2.14–$14.00 | — | 20% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level | $85.60 | $107.00 | $16.37–$107.00 | — | 20% |
| Liver function blood test panel CPT 80076 CMH ONC Hepatic Function Panel | $59.20 | $74.00 | $11.32–$74.00 | 42% above | 20% |
| Liver function blood test panel CPT 80076 Hepatic Function Panel 3 | $96.80 | $121.00 | $6.89–$121.00 | 133% above | 20% |
| Liver function blood test panel inpatient CPT 80076 CMH ONC Hepatic Function Panel | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel 3 | $96.80 | $121.00 | $6.89–$121.00 | — | 20% |
| Lyme disease antibody test CPT 86618 Lyme IgG/IgM LC | $201.60 | $252.00 | $38.56–$252.00 | 362% above | 20% |
| Lyme disease antibody test CPT 86618 86618 Lyme Disease Antibody LC | $201.60 | $252.00 | $38.56–$252.00 | 362% above | 20% |
| Lyme disease antibody test CPT 86618 Lyme Disease Serology w/Reflex LC | $201.60 | $252.00 | $38.56–$252.00 | 362% above | 20% |
| Lyme disease antibody test CPT 86618 Lyme Screen IgG/IgM Abs LLS | $201.60 | $252.00 | $38.56–$252.00 | 362% above | 20% |
| Lyme disease antibody test inpatient CPT 86618 Lyme Screen IgG/IgM Abs LLS | $201.60 | $252.00 | $38.56–$252.00 | — | 20% |
| Lyme disease antibody test inpatient CPT 86618 86618 Lyme Disease Antibody LC | $201.60 | $252.00 | $38.56–$252.00 | — | 20% |
| Lyme disease antibody test inpatient CPT 86618 Lyme Disease Serology w/Reflex LC | $201.60 | $252.00 | $38.56–$252.00 | — | 20% |
| Lyme disease antibody test inpatient CPT 86618 Lyme IgG/IgM LC | $201.60 | $252.00 | $38.56–$252.00 | — | 20% |
| Magnesium blood test CPT 83735 Magnesium Urine Random LLS | $23.20 | $29.00 | $4.44–$29.00 | 27% below | 20% |
| Magnesium blood test CPT 83735 .U Magnesium Timed LLS | $40.80 | $51.00 | $7.80–$51.00 | 28% above | 20% |
| Magnesium blood test CPT 83735 Magnesium Urine Timed LLS | $44.00 | $55.00 | $8.42–$55.00 | 38% above | 20% |
| Magnesium blood test CPT 83735 Magnesium RBC LC | $79.20 | $99.00 | $15.15–$99.00 | 149% above | 20% |
| Magnesium blood test CPT 83735 RBC Magnesium LLS | $79.20 | $99.00 | $15.15–$99.00 | 149% above | 20% |
| Magnesium blood test CPT 83735 Magnesium Level | $79.20 | $99.00 | $5.81–$99.00 | 149% above | 20% |
| Magnesium blood test inpatient CPT 83735 Magnesium Urine Random LLS | $23.20 | $29.00 | $4.44–$29.00 | — | 20% |
| Magnesium blood test inpatient CPT 83735 .U Magnesium Timed LLS | $40.80 | $51.00 | $7.80–$51.00 | — | 20% |
| Magnesium blood test inpatient CPT 83735 Magnesium Urine Timed LLS | $44.00 | $55.00 | $8.42–$55.00 | — | 20% |
| Magnesium blood test inpatient CPT 83735 Magnesium RBC LC | $79.20 | $99.00 | $15.15–$99.00 | — | 20% |
| Magnesium blood test inpatient CPT 83735 RBC Magnesium LLS | $79.20 | $99.00 | $15.15–$99.00 | — | 20% |
| Magnesium blood test inpatient CPT 83735 Magnesium Level | $79.20 | $99.00 | $5.81–$99.00 | — | 20% |
| Measles (rubeola) antibody test CPT 86765 Measles-Rubeola Ab IgG LLS | $152.00 | $190.00 | $29.07–$190.00 | 157% above | 20% |
| Measles (rubeola) antibody test CPT 86765 Rubeola Antibodies IgG LC | $152.00 | $190.00 | $29.07–$190.00 | 157% above | 20% |
| Measles (rubeola) antibody test inpatient CPT 86765 Rubeola Antibodies IgG LC | $152.00 | $190.00 | $29.07–$190.00 | — | 20% |
| Measles (rubeola) antibody test inpatient CPT 86765 Measles-Rubeola Ab IgG LLS | $152.00 | $190.00 | $29.07–$190.00 | — | 20% |
| Mono test (heterophile antibody, Monospot) CPT 86308 Monospot POC | $47.20 | $59.00 | $8.26–$59.00 | 5% below | 20% |
| Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen | $60.80 | $76.00 | $11.63–$76.00 | 23% above | 20% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Monospot POC | $47.20 | $59.00 | $8.26–$59.00 | — | 20% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Mumps immunity blood test CPT 86735 Mumps Antibody IgM LLS | $56.80 | $71.00 | $10.86–$71.00 | 24% above | 20% |
| Mumps immunity blood test CPT 86735 Mumps Antibodies IgM LC | $140.00 | $175.00 | $26.78–$175.00 | 206% above | 20% |
| Mumps immunity blood test CPT 86735 Mumps Antibodies IgG LC | $140.00 | $175.00 | $26.78–$175.00 | 206% above | 20% |
| Mumps immunity blood test CPT 86735 Mumps Ab IgG LLS | $140.00 | $175.00 | $26.78–$175.00 | 206% above | 20% |
| Mumps immunity blood test inpatient CPT 86735 Mumps Antibody IgM LLS | $56.80 | $71.00 | $10.86–$71.00 | — | 20% |
| Mumps immunity blood test inpatient CPT 86735 Mumps Antibodies IgG LC | $140.00 | $175.00 | $26.78–$175.00 | — | 20% |
| Mumps immunity blood test inpatient CPT 86735 Mumps Antibodies IgM LC | $140.00 | $175.00 | $26.78–$175.00 | — | 20% |
| Mumps immunity blood test inpatient CPT 86735 Mumps Ab IgG LLS | $140.00 | $175.00 | $26.78–$175.00 | — | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE LLS | $79.20 | $99.00 | $15.15–$99.00 | 6% above | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 84154 PSA Free LC | $79.20 | $99.00 | $15.15–$99.00 | 6% above | 20% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 84154 PSA Free LC | $79.20 | $99.00 | $15.15–$99.00 | — | 20% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE LLS | $79.20 | $99.00 | $15.15–$99.00 | — | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total+% Free LC | $76.00 | $95.00 | $14.54–$95.00 | 2% above | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL LLS | $76.00 | $95.00 | $14.54–$95.00 | 2% above | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic | $76.00 | $95.00 | $14.54–$95.00 | 2% above | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate-Specific Ag LC | $76.00 | $95.00 | $14.54–$95.00 | 2% above | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen LLS | $76.00 | $95.00 | $14.54–$95.00 | 2% above | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen, Ultrasensitive LLS | $140.00 | $175.00 | $26.78–$175.00 | 87% above | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Ultrasensitive W/O Serial LC | $140.00 | $175.00 | $26.78–$175.00 | 87% above | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total+% Free LC | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate-Specific Ag LC | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL LLS | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen LLS | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen, Ultrasensitive LLS | $140.00 | $175.00 | $26.78–$175.00 | — | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Ultrasensitive W/O Serial LC | $140.00 | $175.00 | $26.78–$175.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap Smear Liquid Based w/automated Screening and Manual Resc | $42.40 | $53.00 | $8.11–$53.00 | 53% below | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap Smear Request LLS | $42.40 | $53.00 | $8.11–$53.00 | 53% below | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG (Image Guided) LC | $52.80 | $66.00 | $10.10–$66.00 | 42% below | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, Ct-Ng TV LC | $63.20 | $79.00 | $12.09–$79.00 | 30% below | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 IGP, Aptima HPV, rfx 16,18/45 on HR pos (chart) LC | $63.20 | $79.00 | $12.09–$79.00 | 30% below | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 PapIG,CtNgTv,HPV(Aptima) + rfx16/18,45LC | $63.20 | $79.00 | $12.09–$79.00 | 30% below | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 IGP,rfxAptima HPV all,16/18,45 LC | $211.20 | $264.00 | $40.39–$264.00 | 133% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, rfx Aptima HPV all pth LC | $240.00 | $300.00 | $45.90–$300.00 | 164% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, HPV, rfx 16/18 + Ct/Ng/Tv LC | $240.00 | $300.00 | $45.90–$300.00 | 164% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, CtNg, Aptima HPV, rfx 16/18, 45 LC | $240.00 | $300.00 | $45.90–$300.00 | 164% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, CtNgTv, rfx Apt HPV all LC | $240.00 | $300.00 | $45.90–$300.00 | 164% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, HPV, rfx 16/18,45 LC | $240.00 | $300.00 | $45.90–$300.00 | 164% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, rfx HPV ASCU LC | $240.00 | $300.00 | $45.90–$300.00 | 164% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, Aptima HPV LC | $240.00 | $300.00 | $45.90–$300.00 | 164% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, CtNg, rfx Apt HPV all pth LC | $240.00 | $300.00 | $45.90–$300.00 | 164% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, Ct-Ng, rfx HPV ASCU LC | $240.00 | $300.00 | $45.90–$300.00 | 164% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, CtNgTv, rfx Aptima HPV ASCU LC | $240.00 | $300.00 | $45.90–$300.00 | 164% above | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap Smear Liquid Based w/automated Screening and Manual Resc | $42.40 | $53.00 | $8.11–$53.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap Smear Request LLS | $42.40 | $53.00 | $8.11–$53.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG (Image Guided) LC | $52.80 | $66.00 | $10.10–$66.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 IGP, Aptima HPV, rfx 16,18/45 on HR pos (chart) LC | $63.20 | $79.00 | $12.09–$79.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PapIG,CtNgTv,HPV(Aptima) + rfx16/18,45LC | $63.20 | $79.00 | $12.09–$79.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, Ct-Ng TV LC | $63.20 | $79.00 | $12.09–$79.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 IGP,rfxAptima HPV all,16/18,45 LC | $211.20 | $264.00 | $40.39–$264.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, rfx HPV ASCU LC | $240.00 | $300.00 | $45.90–$300.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, rfx Aptima HPV all pth LC | $240.00 | $300.00 | $45.90–$300.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, HPV, rfx 16/18,45 LC | $240.00 | $300.00 | $45.90–$300.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, CtNgTv, rfx Apt HPV all LC | $240.00 | $300.00 | $45.90–$300.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, CtNgTv, rfx Aptima HPV ASCU LC | $240.00 | $300.00 | $45.90–$300.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, CtNg, Aptima HPV, rfx 16/18, 45 LC | $240.00 | $300.00 | $45.90–$300.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, Ct-Ng, rfx HPV ASCU LC | $240.00 | $300.00 | $45.90–$300.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, Aptima HPV LC | $240.00 | $300.00 | $45.90–$300.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, HPV, rfx 16/18 + Ct/Ng/Tv LC | $240.00 | $300.00 | $45.90–$300.00 | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, CtNg, rfx Apt HPV all pth LC | $240.00 | $300.00 | $45.90–$300.00 | — | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Intact | $188.80 | $236.00 | $36.11–$236.00 | 14% above | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 83970 Parathormone Level LC | $188.80 | $236.00 | $36.11–$236.00 | 14% above | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Intact Hormone LLS | $188.80 | $236.00 | $36.11–$236.00 | 14% above | 20% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Intact Hormone LLS | $188.80 | $236.00 | $36.11–$236.00 | — | 20% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 83970 Parathormone Level LC | $188.80 | $236.00 | $36.11–$236.00 | — | 20% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone Intact | $188.80 | $236.00 | $36.11–$236.00 | — | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT 1Hr Undiluted LLS | $76.00 | $95.00 | $14.54–$95.00 | 39% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Protime/PTT 2 | $76.00 | $95.00 | $14.54–$95.00 | 39% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 ANTIP PTT LLS | $76.00 | $95.00 | $14.54–$95.00 | 39% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $76.00 | $95.00 | $14.54–$95.00 | 39% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 85730 Thromboplastin Time Partial LC | $76.00 | $95.00 | $14.54–$95.00 | 39% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 85730 Thromboplastin Time, Partial (PTT) LLS | $76.00 | $95.00 | $14.54–$95.00 | 39% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT Immed Undil LLS | $76.00 | $95.00 | $14.54–$95.00 | 39% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT LLS | $76.00 | $95.00 | $14.54–$95.00 | 39% above | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT 1Hr Undiluted LLS | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT Immed Undil LLS | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 85730 Thromboplastin Time, Partial (PTT) LLS | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 85730 Thromboplastin Time Partial LC | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 ANTIP PTT LLS | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Protime/PTT 2 | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT LLS | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| Phosphorus (phosphate) blood test CPT 84100 Phosphorus Level | $56.00 | $70.00 | $3.98–$70.00 | 91% above | 20% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Level | $56.00 | $70.00 | $3.98–$70.00 | — | 20% |
| Potassium blood test CPT 84132 Potassium Level | $54.40 | $68.00 | $10.40–$68.00 | 150% above | 20% |
| Potassium blood test inpatient CPT 84132 Potassium Level | $54.40 | $68.00 | $10.40–$68.00 | — | 20% |
| Progesterone blood test CPT 84144 Progesterone LLS | $248.00 | $310.00 | $47.43–$310.00 | 152% above | 20% |
| Progesterone blood test CPT 84144 Progesterone LC | $248.00 | $310.00 | $47.43–$310.00 | 152% above | 20% |
| Progesterone blood test inpatient CPT 84144 Progesterone LC | $248.00 | $310.00 | $47.43–$310.00 | — | 20% |
| Progesterone blood test inpatient CPT 84144 Progesterone LLS | $248.00 | $310.00 | $47.43–$310.00 | — | 20% |
| Prolactin blood test CPT 84146 Prolactin LLS | $56.80 | $71.00 | $10.86–$71.00 | 29% below | 20% |
| Prolactin blood test CPT 84146 Prolactin LC | $56.80 | $71.00 | $10.86–$71.00 | 29% below | 20% |
| Prolactin blood test CPT 84146 Prolactin | $56.80 | $71.00 | $10.86–$71.00 | 29% below | 20% |
| Prolactin blood test inpatient CPT 84146 Prolactin | $56.80 | $71.00 | $10.86–$71.00 | — | 20% |
| Prolactin blood test inpatient CPT 84146 Prolactin LC | $56.80 | $71.00 | $10.86–$71.00 | — | 20% |
| Prolactin blood test inpatient CPT 84146 Prolactin LLS | $56.80 | $71.00 | $10.86–$71.00 | — | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR POC (Surgery) | $20.80 | $26.00 | $3.98–$26.00 | 28% below | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR POC | $20.80 | $26.00 | $3.67–$26.00 | 28% below | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time and INR LLS | $48.00 | $60.00 | $9.18–$60.00 | 66% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 85610 Protime LLS | $48.00 | $60.00 | $9.18–$60.00 | 66% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Protime 85610 | $48.00 | $60.00 | $9.18–$60.00 | 66% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time 2 | $48.00 | $60.00 | $3.37–$60.00 | 66% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT LLS | $48.00 | $60.00 | $9.18–$60.00 | 66% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin time; | $48.00 | $60.00 | $3.37–$60.00 | 66% above | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR POC | $20.80 | $26.00 | $3.67–$26.00 | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR POC (Surgery) | $20.80 | $26.00 | $3.98–$26.00 | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610 Protime LLS | $48.00 | $60.00 | $9.18–$60.00 | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Protime 85610 | $48.00 | $60.00 | $9.18–$60.00 | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT LLS | $48.00 | $60.00 | $9.18–$60.00 | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time and INR LLS | $48.00 | $60.00 | $9.18–$60.00 | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin time; | $48.00 | $60.00 | $3.37–$60.00 | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time 2 | $48.00 | $60.00 | $3.37–$60.00 | — | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug Urine Screen POC - CMH | $45.60 | $57.00 | $7.96–$57.00 | 33% below | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug Urine Screen POC - CMH | $45.60 | $57.00 | $7.96–$57.00 | — | 20% |
| Rapid flu test (influenza antigen) CPT 87804 Flu Nasal Swab | $56.80 | $71.00 | $10.10–$71.00 | 20% below | 20% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 Flu Nasal Swab | $56.80 | $71.00 | $10.10–$71.00 | — | 20% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 Rapid Strep POC | $35.20 | $44.00 | $6.58–$44.00 | 36% below | 20% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Rapid Strep POC | $35.20 | $44.00 | $6.58–$44.00 | — | 20% |
| Renin blood test CPT 84244 Renin Activity Ratio LLS | $230.40 | $288.00 | $44.06–$288.00 | 261% above | 20% |
| Renin blood test CPT 84244 Renin Activity LLS | $230.40 | $288.00 | $44.06–$288.00 | 261% above | 20% |
| Renin blood test CPT 84244 Renin Activity Plasma LC | $230.40 | $288.00 | $44.06–$288.00 | 261% above | 20% |
| Renin blood test CPT 84244 84244 Renin LC | $230.40 | $288.00 | $44.06–$288.00 | 261% above | 20% |
| Renin blood test inpatient CPT 84244 Renin Activity Ratio LLS | $230.40 | $288.00 | $44.06–$288.00 | — | 20% |
| Renin blood test inpatient CPT 84244 Renin Activity Plasma LC | $230.40 | $288.00 | $44.06–$288.00 | — | 20% |
| Renin blood test inpatient CPT 84244 84244 Renin LC | $230.40 | $288.00 | $44.06–$288.00 | — | 20% |
| Renin blood test inpatient CPT 84244 Renin Activity LLS | $230.40 | $288.00 | $44.06–$288.00 | — | 20% |
| Rh blood typing CPT 86901 Blood typing; Rh (D) | $36.80 | $46.00 | $7.04–$46.00 | 12% below | 20% |
| Rh blood typing CPT 86901 Bill Rh(D) Type | $36.80 | $46.00 | $7.04–$46.00 | 12% below | 20% |
| Rh blood typing CPT 86901 Blood Typing Cord Rh (D) Echo | $36.80 | $46.00 | $7.04–$46.00 | 12% below | 20% |
| Rh blood typing CPT 86901 Anti-D | $36.80 | $46.00 | $7.04–$46.00 | 12% below | 20% |
| Rh blood typing CPT 86901 Blood Typing Rh (D) Echo | $36.80 | $46.00 | $7.04–$46.00 | 12% below | 20% |
| Rh blood typing CPT 86901 Rh. | $36.80 | $46.00 | $7.04–$46.00 | 12% below | 20% |
| Rh blood typing CPT 86901 Rh3 | $36.80 | $46.00 | $7.04–$46.00 | 12% below | 20% |
| Rh blood typing CPT 86901 Blood typing ; Rh (D) | $36.80 | $46.00 | $7.04–$46.00 | 12% below | 20% |
| Rh blood typing inpatient CPT 86901 Rh. | $36.80 | $46.00 | $7.04–$46.00 | — | 20% |
| Rh blood typing inpatient CPT 86901 Bill Rh(D) Type | $36.80 | $46.00 | $7.04–$46.00 | — | 20% |
| Rh blood typing inpatient CPT 86901 Blood typing; Rh (D) | $36.80 | $46.00 | $7.04–$46.00 | — | 20% |
| Rh blood typing inpatient CPT 86901 Rh3 | $36.80 | $46.00 | $7.04–$46.00 | — | 20% |
| Rh blood typing inpatient CPT 86901 Blood Typing Cord Rh (D) Echo | $36.80 | $46.00 | $7.04–$46.00 | — | 20% |
| Rh blood typing inpatient CPT 86901 Anti-D | $36.80 | $46.00 | $7.04–$46.00 | — | 20% |
| Rh blood typing inpatient CPT 86901 Blood Typing Rh (D) Echo | $36.80 | $46.00 | $7.04–$46.00 | — | 20% |
| Rh blood typing inpatient CPT 86901 Blood typing ; Rh (D) | $36.80 | $46.00 | $7.04–$46.00 | — | 20% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid Arthritis Factor LC | $28.80 | $36.00 | $5.51–$36.00 | 29% below | 20% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor | $28.80 | $36.00 | $5.51–$36.00 | 29% below | 20% |
| Rheumatoid factor (RF) test CPT 86431 86431 Rheumatoid Factor Level LC | $173.60 | $217.00 | $33.20–$217.00 | 325% above | 20% |
| Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Arthritis Factor LC | $28.80 | $36.00 | $5.51–$36.00 | — | 20% |
| Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor | $28.80 | $36.00 | $5.51–$36.00 | — | 20% |
| Rheumatoid factor (RF) test inpatient CPT 86431 86431 Rheumatoid Factor Level LC | $173.60 | $217.00 | $33.20–$217.00 | — | 20% |
| Rubella antibody test (immunity check) CPT 86762 Rubella Antibody IgM LLS | $108.00 | $135.00 | $20.66–$135.00 | 137% above | 20% |
| Rubella antibody test (immunity check) CPT 86762 Rubella Abs IgG LC | $108.00 | $135.00 | $20.66–$135.00 | 137% above | 20% |
| Rubella antibody test (immunity check) CPT 86762 Rubella Antibody IgG LLS | $108.00 | $135.00 | $20.66–$135.00 | 137% above | 20% |
| Rubella antibody test (immunity check) CPT 86762 Rubella | $108.00 | $135.00 | $20.66–$135.00 | 137% above | 20% |
| Rubella antibody test (immunity check) CPT 86762 Rubella IgG | $157.60 | $197.00 | $30.14–$197.00 | 246% above | 20% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibody IgG LLS | $108.00 | $135.00 | $20.66–$135.00 | — | 20% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Abs IgG LC | $108.00 | $135.00 | $20.66–$135.00 | — | 20% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Rubella | $108.00 | $135.00 | $20.66–$135.00 | — | 20% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibody IgM LLS | $108.00 | $135.00 | $20.66–$135.00 | — | 20% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Rubella IgG | $157.60 | $197.00 | $30.14–$197.00 | — | 20% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sed Rate-Westergren LC | $10.40 | $13.00 | $1.99–$13.00 | 63% below | 20% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sed Rate-Westergren LC | $10.40 | $13.00 | $1.99–$13.00 | — | 20% |
| Sodium blood test CPT 84295 Sodium Level | $56.80 | $71.00 | $10.86–$71.00 | 123% above | 20% |
| Sodium blood test inpatient CPT 84295 Sodium Level | $56.80 | $71.00 | $10.86–$71.00 | — | 20% |
| Stool ova and parasites exam CPT 87177 OP SMEAR DIRECT LLS | $28.80 | $36.00 | $5.51–$36.00 | 47% below | 20% |
| Stool ova and parasites exam CPT 87177 Ova + Parasite Exam MB LC | $28.80 | $36.00 | $5.51–$36.00 | 47% below | 20% |
| Stool ova and parasites exam CPT 87177 Ova and Parasites Examination, Urine LC | $28.80 | $36.00 | $5.51–$36.00 | 47% below | 20% |
| Stool ova and parasites exam inpatient CPT 87177 Ova and Parasites Examination, Urine LC | $28.80 | $36.00 | $5.51–$36.00 | — | 20% |
| Stool ova and parasites exam inpatient CPT 87177 OP SMEAR DIRECT LLS | $28.80 | $36.00 | $5.51–$36.00 | — | 20% |
| Stool ova and parasites exam inpatient CPT 87177 Ova + Parasite Exam MB LC | $28.80 | $36.00 | $5.51–$36.00 | — | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Screening1 | $36.80 | $46.00 | $7.04–$46.00 | 7% above | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Hemoccult POC | $38.40 | $48.00 | $6.89–$48.00 | 11% above | 20% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Screening1 | $36.80 | $46.00 | $7.04–$46.00 | — | 20% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Hemoccult POC | $38.40 | $48.00 | $6.89–$48.00 | — | 20% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 Stool for Occult Blood POC | $53.60 | $67.00 | $10.25–$67.00 | 3% below | 20% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Stool for Occult Blood POC | $53.60 | $67.00 | $10.25–$67.00 | — | 20% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Scn w/Rflx Reverse Algorithm LLS | $28.80 | $36.00 | $5.51–$36.00 | 13% below | 20% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 T pallidum Screening Cascade LC | $28.80 | $36.00 | $5.51–$36.00 | 13% below | 20% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 .T Pallidum Anitbody by TP-PA LLS | $34.40 | $43.00 | $6.58–$43.00 | 4% above | 20% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 T pallidum Ab (FTA-Ab) LC | $59.20 | $74.00 | $11.32–$74.00 | 79% above | 20% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 .Treponemal Antibodies, TPPA LC | $200.80 | $251.00 | $38.40–$251.00 | 506% above | 20% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 T pallidum Screening Cascade LC | $28.80 | $36.00 | $5.51–$36.00 | — | 20% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis Scn w/Rflx Reverse Algorithm LLS | $28.80 | $36.00 | $5.51–$36.00 | — | 20% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 .T Pallidum Anitbody by TP-PA LLS | $34.40 | $43.00 | $6.58–$43.00 | — | 20% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 T pallidum Ab (FTA-Ab) LC | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 .Treponemal Antibodies, TPPA LC | $200.80 | $251.00 | $38.40–$251.00 | — | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis Screen NEONATAL LLS | $17.60 | $22.00 | $3.37–$22.00 | 39% below | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis Monitor RPR LLS | $34.40 | $43.00 | $6.58–$43.00 | 19% above | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 .RPR LC. | $62.40 | $78.00 | $11.93–$78.00 | 116% above | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis Screen NEONATAL LLS | $17.60 | $22.00 | $3.37–$22.00 | — | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis Monitor RPR LLS | $34.40 | $43.00 | $6.58–$43.00 | — | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 .RPR LC. | $62.40 | $78.00 | $11.93–$78.00 | — | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB Tine Test | $92.00 | $115.00 | $17.60–$115.00 | 44% below | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON-TB Gold Plus (client Incubated) LC | $279.20 | $349.00 | $53.40–$349.00 | 68% above | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFeron-TB Gold Plus LLS | $279.20 | $349.00 | $53.40–$349.00 | 68% above | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFeron Gold TB LLS | $279.20 | $349.00 | $53.40–$349.00 | 68% above | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB Tine Test | $92.00 | $115.00 | $17.60–$115.00 | — | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QuantiFERON-TB Gold Plus (client Incubated) LC | $279.20 | $349.00 | $53.40–$349.00 | — | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QuantiFeron Gold TB LLS | $279.20 | $349.00 | $53.40–$349.00 | — | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QuantiFeron-TB Gold Plus LLS | $279.20 | $349.00 | $53.40–$349.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Free and Total Female/Child LLS | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone CIA LLS | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total CIA LLS | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone LCMSMS LLS | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TL WOMEN AND CHILD LLS | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total LCMSMS LLS | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone LC | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total LC/MS LC | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 84403 Testosterone Total LC | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total Only Female Child LLS | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 84403 Testosterone Free and total LLS | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total Adult Male LLS | $335.20 | $419.00 | $64.11–$419.00 | 369% above | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 84403 Testosterone Total LC | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Free and Total Female/Child LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total CIA LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone CIA LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total Adult Male LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone LCMSMS LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total LCMSMS LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total Only Female Child LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone LC | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TL WOMEN AND CHILD LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total LC/MS LC | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 84403 Testosterone Free and total LLS | $335.20 | $419.00 | $64.11–$419.00 | — | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Ab LC | $170.40 | $213.00 | $32.59–$213.00 | 150% above | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Ab LLS | $170.40 | $213.00 | $32.59–$213.00 | 150% above | 20% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Ab LLS | $170.40 | $213.00 | $32.59–$213.00 | — | 20% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Ab LC | $170.40 | $213.00 | $32.59–$213.00 | — | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/Reflex to Free T4 | $128.80 | $161.00 | $14.38–$161.00 | 83% above | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $128.80 | $161.00 | $14.38–$161.00 | 83% above | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $128.80 | $161.00 | $14.38–$161.00 | — | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH w/Reflex to Free T4 | $128.80 | $161.00 | $14.38–$161.00 | — | 20% |
| Total IgE blood test CPT 82785 82785 Aspergillus Fumigatus 1 | $17.60 | $22.00 | $3.37–$22.00 | 68% below | 20% |
| Total IgE blood test CPT 82785 Immunoglobulin E Total LC | $26.40 | $33.00 | $5.05–$33.00 | 52% below | 20% |
| Total IgE blood test CPT 82785 Allergen Nut and Seed Panel LLS | $144.00 | $180.00 | $27.54–$180.00 | 164% above | 20% |
| Total IgE blood test CPT 82785 Immunoglobulin IgE Total LLS | $196.00 | $245.00 | $37.49–$245.00 | 259% above | 20% |
| Total IgE blood test CPT 82785 IMMUNOGLOBULIN E LLS | $196.00 | $245.00 | $37.49–$245.00 | 259% above | 20% |
| Total IgE blood test CPT 82785 Allergen Pediatric Allergy Profile LLS | $222.40 | $278.00 | $42.53–$278.00 | 307% above | 20% |
| Total IgE blood test inpatient CPT 82785 82785 Aspergillus Fumigatus 1 | $17.60 | $22.00 | $3.37–$22.00 | — | 20% |
| Total IgE blood test inpatient CPT 82785 Immunoglobulin E Total LC | $26.40 | $33.00 | $5.05–$33.00 | — | 20% |
| Total IgE blood test inpatient CPT 82785 Allergen Nut and Seed Panel LLS | $144.00 | $180.00 | $27.54–$180.00 | — | 20% |
| Total IgE blood test inpatient CPT 82785 Immunoglobulin IgE Total LLS | $196.00 | $245.00 | $37.49–$245.00 | — | 20% |
| Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN E LLS | $196.00 | $245.00 | $37.49–$245.00 | — | 20% |
| Total IgE blood test inpatient CPT 82785 Allergen Pediatric Allergy Profile LLS | $222.40 | $278.00 | $42.53–$278.00 | — | 20% |
| Total cholesterol blood test CPT 82465 Cholesterol Total | $51.20 | $64.00 | $9.79–$64.00 | 113% above | 20% |
| Total cholesterol blood test inpatient CPT 82465 Cholesterol Total | $51.20 | $64.00 | $9.79–$64.00 | — | 20% |
| Total thyroxine (T4) blood test CPT 84436 Total T4 LLS | $12.80 | $16.00 | $2.45–$16.00 | 54% below | 20% |
| Total thyroxine (T4) blood test CPT 84436 Thyroxine (T4) LC | $12.80 | $16.00 | $2.45–$16.00 | 54% below | 20% |
| Total thyroxine (T4) blood test CPT 84436 T4 Total | $80.80 | $101.00 | $15.45–$101.00 | 188% above | 20% |
| Total thyroxine (T4) blood test inpatient CPT 84436 Total T4 LLS | $12.80 | $16.00 | $2.45–$16.00 | — | 20% |
| Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine (T4) LC | $12.80 | $16.00 | $2.45–$16.00 | — | 20% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4 Total | $80.80 | $101.00 | $15.45–$101.00 | — | 20% |
| Total triiodothyronine (T3) blood test CPT 84480 Triiodothyronine (T3) LC | $168.80 | $211.00 | $32.28–$211.00 | 128% above | 20% |
| Total triiodothyronine (T3) blood test CPT 84480 T3 Total LLS | $168.80 | $211.00 | $32.28–$211.00 | 128% above | 20% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 Triiodothyronine (T3) LC | $168.80 | $211.00 | $32.28–$211.00 | — | 20% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 Total LLS | $168.80 | $211.00 | $32.28–$211.00 | — | 20% |
| Transferrin blood test CPT 84466 Transferrin Level LLS | $151.20 | $189.00 | $28.92–$189.00 | 190% above | 20% |
| Transferrin blood test CPT 84466 Transferrin LC | $151.20 | $189.00 | $28.92–$189.00 | 190% above | 20% |
| Transferrin blood test inpatient CPT 84466 Transferrin LC | $151.20 | $189.00 | $28.92–$189.00 | — | 20% |
| Transferrin blood test inpatient CPT 84466 Transferrin Level LLS | $151.20 | $189.00 | $28.92–$189.00 | — | 20% |
| Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginallis by Xpert | $44.80 | $56.00 | $8.57–$56.00 | 7% below | 20% |
| Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginallis by PCR LLS | $44.80 | $56.00 | $8.57–$56.00 | 7% below | 20% |
| Trichomonas test (NAAT) CPT 87661 Trich vag by NAA LC | $108.00 | $135.00 | $20.66–$135.00 | 125% above | 20% |
| Trichomonas test (NAAT) CPT 87661 87661 Trichomonas Vag LC | $276.00 | $345.00 | $52.79–$345.00 | 475% above | 20% |
| Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginallis by Xpert | $44.80 | $56.00 | $8.57–$56.00 | — | 20% |
| Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginallis by PCR LLS | $44.80 | $56.00 | $8.57–$56.00 | — | 20% |
| Trichomonas test (NAAT) inpatient CPT 87661 Trich vag by NAA LC | $108.00 | $135.00 | $20.66–$135.00 | — | 20% |
| Trichomonas test (NAAT) inpatient CPT 87661 87661 Trichomonas Vag LC | $276.00 | $345.00 | $52.79–$345.00 | — | 20% |
| Triglycerides blood test CPT 84478 Triglycerides | $67.20 | $84.00 | $12.85–$84.00 | 164% above | 20% |
| Triglycerides blood test inpatient CPT 84478 Triglycerides | $67.20 | $84.00 | $12.85–$84.00 | — | 20% |
| Troponin test, quantitative CPT 84484 Troponin I | $156.80 | $196.00 | $29.99–$196.00 | 49% above | 20% |
| Troponin test, quantitative inpatient CPT 84484 Troponin I | $156.80 | $196.00 | $29.99–$196.00 | — | 20% |
| Uric acid blood test CPT 84550 Uric Acid | $52.80 | $66.00 | $10.10–$66.00 | 107% above | 20% |
| Uric acid blood test inpatient CPT 84550 Uric Acid | $52.80 | $66.00 | $10.10–$66.00 | — | 20% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis | $44.00 | $55.00 | $8.42–$55.00 | 36% above | 20% |
| Urinalysis with microscope exam, automated CPT 81001 UA w/ Micro | $44.00 | $55.00 | $6.43–$55.00 | 36% above | 20% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis | $44.00 | $55.00 | $8.42–$55.00 | — | 20% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA w/ Micro | $44.00 | $55.00 | $6.43–$55.00 | — | 20% |
| Urinalysis without microscope exam, automated CPT 81003 CMH ONC Urinalysis Dipstick | $30.40 | $38.00 | $5.81–$38.00 | 56% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick | $30.40 | $38.00 | $5.81–$38.00 | 56% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick POC | $36.80 | $46.00 | $6.58–$46.00 | 89% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis | $38.40 | $48.00 | $7.34–$48.00 | 97% above | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick | $30.40 | $38.00 | $5.81–$38.00 | — | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 CMH ONC Urinalysis Dipstick | $30.40 | $38.00 | $5.81–$38.00 | — | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Dipstick POC | $36.80 | $46.00 | $6.58–$46.00 | — | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis | $38.40 | $48.00 | $7.34–$48.00 | — | 20% |
| Urine culture for bacteria, with colony count CPT 87086 Urine Culture MB LC | $101.60 | $127.00 | $19.43–$127.00 | 93% above | 20% |
| Urine culture for bacteria, with colony count CPT 87086 Culture Urine LLS | $101.60 | $127.00 | $19.43–$127.00 | 93% above | 20% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 Culture Urine LLS | $101.60 | $127.00 | $19.43–$127.00 | — | 20% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture MB LC | $101.60 | $127.00 | $19.43–$127.00 | — | 20% |
| Urine microalbumin (albumin) test CPT 82043 Microalbumin Urine Quant | $42.40 | $53.00 | $8.11–$53.00 | 4% below | 20% |
| Urine microalbumin (albumin) test CPT 82043 .U Albumin Total Timed LLS | $42.40 | $53.00 | $8.11–$53.00 | 4% below | 20% |
| Urine microalbumin (albumin) test CPT 82043 Micro Albumin | $67.20 | $84.00 | $12.85–$84.00 | 52% above | 20% |
| Urine microalbumin (albumin) test CPT 82043 U Albumin LLS | $67.20 | $84.00 | $12.85–$84.00 | 52% above | 20% |
| Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Urine Quant | $42.40 | $53.00 | $8.11–$53.00 | — | 20% |
| Urine microalbumin (albumin) test inpatient CPT 82043 .U Albumin Total Timed LLS | $42.40 | $53.00 | $8.11–$53.00 | — | 20% |
| Urine microalbumin (albumin) test inpatient CPT 82043 Micro Albumin | $67.20 | $84.00 | $12.85–$84.00 | — | 20% |
| Urine microalbumin (albumin) test inpatient CPT 82043 U Albumin LLS | $67.20 | $84.00 | $12.85–$84.00 | — | 20% |
| Urine pregnancy test, read by color change CPT 81025 CMH ONC Pregancy Test Urine | $29.60 | $37.00 | $5.66–$37.00 | 44% below | 20% |
| Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test POC | $65.60 | $82.00 | $11.63–$82.00 | 23% above | 20% |
| Urine pregnancy test, read by color change CPT 81025 Pregnancy Test Urine | $76.00 | $95.00 | $5.36–$95.00 | 43% above | 20% |
| Urine pregnancy test, read by color change inpatient CPT 81025 CMH ONC Pregancy Test Urine | $29.60 | $37.00 | $5.66–$37.00 | — | 20% |
| Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Test POC | $65.60 | $82.00 | $11.63–$82.00 | — | 20% |
| Urine pregnancy test, read by color change inpatient CPT 81025 Pregnancy Test Urine | $76.00 | $95.00 | $5.36–$95.00 | — | 20% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 | $70.40 | $88.00 | $13.46–$88.00 | 9% below | 20% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Lvl | $70.40 | $88.00 | $13.46–$88.00 | 9% below | 20% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level | $70.40 | $88.00 | $13.46–$88.00 | 9% below | 20% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 | $70.40 | $88.00 | $13.46–$88.00 | — | 20% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level | $70.40 | $88.00 | $13.46–$88.00 | — | 20% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Lvl | $70.40 | $88.00 | $13.46–$88.00 | — | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25-Hydroxy LLS | $240.80 | $301.00 | $46.05–$301.00 | 141% above | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy Level LLS | $240.80 | $301.00 | $46.05–$301.00 | 141% above | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25-Hydroxy | $240.80 | $301.00 | $46.05–$301.00 | 141% above | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy Level LLS | $240.80 | $301.00 | $46.05–$301.00 | — | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25-Hydroxy LLS | $240.80 | $301.00 | $46.05–$301.00 | — | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25-Hydroxy | $240.80 | $301.00 | $46.05–$301.00 | — | 20% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vitamin D 1-25-Dihydroxy LLS | $422.40 | $528.00 | $80.78–$528.00 | 297% above | 20% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vitamin D 125-Dihydroxy LLS | $422.40 | $528.00 | $80.78–$528.00 | 297% above | 20% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 Calcitriol LC | $422.40 | $528.00 | $80.78–$528.00 | 297% above | 20% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Vitamin D 1-25-Dihydroxy LLS | $422.40 | $528.00 | $80.78–$528.00 | — | 20% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Calcitriol LC | $422.40 | $528.00 | $80.78–$528.00 | — | 20% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Vitamin D 125-Dihydroxy LLS | $422.40 | $528.00 | $80.78–$528.00 | — | 20% |
| Zinc blood test CPT 84630 Zinc LLS | $135.20 | $169.00 | $25.86–$169.00 | 374% above | 20% |
| Zinc blood test CPT 84630 Zinc LC | $135.20 | $169.00 | $25.86–$169.00 | 374% above | 20% |
| Zinc blood test inpatient CPT 84630 Zinc LC | $135.20 | $169.00 | $25.86–$169.00 | — | 20% |
| Zinc blood test inpatient CPT 84630 Zinc LLS | $135.20 | $169.00 | $25.86–$169.00 | — | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 hCG Quantitative | $178.40 | $223.00 | $34.12–$223.00 | 164% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 84702 HCG Quantitative LC | $178.40 | $223.00 | $34.12–$223.00 | 164% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG Tumor Marker LC | $178.40 | $223.00 | $34.12–$223.00 | 164% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 hCG Quantitative | $178.40 | $223.00 | $34.12–$223.00 | — | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 84702 HCG Quantitative LC | $178.40 | $223.00 | $34.12–$223.00 | — | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG Tumor Marker LC | $178.40 | $223.00 | $34.12–$223.00 | — | 20% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Oregon | Off list |
|---|---|---|---|---|---|
| Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 Appendectomy for ruptured appendix with abscess or generalized peritonitis | $1,903.20 | $2,379.00 | $293.76–$4,240.00 | 8% below | 20% |
| Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 Appendectomy for ruptured appendix with abscess or generalized peritonitis | $1,903.20 | $2,379.00 | $293.76–$4,240.00 | — | 20% |
| Appendectomy, open surgery CPT 44950 Appendectomy Charge | $1,395.20 | $1,744.00 | $215.88–$3,107.00 | 91% below | 20% |
| Appendectomy, open surgery inpatient CPT 44950 Appendectomy Charge | $1,395.20 | $1,744.00 | $215.88–$3,107.00 | — | 20% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Arthroscopically Aided Anterior Cruciate Ligament Repair/Augmentation Or Reconst | $4,224.00 | $5,280.00 | $293.81–$5,280.00 | 20% above | 20% |
| Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 Arthroscopically Aided Anterior Cruciate Ligament Repair/Augmentation Or Reconst | $4,224.00 | $5,280.00 | $293.81–$5,280.00 | — | 20% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 Arthroscopy, Shoulder, Surgical; With Rotator Cuff Repair | $3,228.80 | $4,036.00 | $293.81–$4,117.00 | 4% above | 20% |
| Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 Arthroscopy, Shoulder, Surgical; With Rotator Cuff Repair | $3,228.80 | $4,036.00 | $293.81–$4,117.00 | — | 20% |
| Botox injections for chronic migraine CPT 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC | $344.00 | $430.00 | $35.34–$575.00 | 1% below | 20% |
| Botox injections for chronic migraine inpatient CPT 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC | $344.00 | $430.00 | $35.34–$575.00 | — | 20% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA Stereotactic Biopsy Lt | $1,118.40 | $1,398.00 | $213.89–$1,398.00 | 72% below | 20% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA Stereotactic Biopsy Rt | $1,118.40 | $1,398.00 | $213.89–$1,398.00 | 72% below | 20% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MA Stereotactic Biopsy Lt | $1,118.40 | $1,398.00 | $213.89–$1,398.00 | — | 20% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MA Stereotactic Biopsy Rt | $1,118.40 | $1,398.00 | $213.89–$1,398.00 | — | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Clsd Tx Dis Fibula w/o manip FAC | $1,102.40 | $1,378.00 | $210.83–$1,378.00 | 100% above | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Closed Trtmt of Distal Fibular Fx (Lateral Malleolus); w/o Manipulation Charge | $1,156.00 | $1,445.00 | $58.60–$1,445.00 | 110% above | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Clsd Tx Dis Fibula w/o manip FAC | $1,102.40 | $1,378.00 | $210.83–$1,378.00 | — | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Closed Trtmt of Distal Fibular Fx (Lateral Malleolus); w/o Manipulation Charge | $1,156.00 | $1,445.00 | $58.60–$1,445.00 | — | 20% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Closed Trtmt of Metatarsal Fx; w/o Manipulation, each Charge | $823.20 | $1,029.00 | $36.41–$1,029.00 | 77% above | 20% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Closed treatment metatarsal fracture without manipulation | $1,124.80 | $1,406.00 | $215.12–$1,406.00 | 141% above | 20% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Closed Trtmt of Metatarsal Fx; w/o Manipulation, each Charge | $823.20 | $1,029.00 | $36.41–$1,029.00 | — | 20% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Closed treatment metatarsal fracture without manipulation | $1,124.80 | $1,406.00 | $215.12–$1,406.00 | — | 20% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Correction, hallux valgus (bunion), with or without sesamoid | $2,064.00 | $2,580.00 | $201.96–$4,210.00 | 72% below | 20% |
| Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 Correction, hallux valgus (bunion), with or without sesamoid | $2,064.00 | $2,580.00 | $201.96–$4,210.00 | — | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 TEE/Cardioversion | $1,027.20 | $1,284.00 | $196.45–$1,284.00 | 24% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion External | $1,027.20 | $1,284.00 | $196.45–$1,284.00 | 24% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion External ED Charge | $1,048.00 | $1,310.00 | $200.43–$1,310.00 | 23% below | 20% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 TEE/Cardioversion | $1,027.20 | $1,284.00 | $196.45–$1,284.00 | — | 20% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion External | $1,027.20 | $1,284.00 | $196.45–$1,284.00 | — | 20% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion External ED Charge | $1,048.00 | $1,310.00 | $200.43–$1,310.00 | — | 20% |
| Carpal tunnel release, open surgery CPT 64721 Neuroplasty and/or Transposition; Median Nerve At Carpal Tunnel Charge | $1,726.40 | $2,158.00 | $106.79–$2,158.00 | 60% below | 20% |
| Carpal tunnel release, open surgery inpatient CPT 64721 Neuroplasty and/or Transposition; Median Nerve At Carpal Tunnel Charge | $1,726.40 | $2,158.00 | $106.79–$2,158.00 | — | 20% |
| Cervical biopsy CPT 57500 Biopsy, Single or Multiple, or Local Excision of Lesion | $290.40 | $363.00 | $22.64–$558.00 | 71% below | 20% |
| Cervical biopsy CPT 57500 Biopsy of Cervix Single or Mult Local Exc Lesion | $388.80 | $486.00 | $74.36–$486.00 | 61% below | 20% |
| Cervical biopsy inpatient CPT 57500 Biopsy, Single or Multiple, or Local Excision of Lesion | $290.40 | $363.00 | $22.64–$558.00 | — | 20% |
| Cervical biopsy inpatient CPT 57500 Biopsy of Cervix Single or Mult Local Exc Lesion | $388.80 | $486.00 | $74.36–$486.00 | — | 20% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Circumcision, surgical excision other than clamp, device, or dorsal slit; older | $851.20 | $1,064.00 | $47.89–$1,064.00 | 26% above | 20% |
| Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 Circumcision, surgical excision other than clamp, device, or dorsal slit; older | $851.20 | $1,064.00 | $47.89–$1,064.00 | — | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 Circumcision with Hemostatic Powder | $240.80 | $301.00 | $34.27–$525.00 | 50% below | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision, Using Clamp or Other Device; Newborn Charge | $271.20 | $339.00 | $34.27–$525.00 | 44% below | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision Infant procedure charge | $320.00 | $400.00 | $61.20–$400.00 | 34% below | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 54150 Circumcision with Hemostatic Powder | $240.80 | $301.00 | $34.27–$525.00 | — | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision, Using Clamp or Other Device; Newborn Charge | $271.20 | $339.00 | $34.27–$525.00 | — | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision Infant procedure charge | $320.00 | $400.00 | $61.20–$400.00 | — | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Cls Trt Ds Rd Fx Inc Uln St Wo Man ED Charge | $1,294.40 | $1,618.00 | $247.55–$1,618.00 | 149% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Closed treatment of distal radial fracture (eg, Colles or Smith type) w/o manip | $1,322.40 | $1,653.00 | $49.73–$1,653.00 | 154% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Cls Trt Ds Rd Fx Inc Uln St Wo Man ED Charge | $1,294.40 | $1,618.00 | $247.55–$1,618.00 | — | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Closed treatment of distal radial fracture (eg, Colles or Smith type) w/o manip | $1,322.40 | $1,653.00 | $49.73–$1,653.00 | — | 20% |
| Colonoscopy with polyp removal CPT 45385 Colonoscopy flexible proximal splenic flexure w/ removal of tumor polyp les | $1,004.00 | $1,255.00 | $66.40–$1,278.00 | 54% below | 20% |
| Colonoscopy with polyp removal inpatient CPT 45385 Colonoscopy flexible proximal splenic flexure w/ removal of tumor polyp les | $1,004.00 | $1,255.00 | $66.40–$1,278.00 | — | 20% |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy, Flexible, Proximal to Splenic Flexure; w/Biopsy, Single or Mult Cha | $959.20 | $1,199.00 | $51.71–$1,217.00 | 25% below | 20% |
| Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy, Flexible, Proximal to Splenic Flexure; w/Biopsy, Single or Mult Cha | $959.20 | $1,199.00 | $51.71–$1,217.00 | — | 20% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 Colposcopy Cervix/Upper Vag w/Loop Bx Charge | $616.00 | $770.00 | $52.33–$1,117.00 | 64% below | 20% |
| Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 Colposcopy Cervix/Upper Vag w/Loop Bx Charge | $616.00 | $770.00 | $52.33–$1,117.00 | — | 20% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Colposcopy Cervix/Upper Vag w/Bx Cervix Endo Charge | $452.00 | $565.00 | $43.91–$625.00 | 3% above | 20% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 Colposcopy Cervix/Upper Vag w/Bx Cervix Endo Charge | $452.00 | $565.00 | $43.91–$625.00 | — | 20% |
| Cystoscopy with ureteral stent placement CPT 52332 Cystourethroscopy, With Insertion Of Indwelling Ureteral Stent (Eg, Gibbons Or D | $924.80 | $1,156.00 | $50.03–$1,301.00 | 78% below | 20% |
| Cystoscopy with ureteral stent placement inpatient CPT 52332 Cystourethroscopy, With Insertion Of Indwelling Ureteral Stent (Eg, Gibbons Or D | $924.80 | $1,156.00 | $50.03–$1,301.00 | — | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystourethroscopy Charge | $554.40 | $693.00 | $28.00–$790.00 | 12% below | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Cystourethroscopy Charge | $554.40 | $693.00 | $28.00–$790.00 | — | 20% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 Dilation Curettage, Non-OB Charge | $902.40 | $1,128.00 | $70.84–$1,153.00 | 85% below | 20% |
| D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 Dilation Curettage, Non-OB Charge | $902.40 | $1,128.00 | $70.84–$1,153.00 | — | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruction Benign/Premalig Lesion Charge | $172.80 | $216.00 | $9.95–$478.46 | at median | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Destruction Benign/Premalig Lesion Charge | $172.80 | $216.00 | $9.95–$478.46 | — | 20% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 69433 Tympanostomy insert vent tube local or topical anes | $516.00 | $645.00 | $31.67–$797.00 | 8% below | 20% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 69433 Tympanostomy insert vent tube local or topical anes | $516.00 | $645.00 | $31.67–$797.00 | — | 20% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 Ear Irrigation Unilateral POC | $56.00 | $70.00 | $9.53–$478.46 | 27% below | 20% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Removal impacted cerumen using irrigation/lavage unilateral | $94.40 | $118.00 | $18.05–$118.00 | 23% above | 20% |
| Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 69209 Ear Irrigation Unilateral POC | $56.00 | $70.00 | $9.53–$478.46 | — | 20% |
| Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 Removal impacted cerumen using irrigation/lavage unilateral | $94.40 | $118.00 | $18.05–$118.00 | — | 20% |
| Earwax removal with instruments, one ear CPT 69210 Remove Impacted Cerumen ED Charge | $109.60 | $137.00 | $20.96–$137.00 | at median | 20% |
| Earwax removal with instruments, one ear one side CPT 69210 69210 Removal impacted cerumen w instrumentation Unilateral | $123.20 | $154.00 | $11.48–$478.46 | 12% above | 20% |
| Earwax removal with instruments, one ear inpatient CPT 69210 Remove Impacted Cerumen ED Charge | $109.60 | $137.00 | $20.96–$137.00 | — | 20% |
| Earwax removal with instruments, one ear inpatient one side CPT 69210 69210 Removal impacted cerumen w instrumentation Unilateral | $123.20 | $154.00 | $11.48–$478.46 | — | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 MS 58100 Endometrial Biopsy without Cervical Dilation | $190.40 | $238.00 | $36.41–$238.00 | 54% below | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Biopsy Endometrial Charge | $241.60 | $302.00 | $24.94–$478.46 | 42% below | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 MS 58100 Endometrial Biopsy without Cervical Dilation | $190.40 | $238.00 | $36.41–$238.00 | — | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Biopsy Endometrial Charge | $241.60 | $302.00 | $24.94–$478.46 | — | 20% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 XR Facet Injection | $490.40 | $613.00 | $93.79–$613.00 | 76% below | 20% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 XR Facet Injection | $490.40 | $613.00 | $93.79–$613.00 | — | 20% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy flexible diagnostic with or without collection of specimen by b | $377.60 | $472.00 | $12.24–$533.00 | 64% below | 20% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Sigmoidoscopy flexible diagnostic with or without collection of specimen by b | $377.60 | $472.00 | $12.24–$533.00 | — | 20% |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopy, Surgical; Cholecystectomy Charge | $1,672.80 | $2,091.00 | $234.70–$3,209.00 | 78% below | 20% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopy, Surgical; Cholecystectomy Charge | $1,672.80 | $2,091.00 | $234.70–$3,209.00 | — | 20% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Laparoscopy surgical cholecystectomy with cholangiography | $1,566.40 | $1,958.00 | $253.06–$3,489.00 | 86% below | 20% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 Laparoscopy surgical cholecystectomy with cholangiography | $1,566.40 | $1,958.00 | $253.06–$3,489.00 | — | 20% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 Transrectal drainage of pelvic abscess | $2,327.20 | $2,909.00 | $293.81–$5,184.00 | 25% below | 20% |
| Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 Transrectal drainage of pelvic abscess | $2,327.20 | $2,909.00 | $293.81–$5,184.00 | — | 20% |
| Hammertoe correction surgery CPT 28285 CORRECTION HAMMERTOE | $1,687.20 | $2,109.00 | $80.94–$2,109.00 | 3% above | 20% |
| Hammertoe correction surgery inpatient CPT 28285 CORRECTION HAMMERTOE | $1,687.20 | $2,109.00 | $80.94–$2,109.00 | — | 20% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 46221 Hemorrhoidectomy, bands CMH | $753.60 | $942.00 | $45.75–$1,092.00 | 2% above | 20% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 46221 Hemorrhoidectomy, bands CMH | $753.60 | $942.00 | $45.75–$1,092.00 | — | 20% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorrhoidectomy internal and external single column/group | $1,559.20 | $1,949.00 | $121.48–$2,508.00 | 73% below | 20% |
| Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 Hemorrhoidectomy internal and external single column/group | $1,559.20 | $1,949.00 | $121.48–$2,508.00 | — | 20% |
| Hysterectomy through an abdominal incision (total) CPT 58150 Total abd. hysterectomy, w/ or w/o removal of tube(s) or ovary(s) Charge | $2,216.00 | $2,770.00 | $293.81–$4,912.00 | 25% below | 20% |
| Hysterectomy through an abdominal incision (total) inpatient CPT 58150 Total abd. hysterectomy, w/ or w/o removal of tube(s) or ovary(s) Charge | $2,216.00 | $2,770.00 | $293.81–$4,912.00 | — | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Catheterization/Introduction Saline for SIS or HSG Charge | $478.40 | $598.00 | $13.16–$684.00 | 71% above | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CMH XR Cath SIS or Hysterosalpingography | $679.20 | $849.00 | $129.90–$849.00 | 143% above | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Catheterization/Introduction Saline for SIS or HSG Charge | $478.40 | $598.00 | $13.16–$684.00 | — | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CMH XR Cath SIS or Hysterosalpingography | $679.20 | $849.00 | $129.90–$849.00 | — | 20% |
| Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy Surgical w/ Endometrial Ablation Charge | $1,654.40 | $2,068.00 | $109.40–$9,445.00 | 43% below | 20% |
| Hysteroscopy with endometrial ablation inpatient CPT 58563 Hysteroscopy Surgical w/ Endometrial Ablation Charge | $1,654.40 | $2,068.00 | $109.40–$9,445.00 | — | 20% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy Surgical w/ Sampling Endometrium/Polypectomy Charge | $1,435.20 | $1,794.00 | $84.00–$4,914.00 | 45% below | 20% |
| Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 Hysteroscopy Surgical w/ Sampling Endometrium/Polypectomy Charge | $1,435.20 | $1,794.00 | $84.00–$4,914.00 | — | 20% |
| IUD insertion (the device itself billed separately) CPT 58300 IUD, Insert Charge | $193.60 | $242.00 | $24.79–$520.00 | 56% below | 20% |
| IUD insertion (the device itself billed separately) CPT 58300 MS 58300 Insertion of Intrauterine Device (IUD) | $296.00 | $370.00 | $56.61–$370.00 | 32% below | 20% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 IUD, Insert Charge | $193.60 | $242.00 | $24.79–$520.00 | — | 20% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 MS 58300 Insertion of Intrauterine Device (IUD) | $296.00 | $370.00 | $56.61–$370.00 | — | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Drain Skin Abscess, Simple/Single Charge | $414.40 | $518.00 | $18.97–$518.00 | 28% above | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 ID Abscess Sgl Simp ED Charge | $456.80 | $571.00 | $87.36–$571.00 | 41% above | 20% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Drain Skin Abscess, Simple/Single Charge | $414.40 | $518.00 | $18.97–$518.00 | — | 20% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ID Abscess Sgl Simp ED Charge | $456.80 | $571.00 | $87.36–$571.00 | — | 20% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair Initial Inguinal Hernia, Age 5 Yrs or Over; Reducible Charge | $1,626.40 | $2,033.00 | $194.92–$2,551.00 | 77% below | 20% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Repair Initial Inguinal Hernia, Age 5 Yrs or Over; Reducible Charge | $1,626.40 | $2,033.00 | $194.92–$2,551.00 | — | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj(s); Single Tendon Sheath, or Ligament, Aponeurosis (eg, Planterar ''''Fascia'''' | $149.60 | $187.00 | $14.84–$478.46 | 29% below | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj(s); Single Tendon Sheath, or Ligament, Aponeurosis (eg, Planterar ''''Fascia'''' | $149.60 | $187.00 | $14.84–$478.46 | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Major Joint, Shoulder, Hip, Knee Charge | $174.40 | $218.00 | $18.97–$478.46 | 42% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocent Aspir Inj Maj Jnt ED Charge | $176.80 | $221.00 | $33.81–$221.00 | 41% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Fluoro Hip Joint Inj Asp Rt | $287.20 | $359.00 | $54.93–$359.00 | 5% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Fluoro Knee Joint Inj Asp Rt | $287.20 | $359.00 | $54.93–$359.00 | 5% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Fluoro Shoulder Joint Inj Asp Rt | $287.20 | $359.00 | $54.93–$359.00 | 5% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Fluoro Knee Joint Inj Asp Lt | $287.20 | $359.00 | $54.93–$359.00 | 5% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Fluoro Hip Joint Inj Asp Lt | $287.20 | $359.00 | $54.93–$359.00 | 5% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Fluoro Shoulder Joint Inj Asp Lt | $287.20 | $359.00 | $54.93–$359.00 | 5% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 CT Barbotage Shoulder Rt | $673.60 | $842.00 | $128.83–$842.00 | 124% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 CT Barbotage Shoulder Lt | $673.60 | $842.00 | $128.83–$842.00 | 124% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis Major Joint, Shoulder, Hip, Knee Charge | $174.40 | $218.00 | $18.97–$478.46 | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocent Aspir Inj Maj Jnt ED Charge | $176.80 | $221.00 | $33.81–$221.00 | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Fluoro Knee Joint Inj Asp Rt | $287.20 | $359.00 | $54.93–$359.00 | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Fluoro Hip Joint Inj Asp Lt | $287.20 | $359.00 | $54.93–$359.00 | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Fluoro Shoulder Joint Inj Asp Lt | $287.20 | $359.00 | $54.93–$359.00 | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Fluoro Knee Joint Inj Asp Lt | $287.20 | $359.00 | $54.93–$359.00 | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Fluoro Shoulder Joint Inj Asp Rt | $287.20 | $359.00 | $54.93–$359.00 | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Fluoro Hip Joint Inj Asp Rt | $287.20 | $359.00 | $54.93–$359.00 | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 CT Barbotage Shoulder Lt | $673.60 | $842.00 | $128.83–$842.00 | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 CT Barbotage Shoulder Rt | $673.60 | $842.00 | $128.83–$842.00 | — | 20% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insertion, Non-Biodegradable Drug Delivery Implant | $241.60 | $302.00 | $27.39–$478.46 | 6% below | 20% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Insertion, Non-Biodegradable Drug Delivery Implant | $241.60 | $302.00 | $27.39–$478.46 | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocent Aspir Inj Int Jnt ED Charge | $156.00 | $195.00 | $29.84–$195.00 | 51% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis Intermed Joint, Wrist, Elbow, Ankle Charge | $170.40 | $213.00 | $14.84–$478.46 | 47% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 XR Fluoro Ankle Joint Inj Asp Rt | $233.60 | $292.00 | $44.68–$292.00 | 27% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 XR Fluoro Ankle Joint Inj Asp Lt | $233.60 | $292.00 | $44.68–$292.00 | 27% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 XR Fluoro Elbow Joint Inj Asp Lt | $233.60 | $292.00 | $44.68–$292.00 | 27% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 XR Fluoro Elbow Joint Inj Asp Rt | $233.60 | $292.00 | $44.68–$292.00 | 27% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 XR Fluoro Wrist Joint Inj Asp Lt | $233.60 | $292.00 | $44.68–$292.00 | 27% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 XR Fluoro Wrist Joint Inj Asp Rt | $233.60 | $292.00 | $44.68–$292.00 | 27% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocent Aspir Inj Int Jnt ED Charge | $156.00 | $195.00 | $29.84–$195.00 | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis Intermed Joint, Wrist, Elbow, Ankle Charge | $170.40 | $213.00 | $14.84–$478.46 | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 XR Fluoro Ankle Joint Inj Asp Lt | $233.60 | $292.00 | $44.68–$292.00 | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 XR Fluoro Elbow Joint Inj Asp Lt | $233.60 | $292.00 | $44.68–$292.00 | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 XR Fluoro Elbow Joint Inj Asp Rt | $233.60 | $292.00 | $44.68–$292.00 | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 XR Fluoro Wrist Joint Inj Asp Lt | $233.60 | $292.00 | $44.68–$292.00 | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 XR Fluoro Wrist Joint Inj Asp Rt | $233.60 | $292.00 | $44.68–$292.00 | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 XR Fluoro Ankle Joint Inj Asp Rt | $233.60 | $292.00 | $44.68–$292.00 | — | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis, Aspirtn and/or Inj; Small Joint or Bursa (eg, Fingers, toes) Cha | $176.80 | $221.00 | $13.62–$478.46 | 44% below | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis aspiration inj small joint or bursa w/out U/S | $214.40 | $268.00 | $41.00–$268.00 | 32% below | 20% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis, Aspirtn and/or Inj; Small Joint or Bursa (eg, Fingers, toes) Cha | $176.80 | $221.00 | $13.62–$478.46 | — | 20% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis aspiration inj small joint or bursa w/out U/S | $214.40 | $268.00 | $41.00–$268.00 | — | 20% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Arthroscopy, Knee, Surgical; With Meniscus Repair (Medial Or Lateral) | $3,088.80 | $3,861.00 | $235.01–$3,861.00 | 16% above | 20% |
| Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 Arthroscopy, Knee, Surgical; With Meniscus Repair (Medial Or Lateral) | $3,088.80 | $3,861.00 | $235.01–$3,861.00 | — | 20% |
| Knee arthroscopy with meniscus trim CPT 29881 Arthroscopy, Knee, Surgical; w/Meniscectomy (Medial or Lateral, w/Any Meniscal S | $2,182.40 | $2,728.00 | $160.04–$2,728.00 | 36% above | 20% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 Arthroscopy, Knee, Surgical; w/Meniscectomy (Medial or Lateral, w/Any Meniscal S | $2,182.40 | $2,728.00 | $160.04–$2,728.00 | — | 20% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Arthroscopy, Knee, Surgical; With Meniscectomy (Medial And Lateral, Including An | $2,409.60 | $3,012.00 | $180.85–$3,012.00 | 45% above | 20% |
| Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 Arthroscopy, Knee, Surgical; With Meniscectomy (Medial And Lateral, Including An | $2,409.60 | $3,012.00 | $180.85–$3,012.00 | — | 20% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Arthroscopy, Knee, Surgical; Debridement/Shaving Of Articular Cartilage (Chondro | $2,385.60 | $2,982.00 | $203.18–$3,050.00 | 13% above | 20% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 Arthroscopy, Knee, Surgical; Debridement/Shaving Of Articular Cartilage (Chondro | $2,385.60 | $2,982.00 | $203.18–$3,050.00 | — | 20% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Laparoscopy Surgical Appendectomy Charge | $1,328.80 | $1,661.00 | $216.34–$2,926.00 | 73% below | 20% |
| Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 Laparoscopy Surgical Appendectomy Charge | $1,328.80 | $1,661.00 | $216.34–$2,926.00 | — | 20% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with r | $1,966.40 | $2,458.00 | $293.81–$4,381.00 | 25% below | 20% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries inpatient CPT 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with r | $1,966.40 | $2,458.00 | $293.81–$4,381.00 | — | 20% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 Hernia Repair Inguinal Charge | $1,607.20 | $2,009.00 | $155.75–$2,116.00 | 3% above | 20% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 Hernia Repair Inguinal Charge | $1,607.20 | $2,009.00 | $155.75–$2,116.00 | — | 20% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Laparoscopy surgical repair recurrent inguinal hernia | $1,489.60 | $1,862.00 | $205.17–$2,759.00 | 10% below | 20% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 Laparoscopy surgical repair recurrent inguinal hernia | $1,489.60 | $1,862.00 | $205.17–$2,759.00 | — | 20% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy Surgical w/ Removal Adnexal Structures Charge | $1,611.20 | $2,014.00 | $203.18–$3,144.00 | 21% below | 20% |
| Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 Laparoscopy Surgical w/ Removal Adnexal Structures Charge | $1,611.20 | $2,014.00 | $203.18–$3,144.00 | — | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Lyr Cls Sclp Trnk Axl Extr < 2.5 Cm ED Charge | $517.60 | $647.00 | $98.99–$647.00 | 18% below | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and | $584.80 | $731.00 | $29.84–$763.00 | 7% below | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Lyr Cls Sclp Trnk Axl Extr < 2.5 Cm ED Charge | $517.60 | $647.00 | $98.99–$647.00 | — | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and | $584.80 | $731.00 | $29.84–$763.00 | — | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 CT Inj Translaminar ESI Lumbar/Sacral BCE | $1,302.40 | $1,628.00 | $249.08–$1,628.00 | 16% below | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 CT Spine Lumbosacral Therapeutic Inj | $1,628.00 | $2,035.00 | $311.36–$2,035.00 | 5% above | 20% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 CT Inj Translaminar ESI Lumbar/Sacral BCE | $1,302.40 | $1,628.00 | $249.08–$1,628.00 | — | 20% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 CT Spine Lumbosacral Therapeutic Inj | $1,628.00 | $2,035.00 | $311.36–$2,035.00 | — | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 XR Inj ESI Lumbar/Sacral Single Lvl | $644.80 | $806.00 | $123.32–$806.00 | 60% below | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CT Inj Transforaminal ESI Lumbar/Sacral Single Lvl BCE | $717.60 | $897.00 | $137.24–$897.00 | 55% below | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CT Inj ESI Lumbar/Sacral Single Lvl | $896.80 | $1,121.00 | $171.51–$1,121.00 | 44% below | 20% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 XR Inj ESI Lumbar/Sacral Single Lvl | $644.80 | $806.00 | $123.32–$806.00 | — | 20% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 CT Inj Transforaminal ESI Lumbar/Sacral Single Lvl BCE | $717.60 | $897.00 | $137.24–$897.00 | — | 20% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 CT Inj ESI Lumbar/Sacral Single Lvl | $896.80 | $1,121.00 | $171.51–$1,121.00 | — | 20% |
| Lumbar spinal fusion (posterior), one level CPT 22612 Arthrodesis, posterior, single; lumbar | $3,678.40 | $4,598.00 | $293.81–$7,685.00 | at median | 20% |
| Lumbar spinal fusion (posterior), one level inpatient CPT 22612 Arthrodesis, posterior, single; lumbar | $3,678.40 | $4,598.00 | $293.81–$7,685.00 | — | 20% |
| Lumpectomy (partial mastectomy) CPT 19301 Mastectomy partial (eg lumpectomy tylectomy quadrantectomy segmentectomy) | $1,638.40 | $2,048.00 | $153.31–$2,048.00 | 60% below | 20% |
| Lumpectomy (partial mastectomy) inpatient CPT 19301 Mastectomy partial (eg lumpectomy tylectomy quadrantectomy segmentectomy) | $1,638.40 | $2,048.00 | $153.31–$2,048.00 | — | 20% |
| Miscarriage treatment with D&C, first trimester CPT 59820 Treatment Missed Abortion, Surgical; First Trimester Charge | $1,501.60 | $1,877.00 | $118.42–$2,120.00 | 67% below | 20% |
| Miscarriage treatment with D&C, first trimester inpatient CPT 59820 Treatment Missed Abortion, Surgical; First Trimester Charge | $1,501.60 | $1,877.00 | $118.42–$2,120.00 | — | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Remove Lesion, Trunk/Arm/Leg <.5 cm Charge | $328.80 | $411.00 | $14.69–$478.46 | 35% below | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Remove Lesion, Trunk/Arm/Leg <.5 cm Charge | $328.80 | $411.00 | $14.69–$478.46 | — | 20% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Remove Lesion, Face/Lid/Ear/Nose/Lip <.5 cm Charge | $417.60 | $522.00 | $18.51–$522.00 | 52% below | 20% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Remove Lesion, Face/Lid/Ear/Nose/Lip <.5 cm Charge | $417.60 | $522.00 | $18.51–$522.00 | — | 20% |
| Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate Sgl Simp ED Charge | $193.60 | $242.00 | $37.03–$242.00 | 2% below | 20% |
| Nail removal (partial or complete), one nail CPT 11730 Avulsion of Nail Plate, Partial or Complete, Simple; Single Charge | $206.40 | $258.00 | $15.30–$478.46 | 4% above | 20% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion Nail Plate Sgl Simp ED Charge | $193.60 | $242.00 | $37.03–$242.00 | — | 20% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion of Nail Plate, Partial or Complete, Simple; Single Charge | $206.40 | $258.00 | $15.30–$478.46 | — | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 Inj, Anesthetic Agent; Greater Occipital Nerve Charge | $339.20 | $424.00 | $23.10–$478.46 | 18% below | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV FAC | $809.60 | $1,012.00 | $154.84–$1,012.00 | 97% above | 20% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 Inj, Anesthetic Agent; Greater Occipital Nerve Charge | $339.20 | $424.00 | $23.10–$478.46 | — | 20% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV FAC | $809.60 | $1,012.00 | $154.84–$1,012.00 | — | 20% |
| Paracentesis with imaging guidance CPT 49083 Abdominal paracentesis (diagnostic or therapeutic); with ima | $1,896.80 | $2,371.00 | $362.76–$2,371.00 | 65% above | 20% |
| Paracentesis with imaging guidance CPT 49083 US Guide Abdomen Paracentesis | $1,896.80 | $2,371.00 | $362.76–$2,371.00 | 65% above | 20% |
| Paracentesis with imaging guidance inpatient CPT 49083 Abdominal paracentesis (diagnostic or therapeutic); with ima | $1,896.80 | $2,371.00 | $362.76–$2,371.00 | — | 20% |
| Paracentesis with imaging guidance inpatient CPT 49083 US Guide Abdomen Paracentesis | $1,896.80 | $2,371.00 | $362.76–$2,371.00 | — | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excise of Nail matrix, Part. or Complete, for Permanent Removal Charge | $392.80 | $491.00 | $28.00–$556.00 | 38% below | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Exc Nail Matrix Permanent ED Charge | $524.80 | $656.00 | $100.37–$656.00 | 17% below | 20% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excise of Nail matrix, Part. or Complete, for Permanent Removal Charge | $392.80 | $491.00 | $28.00–$556.00 | — | 20% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Exc Nail Matrix Permanent ED Charge | $524.80 | $656.00 | $100.37–$656.00 | — | 20% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 Laparoscopy, surgical prostatectomy, retropubic radical | $2,939.20 | $3,674.00 | $293.81–$5,722.00 | — | 20% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 Laparoscopy, surgical prostatectomy, retropubic radical | $2,939.20 | $3,674.00 | $293.81–$5,722.00 | — | 20% |
| Removal of a breast lump, open surgery CPT 19120 Excision of cyst fibroadenoma aberrant breast tissue duct lesion areolar le | $1,633.60 | $2,042.00 | $117.81–$2,053.00 | 2% above | 20% |
| Removal of a breast lump, open surgery inpatient CPT 19120 Excision of cyst fibroadenoma aberrant breast tissue duct lesion areolar le | $1,633.60 | $2,042.00 | $117.81–$2,053.00 | — | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 Incision Removal of Foreign Body, Subcutaneous Tissues; Simple Charge | $409.60 | $512.00 | $20.50–$512.00 | 1% above | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 Incis Remov Fb Subq Simp ED Charge | $732.00 | $915.00 | $140.00–$915.00 | 80% above | 20% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision Removal of Foreign Body, Subcutaneous Tissues; Simple Charge | $409.60 | $512.00 | $20.50–$512.00 | — | 20% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 Incis Remov Fb Subq Simp ED Charge | $732.00 | $915.00 | $140.00–$915.00 | — | 20% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 Lithotripsy, Extracorporeal Shock Wave Charge | $2,208.00 | $2,760.00 | $239.14–$3,545.00 | 32% above | 20% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 Lithotripsy, Extracorporeal Shock Wave Charge | $2,208.00 | $2,760.00 | $239.14–$3,545.00 | — | 20% |
| Short arm cast (elbow to hand) CPT 29075 Applic, Cast; Elbow to Finger (Short Arm) Charge | $147.20 | $184.00 | $15.45–$478.46 | 44% below | 20% |
| Short arm cast (elbow to hand) inpatient CPT 29075 Applic, Cast; Elbow to Finger (Short Arm) Charge | $147.20 | $184.00 | $15.45–$478.46 | — | 20% |
| Short arm splint (forearm and hand) CPT 29125 Applic of Short Arm Splint (Forearm to Hand); Static Charge | $183.20 | $229.00 | $9.49–$478.46 | 10% above | 20% |
| Short arm splint (forearm and hand) CPT 29125 Apply Short Arm Splint Static ED Charge | $340.00 | $425.00 | $65.03–$425.00 | 104% above | 20% |
| Short arm splint (forearm and hand) inpatient CPT 29125 Applic of Short Arm Splint (Forearm to Hand); Static Charge | $183.20 | $229.00 | $9.49–$478.46 | — | 20% |
| Short arm splint (forearm and hand) inpatient CPT 29125 Apply Short Arm Splint Static ED Charge | $340.00 | $425.00 | $65.03–$425.00 | — | 20% |
| Short leg cast (below the knee) CPT 29405 Applic of Short Leg Cast (Below Knee to toes); Charge | $144.80 | $181.00 | $15.76–$478.46 | 50% below | 20% |
| Short leg cast (below the knee) inpatient CPT 29405 Applic of Short Leg Cast (Below Knee to toes); Charge | $144.80 | $181.00 | $15.76–$478.46 | — | 20% |
| Short leg splint (calf to foot) CPT 29515 Applic of Short Leg Splint (Calf to Foot) Charge | $205.60 | $257.00 | $13.77–$478.46 | at median | 20% |
| Short leg splint (calf to foot) CPT 29515 Apply Short Leg Splint ED Charge | $312.00 | $390.00 | $59.67–$390.00 | 52% above | 20% |
| Short leg splint (calf to foot) inpatient CPT 29515 Applic of Short Leg Splint (Calf to Foot) Charge | $205.60 | $257.00 | $13.77–$478.46 | — | 20% |
| Short leg splint (calf to foot) inpatient CPT 29515 Apply Short Leg Splint ED Charge | $312.00 | $390.00 | $59.67–$390.00 | — | 20% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Arthroscopy, Shoulder, Surgical; Distal Claviculectomy Including Distal Articula | $2,315.20 | $2,894.00 | $219.86–$3,323.00 | 16% above | 20% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 Arthroscopy, Shoulder, Surgical; Distal Claviculectomy Including Distal Articula | $2,315.20 | $2,894.00 | $219.86–$3,323.00 | — | 20% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Arthroscopy, Shoulder, Surgical; Decompression Of Subacromial Space With Partial | $1,540.80 | $1,926.00 | $97.75–$1,926.00 | at median | 20% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Arthroscopy, Shoulder, Surgical; Decompression Of Subacromial Space With Partial | $1,540.80 | $1,926.00 | $97.75–$1,926.00 | — | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.5 cm > | $264.00 | $330.00 | $16.07–$478.46 | 22% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Rep Simp Sclp Trnk Xtrm <2.5 Cm ED Charge | $313.60 | $392.00 | $59.98–$392.00 | 8% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.5 cm > | $264.00 | $330.00 | $16.07–$478.46 | — | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Rep Simp Sclp Trnk Xtrm <2.5 Cm ED Charge | $313.60 | $392.00 | $59.98–$392.00 | — | 20% |
| Skin biopsy, punch, one lesion CPT 11104 11104 Punch biopsy of skin; single lesion | $179.20 | $224.00 | $13.92–$478.46 | 31% below | 20% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch biopsy of skin; single lesion | $179.20 | $224.00 | $13.92–$478.46 | — | 20% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 0.5 cm or Le | $472.00 | $590.00 | $25.86–$612.00 | at median | 20% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 0.5 cm or Le | $472.00 | $590.00 | $25.86–$612.00 | — | 20% |
| Skin tag removal, up to 15 tags CPT 11200 Removal of Skin Tags, Mult Fibrocutaneous Tags, Any Area; Up to w/15 Lesions C | $215.20 | $269.00 | $12.39–$478.46 | 8% below | 20% |
| Skin tag removal, up to 15 tags CPT 11200 Removal skin tags any area up to and including 15 tags | $417.60 | $522.00 | $79.87–$522.00 | 78% above | 20% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 Removal of Skin Tags, Mult Fibrocutaneous Tags, Any Area; Up to w/15 Lesions C | $215.20 | $269.00 | $12.39–$478.46 | — | 20% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 Removal skin tags any area up to and including 15 tags | $417.60 | $522.00 | $79.87–$522.00 | — | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal puncture, lumbar, diagnostic Charge | $308.80 | $386.00 | $21.73–$510.00 | 69% below | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Puncture Lumbar Diag ED Charge | $622.40 | $778.00 | $119.03–$778.00 | 37% below | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 CMH CRNA LUMBAR PUNCTURE | $664.00 | $830.00 | $126.99–$830.00 | 32% below | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal puncture, lumbar, diagnostic Charge | $308.80 | $386.00 | $21.73–$510.00 | — | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal Puncture Lumbar Diag ED Charge | $622.40 | $778.00 | $119.03–$778.00 | — | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 CMH CRNA LUMBAR PUNCTURE | $664.00 | $830.00 | $126.99–$830.00 | — | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple Repair Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.6 cm t | $336.80 | $421.00 | $21.27–$478.46 | 14% below | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Rep Simp Sclp Trnk Xtrm 2.6 7.5 Cm ED Charge | $420.80 | $526.00 | $80.48–$526.00 | 7% above | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Simple Repair Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.6 cm t | $336.80 | $421.00 | $21.27–$478.46 | — | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Rep Simp Sclp Trnk Xtrm 2.6 7.5 Cm ED Charge | $420.80 | $526.00 | $80.48–$526.00 | — | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Simple repair wound face/ear/eyelid/nose/lip2.5cm or < | $325.60 | $407.00 | $20.66–$478.46 | 4% below | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Rep Simp Face < 2.5 Cm ED Charge | $462.40 | $578.00 | $88.43–$578.00 | 36% above | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 Simple repair wound face/ear/eyelid/nose/lip2.5cm or < | $325.60 | $407.00 | $20.66–$478.46 | — | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Rep Simp Face < 2.5 Cm ED Charge | $462.40 | $578.00 | $88.43–$578.00 | — | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangential biopsy of skin; single lesion | $143.20 | $179.00 | $11.02–$478.46 | 34% below | 20% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 11102 Tangential biopsy of skin; single lesion | $143.20 | $179.00 | $11.02–$478.46 | — | 20% |
| Thoracentesis with imaging guidance CPT 32555 Thoracentesis needle or catheter aspiration of the pleural space; with imaging | $204.00 | $255.00 | $39.02–$255.00 | 86% below | 20% |
| Thoracentesis with imaging guidance CPT 32555 US Guide Thoracentesis | $1,628.80 | $2,036.00 | $311.51–$2,036.00 | 14% above | 20% |
| Thoracentesis with imaging guidance CPT 32555 IR Thoracentesis aspiration, needle or cath w/ imaging | $1,628.80 | $2,036.00 | $311.51–$2,036.00 | 14% above | 20% |
| Thoracentesis with imaging guidance one side CPT 32555 US Guide Thoracentesis Lt | $1,628.80 | $2,036.00 | $311.51–$2,036.00 | 14% above | 20% |
| Thoracentesis with imaging guidance one side CPT 32555 US Guide Thoracentesis Rt | $1,628.80 | $2,036.00 | $311.51–$2,036.00 | 14% above | 20% |
| Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis needle or catheter aspiration of the pleural space; with imaging | $204.00 | $255.00 | $39.02–$255.00 | — | 20% |
| Thoracentesis with imaging guidance inpatient CPT 32555 US Guide Thoracentesis | $1,628.80 | $2,036.00 | $311.51–$2,036.00 | — | 20% |
| Thoracentesis with imaging guidance inpatient CPT 32555 IR Thoracentesis aspiration, needle or cath w/ imaging | $1,628.80 | $2,036.00 | $311.51–$2,036.00 | — | 20% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 US Guide Thoracentesis Lt | $1,628.80 | $2,036.00 | $311.51–$2,036.00 | — | 20% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 US Guide Thoracentesis Rt | $1,628.80 | $2,036.00 | $311.51–$2,036.00 | — | 20% |
| Trigger finger release surgery CPT 26055 Tendon Sheath Incision (Eg, For Trigger Finger) | $1,394.40 | $1,743.00 | $57.99–$2,147.00 | at median | 20% |
| Trigger finger release surgery inpatient CPT 26055 Tendon Sheath Incision (Eg, For Trigger Finger) | $1,394.40 | $1,743.00 | $57.99–$2,147.00 | — | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Inj(s); Single or Mult Trigger Point(S), One or Two Muscle(s) Charge | $218.40 | $273.00 | $14.54–$478.46 | 9% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 20552 Trigger Point Injections ED facility charge | $228.00 | $285.00 | $43.61–$285.00 | 5% below | 20% |
| Trigger point injections, 1 or 2 muscles one side CPT 20552 CT Inj Piriformis Lt | $514.40 | $643.00 | $98.38–$643.00 | 115% above | 20% |
| Trigger point injections, 1 or 2 muscles one side CPT 20552 CT Inj Piriformis Rt | $514.40 | $643.00 | $98.38–$643.00 | 115% above | 20% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj(s); Single or Mult Trigger Point(S), One or Two Muscle(s) Charge | $218.40 | $273.00 | $14.54–$478.46 | — | 20% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 Trigger Point Injections ED facility charge | $228.00 | $285.00 | $43.61–$285.00 | — | 20% |
| Trigger point injections, 1 or 2 muscles inpatient one side CPT 20552 CT Inj Piriformis Lt | $514.40 | $643.00 | $98.38–$643.00 | — | 20% |
| Trigger point injections, 1 or 2 muscles inpatient one side CPT 20552 CT Inj Piriformis Rt | $514.40 | $643.00 | $98.38–$643.00 | — | 20% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 Laparoscopy Surgical w/ Fulguration Oviducts Charge | $806.40 | $1,008.00 | $130.05–$1,796.00 | 14% below | 20% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 Laparoscopy Surgical w/ Fulguration Oviducts Charge | $806.40 | $1,008.00 | $130.05–$1,796.00 | — | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Biopsy, breast, percutaneous, with US guidance | $580.00 | $725.00 | $75.89–$2,304.00 | 80% below | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Rt | $980.80 | $1,226.00 | $187.58–$1,226.00 | 66% below | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Lt | $980.80 | $1,226.00 | $187.58–$1,226.00 | 66% below | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Biopsy, breast, percutaneous, with US guidance | $580.00 | $725.00 | $75.89–$2,304.00 | — | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Lt | $980.80 | $1,226.00 | $187.58–$1,226.00 | — | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Rt | $980.80 | $1,226.00 | $187.58–$1,226.00 | — | 20% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Upper GI endoscopy; w balloon dilation of esophagus less than 30 MM Technical Ch | $1,292.00 | $1,615.00 | $38.86–$2,909.00 | 40% below | 20% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 Upper GI endoscopy; w balloon dilation of esophagus less than 30 MM Technical Ch | $1,292.00 | $1,615.00 | $38.86–$2,909.00 | — | 20% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Upper GI endoscopy incl. esophagus stomach the duodenum/jejunum w/ biopsy sin | $759.20 | $949.00 | $34.73–$1,049.00 | 49% below | 20% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Upper GI endoscopy incl. esophagus stomach the duodenum/jejunum w/ biopsy sin | $759.20 | $949.00 | $34.73–$1,049.00 | — | 20% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 Esophagogastroduodenoscopy w/ Submucosal Injection | $640.80 | $801.00 | $58.45–$1,878.00 | 54% below | 20% |
| Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 Esophagogastroduodenoscopy w/ Submucosal Injection | $640.80 | $801.00 | $58.45–$1,878.00 | — | 20% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Upper GI Endoscopy Including Esophagus, Stomach,Duodenum And/Or Jejunum; With Re | $853.60 | $1,067.00 | $50.49–$1,375.00 | 49% below | 20% |
| Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 Upper GI Endoscopy Including Esophagus, Stomach,Duodenum And/Or Jejunum; With Re | $853.60 | $1,067.00 | $50.49–$1,375.00 | — | 20% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Esophagogastroduodenoscopy w/ Insertion guide wire | $796.00 | $995.00 | $42.38–$1,155.00 | 47% below | 20% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 Esophagogastroduodenoscopy w/ Insertion guide wire | $796.00 | $995.00 | $42.38–$1,155.00 | — | 20% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Esophagogastroduodenoscopy Charge | $587.20 | $734.00 | $37.64–$1,006.00 | 63% below | 20% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Esophagogastroduodenoscopy Charge | $587.20 | $734.00 | $37.64–$1,006.00 | — | 20% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 Cystourethroscopy, With Ureteroscopy And/Or Pyeloscopy; With Lithotripsy | $989.60 | $1,237.00 | $100.37–$1,856.00 | 11% below | 20% |
| Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 Cystourethroscopy, With Ureteroscopy And/Or Pyeloscopy; With Lithotripsy | $989.60 | $1,237.00 | $100.37–$1,856.00 | — | 20% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 Lithotripsy w/ insert JJ stent | $1,520.00 | $1,900.00 | $105.72–$1,971.00 | at median | 20% |
| Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 Lithotripsy w/ insert JJ stent | $1,520.00 | $1,900.00 | $105.72–$1,971.00 | — | 20% |
| Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 Vasectomy, Unilateral or Bilateral (Separate Procedure), w/Postoperative Semen E | $660.00 | $825.00 | $60.89–$1,182.00 | — | 20% |
| Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 Vasectomy, Unilateral or Bilateral (Separate Procedure), w/Postoperative Semen E | $660.00 | $825.00 | $60.89–$1,182.00 | — | 20% |
| Wart removal, up to 14 warts CPT 17110 Destruction (eg, laser/electro/cryo/chemosurgery/curettement), of warts; up to 1 | $243.20 | $304.00 | $11.02–$478.46 | 3% below | 20% |
| Wart removal, up to 14 warts inpatient CPT 17110 Destruction (eg, laser/electro/cryo/chemosurgery/curettement), of warts; up to 1 | $243.20 | $304.00 | $11.02–$478.46 | — | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Skin/Soft Tissue Charge | $244.00 | $305.00 | $14.69–$478.46 | 50% below | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debridement subcutaneous tissue first 20 cm or less | $360.00 | $450.00 | $68.85–$450.00 | 26% below | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride Skin/Soft Tissue Charge | $244.00 | $305.00 | $14.69–$478.46 | — | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 Debridement subcutaneous tissue first 20 cm or less | $360.00 | $450.00 | $68.85–$450.00 | — | 20% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 Treat fracture rad extra-articul | $3,488.80 | $4,361.00 | $234.09–$4,361.00 | at median | 20% |
| Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 Treat fracture rad extra-articul | $3,488.80 | $4,361.00 | $234.09–$4,361.00 | — | 20% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Oregon | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Blood transfusion X1 | $342.40 | $428.00 | $65.48–$428.00 | 58% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 36430 BLOOD TRANFSN <2 HR | $524.80 | $656.00 | $100.37–$656.00 | 36% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 ED Blood transf <2 hrs | $564.00 | $705.00 | $107.87–$705.00 | 32% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 ICU Blood Transfusion <2 Hours | $703.20 | $879.00 | $134.49–$879.00 | 15% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion <2 Hours | $703.20 | $879.00 | $134.49–$879.00 | 15% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 36430 BLOOD TRANFSN 2-4 HRS | $707.20 | $884.00 | $135.25–$884.00 | 14% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 ED Blood trans 2-4 hrs | $761.60 | $952.00 | $145.66–$952.00 | 8% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 36430 BLOOD TRANFSN 4-6 HRS | $895.20 | $1,119.00 | $171.21–$1,119.00 | 9% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 ICU Blood Transfusion 2-4 Hours | $951.20 | $1,189.00 | $181.92–$1,189.00 | 15% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 2-4 Hours | $951.20 | $1,189.00 | $181.92–$1,189.00 | 15% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 ED Blood transf 4-6 hrs | $962.40 | $1,203.00 | $184.06–$1,203.00 | 17% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 36430 BLOOD TRANFSN >6 HRS | $1,078.40 | $1,348.00 | $206.24–$1,348.00 | 31% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 ED Blood Trans >6 hrs | $1,159.20 | $1,449.00 | $221.70–$1,449.00 | 41% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 ICU Blood Transfusion 4-6 Hours | $1,199.20 | $1,499.00 | $229.35–$1,499.00 | 45% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 4-6 Hours | $1,199.20 | $1,499.00 | $229.35–$1,499.00 | 45% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >6 Hours | $1,448.00 | $1,810.00 | $276.93–$1,810.00 | 76% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 ICU Blood Transfusion >6 Hours | $1,448.00 | $1,810.00 | $276.93–$1,810.00 | 76% above | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood transfusion X1 | $342.40 | $428.00 | $65.48–$428.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 BLOOD TRANFSN <2 HR | $524.80 | $656.00 | $100.37–$656.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED Blood transf <2 hrs | $564.00 | $705.00 | $107.87–$705.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 ICU Blood Transfusion <2 Hours | $703.20 | $879.00 | $134.49–$879.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion <2 Hours | $703.20 | $879.00 | $134.49–$879.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 BLOOD TRANFSN 2-4 HRS | $707.20 | $884.00 | $135.25–$884.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED Blood trans 2-4 hrs | $761.60 | $952.00 | $145.66–$952.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 BLOOD TRANFSN 4-6 HRS | $895.20 | $1,119.00 | $171.21–$1,119.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 ICU Blood Transfusion 2-4 Hours | $951.20 | $1,189.00 | $181.92–$1,189.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion 2-4 Hours | $951.20 | $1,189.00 | $181.92–$1,189.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED Blood transf 4-6 hrs | $962.40 | $1,203.00 | $184.06–$1,203.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 BLOOD TRANFSN >6 HRS | $1,078.40 | $1,348.00 | $206.24–$1,348.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED Blood Trans >6 hrs | $1,159.20 | $1,449.00 | $221.70–$1,449.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 ICU Blood Transfusion 4-6 Hours | $1,199.20 | $1,499.00 | $229.35–$1,499.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion 4-6 Hours | $1,199.20 | $1,499.00 | $229.35–$1,499.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >6 Hours | $1,448.00 | $1,810.00 | $276.93–$1,810.00 | — | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 ICU Blood Transfusion >6 Hours | $1,448.00 | $1,810.00 | $276.93–$1,810.00 | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Nonpressurized inhalation treatment acute airway obstr | $39.20 | $49.00 | $4.86–$478.46 | 70% below | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 MDI ADMINISTRATION | $300.00 | $375.00 | $57.38–$375.00 | 132% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 SPUTUM INDUCTION SUBSEQUENT | $300.00 | $375.00 | $57.38–$375.00 | 132% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 MINI-NEB TREATMENT INIT | $300.00 | $375.00 | $57.38–$375.00 | 132% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 MINI NEB TREATMENT SUBSEQ | $300.00 | $375.00 | $57.38–$375.00 | 132% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Aero Large Volume, Cool Charge | $300.00 | $375.00 | $57.38–$375.00 | 132% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Aero Large Volume, Heated Charge | $300.00 | $375.00 | $57.38–$375.00 | 132% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 SPUTUM INDUCTION INITIAL | $300.00 | $375.00 | $57.38–$375.00 | 132% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 Nonpressurized inhalation treatment acute airway obstr | $39.20 | $49.00 | $4.86–$478.46 | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 MDI ADMINISTRATION | $300.00 | $375.00 | $57.38–$375.00 | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 SPUTUM INDUCTION SUBSEQUENT | $300.00 | $375.00 | $57.38–$375.00 | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 MINI-NEB TREATMENT INIT | $300.00 | $375.00 | $57.38–$375.00 | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 MINI NEB TREATMENT SUBSEQ | $300.00 | $375.00 | $57.38–$375.00 | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Aero Large Volume, Cool Charge | $300.00 | $375.00 | $57.38–$375.00 | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Aero Large Volume, Heated Charge | $300.00 | $375.00 | $57.38–$375.00 | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 SPUTUM INDUCTION INITIAL | $300.00 | $375.00 | $57.38–$375.00 | — | 20% |
| Chemotherapy IV infusion, first hour CPT 96413 96413 Chemo Infusion Initial/Single up to 1 hour | $841.60 | $1,052.00 | $160.96–$1,052.00 | 10% above | 20% |
| Chemotherapy IV infusion, first hour CPT 96413 96413 CHEMO INFUSE ONLY INIT HR | $841.60 | $1,052.00 | $160.96–$1,052.00 | 10% above | 20% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 96413 Chemo Infusion Initial/Single up to 1 hour | $841.60 | $1,052.00 | $160.96–$1,052.00 | — | 20% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 96413 CHEMO INFUSE ONLY INIT HR | $841.60 | $1,052.00 | $160.96–$1,052.00 | — | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 99291 - Critical Care | $4,123.20 | $5,154.00 | $788.56–$5,154.00 | 62% above | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 30 Minutes Critical Care | $4,123.20 | $5,154.00 | $788.56–$5,154.00 | 62% above | 20% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 - Critical Care | $4,123.20 | $5,154.00 | $788.56–$5,154.00 | — | 20% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 30 Minutes Critical Care | $4,123.20 | $5,154.00 | $788.56–$5,154.00 | — | 20% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 95816 EEG including recording awake and drowsy | $1,060.00 | $1,325.00 | $202.73–$1,325.00 | 19% above | 20% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 95816 EEG including recording awake and drowsy | $1,060.00 | $1,325.00 | $202.73–$1,325.00 | — | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG 12 Lead Tracing Only | $328.00 | $410.00 | $62.73–$410.00 | 39% above | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG 12-Lead Acquisition | $328.00 | $410.00 | $62.73–$410.00 | 39% above | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG 12-Lead Acquisition | $328.00 | $410.00 | $62.73–$410.00 | — | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG 12 Lead Tracing Only | $328.00 | $410.00 | $62.73–$410.00 | — | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER Visit Level 1 Triage Only | $131.20 | $164.00 | $25.09–$164.00 | 19% below | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 - Level 1 | $357.60 | $447.00 | $68.39–$447.00 | 120% above | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER Visit Level 1 | $357.60 | $447.00 | $68.39–$447.00 | 120% above | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER Visit Level 1 Triage Only | $131.20 | $164.00 | $25.09–$164.00 | — | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 - Level 1 | $357.60 | $447.00 | $68.39–$447.00 | — | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER Visit Level 1 | $357.60 | $447.00 | $68.39–$447.00 | — | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 - Level 2 | $639.20 | $799.00 | $122.25–$799.00 | 41% above | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER Visit Level 2 | $639.20 | $799.00 | $122.25–$799.00 | 41% above | 20% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 - Level 2 | $639.20 | $799.00 | $122.25–$799.00 | — | 20% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER Visit Level 2 | $639.20 | $799.00 | $122.25–$799.00 | — | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 - Level 3 | $1,034.40 | $1,293.00 | $197.83–$1,293.00 | 19% above | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER Visit Level 3 | $1,034.40 | $1,293.00 | $197.83–$1,293.00 | 19% above | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 - Level 3 | $1,034.40 | $1,293.00 | $197.83–$1,293.00 | — | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER Visit Level 3 | $1,034.40 | $1,293.00 | $197.83–$1,293.00 | — | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER Visit Level 4 | $1,637.60 | $2,047.00 | $313.19–$2,047.00 | 42% above | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 - Level 4 | $1,637.60 | $2,047.00 | $313.19–$2,047.00 | 42% above | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 - Level 4 | $1,637.60 | $2,047.00 | $313.19–$2,047.00 | — | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER Visit Level 4 | $1,637.60 | $2,047.00 | $313.19–$2,047.00 | — | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER Visit Level 5 | $2,656.00 | $3,320.00 | $507.96–$3,320.00 | 39% above | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 - Level 5 | $2,656.00 | $3,320.00 | $507.96–$3,320.00 | 39% above | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 - Level 5 | $2,656.00 | $3,320.00 | $507.96–$3,320.00 | — | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER Visit Level 5 | $2,656.00 | $3,320.00 | $507.96–$3,320.00 | — | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Tracing only, without interpretation and report; Cardiovascu | $273.60 | $342.00 | $52.33–$342.00 | 59% below | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiovascular stress test continuous ECG tracing only | $273.60 | $342.00 | $52.33–$342.00 | 59% below | 20% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Tracing only, without interpretation and report; Cardiovascu | $273.60 | $342.00 | $52.33–$342.00 | — | 20% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiovascular stress test continuous ECG tracing only | $273.60 | $342.00 | $52.33–$342.00 | — | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 90847 Family psychotherapy (conjoint psyc w pt) 50 minutes | $32.80 | $41.00 | $6.27–$298.00 | 79% below | 20% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 90847 Family psychotherapy (conjoint psyc w pt) 50 minutes | $32.80 | $41.00 | $6.27–$298.00 | — | 20% |
| Family therapy without the patient, 50 minutes CPT 90846 90846 Family Psychotherapy w/o patient, 50 minutes | $30.40 | $38.00 | $5.81–$275.00 | 80% below | 20% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 90846 Family Psychotherapy w/o patient, 50 minutes | $30.40 | $38.00 | $5.81–$275.00 | — | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Infusion Hydration 31 Min to 1 Hour | $475.20 | $594.00 | $90.88–$594.00 | 21% above | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 IV INFSN HYDRATN 31 MIN TO 1 HR | $475.20 | $594.00 | $90.88–$594.00 | 21% above | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 - Hydration, first hour | $475.20 | $594.00 | $90.88–$594.00 | 21% above | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Infusion Hydration 31 Min to 1 Hour | $475.20 | $594.00 | $90.88–$594.00 | — | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 - Hydration, first hour | $475.20 | $594.00 | $90.88–$594.00 | — | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 IV INFSN HYDRATN 31 MIN TO 1 HR | $475.20 | $594.00 | $90.88–$594.00 | — | 20% |
| IV infusion of a medicine, first hour CPT 96365 ICU Infusion 1st Hour | $500.80 | $626.00 | $95.78–$626.00 | 26% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 96365 - IV tx, first hour | $500.80 | $626.00 | $95.78–$626.00 | 26% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 96365 IV INFSN NON-CHEMO TO 1 HR | $500.80 | $626.00 | $95.78–$626.00 | 26% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 96365 IV INFSN Non-Chemo to 1 Hr | $500.80 | $626.00 | $95.78–$626.00 | 26% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 Infusion Therapy 1st Hour | $500.80 | $626.00 | $95.78–$626.00 | 26% above | 20% |
| IV infusion of a medicine, first hour inpatient CPT 96365 96365 - IV tx, first hour | $500.80 | $626.00 | $95.78–$626.00 | — | 20% |
| IV infusion of a medicine, first hour inpatient CPT 96365 ICU Infusion 1st Hour | $500.80 | $626.00 | $95.78–$626.00 | — | 20% |
| IV infusion of a medicine, first hour inpatient CPT 96365 Infusion Therapy 1st Hour | $500.80 | $626.00 | $95.78–$626.00 | — | 20% |
| IV infusion of a medicine, first hour inpatient CPT 96365 96365 IV INFSN Non-Chemo to 1 Hr | $500.80 | $626.00 | $95.78–$626.00 | — | 20% |
| IV infusion of a medicine, first hour inpatient CPT 96365 96365 IV INFSN NON-CHEMO TO 1 HR | $500.80 | $626.00 | $95.78–$626.00 | — | 20% |
| IV push of a medicine, first drug CPT 96374 IV Push Initial/ SIN Charge | $111.20 | $139.00 | $4.44–$478.46 | 55% below | 20% |
| IV push of a medicine, first drug CPT 96374 96374 INJ IVP THER DX INTRV S/I DRUG | $356.00 | $445.00 | $68.09–$445.00 | 43% above | 20% |
| IV push of a medicine, first drug CPT 96374 96374 Inj IVP Ther Dx INTRV S/I Drug | $356.00 | $445.00 | $68.09–$445.00 | 43% above | 20% |
| IV push of a medicine, first drug CPT 96374 IV Push Ther/DX/Intrv Single/Init Drug | $356.00 | $445.00 | $68.09–$445.00 | 43% above | 20% |
| IV push of a medicine, first drug CPT 96374 ICU IV Push Ther/DX/Intrv Single/Init Drug | $356.00 | $445.00 | $68.09–$445.00 | 43% above | 20% |
| IV push of a medicine, first drug CPT 96374 96374 - IV Injection, single/initial | $356.00 | $445.00 | $68.09–$445.00 | 43% above | 20% |
| IV push of a medicine, first drug inpatient CPT 96374 IV Push Initial/ SIN Charge | $111.20 | $139.00 | $4.44–$478.46 | — | 20% |
| IV push of a medicine, first drug inpatient CPT 96374 ICU IV Push Ther/DX/Intrv Single/Init Drug | $356.00 | $445.00 | $68.09–$445.00 | — | 20% |
| IV push of a medicine, first drug inpatient CPT 96374 96374 - IV Injection, single/initial | $356.00 | $445.00 | $68.09–$445.00 | — | 20% |
| IV push of a medicine, first drug inpatient CPT 96374 96374 INJ IVP THER DX INTRV S/I DRUG | $356.00 | $445.00 | $68.09–$445.00 | — | 20% |
| IV push of a medicine, first drug inpatient CPT 96374 96374 Inj IVP Ther Dx INTRV S/I Drug | $356.00 | $445.00 | $68.09–$445.00 | — | 20% |
| IV push of a medicine, first drug inpatient CPT 96374 IV Push Ther/DX/Intrv Single/Init Drug | $356.00 | $445.00 | $68.09–$445.00 | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic, prophylactic, or diagnosite injection | $55.20 | $69.00 | $10.56–$478.46 | 42% below | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic, prophylactic, or diagnostic injection, subcutaneous or intra | $55.20 | $69.00 | $10.56–$478.46 | 42% below | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic, prophylactic, or diagnostic injection, subcutan | $55.20 | $69.00 | $10.56–$478.46 | 42% below | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic Injection | $55.20 | $69.00 | $10.56–$478.46 | 42% below | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 - Subq/IM Injection | $121.60 | $152.00 | $23.26–$152.00 | 27% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 MS Injection Subsequent | $121.60 | $152.00 | $23.26–$152.00 | 27% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 INJECT THER DX SUBCU OR IM | $121.60 | $152.00 | $23.26–$152.00 | 27% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Inject Ther Dx SubQ or IM | $121.60 | $152.00 | $23.26–$152.00 | 27% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Therapeutic Injection | $55.20 | $69.00 | $10.56–$478.46 | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapeutic, prophylactic, or diagnostic injection, subcutan | $55.20 | $69.00 | $10.56–$478.46 | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Therapeutic, prophylactic, or diagnosite injection | $55.20 | $69.00 | $10.56–$478.46 | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Therapeutic, prophylactic, or diagnostic injection, subcutaneous or intra | $55.20 | $69.00 | $10.56–$478.46 | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 INJECT THER DX SUBCU OR IM | $121.60 | $152.00 | $23.26–$152.00 | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 MS Injection Subsequent | $121.60 | $152.00 | $23.26–$152.00 | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Inject Ther Dx SubQ or IM | $121.60 | $152.00 | $23.26–$152.00 | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 - Subq/IM Injection | $121.60 | $152.00 | $23.26–$152.00 | — | 20% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 Psychiatric Diagnostic Evaluation | $366.40 | $458.00 | $16.22–$458.00 | 28% above | 20% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 ED Psychiatric Diagnostic Eval CMH | $366.40 | $458.00 | $70.07–$458.00 | 28% above | 20% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 90791 ED Psychiatric Diagnostic Eval CMH | $366.40 | $458.00 | $70.07–$458.00 | — | 20% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 90791 Psychiatric Diagnostic Evaluation | $366.40 | $458.00 | $16.22–$458.00 | — | 20% |
| New patient office visit, about 30 minutes CPT 99203 Office/OP New Visit Level 3 99203 | $141.60 | $177.00 | $24.48–$478.46 | 31% below | 20% |
| New patient office visit, about 30 minutes CPT 99203 99203 LACTATION INITIAL DETAILED CHARGE | $179.20 | $224.00 | $34.27–$224.00 | 12% below | 20% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office/OP New Visit Level 3 99203 | $141.60 | $177.00 | $24.48–$478.46 | — | 20% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 LACTATION INITIAL DETAILED CHARGE | $179.20 | $224.00 | $34.27–$224.00 | — | 20% |
| New patient office visit, about 45 minutes CPT 99204 Office/OP New Visit Level 4 99204 | $186.40 | $233.00 | $35.65–$480.00 | 36% below | 20% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office/OP New Visit Level 4 99204 | $186.40 | $233.00 | $35.65–$480.00 | — | 20% |
| New patient office visit, about 60 minutes CPT 99205 Office/OP New Visit Level 5 99205 | $228.00 | $285.00 | $43.61–$600.00 | 34% below | 20% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office/OP New Visit Level 5 99205 | $228.00 | $285.00 | $43.61–$600.00 | — | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office/OP New Visit Level 2 99202 | $108.00 | $135.00 | $15.61–$478.46 | 20% below | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 LACTATION CONSULT INITIAL CHARGE | $115.20 | $144.00 | $22.03–$144.00 | 14% below | 20% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office/OP New Visit Level 2 99202 | $108.00 | $135.00 | $15.61–$478.46 | — | 20% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 LACTATION CONSULT INITIAL CHARGE | $115.20 | $144.00 | $22.03–$144.00 | — | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 97802 MNT INITIAL INDIV EA 15 MIN | $71.20 | $89.00 | $13.62–$89.00 | 2% above | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 97802 MNT INITIAL INDIV EA 15 MIN | $71.20 | $89.00 | $13.62–$89.00 | — | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 99385 Initial Preventive care, new pt, 18-39yr | $134.40 | $168.00 | $24.94–$478.46 | 3% below | 20% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 99385 Initial Preventive care, new pt, 18-39yr | $134.40 | $168.00 | $24.94–$478.46 | — | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Preventive Medicine 40-64 years New - 99386 | $147.20 | $184.00 | $28.15–$478.46 | 29% below | 20% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Preventive Medicine 40-64 years New - 99386 | $147.20 | $184.00 | $28.15–$478.46 | — | 20% |
| Preventive checkup, new patient aged 65 or older CPT 99387 Preventive Medicine 65+ years New - 99387 | $161.60 | $202.00 | $30.91–$478.46 | 28% below | 20% |
| Preventive checkup, new patient aged 65 or older inpatient CPT 99387 Preventive Medicine 65+ years New - 99387 | $161.60 | $202.00 | $30.91–$478.46 | — | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 Preventive Medicine 18-39 years Established - 99395 | $120.00 | $150.00 | $22.80–$478.46 | at median | 20% |
| Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 Preventive Medicine 18-39 years Established - 99395 | $120.00 | $150.00 | $22.80–$478.46 | — | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 Preventive Medicine 40-64 years Established - 99396 | $124.80 | $156.00 | $23.87–$478.46 | 28% below | 20% |
| Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 Preventive Medicine 40-64 years Established - 99396 | $124.80 | $156.00 | $23.87–$478.46 | — | 20% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 Preventive Medicine 65+ years Established - 99397 | $138.40 | $173.00 | $26.01–$478.46 | 26% below | 20% |
| Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 Preventive Medicine 65+ years Established - 99397 | $138.40 | $173.00 | $26.01–$478.46 | — | 20% |
| Psychiatric evaluation with medical services CPT 90792 90792 Psych Diag Eval w/ Med Services | $129.60 | $162.00 | $24.79–$570.00 | 49% below | 20% |
| Psychiatric evaluation with medical services inpatient CPT 90792 90792 Psych Diag Eval w/ Med Services | $129.60 | $162.00 | $24.79–$570.00 | — | 20% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 90839 Psychotherapy for crisis; first 60 minutes | $64.00 | $80.00 | $12.24–$317.00 | 79% below | 20% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 90839 Psychotherapy for crisis; first 60 minutes | $64.00 | $80.00 | $12.24–$317.00 | — | 20% |
| Psychotherapy session, 30 minutes CPT 90832 90832 Psychotherapy, 30 minutes | $39.20 | $49.00 | $7.50–$205.00 | 67% below | 20% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 90832 Psychotherapy, 30 minutes | $39.20 | $49.00 | $7.50–$205.00 | — | 20% |
| Psychotherapy session, 45 minutes CPT 90834 90834 Psychotherapy, 45 minutes | $44.80 | $56.00 | $8.57–$236.00 | 75% below | 20% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 90834 Psychotherapy, 45 minutes | $44.80 | $56.00 | $8.57–$236.00 | — | 20% |
| Psychotherapy session, 60 minutes CPT 90837 90837 Psychotherapy, 60 minutes | $61.60 | $77.00 | $11.78–$322.00 | 73% below | 20% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 90837 Psychotherapy, 60 minutes | $61.60 | $77.00 | $11.78–$322.00 | — | 20% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking and tobacco-use cessation visit >3 min up to 10 min | $19.20 | $24.00 | $3.67–$478.46 | 43% below | 20% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 99406 TOBACCO CESSATION COUNSELING 3-10 MIN | $20.80 | $26.00 | $3.98–$26.00 | 38% below | 20% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 99406 TOBACCO CESSATION COUNSEL 3 TO 10 MIN | $20.80 | $26.00 | $3.98–$26.00 | 38% below | 20% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Smoking and tobacco-use cessation visit >3 min up to 10 min | $19.20 | $24.00 | $3.67–$478.46 | — | 20% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 99406 TOBACCO CESSATION COUNSEL 3 TO 10 MIN | $20.80 | $26.00 | $3.98–$26.00 | — | 20% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 99406 TOBACCO CESSATION COUNSELING 3-10 MIN | $20.80 | $26.00 | $3.98–$26.00 | — | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office/OP Established Visit Level 5 99215 | $189.60 | $237.00 | $36.26–$489.00 | 44% below | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 EST PT VISIT LEVEL 5 | $279.20 | $349.00 | $53.40–$349.00 | 17% below | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PT IV THPY VST LVL 5 | $279.20 | $349.00 | $53.40–$349.00 | 17% below | 20% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office/OP Established Visit Level 5 99215 | $189.60 | $237.00 | $36.26–$489.00 | — | 20% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 EST PT VISIT LEVEL 5 | $279.20 | $349.00 | $53.40–$349.00 | — | 20% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PT IV THPY VST LVL 5 | $279.20 | $349.00 | $53.40–$349.00 | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OB Check Level 1 | $88.00 | $110.00 | $16.83–$110.00 | 53% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office/Outpatient Visit Level 3 Established - 99213 | $108.80 | $136.00 | $18.67–$478.46 | 42% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 NEWBORN FOLLOW-UP VISIT CHARGE | $109.60 | $137.00 | $20.96–$137.00 | 42% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 STERILE SPEC EXAM | $115.20 | $144.00 | $22.03–$144.00 | 39% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT IV THPY VST LVL 3 | $128.80 | $161.00 | $24.63–$161.00 | 32% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 EST PT VISIT LEVEL 3 | $128.80 | $161.00 | $24.63–$161.00 | 32% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OB Check Level 1 | $88.00 | $110.00 | $16.83–$110.00 | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office/Outpatient Visit Level 3 Established - 99213 | $108.80 | $136.00 | $18.67–$478.46 | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 NEWBORN FOLLOW-UP VISIT CHARGE | $109.60 | $137.00 | $20.96–$137.00 | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 STERILE SPEC EXAM | $115.20 | $144.00 | $22.03–$144.00 | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 EST PT VISIT LEVEL 3 | $128.80 | $161.00 | $24.63–$161.00 | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PT IV THPY VST LVL 3 | $128.80 | $161.00 | $24.63–$161.00 | — | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 OB Check Level 2 | $136.00 | $170.00 | $26.01–$170.00 | 44% below | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office/OP Established Visit Level 4 99214 | $148.00 | $185.00 | $27.85–$478.46 | 39% below | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PT IV THPY VST LVL 4 | $198.40 | $248.00 | $37.94–$248.00 | 19% below | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 EST PT VISIT LEVEL 4 | $198.40 | $248.00 | $37.94–$248.00 | 19% below | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 OB Check Level 2 | $136.00 | $170.00 | $26.01–$170.00 | — | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office/OP Established Visit Level 4 99214 | $148.00 | $185.00 | $27.85–$478.46 | — | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PT IV THPY VST LVL 4 | $198.40 | $248.00 | $37.94–$248.00 | — | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 EST PT VISIT LEVEL 4 | $198.40 | $248.00 | $37.94–$248.00 | — | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 LACTATION CONSULT FOLLOW-UP CHARGE | $56.80 | $71.00 | $10.86–$71.00 | 43% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT IV THPY VST LVL 2 | $63.20 | $79.00 | $12.09–$79.00 | 37% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 EST PT VISIT LEVEL 2 | $63.20 | $79.00 | $12.09–$79.00 | 37% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office/OP Established Visit Level 2 99212 | $73.60 | $92.00 | $9.95–$478.46 | 27% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 LACTATION CONSULT FOLLOW-UP CHARGE | $56.80 | $71.00 | $10.86–$71.00 | — | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PT IV THPY VST LVL 2 | $63.20 | $79.00 | $12.09–$79.00 | — | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 EST PT VISIT LEVEL 2 | $63.20 | $79.00 | $12.09–$79.00 | — | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office/OP Established Visit Level 2 99212 | $73.60 | $92.00 | $9.95–$478.46 | — | 20% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 Office Consultation Level 3 - 99243 | $210.40 | $263.00 | $24.17–$478.46 | 51% below | 20% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office Consultation Level 3 - 99243 | $210.40 | $263.00 | $24.17–$478.46 | — | 20% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office Consultation Level 4 - 99244 | $160.80 | $201.00 | $30.75–$478.46 | 73% below | 20% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Consultation Level 4 - 99244 | $160.80 | $201.00 | $30.75–$478.46 | — | 20% |
| Spirometry (breathing test) CPT 94010 PFT Occ Med | $145.60 | $182.00 | $27.85–$182.00 | 35% below | 20% |
| Spirometry (breathing test) CPT 94010 94010 SPIROMETRY INCL GRAPHIC REC | $427.20 | $534.00 | $81.70–$534.00 | 91% above | 20% |
| Spirometry (breathing test) inpatient CPT 94010 PFT Occ Med | $145.60 | $182.00 | $27.85–$182.00 | — | 20% |
| Spirometry (breathing test) inpatient CPT 94010 94010 SPIROMETRY INCL GRAPHIC REC | $427.20 | $534.00 | $81.70–$534.00 | — | 20% |
| Spirometry before and after a bronchodilator CPT 94060 94060 BRONCHOSPASM EVAL SPIROMETRY | $740.00 | $925.00 | $141.53–$925.00 | 81% above | 20% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 94060 BRONCHOSPASM EVAL SPIROMETRY | $740.00 | $925.00 | $141.53–$925.00 | — | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 99195 Therapeutic Phlebotomy | $313.60 | $392.00 | $59.98–$392.00 | 57% above | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 99195 THERAPEUTIC PHLEBOTOMY | $313.60 | $392.00 | $59.98–$392.00 | 57% above | 20% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 99195 THERAPEUTIC PHLEBOTOMY | $313.60 | $392.00 | $59.98–$392.00 | — | 20% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 99195 Therapeutic Phlebotomy | $313.60 | $392.00 | $59.98–$392.00 | — | 20% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Oregon | Off list |
|---|---|---|---|---|---|
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 91322 Moderna COVID-19 Vaccine 50mcg/0.5mL prefilled 12y+ | $140.00 | $175.00 | $26.78–$175.00 | 36% below | 20% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SARS-CoV-2 (COVID-19) mRNA-LNP vaccine (cvx 312) preservative-free 50 mcg/0.5 mL Sus | $689.08 | $861.35 | $125.65–$821.25 | 215% above | 20% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 91322 Moderna COVID-19 Vaccine 50mcg/0.5mL prefilled 12y+ | $140.00 | $175.00 | $26.78–$175.00 | — | 20% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SARS-CoV-2 (COVID-19) mRNA-LNP vaccine (cvx 312) preservative-free 50 mcg/0.5 mL Sus | $689.08 | $861.35 | $125.65–$821.25 | — | 20% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella Virus Vaccine POC | $157.60 | $197.00 | $30.14–$197.00 | 41% below | 20% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 varicella virus vaccine - Pow | $1,413.96 | $1,767.45 | $246.38–$1,610.35 | 428% above | 20% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varicella Virus Vaccine POC | $157.60 | $197.00 | $30.14–$197.00 | — | 20% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 varicella virus vaccine - Pow | $1,413.96 | $1,767.45 | $246.38–$1,610.35 | — | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, | $113.60 | $142.00 | $21.73–$142.00 | 55% above | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 diphtheria/pertussis,acel/tetanus/polio - Sus | $561.84 | $702.30 | $102.44–$669.55 | 665% above | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 diphtheria/hepB/pertussis,acel/polio/tetanus - Sus [CMH] | $567.04 | $708.80 | $103.11–$673.90 | 672% above | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, | $113.60 | $142.00 | $21.73–$142.00 | — | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 diphtheria/pertussis,acel/tetanus/polio - Sus | $561.84 | $702.30 | $102.44–$669.55 | — | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 diphtheria/hepB/pertussis,acel/polio/tetanus - Sus [CMH] | $567.04 | $708.80 | $103.11–$673.90 | — | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTaP Diphtheria/Pertussis, acellular/Tetanus Vaccine DTaP Under 7 yrs POC | $37.60 | $47.00 | $7.19–$47.00 | 43% below | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 diphtheria/tetanus/pertussis (DTaP) ped 15 units-5 units-23 mcg/0.5 mL Sus | $215.48 | $269.35 | $39.10–$255.55 | 225% above | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTaP Diphtheria/Pertussis, acellular/Tetanus Vaccine DTaP Under 7 yrs POC | $37.60 | $47.00 | $7.19–$47.00 | — | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 diphtheria/tetanus/pertussis (DTaP) ped 15 units-5 units-23 mcg/0.5 mL Sus | $215.48 | $269.35 | $39.10–$255.55 | — | 20% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 Diphth/HepB/Pertussis,Acel/Polio/Tetanus Vaccine POC | $116.80 | $146.00 | $22.34–$146.00 | 13% above | 20% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 Diphth/HepB/Pertussis,Acel/Polio/Tetanus Vaccine POC | $116.80 | $146.00 | $22.34–$146.00 | — | 20% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTaP-Hib-IPV Vaccine IM | $114.40 | $143.00 | $21.88–$143.00 | 17% below | 20% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 diphth/haemophilus/pertussis/tetanus/polio - Kit | $496.36 | $620.45 | $90.50–$591.50 | 260% above | 20% |
| DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTaP-Hib-IPV Vaccine IM | $114.40 | $143.00 | $21.88–$143.00 | — | 20% |
| DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 diphth/haemophilus/pertussis/tetanus/polio - Kit | $496.36 | $620.45 | $90.50–$591.50 | — | 20% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 Vaxelis Single Dose Pre-Filled Syringe | $120.00 | $150.00 | $22.95–$150.00 | 8% above | 20% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 Vaxelis Single Dose Vial | $120.00 | $150.00 | $22.95–$150.00 | 8% above | 20% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 diphtheria/haem/hepB/pert,acel/polio/tetan - Sus | $642.36 | $802.95 | $117.13–$765.55 | 479% above | 20% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 Vaxelis Single Dose Vial | $120.00 | $150.00 | $22.95–$150.00 | — | 20% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 Vaxelis Single Dose Pre-Filled Syringe | $120.00 | $150.00 | $22.95–$150.00 | — | 20% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 diphtheria/haem/hepB/pert,acel/polio/tetan - Sus | $642.36 | $802.95 | $117.13–$765.55 | — | 20% |
| Flu shot, recombinant, egg-free (Flublok) CPT 90673 90673 Flublok Trivalent Influenza Egg Free Vaccine | $56.00 | $70.00 | $10.71–$70.00 | 41% below | 20% |
| Flu shot, recombinant, egg-free (Flublok) CPT 90673 influenza virus vaccine, inactivated recombinant hemagglutinin trivalent preservative-free Sol | $358.44 | $448.05 | $65.17–$425.95 | 275% above | 20% |
| Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 90673 Flublok Trivalent Influenza Egg Free Vaccine | $56.00 | $70.00 | $10.71–$70.00 | — | 20% |
| Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 influenza virus vaccine, inactivated recombinant hemagglutinin trivalent preservative-free Sol | $358.44 | $448.05 | $65.17–$425.95 | — | 20% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90656 Fluarix Trivalent Preservative Free Vaccine | $33.60 | $42.00 | $6.43–$42.00 | 10% below | 20% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine, inactivated preservative-free trivalent Sus | $192.12 | $240.15 | $34.85–$227.75 | 416% above | 20% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 90656 Fluarix Trivalent Preservative Free Vaccine | $33.60 | $42.00 | $6.43–$42.00 | — | 20% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine, inactivated preservative-free trivalent Sus | $192.12 | $240.15 | $34.85–$227.75 | — | 20% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Human Papilloma virus (HPV) Vaccine POC | $254.40 | $318.00 | $48.65–$318.00 | 22% below | 20% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 human papillomavirus vaccine 9-valent Sus | $1,124.32 | $1,405.40 | $205.53–$1,343.35 | 247% above | 20% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Human Papilloma virus (HPV) Vaccine POC | $254.40 | $318.00 | $48.65–$318.00 | — | 20% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 human papillomavirus vaccine 9-valent Sus | $1,124.32 | $1,405.40 | $205.53–$1,343.35 | — | 20% |
| Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A vaccine, adult dosage, for intramuscular use | $130.40 | $163.00 | $24.94–$163.00 | 30% above | 20% |
| Hepatitis A vaccine, adult dose CPT 90632 hepatitis A adult vaccine 1440 units/mL PF IM Susp [CMH] | $499.64 | $624.55 | $90.84–$593.75 | 398% above | 20% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis A vaccine, adult dosage, for intramuscular use | $130.40 | $163.00 | $24.94–$163.00 | — | 20% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A adult vaccine 1440 units/mL PF IM Susp [CMH] | $499.64 | $624.55 | $90.84–$593.75 | — | 20% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Hepatitis A Peds/Adol Vaccine 2 Dose Sched Charge | $56.00 | $70.00 | $10.71–$70.00 | at median | 20% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Hepatitis A Peds/Adol Vaccine 2 Dose Sched Charge | $56.00 | $70.00 | $10.71–$70.00 | — | 20% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 90746 Hep B Vaccine | $170.40 | $213.00 | $32.59–$426.00 | 62% above | 20% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B adult vaccine 20 mcg/mL Sus | $407.40 | $509.25 | $71.27–$484.10 | 286% above | 20% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 90746 Hep B Vaccine | $170.40 | $213.00 | $32.59–$426.00 | — | 20% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B adult vaccine 20 mcg/mL Sus | $407.40 | $509.25 | $71.27–$484.10 | — | 20% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 hepatitis B adult vaccine 20 mcg/0.5 mL Sol | $561.68 | $702.10 | $102.41–$669.35 | 224% above | 20% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 hepatitis B adult vaccine 20 mcg/0.5 mL Sol | $561.68 | $702.10 | $102.41–$669.35 | — | 20% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis B Vaccine, Pediatric 3 Dose Sched POC | $20.00 | $25.00 | $3.83–$65.00 | 71% below | 20% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus | $214.12 | $267.65 | $38.85–$253.95 | 211% above | 20% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hepatitis B Vaccine, Pediatric 3 Dose Sched POC | $20.00 | $25.00 | $3.83–$65.00 | — | 20% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus | $214.12 | $267.65 | $38.85–$253.95 | — | 20% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for IM | $42.40 | $53.00 | $8.11–$53.00 | 2% above | 20% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 haemophilus b conjugate (PRP-T) vaccine - Pow | $123.12 | $153.90 | $22.32–$145.90 | 198% above | 20% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for IM | $42.40 | $53.00 | $8.11–$53.00 | — | 20% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 haemophilus b conjugate (PRP-T) vaccine - Pow | $123.12 | $153.90 | $22.32–$145.90 | — | 20% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 90662 Fluzone Trivalent High Dose Influenza Vaccine 65yrs+ | $56.00 | $70.00 | $10.71–$70.00 | 22% below | 20% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 influenza virus vaccine, inactivated high-dose preservative-free trivalent Sus | $361.44 | $451.80 | $65.71–$429.50 | 404% above | 20% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 90662 Fluzone Trivalent High Dose Influenza Vaccine 65yrs+ | $56.00 | $70.00 | $10.71–$70.00 | — | 20% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 influenza virus vaccine, inactivated high-dose preservative-free trivalent Sus | $361.44 | $451.80 | $65.71–$429.50 | — | 20% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR Measles/Mumps/Rubella Virus Vaccine POC | $76.00 | $95.00 | $14.54–$95.00 | 60% below | 20% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 measles/mumps/rubella virus vaccine SubQ Inj [CMH] | $538.44 | $673.05 | $95.20–$622.25 | 183% above | 20% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR Measles/Mumps/Rubella Virus Vaccine POC | $76.00 | $95.00 | $14.54–$95.00 | — | 20% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles/mumps/rubella virus vaccine SubQ Inj [CMH] | $538.44 | $673.05 | $95.20–$622.25 | — | 20% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous us | $232.80 | $291.00 | $44.52–$291.00 | 31% below | 20% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 measles/mumps/rubella/varicella virus vaccine - Pow UD [CMH] | $2,076.16 | $2,595.20 | $365.27–$2,387.40 | 515% above | 20% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous us | $232.80 | $291.00 | $44.52–$291.00 | — | 20% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 measles/mumps/rubella/varicella virus vaccine - Pow UD [CMH] | $2,076.16 | $2,595.20 | $365.27–$2,387.40 | — | 20% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal conjugate vaccine, serogroups A, C, Y and W-13 | $57.60 | $72.00 | $11.02–$179.00 | 68% below | 20% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Meningococcal conjugate vaccine, serogroups A, C, Y and W-13 | $57.60 | $72.00 | $11.02–$179.00 | — | 20% |
| Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 90619 MenQuadfi tetanus toxoid | $172.80 | $216.00 | $33.05–$216.00 | 18% below | 20% |
| Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 meningococcal conjugate vaccine polysaccharide tetanus toxoid group ACYW Sol | $683.40 | $854.25 | $82.26–$537.65 | 223% above | 20% |
| Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 90619 MenQuadfi tetanus toxoid | $172.80 | $216.00 | $33.05–$216.00 | — | 20% |
| Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 meningococcal conjugate vaccine polysaccharide tetanus toxoid group ACYW Sol | $683.40 | $854.25 | $82.26–$537.65 | — | 20% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal recombinant protein and outer membrane vesicle | $180.00 | $225.00 | $34.43–$225.00 | 33% below | 20% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal Group B Vaccine (Bexsero) | $180.00 | $225.00 | $34.43–$225.00 | 33% below | 20% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Meningococcal recombinant protein and outer membrane vesicle | $180.00 | $225.00 | $34.43–$225.00 | — | 20% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Meningococcal Group B Vaccine (Bexsero) | $180.00 | $225.00 | $34.43–$225.00 | — | 20% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use | $369.60 | $462.00 | $70.69–$462.00 | 5% above | 20% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 pneumococcal 13-valent conjugate vaccine - Sus | $866.28 | $1,082.85 | $158.36–$1,035.00 | 145% above | 20% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use | $369.60 | $462.00 | $70.69–$462.00 | — | 20% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 pneumococcal 13-valent conjugate vaccine - Sus | $866.28 | $1,082.85 | $158.36–$1,035.00 | — | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 90677 Prevnar-20 PFS 10x0.5 mL | $196.80 | $246.00 | $37.64–$246.00 | 40% below | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate vaccine - Sus | $1,024.80 | $1,281.00 | $173.74–$1,135.55 | 213% above | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 90677 Prevnar-20 PFS 10x0.5 mL | $196.80 | $246.00 | $37.64–$246.00 | — | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conjugate vaccine - Sus | $1,024.80 | $1,281.00 | $173.74–$1,135.55 | — | 20% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 90684 Pneumococcal conjugate vaccine 21 valent | $205.60 | $257.00 | $39.32–$257.00 | 44% below | 20% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 pneumococcal 21-valent conjugate vaccine (cvx 327) - Sus | $873.72 | $1,092.15 | $159.72–$1,043.90 | 137% above | 20% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 90684 Pneumococcal conjugate vaccine 21 valent | $205.60 | $257.00 | $39.32–$257.00 | — | 20% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 pneumococcal 21-valent conjugate vaccine (cvx 327) - Sus | $873.72 | $1,092.15 | $159.72–$1,043.90 | — | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal 23-Valent Adult Vaccine POC | $100.80 | $126.00 | $19.28–$126.00 | 46% below | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 pneumococcal 23-polyvalent vaccine - Sol | $544.24 | $680.30 | $94.43–$617.20 | 192% above | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal 23-Valent Adult Vaccine POC | $100.80 | $126.00 | $19.28–$126.00 | — | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 pneumococcal 23-polyvalent vaccine - Sol | $544.24 | $680.30 | $94.43–$617.20 | — | 20% |
| Polio vaccine, inactivated (IPV) CPT 90713 IPV Inactivated Poliovirus Vaccine POC | $41.60 | $52.00 | $7.96–$52.00 | 56% below | 20% |
| Polio vaccine, inactivated (IPV) inpatient CPT 90713 IPV Inactivated Poliovirus Vaccine POC | $41.60 | $52.00 | $7.96–$52.00 | — | 20% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 90381 Beyfortus RSV Vaccine Pediatric 100mg up to 24 mos | $472.00 | $590.00 | $90.27–$590.00 | 25% below | 20% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 nirsevimab (cvx 307) alip preservative-free 100 mg/mL Sol | $2,101.96 | $2,627.45 | $349.32–$2,283.15 | 233% above | 20% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 90381 Beyfortus RSV Vaccine Pediatric 100mg up to 24 mos | $472.00 | $590.00 | $90.27–$590.00 | — | 20% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 nirsevimab (cvx 307) alip preservative-free 100 mg/mL Sol | $2,101.96 | $2,627.45 | $349.32–$2,283.15 | — | 20% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 90380 Beyfortus RSV Vaccine Pediatric 50mg up to 24 mos | $472.00 | $590.00 | $90.27–$590.00 | 25% below | 20% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 nirsevimab (cvx 306) alip preservative-free 50 mg/0.5 mL Sol | $2,101.96 | $2,627.45 | $346.90–$2,267.30 | 233% above | 20% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 90380 Beyfortus RSV Vaccine Pediatric 50mg up to 24 mos | $472.00 | $590.00 | $90.27–$590.00 | — | 20% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 nirsevimab (cvx 306) alip preservative-free 50 mg/0.5 mL Sol | $2,101.96 | $2,627.45 | $346.90–$2,267.30 | — | 20% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 90678 ABRYSVO RSV vaccine preF subunit bivalent for IM use | $233.60 | $292.00 | $44.68–$292.00 | 58% below | 20% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV vaccine, preF A-preF B, recombinant preservative-free 60 mcg-60 mcg Inj | $1,059.44 | $1,324.30 | $193.67–$1,265.80 | 89% above | 20% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 90678 ABRYSVO RSV vaccine preF subunit bivalent for IM use | $233.60 | $292.00 | $44.68–$292.00 | — | 20% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV vaccine, preF A-preF B, recombinant preservative-free 60 mcg-60 mcg Inj | $1,059.44 | $1,324.30 | $193.67–$1,265.80 | — | 20% |
| Rabies vaccine, one dose CPT 90675 90675 Rabies vaccine for intramuscular use | $278.40 | $348.00 | $53.24–$348.00 | 47% below | 20% |
| Rabies vaccine, one dose CPT 90675 rabies vaccine, purified chick embryo cell 2.5 intl units Pow | $1,100.92 | $1,376.15 | $201.26–$1,315.45 | 109% above | 20% |
| Rabies vaccine, one dose inpatient CPT 90675 90675 Rabies vaccine for intramuscular use | $278.40 | $348.00 | $53.24–$348.00 | — | 20% |
| Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, purified chick embryo cell 2.5 intl units Pow | $1,100.92 | $1,376.15 | $201.26–$1,315.45 | — | 20% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use POC | $113.60 | $142.00 | $21.73–$142.00 | 18% below | 20% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 rotavirus vaccine pentavalent Sus UD [CMH] | $393.44 | $491.80 | $69.36–$453.35 | 183% above | 20% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use POC | $113.60 | $142.00 | $21.73–$142.00 | — | 20% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 rotavirus vaccine pentavalent Sus UD [CMH] | $393.44 | $491.80 | $69.36–$453.35 | — | 20% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 90750 Shingrix | $186.40 | $233.00 | $35.65–$233.00 | 15% below | 20% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 zoster vaccine, inactivated adjuvanted Pow | $841.92 | $1,052.40 | $153.90–$1,005.90 | 283% above | 20% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 90750 Shingrix | $186.40 | $233.00 | $35.65–$233.00 | — | 20% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 zoster vaccine, inactivated adjuvanted Pow | $841.92 | $1,052.40 | $153.90–$1,005.90 | — | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD TOXOIDS ADSORBED PRSRV FR 7 YR>IM | $43.20 | $54.00 | $8.26–$54.00 | 7% below | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diphth toxoids (Td) adult/adol 5 units-2units/0.5 mL Sus | $301.76 | $377.20 | $54.76–$357.90 | 550% above | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD TOXOIDS ADSORBED PRSRV FR 7 YR>IM | $43.20 | $54.00 | $8.26–$54.00 | — | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus-diphth toxoids (Td) adult/adol 5 units-2units/0.5 mL Sus | $301.76 | $377.20 | $54.76–$357.90 | — | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus Injection Charge | $49.60 | $62.00 | $9.49–$62.00 | 32% below | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL Sus | $357.84 | $447.30 | $63.23–$413.25 | 392% above | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tetanus Injection Charge | $49.60 | $62.00 | $9.49–$62.00 | — | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL Sus | $357.84 | $447.30 | $63.23–$413.25 | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 VACCINE ADMIN SINGLE | $59.20 | $74.00 | $11.32–$74.00 | 2% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Administration Single | $59.20 | $74.00 | $11.32–$74.00 | 2% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ER Immunization DIP/TET | $59.20 | $74.00 | $11.32–$74.00 | 2% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471-Immunization Admin 1st vaccine | $60.80 | $76.00 | $11.63–$76.00 | 5% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Immunization administration; 1 vaccine | $60.80 | $76.00 | $11.63–$76.00 | 5% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Administration Single | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 VACCINE ADMIN SINGLE | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ER Immunization DIP/TET | $59.20 | $74.00 | $11.32–$74.00 | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 Immunization administration; 1 vaccine | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471-Immunization Admin 1st vaccine | $60.80 | $76.00 | $11.63–$76.00 | — | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 VACCINE ADMIN EA ADDL VACCINE | $38.40 | $48.00 | $7.34–$48.00 | at median | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 Each additional vaccine | $39.20 | $49.00 | $7.50–$49.00 | 2% above | 20% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 VACCINE ADMIN EA ADDL VACCINE | $38.40 | $48.00 | $7.34–$48.00 | — | 20% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 Each additional vaccine | $39.20 | $49.00 | $7.50–$49.00 | — | 20% |