Hospital

Calais Community Hospital

Calais Community Hospital in Calais, ME publishes cash prices for 289 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 Maine median for 163 of 287 procedures and below it for 120. By typical cash price it ranks #19 of 29 Maine hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

24 Hospital Lane, Calais, ME 04619 Collected Sep 29, 2026 Source price file (207) 454-7521

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 201305 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 Ankle-l (3 Views Min)	$338.00	$451.00	$79.00–$413.00	26% above	25%
Ankle X-ray, complete, 3 or more views CPT 73610 Ankle-r (3 Views Min)	$338.00	$451.00	$79.00–$413.00	26% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Rhcltd Bilat Doppler Study Tc	$103.00	$137.00	$24.00–$125.00	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Doppler Reading	$146.00	$195.00	$34.00–$178.00	43% below	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 I-esophagus	$114.00	$152.00	$12.00–$139.00	76% below	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Barium Swallow	$481.00	$641.00	$113.00–$587.00	at median	25%
Breast ultrasound, complete, one breast CPT 76641 Us Breast Completelt	$544.00	$725.00	$128.00–$663.00	4% above	25%
Breast ultrasound, complete, one breast CPT 76641 Us Breast Completert	$544.00	$725.00	$128.00–$663.00	4% above	25%
Breast ultrasound, complete, one breast CPT 76641 Us Breast Completebilateral	$628.00	$837.00	$147.00–$766.00	20% above	25%
Breast ultrasound, limited (one breast or one area) CPT 76642 Us Breast Limitedrt	$536.00	$714.00	$126.00–$653.00	27% above	25%
Breast ultrasound, limited (one breast or one area) CPT 76642 Us Breast Limitedlt	$536.00	$714.00	$126.00–$653.00	27% above	25%
Breast ultrasound, limited (one breast or one area) CPT 76642 Us Breast Limitedbilateral	$756.00	$1,008.00	$177.00–$922.00	79% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 I-cta Chest Ct	$371.00	$494.00	$35.00–$452.00	80% below	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Cta Chest	$1,836.00	$2,448.00	$431.00–$2,240.00	at median	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 I-ct Abd/pel Wo Cont	$609.00	$812.00	$34.00–$743.00	54% below	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abd/pel Wo Cont	$2,888.00	$3,851.00	$678.00–$3,524.00	118% above	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast	$3,432.00	$4,576.00	$805.00–$4,187.00	75% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 I-ct Abd/pel W/wo Cont	$734.00	$979.00	$39.00–$896.00	64% below	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd/pel W/wo Cont	$2,513.00	$3,350.00	$590.00–$3,065.00	24% above	25%
CT scan of the abdomen with contrast CPT 74160 I-ct Abd W Cont	$341.00	$454.00	$25.00–$415.00	74% below	25%
CT scan of the abdomen with contrast CPT 74160 Ct Abd W Cont	$1,716.00	$2,288.00	$403.00–$2,094.00	29% above	25%
CT scan of the abdomen without contrast CPT 74150 I-ct Abd Wo Cont	$318.00	$424.00	$23.00–$388.00	63% below	25%
CT scan of the abdomen without contrast CPT 74150 Ct Abd Wo Cont	$1,449.00	$1,932.00	$340.00–$1,768.00	68% above	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 I-ct Max/facial Wo Cont	$308.00	$411.00	$17.00–$376.00	64% below	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Max/facial Wo Cont	$1,449.00	$1,932.00	$340.00–$1,768.00	68% above	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT scan	$1,449.00	$1,932.00	$340.00–$1,768.00	18% above	25%
CT scan of the head with contrast CPT 70460 I-ct Head W Cont	$300.00	$400.00	$22.00–$366.00	70% below	25%
CT scan of the head with contrast CPT 70460 Ct Head W Cont	$1,574.00	$2,099.00	$369.00–$1,921.00	55% above	25%
CT scan of the head without and with contrast CPT 70470 I-ct Head W/wo Cont	$372.00	$496.00	$25.00–$454.00	76% below	25%
CT scan of the head without and with contrast CPT 70470 Ct Head W/wo Cont	$2,121.00	$2,828.00	$498.00–$2,588.00	37% above	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 I-ct Lumbar Wo Cont	$311.00	$415.00	$20.00–$380.00	75% below	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct Lumbar Wo Cont	$1,449.00	$1,932.00	$340.00–$1,768.00	16% above	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 I-ct Cervical Wo Cont	$311.00	$415.00	$20.00–$380.00	71% below	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct Cervical Wo Cont	$1,449.00	$1,932.00	$340.00–$1,768.00	37% above	25%
CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast	$1,716.00	$2,288.00	$403.00–$2,094.00	14% above	25%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Us Carotidscomplete	$1,091.00	$1,455.00	$256.00–$1,331.00	at median	25%
Chest X-ray, 2 views CPT 71046 I-chest Fron/lat (2 Views)	$59.00	$79.00	$4.00–$72.00	71% below	25%
Chest X-ray, 2 views CPT 71046 Chest Frontal+lateral (2 Views)	$386.00	$515.00	$91.00–$471.00	89% above	25%
Chest X-ray, single view CPT 71045 I-chest Frontal (1 View)	$48.00	$64.00	$4.00–$59.00	74% below	25%
Chest X-ray, single view CPT 71045 Chest Frontal (1 View)	$314.00	$419.00	$74.00–$383.00	71% above	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 I-us Renal Complete	$201.00	$268.00	$14.00–$245.00	71% below	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Us Renal And Bladder	$756.00	$1,008.00	$177.00–$922.00	11% above	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 I-bone Densitometry Skeletal	$76.00	$101.00	$4.00–$92.00	78% below	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Bone Densitometry Skeletal	$436.00	$581.00	$102.00–$532.00	24% above	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 I-bone Densitometry Appendage	$71.00	$95.00	$4.00–$87.00	56% below	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Bone Densitometry Appendage	$289.00	$385.00	$68.00–$352.00	78% above	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 I-ct Chest Wo Cont	$311.00	$415.00	$21.00–$380.00	67% below	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest Wo Cont	$1,449.00	$1,932.00	$340.00–$1,768.00	54% above	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 I-ct Chest W Cont	$329.00	$439.00	$23.00–$402.00	72% below	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest W Cont	$1,574.00	$2,099.00	$369.00–$1,921.00	35% above	25%
Diagnostic mammogram, both breasts CPT 77066 Mammography of both breasts	$431.00	$575.00	$101.00–$526.00	—	25%
Diagnostic mammogram, one breast CPT 77065 Mammography of one breast	$266.00	$354.00	$62.00–$324.00	5% below	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Us Ext-bilat Ven Doppler	$1,091.00	$1,455.00	$256.00–$1,331.00	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Us Echocomplete	$2,435.00	$3,247.00	$571.00–$2,971.00	55% above	25%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Home Sleep Study Interp	$135.00	$180.00	$19.00–$165.00	42% below	25%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Reading Home Sleep Study Test	$278.00	$371.00	$65.00–$339.00	20% above	25%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Home Sleep Study Test	$659.00	$879.00	$155.00–$804.00	184% above	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Sleep Staging W/4 Or More, Pos Airway	$1,745.00	$2,327.00	$410.00–$2,129.00	2% below	25%
Knee X-ray, 3 views one side CPT 73562 Knee-rt (3 Views)	$386.00	$515.00	$91.00–$471.00	45% above	25%
Knee X-ray, 3 views one side CPT 73562 Knee-lt (3 Views)	$386.00	$515.00	$91.00–$471.00	45% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 I-us Abdomen Limited	$161.00	$215.00	$12.00–$197.00	62% below	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Abdomen Limited	$544.00	$725.00	$128.00–$663.00	29% above	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 I-ct Low Dose Lung Cancer Screening	$92.00	$123.00	$21.00–$113.00	53% below	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct Low Dose Lung Cancer Screening	$626.00	$835.00	$147.00–$764.00	217% above	25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI scan of leg joint	$1,910.00	$2,546.00	$448.00–$2,330.00	9% above	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 I-mri L Ext-r (Jt) W/wo Cont	$290.00	$386.00	$42.00–$353.00	90% below	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri L Ext-l (Jt) W/wo Cont	$2,627.00	$3,503.00	$617.00–$3,205.00	8% below	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri L Ext-r (Jt) W/wo Cont	$2,627.00	$3,503.00	$617.00–$3,205.00	8% below	25%
MRI of the abdomen without contrast CPT 74181 I-mri Abd Wo Cont	$237.00	$316.00	$28.00–$289.00	86% below	25%
MRI of the abdomen without contrast CPT 74181 Mri Abd Wo Cont	$1,910.00	$2,546.00	$448.00–$2,330.00	16% above	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Abd W/wo Cont	$2,627.00	$3,503.00	$617.00–$3,205.00	7% below	25%
MRI of the brain, no contrast dye CPT 70551 I-mri Brain/head Wo Cont	$453.00	$604.00	$29.00–$553.00	70% below	25%
MRI of the brain, no contrast dye CPT 70551 Mri Brain/head Wo Cont	$1,910.00	$2,546.00	$448.00–$2,330.00	27% above	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI Scan	$2,627.00	$3,503.00	$617.00–$3,205.00	at median	25%
MRI of the lower back, no contrast dye CPT 72148 MRI scan of lower spinal canal	$1,910.00	$2,546.00	$448.00–$2,330.00	29% above	25%
MRI of the lower back, without and then with contrast dye CPT 72158 I-mri Lumbar W/wo Cont	$725.00	$966.00	$45.00–$884.00	67% below	25%
MRI of the lower back, without and then with contrast dye CPT 72158 Mri Lumbar W/wo Cont	$2,627.00	$3,503.00	$617.00–$3,205.00	20% above	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 I-mri Mri Thoracic Wo Cont	$489.00	$652.00	$29.00–$597.00	62% below	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri Thoracic Wo Cont	$1,910.00	$2,546.00	$448.00–$2,330.00	47% above	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 I-mri Cervical W/wo Cont	$671.00	$894.00	$45.00–$818.00	68% below	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri Cervical W/wo Cont	$2,627.00	$3,503.00	$617.00–$3,205.00	26% above	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 I-mri Cervical Wo Cont	$489.00	$652.00	$29.00–$597.00	66% below	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri Cervical Wo Cont	$1,910.00	$2,546.00	$448.00–$2,330.00	32% above	25%
MRI of the pelvis without and with contrast CPT 72197 I-mri Pelvis W/wo Cont	$489.00	$652.00	$43.00–$597.00	80% below	25%
MRI of the pelvis without and with contrast CPT 72197 Mri Pelvis W/wo Cont	$2,627.00	$3,503.00	$617.00–$3,205.00	7% above	25%
MRI of the pelvis, no contrast dye CPT 72195 I-mri Pelvis Wo Cont	$489.00	$652.00	$28.00–$597.00	73% below	25%
MRI of the pelvis, no contrast dye CPT 72195 Mri Pelvis Wo Cont	$1,910.00	$2,546.00	$448.00–$2,330.00	5% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri U Ext-r (Jt) Wo Cont	$1,910.00	$2,546.00	$448.00–$2,330.00	19% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri U Ext-l (Jt) Wo Cont	$1,910.00	$2,546.00	$448.00–$2,330.00	19% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 I-us Pelvic Limited	$161.00	$215.00	$10.00–$197.00	22% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us Pelvic Limited	$486.00	$648.00	$114.00–$593.00	270% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 I-us Pelvic Complete	$191.00	$255.00	$14.00–$233.00	53% below	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us Pelvic Complete	$544.00	$725.00	$128.00–$663.00	33% above	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Abdomial ultrasound of pregnant uterus	$914.00	$1,218.00	$214.00–$1,114.00	73% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 I-us Ob Complete <14 Wks	$140.00	$187.00	$20.00–$171.00	58% below	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Us Ob Complete <14 Wks	$544.00	$725.00	$128.00–$663.00	64% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 I-us Ob Limited	$175.00	$233.00	$13.00–$213.00	7% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Limited	$544.00	$725.00	$128.00–$663.00	233% above	25%
Screening mammogram, both breasts both sides CPT 77067 Mammography, screening, bilateral	$431.00	$575.00	$101.00–$526.00	—	25%
Screening mammogram, both breasts CPT 77067 I-mammo Screeningunilateral	$137.00	$182.00	$52.00–$167.00	26% below	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 Shoulder-r (2 Views Min)	$338.00	$451.00	$79.00–$413.00	36% above	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 Shoulder-l (2 Views Min)	$338.00	$451.00	$79.00–$413.00	36% above	25%
Sleep study in a lab (polysomnography) CPT 95810 Sleep study	$1,397.00	$1,862.00	$328.00–$1,704.00	19% below	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 I-esophagus-sw Func W/video	$142.00	$189.00	$10.00–$173.00	70% below	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Barium Swallow Modified	$489.00	$652.00	$115.00–$597.00	5% above	25%
Transvaginal pelvic ultrasound CPT 76830 Ultrasound pelvis through vagina	$544.00	$725.00	$128.00–$663.00	145% above	25%
Transvaginal ultrasound during pregnancy CPT 76817 I-us Ob Transvaginal	$155.00	$207.00	$15.00–$189.00	15% below	25%
Transvaginal ultrasound during pregnancy CPT 76817 Us Ob Transvaginal	$544.00	$725.00	$128.00–$663.00	199% above	25%
Ultrasound of the abdomen, complete CPT 76700 Ultrasound of abdomen	$850.00	$1,133.00	$199.00–$1,037.00	11% above	25%
Ultrasound of the scrotum and testicles CPT 76870 I-us Scrotum/testicular	$171.00	$228.00	$13.00–$209.00	50% below	25%
Ultrasound of the scrotum and testicles CPT 76870 Us Scrotum/testicular W/ Doppler	$700.00	$933.00	$164.00–$854.00	104% above	25%
Ultrasound of the scrotum and testicles CPT 76870 Us Scrotum/testicular	$700.00	$933.00	$164.00–$854.00	104% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 I-us Neck/head	$153.00	$204.00	$11.00–$187.00	51% below	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Neck/head	$544.00	$725.00	$128.00–$663.00	75% above	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 I-gi Wo Kub	$212.00	$283.00	$16.00–$259.00	67% below	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Gi Wo Kub	$773.00	$1,031.00	$181.00–$943.00	20% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Us Ext-l Ven Doppler	$872.00	$1,162.00	$205.00–$1,063.00	35% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Us Ext-r Ven Doppler	$872.00	$1,162.00	$205.00–$1,063.00	35% above	25%
Wrist X-ray, complete, 3 or more views CPT 73110 Wrist-l (3 Views Min)	$289.00	$385.00	$68.00–$352.00	8% above	25%
Wrist X-ray, complete, 3 or more views CPT 73110 Wrist-r (3 Views Min)	$289.00	$385.00	$68.00–$352.00	8% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 Hip-r W Pelvis	$289.00	$385.00	$68.00–$352.00	36% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 Hip-l W Pelvis	$289.00	$385.00	$68.00–$352.00	36% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 Hip-l (2 Views Min)	$338.00	$451.00	$79.00–$413.00	59% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 Hip-r (2 Views Min)	$338.00	$451.00	$79.00–$413.00	59% above	25%
X-ray of the abdomen, 1 view CPT 74018 I-abdomen (1 View)	$48.00	$64.00	$4.00–$59.00	78% below	25%
X-ray of the abdomen, 1 view CPT 74018 Abdomen (1 View)	$338.00	$451.00	$79.00–$413.00	56% above	25%
X-ray of the ankle, 2 views CPT 73600 Ankle-l (1 View)	$242.00	$322.00	$57.00–$295.00	12% above	25%
X-ray of the ankle, 2 views CPT 73600 Ankle-r (1 View)	$242.00	$322.00	$57.00–$295.00	12% above	25%
X-ray of the ankle, 2 views CPT 73600 Ankle-r (2 Views)	$289.00	$385.00	$68.00–$352.00	33% above	25%
X-ray of the ankle, 2 views CPT 73600 Ankle-l (2 Views)	$289.00	$385.00	$68.00–$352.00	33% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Finger-l (4th Digit)	$289.00	$385.00	$68.00–$352.00	24% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Finger-l (3rd Digit)	$289.00	$385.00	$68.00–$352.00	24% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Finger-r (5th Digit)	$289.00	$385.00	$68.00–$352.00	24% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Finger-l (2nd Digit)	$289.00	$385.00	$68.00–$352.00	24% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Finger-l (Thumb)	$289.00	$385.00	$68.00–$352.00	24% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Finger-r (2nd Digit)	$289.00	$385.00	$68.00–$352.00	24% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Finger-l (5th Digit)	$289.00	$385.00	$68.00–$352.00	24% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Finger-r (Thumb)	$289.00	$385.00	$68.00–$352.00	24% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Finger-r (4th Digit)	$289.00	$385.00	$68.00–$352.00	24% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Finger-r (3rd Digit)	$289.00	$385.00	$68.00–$352.00	24% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Fingers-r (Multi)	$338.00	$451.00	$79.00–$413.00	45% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Fingers-l (Multi)	$338.00	$451.00	$79.00–$413.00	45% above	25%
X-ray of the foot, 2 views CPT 73620 Foot-r (1 View)	$242.00	$322.00	$57.00–$295.00	17% above	25%
X-ray of the foot, 2 views CPT 73620 Foot-l (1 View)	$242.00	$322.00	$57.00–$295.00	17% above	25%
X-ray of the foot, 2 views CPT 73620 Foot-r (2 Views)	$289.00	$385.00	$68.00–$352.00	40% above	25%
X-ray of the foot, 2 views CPT 73620 Foot-l (2 Views)	$289.00	$385.00	$68.00–$352.00	40% above	25%
X-ray of the foot, complete, 3 or more views CPT 73630 Foot-l (3 Views Min)	$338.00	$451.00	$79.00–$413.00	29% above	25%
X-ray of the foot, complete, 3 or more views CPT 73630 Foot-r (3 Views Min)	$338.00	$451.00	$79.00–$413.00	29% above	25%
X-ray of the hand, 3 or more views CPT 73130 Hand-r (3 Views Min)	$338.00	$451.00	$79.00–$413.00	47% above	25%
X-ray of the hand, 3 or more views CPT 73130 Hand-l (3 Views Min)	$338.00	$451.00	$79.00–$413.00	47% above	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 Knee-lt (1-2 Views)	$338.00	$451.00	$79.00–$413.00	51% above	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 Knee-rt (1-2 Views)	$338.00	$451.00	$79.00–$413.00	51% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 I-lumbar (2-3 Views)	$59.00	$79.00	$5.00–$72.00	78% below	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Lumbar (1 View)	$290.00	$387.00	$68.00–$354.00	10% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Lumbar (2-3 Views)	$436.00	$581.00	$102.00–$532.00	65% above	25%
X-ray of the lower back, 4 or more views CPT 72110 X-Ray of lower back	$522.00	$696.00	$122.00–$637.00	13% above	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 I-thoracic Dorsal Spine (2 Views)	$59.00	$79.00	$4.00–$72.00	75% below	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Thoracic Spine (1 View)	$386.00	$515.00	$91.00–$471.00	61% above	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Thoracic Dorsal Spine (2 Views)	$436.00	$581.00	$102.00–$532.00	82% above	25%
X-ray of the nasal bones, 3 or more views CPT 70160 I-nasal Bones (3 Views Min)	$47.00	$62.00	$4.00–$57.00	80% below	24%
X-ray of the nasal bones, 3 or more views CPT 70160 Nasal Bones (<3 Views)	$251.00	$335.00	$59.00–$307.00	7% above	25%
X-ray of the nasal bones, 3 or more views CPT 70160 Nasal Bones (3 Views Min)	$348.00	$464.00	$82.00–$425.00	48% above	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 I-cervical Spine (2-3 Views)	$66.00	$88.00	$4.00–$81.00	77% below	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Cervical Spine (1 View)	$242.00	$322.00	$57.00–$295.00	14% below	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Cervical Spine (2-3 Views)	$397.00	$529.00	$93.00–$484.00	40% above	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 I-pelvis (1-2 Views)	$44.00	$59.00	$4.00–$54.00	79% below	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 Pelvis (1-2 Views)	$386.00	$515.00	$91.00–$471.00	85% above	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 I-sacrum Coccyx (2 Views Min)	$51.00	$68.00	$4.00–$62.00	79% below	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Sacrum Coccyx (1 View)	$242.00	$322.00	$57.00–$295.00	at median	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Sacrum Coccyx (2 Views Min)	$289.00	$385.00	$68.00–$352.00	20% above	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alt	$63.00	$84.00	$15.00–$77.00	92% above	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 .Transferase; Alanine Amino (Alt) (Sgpt)	$63.00	$84.00	$15.00–$77.00	92% above	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 .Transferase Aspartate Amino (Ast)	$58.00	$77.00	$14.00–$70.00	98% above	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 Ast	$61.00	$81.00	$14.00–$74.00	108% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Ginger (F270) Igequest	$48.00	$64.00	$11.00–$59.00	125% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Apple (F49) Ige- Quest	$48.00	$64.00	$11.00–$59.00	125% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Peach (F95) Ige- Quest	$48.00	$64.00	$11.00–$59.00	125% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Cherry (F242) Ige- Quest	$48.00	$64.00	$11.00–$59.00	125% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Pear (F94) Ige- Quest	$48.00	$64.00	$11.00–$59.00	125% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Guinea Pig Epithelia Ige (E6)quest	$48.00	$64.00	$11.00–$59.00	125% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Gluten (F79) Igequest	$50.00	$67.00	$12.00–$61.00	135% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Rat Epithelia Igequest	$53.00	$71.00	$12.00–$65.00	149% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Pineapple (F210) Igequest	$53.00	$71.00	$12.00–$65.00	149% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut Total W/ Rflx To Component Panel	$57.00	$76.00	$13.00–$70.00	168% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 .Orchard Grass	$59.00	$79.00	$14.00–$72.00	177% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Cinnamon (Rf220) Igequest	$59.00	$79.00	$14.00–$72.00	177% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenbeef Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillis Fumigatus (M3) Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenshrimp	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergentuna Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergentrout Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergensalmon Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenoyster Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenlobster Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergencrab Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergencodfish Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenclam Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Scallops Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Rye Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Buckwheat Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophagoides Farinae Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophagoides Pteronyssinus Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 White Oak Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Lambs Quarter Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Common Ragweed Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium Herbarum Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria Alternata Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Holl. Stier Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Greer Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 English Planton Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Epithelium Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Dander Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Wheat Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Soybean Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Milk Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Chicken Meat Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenmussel Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenkiwi Fruit Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Pork Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Chocolate Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Tomato Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenhouse Dust Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergendog Dander Ige (E5)quest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenwalnut Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenshrimp Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenpeanut Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenchicken Meat	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenscallop Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific Ige,quant,semi-quant	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenstrawberry Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergencat Dander Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenhouse Dust(h-s) Quest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenbeech Tree Quest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Pine Ige (Tree) Quest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Popular Ige (Tree) Quest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenwhite Ash (T15) Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenlatex Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergencow's Milk (F2) Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenegg Whitequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergensoybean Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenwheat Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 North-east Profile I Part 13	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 North-east Profile I Part 12	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 North-east Profile I Part 11	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 North-east Profile I Part 10	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 North-east Profile I Part 9	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 North-east Profile I Part 8	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 North-east Profile I Part 7	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 North-east Profile I Part 6	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 North-east Profile I Part 4	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 North-east Profile I Part 3	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 North-east Profile I Part 2	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 North-east Profile I Part 1	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific Ige Each	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Rast Banana Quest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenbass Black Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergentrout Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenperch Ocean Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergengulf Flounder Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergencatfish Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenchicken Feathersquest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicilloyl V (C2) Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicilloyl G (C1) Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Goose Feathers	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Short Ragweed	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .D Pteronyssius	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Immunocap Score Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenhalibut	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Cashew Nut Ige (F202)quest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Brazil Nut Ige (F18)quest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Macadamia Nut Ige (Rf345)quest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenhaddock Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Allergen Specific Ige, Quantitative	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Sagebrush/wormwood	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .White Ash Tree	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Wheat	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Timothy Grass	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Russian Thistle	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Penicillium Notatum	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Pecan (White Hickory) Tree	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Oak Tree	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Mountain Cedar (Juniper Tree)	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Milk (Cow's)	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Mesquite Tree	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Marsh Elder	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Box Elder/maple Tree	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Lamb's Quarters	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .June Grass/kentucky Buegrass	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Johnson Grass	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .House Dust Stier	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .House Dust Greer	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Hormodendrum (Cladosporium)	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .False Ragweed	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Giant Ragweed	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Elm Tree	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Egg White	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Dog Epithelium	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .D. Farinae (Mites)	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Cottonwood Tree	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Cat Epithelium & Dander	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Bermuda Grass	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Bahia Grass	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Aspergillus Fumigatus	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Alternaria Alternata (Tenius)	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Common Pigweed (W14) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .White Mulberry (T70) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Sycamore Allergen, Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Mountain Cedar (T6) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Sheep Sorrel (W18) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Cockroach (I6) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Dermatophagoides Farinae (D2) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Dermatophagoides Pteronyssinus (D1) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Alternaria Alternata (M6) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Aspergillus Fumigatus (M3) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Cladosporium Herbarum (M2) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Penicillium Notatum (M1) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Dog Dander (E5) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Cat Epithelium And Dander (E1) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .White Ash (T15) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Cottonwood (T14) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Walnut Tree (T10) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Elm (T8) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .White Oak (T7) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Birch (T3) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Maple (Box Elder) (T1) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Mugwort (W6) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Common Ragweed (Short) (W1) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Timothy Grass (G6) Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Allergen Specific Ige	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Allergen Specific Ige; Quant Or Semiqua	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Beetroot (F319) Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 .Allergen Specific	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenwasps Paper Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenyellow Jacket Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenyellow Hornet Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenwhite Faced Hornet Igeque	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenhoney Bee Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergengarlic	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergensesame Seed Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenegg Yolk Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenhazelnut Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenalmond Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Mandarin (F302) Igequest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergenapple Quest	$62.00	$82.00	$14.00–$75.00	191% above	24%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 .Cyclic Citrullinated Peptide	$94.00	$125.00	$22.00–$114.00	32% above	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Citrullinated Peptide Igg -Quest	$154.00	$205.00	$36.00–$188.00	116% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Multiplex W/ Rflx 11 Ab Cascadequ	$83.00	$110.00	$19.00–$101.00	69% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Screen Ifa W/ Rflx Titer & Pattern	$96.00	$128.00	$23.00–$117.00	96% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Multiplex W/ Rflx Dsdnaquest	$96.00	$128.00	$23.00–$117.00	96% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Connective Tissue Disease Panel (Refl-p1	$96.00	$128.00	$23.00–$117.00	96% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana (Anti-nuclear Ab) Quest	$96.00	$128.00	$23.00–$117.00	96% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 .Antinuclear Antibodies (Ana)	$96.00	$128.00	$23.00–$117.00	96% above	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Questbnp	$179.00	$238.00	$42.00–$218.00	14% above	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Bnp	$179.00	$238.00	$42.00–$218.00	14% above	25%
Basic metabolic panel (blood test) CPT 80048 Basic metabolic panel	$89.00	$119.00	$21.00–$109.00	11% above	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Cell Block Process Dahl-chase	$154.00	$205.00	$36.00–$188.00	5% above	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Microscopic-biopsy; Level Ivdcpa	$217.00	$289.00	$51.00–$264.00	48% above	25%
Blood culture for bacteria CPT 87040 ..Culturebloodquest	$85.00	$113.00	$20.00–$103.00	4% below	25%
Blood culture for bacteria CPT 87040 .Blood Culture Id & Suscepitibilityqu	$100.00	$133.00	$23.00–$122.00	13% above	25%
Blood culture for bacteria CPT 87040 .Culturebloodcch	$110.00	$146.00	$26.00–$134.00	24% above	25%
Blood culture for bacteria CPT 87040 .Cultureblood (Set 1)quest	$110.00	$146.00	$26.00–$134.00	24% above	25%
Blood culture for bacteria CPT 87040 .Cultureblood (Set 2)quest	$110.00	$146.00	$26.00–$134.00	24% above	25%
Blood culture for bacteria CPT 87040 .Cultureblood (Set 3)quest	$110.00	$146.00	$26.00–$134.00	24% above	25%
Blood culture for bacteria CPT 87040 .Culture, Bacterial; Blood Aerobic, W/ I	$110.00	$146.00	$26.00–$134.00	24% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 .Venipuncture	$14.00	$19.00	$3.00–$17.00	5% above	26%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Coll Of Venous Bld By Venipuncture	$14.00	$19.00	$3.00–$17.00	5% above	26%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Collection Of Venous Blood By Venipuncture	$14.00	$19.00	$3.00–$17.00	5% above	26%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Va Specimen Processing	$14.00	$19.00	$3.00–$17.00	5% above	26%
Blood glucose (sugar) test CPT 82947 Assay Of Glucose; Quantitative	$11.00	$14.00	$2.00–$13.00	53% below	21%
Blood glucose (sugar) test CPT 82947 .2hr Glucose Gtt Nongestational	$47.00	$62.00	$11.00–$57.00	102% above	24%
Blood glucose (sugar) test CPT 82947 Fasting Glucose Gtt Nongestational	$47.00	$62.00	$11.00–$57.00	102% above	24%
Blood glucose (sugar) test CPT 82947 .Glucose Dialysate	$47.00	$62.00	$11.00–$57.00	102% above	24%
Blood glucose (sugar) test CPT 82947 Glucose 2hr Pc	$47.00	$62.00	$11.00–$57.00	102% above	24%
Blood glucose (sugar) test CPT 82947 Glucose	$47.00	$62.00	$11.00–$57.00	102% above	24%
Blood lead test CPT 83655 .Heavy Metalsblood (Lead)	$96.00	$128.00	$23.00–$117.00	113% above	25%
Blood lead test CPT 83655 .Lead	$96.00	$128.00	$23.00–$117.00	113% above	25%
Blood lead test CPT 83655 .Leadstate Lab Charge Only	$96.00	$128.00	$23.00–$117.00	113% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hcg Qualitative Quest	$80.00	$106.00	$19.00–$97.00	89% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hcg Serum Qualt	$80.00	$106.00	$19.00–$97.00	89% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 .Abo	$40.00	$53.00	$9.00–$48.00	19% below	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo Type	$40.00	$53.00	$9.00–$48.00	19% below	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 .Nllblood Typing, Abo	$40.00	$53.00	$9.00–$48.00	19% below	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Typing-abo	$40.00	$53.00	$9.00–$48.00	19% below	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 .Arc Abo Type	$40.00	$53.00	$9.00–$48.00	19% below	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 .Crp	$61.00	$81.00	$14.00–$74.00	46% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 .C-reactive Protein	$61.00	$81.00	$14.00–$74.00	46% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Connective Tissue Disease Panel (Refl-p3	$61.00	$81.00	$14.00–$74.00	46% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive Protein	$61.00	$81.00	$14.00–$74.00	46% above	25%
C. difficile toxin gene test (stool PCR) CPT 87493 .Clostridium Difficile Toxin B, Qlt Pcr	$137.00	$183.00	$32.00–$167.00	44% above	25%
C. difficile toxin gene test (stool PCR) CPT 87493 .C Difficile Amp Probe	$137.00	$183.00	$32.00–$167.00	44% above	25%
CA 19-9 blood test (tumor marker) CPT 86301 Ca 19-9 Quest	$164.00	$219.00	$39.00–$200.00	241% above	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 Ca 125quest	$164.00	$219.00	$39.00–$200.00	82% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 .Chlamydia Trach Amp Probe	$131.00	$174.00	$31.00–$159.00	77% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 .Chlamydia Trachomatis, Amp Probe Tech	$137.00	$183.00	$32.00–$167.00	85% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis Rna (Urogenital) -	$137.00	$183.00	$32.00–$167.00	85% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 .Chlamydia	$137.00	$183.00	$32.00–$167.00	85% above	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids	$105.00	$140.00	$25.00–$128.00	43% above	25%
Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (CBC), with differential white blood cells, automated	$83.00	$110.00	$19.00–$101.00	77% above	25%
Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (CBC), automated	$77.00	$102.00	$18.00–$93.00	148% above	25%
Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals	$111.00	$148.00	$26.00–$135.00	3% above	25%
D-dimer blood test (blood clot marker) CPT 85379 D-dimer Quantitative	$107.00	$143.00	$25.00–$131.00	59% above	25%
D-dimer blood test (blood clot marker) CPT 85379 Questd-dimer Quantitative	$107.00	$143.00	$25.00–$131.00	59% above	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 .Dhea-s	$117.00	$156.00	$27.00–$143.00	29% above	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 .Hirsutism Panel 2 (Dhea-s)	$117.00	$156.00	$27.00–$143.00	29% above	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dhea Sulfatequest	$117.00	$156.00	$27.00–$143.00	29% above	25%
Estradiol blood test CPT 82670 Estradiol Ultrasensitive Lc/msquest	$147.00	$196.00	$34.00–$179.00	44% above	25%
Estradiol blood test CPT 82670 .Estradiol Quest	$147.00	$196.00	$34.00–$179.00	44% above	25%
FSH (follicle-stimulating hormone) test CPT 83001 24h Ur Fsh Quest	$123.00	$164.00	$29.00–$150.00	51% above	25%
FSH (follicle-stimulating hormone) test CPT 83001 Fsh (Follicle Stimulating Hormone)que	$147.00	$196.00	$34.00–$179.00	80% above	25%
FSH (follicle-stimulating hormone) test CPT 83001 Fsh Pediatricsquest	$147.00	$196.00	$34.00–$179.00	80% above	25%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin Stoolquest	$155.00	$206.00	$36.00–$188.00	at median	25%
Ferritin blood test (iron stores) CPT 82728 Questferritin	$107.00	$143.00	$25.00–$131.00	50% above	25%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$107.00	$143.00	$25.00–$131.00	50% above	25%
Folate (folic acid) blood test CPT 82746 Folate	$116.00	$155.00	$27.00–$142.00	58% above	25%
Free T3 thyroid hormone test CPT 84481 T3 Freequest	$134.00	$178.00	$31.00–$163.00	56% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T3	$95.00	$126.00	$22.00–$115.00	66% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Free	$95.00	$126.00	$22.00–$115.00	66% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 .T4 Free Cascade	$95.00	$126.00	$22.00–$115.00	66% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 .Assay Of Thyroxine, Free	$95.00	$126.00	$22.00–$115.00	66% above	25%
Free testosterone test CPT 84402 Testosterone Freequest	$134.00	$179.00	$32.00–$164.00	45% above	25%
Free testosterone test CPT 84402 Testosterone Free Serum Quest	$134.00	$179.00	$32.00–$164.00	45% above	25%
Free testosterone test CPT 84402 .Testosterone Free	$134.00	$179.00	$32.00–$164.00	45% above	25%
Free testosterone test CPT 84402 .Free Testosterone	$134.00	$179.00	$32.00–$164.00	45% above	25%
Free testosterone test CPT 84402 .Testosterone; Free	$134.00	$179.00	$32.00–$164.00	45% above	25%
Free testosterone test CPT 84402 .Hirsutism Panel 2 (Testosterone; Free)	$134.00	$179.00	$32.00–$164.00	45% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Gtt 1hr Gestational	$56.00	$75.00	$13.00–$69.00	53% above	25%
Glucose tolerance test, 3 samples CPT 82951 .Gtt 3 Hr Part 2	$38.00	$50.00	$9.00–$46.00	41% below	24%
Glucose tolerance test, 3 samples CPT 82951 .Gtt, 3 Specimens	$67.00	$89.00	$16.00–$81.00	5% above	25%
Glucose tolerance test, 3 samples CPT 82951 .Tolerance Test Gtt 3 Specimens Quest	$101.00	$135.00	$24.00–$124.00	58% above	25%
Glucose tolerance test, 3 samples CPT 82951 .1hr Glucose Gtt Gestational	$101.00	$135.00	$24.00–$124.00	58% above	25%
Glucose tolerance test, 3 samples CPT 82951 Tolerance Test (Gtt) 3 Spec	$101.00	$135.00	$24.00–$124.00	58% above	25%
Glucose tolerance test, 3 samples CPT 82951 .30 Min Glucose Gtt Hypoglycemia	$101.00	$135.00	$24.00–$124.00	58% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 .Neisseria Gonor Amp Probe	$131.00	$174.00	$31.00–$159.00	96% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 .N.gonorrhoeae, Dna, Amp Probe	$137.00	$183.00	$32.00–$167.00	105% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae Rnaquest	$137.00	$183.00	$32.00–$167.00	105% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 .Neisseria	$137.00	$183.00	$32.00–$167.00	105% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 .Neisseria Gonorrhoeae, Amp Probe Tech	$137.00	$183.00	$32.00–$167.00	105% above	25%
H. pylori antibody blood test CPT 86677 Helicobacter Pylori; Qualitative	$115.00	$153.00	$27.00–$140.00	50% above	25%
H. pylori stool antigen test CPT 87338 H. Pylori Ag Stoolquest	$91.00	$121.00	$21.00–$111.00	21% below	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv-1 Rna Pcr Quan 1st Gen Quest	$222.00	$296.00	$52.00–$271.00	3% above	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 .Hiv-1 Quantification Includes Reverse T	$222.00	$296.00	$52.00–$271.00	3% above	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv-1 Rna Qnt Pcr Quest	$222.00	$296.00	$52.00–$271.00	3% above	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv-1 Rna Quant/pcr Ultrasensitive Quest	$222.00	$296.00	$52.00–$271.00	3% above	25%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Papillomavirus Human Amplified Probe	$137.00	$183.00	$32.00–$167.00	78% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Questhemoglobin A1c	$103.00	$137.00	$24.00–$125.00	123% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c	$103.00	$137.00	$24.00–$125.00	123% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab Qltquest	$86.00	$114.00	$20.00–$104.00	71% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 .Hepatitis B Surface Ab	$101.00	$134.00	$24.00–$123.00	100% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Surface Ab Immunity Qntquest	$110.00	$147.00	$26.00–$135.00	118% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Surface Ab Quest	$110.00	$147.00	$26.00–$135.00	118% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis Bsurface Antibody (Ali Emp)	$110.00	$147.00	$26.00–$135.00	118% above	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 .Hepatitis B Surface Ag Eia	$100.00	$133.00	$23.00–$122.00	105% above	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hep B Surface Ag W/ Rflxquest	$110.00	$146.00	$26.00–$134.00	126% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 .Hepatitis C Antibody	$84.00	$112.00	$20.00–$102.00	19% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab W/ Rflx Hcv Rna & Genoty	$92.00	$122.00	$21.00–$112.00	30% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Virus Confirmation	$92.00	$122.00	$21.00–$112.00	30% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody W/ Rflx To Hcv Rna	$92.00	$122.00	$21.00–$112.00	30% above	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hep C Virus Rna/pcr Quant Quest	$169.00	$225.00	$40.00–$206.00	2% below	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hep C Viral Rna Qnt W/ Rflx To Genotype	$169.00	$225.00	$40.00–$206.00	2% below	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hep C Viral Rna Genotypequest	$169.00	$225.00	$40.00–$206.00	2% below	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 .Hepatitis C Quant Includes Reverse Tran	$169.00	$225.00	$40.00–$206.00	2% below	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 .Hepatitis C Viral Rna, Qnt, Real-time	$169.00	$225.00	$40.00–$206.00	2% below	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hep C Viral Load Rna Qnt Pcr Quest	$169.00	$225.00	$40.00–$206.00	2% below	25%
Herpes blood test, HSV-1 antibody CPT 86695 .Hsv Type 1	$104.00	$139.00	$24.00–$127.00	123% above	25%
Herpes blood test, HSV-1 antibody CPT 86695 .Antibody; Herpes Simplex Virus, Type 1	$104.00	$139.00	$24.00–$127.00	123% above	25%
Herpes blood test, HSV-1 antibody CPT 86695 .Antibody; Herpes Simplex Type 1	$104.00	$139.00	$24.00–$127.00	123% above	25%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes 1	$104.00	$139.00	$24.00–$127.00	123% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes 2	$128.00	$170.00	$30.00–$156.00	106% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 Hsv 2 Igg Inhibition Iaquest	$140.00	$186.00	$33.00–$170.00	126% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 .Hsv Type 2	$153.00	$204.00	$36.00–$187.00	146% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 .Antibody; Herpes Simplex Virus, Type 2	$153.00	$204.00	$36.00–$187.00	146% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 .Antibody; Herpes Simplex Type 2	$153.00	$204.00	$36.00–$187.00	146% above	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 Hs-crpquest	$103.00	$137.00	$24.00–$125.00	98% above	25%
Homocysteine blood test CPT 83090 Homocysteineali	$67.00	$89.00	$16.00–$81.00	7% below	25%
Homocysteine blood test CPT 83090 .Assay Of Homocystine	$134.00	$178.00	$31.00–$163.00	86% above	25%
Homocysteine blood test CPT 83090 Homocysteine Quest	$134.00	$178.00	$31.00–$163.00	86% above	25%
Insulin blood test CPT 83525 Insulinquest	$90.00	$120.00	$21.00–$110.00	53% above	25%
Iron blood test (serum iron) CPT 83540 .Iron Quest	$77.00	$102.00	$18.00–$93.00	108% above	25%
Iron blood test (serum iron) CPT 83540 Iron	$77.00	$102.00	$18.00–$93.00	108% above	25%
Iron blood test (serum iron) CPT 83540 .Iron Quest	$77.00	$102.00	$18.00–$93.00	108% above	25%
Iron blood test (serum iron) CPT 83540 .Iron Crh	$77.00	$102.00	$18.00–$93.00	108% above	25%
Iron-binding capacity (TIBC) test CPT 83550 .Iron Binding Capacity Ibc Crh	$92.00	$122.00	$21.00–$112.00	128% above	25%
Iron-binding capacity (TIBC) test CPT 83550 .Iron Binding Capacity Ibc Quest	$92.00	$122.00	$21.00–$112.00	128% above	25%
Iron-binding capacity (TIBC) test CPT 83550 .Iron Binding Capacity Ibc Quest	$92.00	$122.00	$21.00–$112.00	128% above	25%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity Ibc Ali	$92.00	$122.00	$21.00–$112.00	128% above	25%
Kidney function blood test panel CPT 80069 Kidney function panel test	$92.00	$122.00	$21.00–$112.00	34% above	25%
LH (luteinizing hormone) test CPT 83002 Lh Pediatricsquest	$146.00	$195.00	$34.00–$178.00	64% above	25%
LH (luteinizing hormone) test CPT 83002 Lhquest	$146.00	$195.00	$34.00–$178.00	64% above	25%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase (Peritoneal Fluid)quest	$74.00	$99.00	$17.00–$91.00	59% above	25%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase (Pleural Fluid)quest	$74.00	$99.00	$17.00–$91.00	59% above	25%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Quest	$81.00	$108.00	$19.00–$99.00	74% above	25%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase	$81.00	$108.00	$19.00–$99.00	74% above	25%
Liver function blood test panel CPT 80076 Liver function blood test	$97.00	$129.00	$23.00–$118.00	17% above	25%
Lyme disease antibody test CPT 86618 .Borrelia Burgdorferi	$88.00	$117.00	$21.00–$107.00	13% above	25%
Lyme disease antibody test CPT 86618 Lyme Disease Ab W/ Rfx To Blot Igg Igm	$113.00	$151.00	$27.00–$138.00	46% above	25%
Magnesium blood test CPT 83735 Magnesium	$80.00	$106.00	$19.00–$97.00	100% above	25%
Magnesium blood test CPT 83735 Magnesium Rbcquest	$80.00	$106.00	$19.00–$97.00	100% above	25%
Magnesium blood test CPT 83735 .Assay Of Magnesium	$80.00	$106.00	$19.00–$97.00	100% above	25%
Magnesium blood test CPT 83735 .Magnesium	$111.00	$148.00	$26.00–$135.00	177% above	25%
Magnesium blood test CPT 83735 Stone Renal Formation Diag.profile P-7	$111.00	$148.00	$26.00–$135.00	177% above	25%
Magnesium blood test CPT 83735 Magnesium 24-hour Urine (W/o Creat)	$111.00	$148.00	$26.00–$135.00	177% above	25%
Measles (rubeola) antibody test CPT 86765 .Rubeolastate Lab	$101.00	$135.00	$24.00–$124.00	215% above	25%
Measles (rubeola) antibody test CPT 86765 .Rubeola Iggstate	$101.00	$135.00	$24.00–$124.00	215% above	25%
Measles (rubeola) antibody test CPT 86765 Measles Antibody (Igm)quest	$101.00	$135.00	$24.00–$124.00	215% above	25%
Measles (rubeola) antibody test CPT 86765 Measles Antibody (Igg)quest	$101.00	$135.00	$24.00–$124.00	215% above	25%
Mono test (heterophile antibody, Monospot) CPT 86308 Mono (Heterophile Antibodies; Screen)	$61.00	$81.00	$14.00–$74.00	71% above	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 Total prostate-specific antigen (PSA) test	$145.00	$193.00	$34.00–$177.00	53% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 Total prostate-specific antigen (PSA) test	$145.00	$193.00	$34.00–$177.00	111% above	25%
Pap test (liquid-based, automated screening with review) CPT 88175 .Cytopathology W/ Scrn By Auto & Manual	$133.00	$177.00	$31.00–$162.00	102% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Cyto Concen-thin Prep (Fluid In Preserv)	$97.00	$129.00	$23.00–$118.00	37% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Pap Smear Gynop	$134.00	$178.00	$31.00–$163.00	89% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Pap Smear Gynip	$134.00	$178.00	$31.00–$163.00	89% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 Parathormone	$164.00	$218.00	$38.00–$199.00	72% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 .Parathyroid Hormone	$164.00	$218.00	$38.00–$199.00	72% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 .Parathormone (Parathyroid Hormone)	$164.00	$218.00	$38.00–$199.00	72% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 Pth Intact Without Calciumquest	$164.00	$218.00	$38.00–$199.00	72% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test	$103.00	$137.00	$24.00–$125.00	145% above	25%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 .Fetal Chromosomal Aneuploidy (Eg Trisom	$461.00	$615.00	$108.00–$563.00	56% below	25%
Progesterone blood test CPT 84144 Progesteronequest	$137.00	$183.00	$32.00–$167.00	53% above	25%
Progesterone blood test CPT 84144 Progesterone Lc/msquest	$137.00	$183.00	$32.00–$167.00	53% above	25%
Prolactin blood test CPT 84146 .Assay Of Prolactin	$153.00	$204.00	$36.00–$187.00	104% above	25%
Prolactin blood test CPT 84146 Prolactinquest	$153.00	$204.00	$36.00–$187.00	104% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time	$47.00	$62.00	$11.00–$57.00	63% above	24%
Rapid flu test (influenza antigen) CPT 87804 Influenza Rapid Test	$30.00	$40.00	$7.00–$37.00	49% below	25%
Rapid flu test (influenza antigen) CPT 87804 .Influenza, A Or B, Each	$91.00	$121.00	$21.00–$111.00	54% above	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep A Rapid Test	$30.00	$40.00	$7.00–$37.00	24% below	25%
Rheumatoid factor (RF) test CPT 86431 .Quantitative	$68.00	$90.00	$16.00–$82.00	111% above	24%
Rheumatoid factor (RF) test CPT 86431 Ra; Titer (Rheumatoid Factor)	$68.00	$90.00	$16.00–$82.00	111% above	24%
Rheumatoid factor (RF) test CPT 86431 Connective Tissue Disease Panel (Refl-p2	$68.00	$90.00	$16.00–$82.00	111% above	24%
Rheumatoid factor (RF) test CPT 86431 .Rheumatoid Factor	$68.00	$90.00	$16.00–$82.00	111% above	24%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factorquest	$68.00	$90.00	$16.00–$82.00	111% above	24%
Rubella antibody test (immunity check) CPT 86762 .Rubella Igg	$98.00	$131.00	$23.00–$120.00	100% above	25%
Rubella antibody test (immunity check) CPT 86762 Rubella Immune Statusquest	$114.00	$152.00	$27.00–$139.00	133% above	25%
Rubella antibody test (immunity check) CPT 86762 .Rubellastate Lab	$114.00	$152.00	$27.00–$139.00	133% above	25%
Rubella antibody test (immunity check) CPT 86762 Rubella State Lab	$114.00	$152.00	$27.00–$139.00	133% above	25%
Rubella antibody test (immunity check) CPT 86762 .Rubella Virus Antibodies Igg	$114.00	$152.00	$27.00–$139.00	133% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sed Rate	$36.00	$48.00	$8.00–$44.00	at median	25%
Stool ova and parasites exam CPT 87177 .Ova & Parasities	$94.00	$125.00	$22.00–$114.00	124% above	25%
Stool ova and parasites exam CPT 87177 .Ova And Parasites Smears	$94.00	$125.00	$22.00–$114.00	124% above	25%
Stool ova and parasites exam CPT 87177 0&p Direct Smear,concentration & Id	$94.00	$125.00	$22.00–$114.00	124% above	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Blood, Occult; By Peroxidase Activity, Q	$14.00	$18.00	$3.00–$16.00	18% below	22%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Stool Occult Bloodscreen (3 Samples)	$43.00	$57.00	$10.00–$52.00	153% above	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Ifob	$110.00	$147.00	$26.00–$135.00	134% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rpr W/ Rflx To Titer & Treponema Abqu	$50.00	$67.00	$12.00–$61.00	60% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis Vdrl Screen W/ Rflx To Titer	$50.00	$67.00	$12.00–$61.00	60% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rpr W/ Reflex To Titer, Quest	$50.00	$67.00	$12.00–$61.00	60% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl, Csfquest	$50.00	$67.00	$12.00–$61.00	60% above	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon-tb Gold Plus (4 Tubes)qu	$245.00	$326.00	$57.00–$298.00	118% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total (Adult Males)ques	$137.00	$182.00	$32.00–$167.00	68% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 .Total Testosterone	$137.00	$182.00	$32.00–$167.00	68% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 .Assay Of Testosterone Total	$137.00	$182.00	$32.00–$167.00	68% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total (Women/child)ques	$137.00	$182.00	$32.00–$167.00	68% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 .Testosterone; Total	$137.00	$182.00	$32.00–$167.00	68% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 .Testosterone Total	$137.00	$182.00	$32.00–$167.00	68% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 .Hirsutism Panel 2 (Testosterone; Total)	$137.00	$182.00	$32.00–$167.00	68% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Microsomal Antibody	$115.00	$153.00	$27.00–$140.00	36% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Ab & Thyroid Peroxidase Ab P-2	$115.00	$153.00	$27.00–$140.00	36% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver Kidney Microsomal, Iggquest	$115.00	$153.00	$27.00–$140.00	36% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Anti-kidney Liver Microsomequest	$115.00	$153.00	$27.00–$140.00	36% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 .Microsomal Antibodies (Eg Thyroid Or Li	$115.00	$153.00	$27.00–$140.00	36% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibodiesquest	$115.00	$153.00	$27.00–$140.00	36% above	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH)	$132.00	$176.00	$31.00–$161.00	78% above	25%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis Pcr	$131.00	$174.00	$31.00–$159.00	46% above	25%
Trichomonas test (NAAT) CPT 87661 .Trichomonas Vagin Amp Probe	$131.00	$174.00	$31.00–$159.00	46% above	25%
Trichomonas test (NAAT) CPT 87661 .Trichomonas Vaginalis, Amp Probe Tech	$137.00	$183.00	$32.00–$167.00	53% above	25%
Uric acid blood test CPT 84550 Uric Acid	$53.00	$71.00	$12.00–$65.00	86% above	25%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis test using microscope	$81.00	$108.00	$19.00–$99.00	129% above	25%
Urinalysis with microscope exam, manual CPT 81000 Urinalysis test using microscope	$81.00	$108.00	$19.00–$99.00	238% above	25%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis test	$34.00	$45.00	$8.00–$41.00	64% above	24%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis test	$34.00	$45.00	$8.00–$41.00	113% above	24%
Urine culture for bacteria, with colony count CPT 87086 Culture (Urine)quest	$78.00	$104.00	$18.00–$95.00	12% above	25%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test, Visual Color Compa	$17.00	$22.00	$4.00–$20.00	39% below	23%
Urine pregnancy test, read by color change CPT 81025 Pregnancy Test Urine Qualt Hcg	$74.00	$99.00	$17.00–$91.00	164% above	25%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Reflex	$98.00	$131.00	$23.00–$120.00	16% above	25%
Vitamin B12 (cobalamin) blood test CPT 82607 Questvitamin B12	$98.00	$131.00	$23.00–$120.00	16% above	25%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12	$118.00	$157.00	$28.00–$144.00	40% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25-hydroxy Total	$155.00	$207.00	$36.00–$189.00	36% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D (D2,d3) 25-hydroxyquest	$155.00	$207.00	$36.00–$189.00	36% above	25%
Zinc blood test CPT 84630 Zinc Rbcquest	$90.00	$120.00	$21.00–$110.00	132% above	25%
Zinc blood test CPT 84630 Zincquest	$90.00	$120.00	$21.00–$110.00	132% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Urine; Beta	$100.00	$133.00	$23.00–$122.00	38% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 .Hcg Tumor Marker, Quantquest	$100.00	$133.00	$23.00–$122.00	38% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta Hcg-tumor Marker Quest	$100.00	$133.00	$23.00–$122.00	38% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Tumor Markercrh	$119.00	$158.00	$28.00–$145.00	65% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Tumor Markerquest	$119.00	$158.00	$28.00–$145.00	65% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 .Hcg Quant	$119.00	$158.00	$28.00–$145.00	65% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcgserum Quant	$119.00	$158.00	$28.00–$145.00	65% above	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Hosp Fac: Closed-distal Fib Fx Wo	$157.00	$209.00	$37.00–$191.00	43% below	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Closed Tx Distal Fib Fx W/o Manip	$218.00	$291.00	$51.00–$266.00	21% below	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 Off Fac: Clsd Metatarsal Fx Wo	$110.00	$146.00	$26.00–$134.00	53% below	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Closed Tx Of Metatarsal Fx W/o Manip	$218.00	$291.00	$51.00–$266.00	6% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion	$371.00	$494.00	$40.00–$452.00	11% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion/defibrillation	$570.00	$760.00	$134.00–$695.00	36% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Off Fac: Clsd Fx Distal Med Wo	$161.00	$215.00	$38.00–$197.00	38% below	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Closed Tx Distal Rad/uln Fx W/o Manip	$218.00	$291.00	$51.00–$266.00	16% below	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Off Pro: Clsd Fx Distal Med Wo	$378.00	$504.00	$222.00–$461.00	45% above	25%
Colonoscopy with polyp removal CPT 45385 Removal of polyps or growths of large bowel using an endoscope	$5,551.00	$7,401.00	$1,303.00–$6,772.00	236% above	25%
Colonoscopy with tissue sample CPT 45380 Biopsy exam of large bowel using an endoscope	$4,758.00	$6,344.00	$1,117.00–$5,805.00	219% above	25%
Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using an endoscope	$3,893.00	$5,191.00	$914.00–$4,750.00	221% above	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Off Fac: Destr Premal Lesion, 1st	$33.00	$44.00	$8.00–$40.00	64% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Off Pro: Destr Premal Lesion, 1st	$77.00	$103.00	$20.00–$94.00	16% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruction, Benign/premalig Lesions, Ex	$110.00	$147.00	$26.00–$135.00	20% above	25%
Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 Removal Impacted Cerumen Using Irrigation Or Lavage Bilateral	$32.00	$43.00	$8.00–$39.00	—	26%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Removal Impacted Cerumen W/o Instrument	$71.00	$94.00	$17.00–$86.00	62% above	24%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Removal Impacted Cerumen Using Irrigation Or Lavage Unilateral	$21.00	$28.00	$5.00–$26.00	52% below	25%
Earwax removal with instruments, one ear both sides CPT 69210 Removal Impacted Cerumen W/ Instr Bilat	$105.00	$140.00	$25.00–$128.00	—	25%
Earwax removal with instruments, one ear both sides CPT 69210 Removal Impacted Cerumen (Sep Proc), Bilateral Pro	$124.00	$165.00	$29.00–$151.00	—	25%
Earwax removal with instruments, one ear CPT 69210 Removal Impacted Cerumen W/ Instrument	$71.00	$94.00	$17.00–$86.00	10% above	24%
Earwax removal with instruments, one ear CPT 69210 Removal Impacted Cerumen (Sep Proc), One	$83.00	$110.00	$19.00–$101.00	29% above	25%
Earwax removal with instruments, one ear CPT 69210 Impact Cerumen Removal	$97.00	$129.00	$11.00–$118.00	50% above	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 P-inj, Dx Or Thx Subst, W Imagingrt	$180.00	$240.00	$40.00–$220.00	75% below	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 P-inj, Dx Or Thx Subst, W Imagingbila	$269.00	$359.00	$158.00–$328.00	63% below	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Inj, Dx Or Thx Subs W/imagingrt	$1,469.00	$1,958.00	$345.00–$1,792.00	104% above	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Inj, Dx Or Thx Subs W/imagingbilat	$2,203.00	$2,937.00	$517.00–$2,687.00	207% above	25%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 Inj Paravertf Joint C/t 3 Bilat	$2,899.00	$3,865.00	$680.00–$3,536.00	—	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 P-inj Paravertf Joint C/t 3 50	$218.00	$290.00	$128.00–$265.00	75% below	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj Paravertf Joint C/t 3rt	$2,111.00	$2,815.00	$495.00–$2,576.00	138% above	25%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 Inject Pavavertl/t 3 Lt/rt 50	$2,029.00	$2,705.00	$476.00–$2,475.00	129% above	25%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 Inj Paravertf Joint C/t 3 Lt	$2,029.00	$2,705.00	$476.00–$2,475.00	129% above	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330 Hosp Pro: Sigmoidoscopy Flexible	$274.00	$365.00	$22.00–$334.00	13% below	25%
Gallbladder removal, laparoscopic CPT 47562 Removal of gallbladder using an endoscope	$26,854.00	$35,805.00	$6,302.00–$32,762.00	987% above	25%
Hemorrhoid banding (rubber band ligation) CPT 46221 46221 Off Fac: Hemorrhoidectomy Sim	$132.00	$176.00	$31.00–$161.00	80% below	25%
Hemorrhoid banding (rubber band ligation) CPT 46221 46221 Hosp Pro: Hemorrhoidectomy Simple	$443.00	$591.00	$81.00–$541.00	33% below	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 I-injection Proc For Hysterosalpingog	$195.00	$260.00	$114.00–$238.00	16% below	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Injection Proc For Hysterosalpingography	$362.00	$483.00	$85.00–$442.00	56% above	25%
Incision and drainage of a simple or single skin abscess both sides CPT 10060 I/d Drainage Of Abscess Bilateral	$281.00	$375.00	$66.00–$343.00	—	25%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 Off Fac: I&d, Abscess; Simple	$58.00	$77.00	$14.00–$70.00	59% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I/d Drainage Of Abscess	$171.00	$228.00	$40.00–$209.00	21% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 Incision & Drainage, Abscess; Simple/sin	$194.00	$259.00	$46.00–$237.00	38% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 Id Abscess Simple	$284.00	$378.00	$42.00–$346.00	101% above	25%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair of groin hernia patient age 5 years or older	$22,352.00	$29,803.00	$5,245.00–$27,270.00	1431% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) both sides CPT 20550 20550 Bilat Inject Tendon/ligament	$197.00	$263.00	$46.00–$241.00	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Off Fac: Injection Tendoin/ligamen	$59.00	$79.00	$14.00–$72.00	64% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Off Pro: Inject Tendon/ligament	$70.00	$93.00	$41.00–$85.00	58% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Hosp Pro: Bone Bx Trocar/needle	$98.00	$131.00	$58.00–$120.00	41% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Inject Tendon/ligament	$98.00	$131.00	$23.00–$120.00	41% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Off Pro: Injection Tendoin/ligamen	$138.00	$184.00	$81.00–$168.00	17% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection Tendon/ligament Single	$272.00	$362.00	$64.00–$331.00	64% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 20610 Off Fac: Asp/inj; Major Bilat	$46.00	$61.00	$11.00–$56.00	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 P-n Inject Joint/bursa Bilat	$151.00	$201.00	$88.00–$184.00	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 Inj Joint/bursa Bilat	$1,449.00	$1,932.00	$340.00–$1,768.00	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Aspiration/injection; Major Jt	$101.00	$134.00	$24.00–$123.00	47% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Joint Or Bursa Major	$147.00	$196.00	$16.00–$179.00	23% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 2061050 Drain/inject Joint/bursa Majorbilateral	$151.00	$201.00	$35.00–$184.00	21% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Major Joint/bursa	$272.00	$362.00	$64.00–$331.00	43% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 P-n Inject Joint/bursa Left	$101.00	$134.00	$59.00–$123.00	47% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 P-n Inject Joint/bursa Right	$101.00	$134.00	$59.00–$123.00	47% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Inj Joint/bursa Left	$946.00	$1,261.00	$222.00–$1,154.00	397% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Inj Joint/bursa Rt	$946.00	$1,261.00	$222.00–$1,154.00	397% above	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insertion Non-biodegradable Drug Implant Delivery Implant	$231.00	$308.00	$54.00–$282.00	74% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 P-arthro; Asp/imj Inter Joint; Bilat	$145.00	$193.00	$85.00–$177.00	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 Arthrocentesis; Asp &/Or Injint Jt Bi	$1,008.00	$1,344.00	$237.00–$1,230.00	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Aspiration/injection; Med	$84.00	$112.00	$20.00–$102.00	53% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis Joint Or Bursa Int	$121.00	$161.00	$13.00–$147.00	32% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain/inj-m D J T	$127.00	$169.00	$30.00–$155.00	29% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Intmd Joint/bursa	$272.00	$362.00	$64.00–$331.00	52% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis; Asp &/Or Injint Joint	$671.00	$895.00	$158.00–$819.00	275% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 P-arthro; Asp/imj Inter Joint; Lt	$97.00	$129.00	$57.00–$118.00	46% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 P-arthro; Asp/imj Inter Joint; Rt	$97.00	$129.00	$57.00–$118.00	46% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 Arthrocentesis; Asp &/Or Injint Jt Lt	$671.00	$895.00	$158.00–$819.00	275% above	25%
Joint injection or drainage, small joint (fingers, toes) both sides CPT 20600 Bilateral Sm Joint	$121.00	$161.00	$28.00–$147.00	—	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Aspiration/injection; Sm	$80.00	$107.00	$19.00–$98.00	54% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Hosp Pro: Aspiration/injection; Sm	$80.00	$107.00	$47.00–$98.00	54% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis, Aspiration &/Or Injectio	$80.00	$107.00	$13.00–$98.00	54% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Off Pro: Aspiration/inject; Sm	$86.00	$115.00	$51.00–$105.00	50% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis-asp/inj Small	$272.00	$362.00	$64.00–$331.00	57% above	25%
Knee arthroscopy with meniscus trim CPT 29881 Removal of one knee cartilage using an endoscope	$14,751.00	$19,668.00	$3,462.00–$17,996.00	973% above	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Off Fac: Repair, Interm Wound	$117.00	$156.00	$27.00–$143.00	59% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Intmdrpr Scalp/axil/trk/extrm Exc Hnd/ft	$315.00	$420.00	$74.00–$384.00	9% above	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Layer Close Wnd Trk/exterm2.5 Or <	$389.00	$518.00	$91.00–$474.00	35% above	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Layer Closure2.5cm Scalp/trunk Extrem	$456.00	$608.00	$55.00–$556.00	58% above	25%
Lower-back epidural injection, with imaging guidance CPT 62323 Injection(s) of therapeutic substance	$2,633.00	$3,511.00	$618.00–$3,213.00	183% above	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection(s) of anesthetic into lower spine using imaging guidance	$3,092.00	$4,123.00	$726.00–$3,773.00	220% above	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Off Fac: Excis, Benign Skin L	$61.00	$81.00	$14.00–$74.00	59% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Excision, Benign Skin Lesion Including M	$203.00	$271.00	$48.00–$248.00	35% above	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Hosp Pro: Excis, Benign Skin Lesio	$203.00	$271.00	$32.00–$248.00	35% above	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Hosp Pro: Excis, Benign Les <=.5cm	$221.00	$295.00	$40.00–$270.00	9% below	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Excision, Other Benign Lesion Including	$221.00	$295.00	$52.00–$270.00	9% below	25%
Nail removal (partial or complete), one nail both sides CPT 11730 Avulsion, Nail Plate, Partail/complete/ Bilateral Proc	$389.00	$518.00	$91.00–$474.00	—	25%
Nail removal (partial or complete), one nail CPT 11730 11730 Off Pro: Avul Nail Plate, Simpl	$165.00	$220.00	$21.00–$201.00	34% above	25%
Nail removal (partial or complete), one nail CPT 11730 Avulsion, Nail Plate, Partial/complete,	$165.00	$220.00	$39.00–$201.00	34% above	25%
Nail removal (partial or complete), one nail CPT 11730 Avulsion Of Nail Plate Part/comp Sing/si	$171.00	$228.00	$40.00–$209.00	39% above	25%
Occipital nerve block (injection for headaches) CPT 64405 64405 Off Fac: Inj Anesthetic Agent	$50.00	$66.00	$12.00–$60.00	78% below	24%
Occipital nerve block (injection for headaches) CPT 64405 Inj, Anesth Agent, Greater Occipital Ner	$272.00	$362.00	$64.00–$331.00	17% above	25%
Occipital nerve block (injection for headaches) CPT 64405 P-n Block Inj Greater Occipital	$311.00	$415.00	$19.00–$380.00	34% above	25%
Occipital nerve block (injection for headaches) CPT 64405 N Block Inj Greater Occipital	$1,256.00	$1,675.00	$295.00–$1,533.00	442% above	25%
Paracentesis with imaging guidance CPT 49083 49083 Off Fac: Abd Paracentesis W/imagng	$146.00	$195.00	$34.00–$178.00	81% below	25%
Paracentesis with imaging guidance CPT 49083 49083 Hosp Pro: Abd Paracentesis W/imag	$485.00	$647.00	$39.00–$592.00	37% below	25%
Paracentesis with imaging guidance CPT 49083 Pxparacentis W Image Guidance	$755.00	$1,006.00	$177.00–$920.00	2% below	25%
Paracentesis with imaging guidance CPT 49083 Abdominal Paracentesis W/ Imaging	$755.00	$1,006.00	$177.00–$920.00	2% below	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision, Nail/nail Matrix, Permanent Re	$299.00	$398.00	$70.00–$364.00	2% above	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision Of Nail Part/comp	$315.00	$420.00	$74.00–$384.00	8% above	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Dest Paravert Lum/sacr	$406.00	$541.00	$95.00–$495.00	71% below	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 P-dest Paravert Lum/sacr	$422.00	$563.00	$73.00–$515.00	70% below	25%
Removal of a foreign object under the skin, simple CPT 10120 10120 Off Fac: Rem Forgn Body Simpl	$74.00	$99.00	$17.00–$91.00	58% below	25%
Removal of a foreign object under the skin, simple CPT 10120 10120 Remove Foreign Body Simple	$251.00	$334.00	$59.00–$306.00	43% above	25%
Removal of a foreign object under the skin, simple CPT 10120 Removal-tissue Simple	$278.00	$370.00	$42.00–$339.00	58% above	25%
Removal of a foreign object under the skin, simple CPT 10120 Incision/removal Fb Subcutaneous Simp	$315.00	$420.00	$74.00–$384.00	79% above	25%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 G0121 Off Fac: Colorectal Ca Screen	$188.00	$250.00	$44.00–$229.00	79% below	25%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 G0121 Hosp Pro: Colorectal Ca Screen;	$626.00	$834.00	$69.00–$763.00	31% below	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 G0105 Off Fac: Colorectal Ca Screen	$187.00	$249.00	$44.00–$228.00	80% below	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 G0105 Hosp Pro: Colorectal Ca Screen; Hi	$624.00	$832.00	$69.00–$761.00	35% below	25%
Short arm cast (elbow to hand) CPT 29075 29075 Off Fac: App Fore Arm Cast	$43.00	$57.00	$10.00–$52.00	75% below	25%
Short arm cast (elbow to hand) CPT 29075 29075 Hosp Pro: App Forearm Cast	$144.00	$192.00	$24.00–$176.00	16% below	25%
Short arm splint (forearm and hand) both sides CPT 29125 Application Of Short Arm Splint Bilat	$175.00	$233.00	$41.00–$213.00	—	25%
Short arm splint (forearm and hand) CPT 29125 29125 Off Fac: App Fore Arm Splnt St	$32.00	$43.00	$8.00–$39.00	69% below	26%
Short arm splint (forearm and hand) CPT 29125 Short Arm Splint	$116.00	$155.00	$17.00–$142.00	14% above	25%
Short arm splint (forearm and hand) CPT 29125 Application Of Short Arm Splint	$117.00	$156.00	$27.00–$143.00	15% above	25%
Short leg cast (below the knee) CPT 29405 29405 Off Fac: App Shortleg Cast	$41.00	$54.00	$10.00–$49.00	72% below	24%
Short leg cast (below the knee) CPT 29405 29405 Hosp Pro: App Shortleg Cast	$137.00	$182.00	$23.00–$167.00	6% below	25%
Short leg splint (calf to foot) both sides CPT 29515 Application Of Short Leg Splint Bilat	$226.00	$301.00	$53.00–$275.00	—	25%
Short leg splint (calf to foot) CPT 29515 Short Leg Splint	$147.00	$196.00	$20.00–$179.00	33% above	25%
Short leg splint (calf to foot) CPT 29515 Application Of Short Leg Splint	$151.00	$201.00	$35.00–$184.00	36% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Off Fac: Rpr S/n/a/e; <=2.5cm	$44.00	$59.00	$10.00–$54.00	67% below	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Off Pro: Rpr S/n/a/eg/t <=2.5cm	$103.00	$137.00	$60.00–$125.00	22% below	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple Repair, Superficial Wounds, Scalp	$147.00	$196.00	$34.00–$179.00	11% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Smplrpr Scalp/neck/axil/extgen/trk/extrm	$171.00	$228.00	$40.00–$209.00	29% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple Suture 2.5cm Scalp/trunk/extrem	$263.00	$351.00	$18.00–$321.00	98% above	25%
Skin biopsy, punch, one lesion CPT 11104 11104 Off Fac: Punch Biopsy Skin, 1st Le	$66.00	$88.00	$15.00–$81.00	70% below	25%
Skin biopsy, punch, one lesion CPT 11104 Punch Bx Skin Single Lesion	$218.00	$291.00	$51.00–$266.00	1% below	25%
Skin biopsy, punch, one lesion CPT 11104 11104 Hosp Pro: Punch Biopsy Skin,1st Le	$218.00	$291.00	$16.00–$266.00	1% below	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 Off Fac: Exc Tr-ext Mal+marg	$95.00	$126.00	$22.00–$115.00	67% below	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 Exc Tr-ext Mal+marg 0.5 Cm/<	$316.00	$421.00	$74.00–$385.00	10% above	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 Hosp Pro: Exc Tr-ext Mal+marg 0.5c	$316.00	$421.00	$45.00–$385.00	10% above	25%
Skin tag removal, up to 15 tags CPT 11200 11200 Off Fac: Rem, Skin Tags, Mult	$44.00	$58.00	$10.00–$53.00	62% below	24%
Skin tag removal, up to 15 tags CPT 11200 11200 Hosp Pro: Remove Skin Tags, Mult	$145.00	$193.00	$29.00–$177.00	25% above	25%
Skin tag removal, up to 15 tags CPT 11200 Removal, Skin Tags, Multiple Fibrocutane	$145.00	$193.00	$34.00–$177.00	25% above	25%
Skin tag removal, up to 15 tags CPT 11200 Removal Skin Tags, Multi Fibro Tags, Any	$171.00	$228.00	$40.00–$209.00	47% above	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Punct	$230.00	$307.00	$24.00–$281.00	48% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Puncture Lumbar Diagnostic	$604.00	$805.00	$142.00–$737.00	35% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Off Pro: Rpr S/n/a/eg/t 2.6-7.5cm	$54.00	$72.00	$13.00–$66.00	68% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Smplrpr Scalp/neck/axil/extgen/trk/extrm	$171.00	$228.00	$40.00–$209.00	1% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Simple Repr Wnd Trk/extrm 2.6-7.5	$179.00	$238.00	$42.00–$218.00	5% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple Suture 2.6-7.5cm Scalp/trunk/extr	$293.00	$390.00	$24.00–$357.00	73% above	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Off Fac: Rpr F/e/e/n; <=2.5cm	$54.00	$72.00	$13.00–$66.00	67% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Smplrpr Face/ears/eyelid/nose/lip/mm	$171.00	$228.00	$40.00–$209.00	4% above	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Simple Rpr Feenl 2.5cm Or Less	$180.00	$240.00	$42.00–$220.00	10% above	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple Suture 2.5 Cm Face	$272.00	$362.00	$22.00–$331.00	66% above	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Off Fac: Skin Biopsyshaving	$60.00	$80.00	$14.00–$73.00	65% below	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Hosp Pro: Targentl Biopsy Skin Les	$199.00	$265.00	$13.00–$242.00	16% above	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential Biopsy Skin Single Lesion	$199.00	$265.00	$47.00–$242.00	16% above	25%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis W/ Imaging	$621.00	$828.00	$146.00–$758.00	4% below	25%
Thoracentesis with imaging guidance CPT 32555 Us Thoracentesis	$992.00	$1,322.00	$233.00–$1,210.00	53% above	25%
Thoracentesis with imaging guidance one side CPT 32555 32555 Hosp Pro: Drain Right Pleural Cav	$480.00	$640.00	$40.00–$586.00	26% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 Injection(s), Single Or Multiple Trigger	$93.00	$124.00	$22.00–$113.00	32% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Single/multi Trigger 1 Or 2 Muscles	$110.00	$147.00	$15.00–$135.00	19% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 Injection Trigger Point Single/multiple	$272.00	$362.00	$64.00–$331.00	100% above	25%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Point 1 Or 2 Muscles	$315.00	$420.00	$74.00–$384.00	131% above	25%
Upper endoscopy (EGD) with biopsy CPT 43239 Biopsy exam of esophagus, stomach or small bowel using an endoscope	$4,169.00	$5,558.00	$978.00–$5,086.00	293% above	25%
Upper endoscopy (EGD), diagnostic CPT 43235 Diagnostic exam of esophagus, stomach or small bowel using an endoscope	$3,353.00	$4,470.00	$787.00–$4,090.00	261% above	25%
Wart removal, up to 14 warts CPT 17110 17110 Off Fac: Destruct, Any Method	$54.00	$72.00	$13.00–$66.00	55% below	25%
Wart removal, up to 14 warts CPT 17110 Destruction, Any Method, Flat Warts, Mol	$182.00	$242.00	$43.00–$221.00	51% above	25%
Wart removal, up to 14 warts CPT 17110 17110 Hosp Pro: Destruct, Any Method	$182.00	$242.00	$26.00–$221.00	51% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Off Fac: Debride Skin/tissue	$57.00	$76.00	$13.00–$70.00	67% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debride Skin/tissue	$192.00	$256.00	$45.00–$234.00	12% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Hosp Pro: Debride Skin/tissue	$192.00	$256.00	$23.00–$234.00	12% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debridement-subcutaneous	$305.00	$406.00	$71.00–$371.00	77% above	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Tranfusion, Blood/blood Components	$725.00	$966.00	$170.00–$884.00	46% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 Tranfusions, Bld/blood Comp2 Transfus	$1,449.00	$1,932.00	$340.00–$1,768.00	192% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 Tranfusions, Bld/blood Comp3 Transfus	$2,174.00	$2,899.00	$510.00–$2,653.00	337% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 Tranfusions, Bld/blood Comp4 Transfus	$2,900.00	$3,866.00	$680.00–$3,537.00	484% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Airway Inhalation Treatment	$30.00	$40.00	$7.00–$37.00	83% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Treatment	$181.00	$241.00	$42.00–$221.00	at median	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Sputum Induction	$181.00	$241.00	$42.00–$221.00	at median	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Heated	$181.00	$241.00	$3.00–$221.00	at median	25%
Critical care, first 30 to 74 minutes CPT 99291 Critical Care, Evaluation & Management,	$460.00	$613.00	$108.00–$561.00	52% below	25%
Critical care, first 30 to 74 minutes CPT 99291 Dr-critical Care Evaluation & Management	$1,013.00	$1,350.00	$84.00–$1,235.00	5% above	25%
Critical care, first 30 to 74 minutes CPT 99291 Ed-critical Care Eval And Management	$1,063.00	$1,417.00	$249.00–$1,297.00	10% above	25%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram, routine, with interpretation and report	$160.00	$213.00	$37.00–$195.00	28% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg Repeat (Same Day)	$108.00	$144.00	$25.00–$132.00	2% below	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg	$108.00	$144.00	$25.00–$132.00	2% below	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 Out Patient/er Consultation Level 1	$37.00	$49.00	$9.00–$45.00	58% below	24%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Ed-probs Are Self Limited Or Minor	$142.00	$189.00	$33.00–$173.00	60% above	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Dr-probs Are Self Limited Or Minor	$157.00	$209.00	$5.00–$191.00	77% above	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 Outpatient/er (V01/09)	$71.00	$94.00	$17.00–$86.00	60% below	24%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Dr-probs Are Of Low To Moderate Severity	$184.00	$245.00	$17.00–$224.00	4% above	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Ed-probs Are Of Low To Moderate Severity	$248.00	$330.00	$58.00–$302.00	40% above	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency Dept Visit,3 Key Components:ex	$105.00	$140.00	$25.00–$128.00	68% below	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Dr-probs Are Of Moderate Severity	$207.00	$276.00	$29.00–$253.00	38% below	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Ed-probs Are Of Moderate Severity	$370.00	$493.00	$87.00–$451.00	11% above	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency Dept Visit, 3 Key Components:	$199.00	$265.00	$47.00–$242.00	65% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Dr-probs Are Of High Severity-eval	$239.00	$319.00	$50.00–$292.00	58% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Ed-probs Are Of High Severity-eval	$515.00	$687.00	$121.00–$629.00	9% below	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Dr-probs Are Of High Severity	$368.00	$491.00	$72.00–$449.00	60% below	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Ed-probs Are Of High Severity	$755.00	$1,006.00	$177.00–$920.00	18% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Infusion Hydration Initial 31min-1hr	$323.00	$430.00	$76.00–$393.00	55% above	25%
IV infusion of a medicine, first hour CPT 96365 Iv Infusion Therapy/propylxs/diag Init	$323.00	$430.00	$76.00–$393.00	1% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Off Fac: Prophylatic Or Diag Inj	$13.00	$17.00	$3.00–$16.00	80% below	24%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96370 Off Pro: Prophylatic Or Diag Inj	$29.00	$39.00	$6.00–$36.00	55% below	26%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Im/subq Injection	$41.00	$55.00	$10.00–$50.00	36% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic/propylctc Dignostic Inj Sc/i	$98.00	$131.00	$23.00–$120.00	54% above	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Initial Psychiatric Diagnostic Eval (No Medical Serv)	$225.00	$300.00	$53.00–$275.00	10% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 Pt Neuro Re-education	$157.00	$209.00	$37.00–$191.00	58% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 Ot Neuro Re-education	$157.00	$209.00	$37.00–$191.00	58% above	25%
New patient office visit, about 30 minutes CPT 99203 New patient office or other outpatient visit, 30 min	$369.00	$492.00	$87.00–$450.00	229% above	25%
New patient office visit, about 45 minutes CPT 99204 New patient office or other outpatient visit, 45 min	$461.00	$614.00	$108.00–$562.00	175% above	25%
New patient office visit, about 60 minutes CPT 99205 New patient office or other outpatient visit, 60 min	$553.00	$737.00	$130.00–$674.00	76% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Off Pro: Office/op Visit, New P	$87.00	$116.00	$17.00–$106.00	20% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office/op Visit, New Pt, 3 Key Component	$124.00	$165.00	$29.00–$151.00	71% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Np Consult Limited 16-30 Min	$278.00	$370.00	$65.00–$339.00	283% above	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Mnt Initial Assessment (Ea 15min)	$35.00	$46.00	$8.00–$42.00	23% below	24%
Occupational therapy evaluation, low complexity CPT 97165 Ot Evaluation, Low Complexity	$290.00	$387.00	$68.00–$354.00	30% above	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Evaluation, High Complexity	$348.00	$464.00	$82.00–$425.00	33% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Evaluation, Low Complexity	$242.00	$322.00	$57.00–$295.00	9% above	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Evaluation, Moderate Complexity	$281.00	$375.00	$66.00–$343.00	7% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Pt Manual Therapy	$140.00	$186.00	$33.00–$170.00	42% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Ot Manual Therapy	$140.00	$186.00	$33.00–$170.00	42% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Physical therapy, therapeutic exercise	$150.00	$200.00	$35.00–$183.00	127% above	25%
Preventive checkup, new patient aged 18–39 CPT 99385 Initial new patient preventative medicine evaluation (18-39 years)	$178.00	$237.00	$42.00–$217.00	37% above	25%
Preventive checkup, new patient aged 40–64 CPT 99386 Initial new patient preventative medicine evaluation (40-64 years)	$202.00	$269.00	$47.00–$246.00	15% above	25%
Preventive checkup, new patient aged 65 or older CPT 99387 Initial Preventive Medicine E&m W/ Compr	$219.00	$292.00	$51.00–$267.00	32% above	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 Periodic Preventive Medicine E&m W/ Comp	$149.00	$198.00	$35.00–$181.00	20% above	25%
Preventive checkup, returning patient aged 40–64 CPT 99396 Periodic Preventive Medicine E&m W/ Comp	$161.00	$215.00	$38.00–$197.00	33% above	25%
Preventive checkup, returning patient aged 65 or older CPT 99397 Periodic Preventive Medicine E&m W/ Comp	$184.00	$245.00	$43.00–$224.00	53% above	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking Cessation	$24.00	$32.00	$6.00–$29.00	3% below	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Off Pro: Office/op Visit, Est P	$169.00	$225.00	$53.00–$206.00	19% above	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office/op Visit, Est Pt, 3 Key Component	$242.00	$322.00	$57.00–$295.00	71% above	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Ep Visit Comp > 61 Min	$323.00	$430.00	$76.00–$393.00	128% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 P-99213 Outpatient Visit	$122.00	$162.00	$24.00–$148.00	75% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office/op Visit, Est Pt, 2 Key Component	$122.00	$162.00	$29.00–$148.00	75% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Ep Visit Moderate 31-45 Min	$232.00	$309.00	$54.00–$283.00	233% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Off Pro: Office/op Visit, Est P	$125.00	$167.00	$36.00–$153.00	32% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office/op Visit, Est Pt, 2 Key Component	$179.00	$238.00	$42.00–$218.00	89% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Ep Visit Extended 46-60 Min	$278.00	$370.00	$65.00–$339.00	193% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Off Pro: Office/op Visit, Est P	$50.00	$67.00	$13.00–$61.00	7% below	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office/op Visit, Est Pt, 2 Key Component	$71.00	$95.00	$17.00–$87.00	31% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Ep Visit Limited 16-30 Min	$185.00	$247.00	$43.00–$226.00	242% above	25%
Specialist consultation, low complexity or 30+ minutes CPT 99243 Patient office consultation, 40 min	$190.00	$253.00	$45.00–$231.00	56% above	25%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Patient office consultation, 60 min	$248.00	$331.00	$58.00–$303.00	46% above	25%
Speech and language evaluation CPT 92523 St Eval Of Sound Prod & Comp+express	$452.00	$603.00	$106.00–$552.00	47% above	25%
Speech therapy session, individual CPT 92507 St Speech Treatment	$296.00	$394.00	$69.00–$361.00	81% above	25%
Spirometry (breathing test) CPT 94010 Pft-interp & Report Pre Dilator	$32.00	$42.00	$4.00–$38.00	79% below	24%
Spirometry (breathing test) CPT 94010 Pft-spirometry Pre Dilator (Only)	$395.00	$527.00	$93.00–$482.00	164% above	25%
Spirometry before and after a bronchodilator CPT 94060 Pft-spirometry Pre/post Dilator	$433.00	$577.00	$102.00–$528.00	18% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 Ot Therapeutic Activities	$161.00	$215.00	$38.00–$197.00	53% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 Pt Therapeutic Activities	$161.00	$215.00	$38.00–$197.00	53% above	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy Therapeutic	$158.00	$211.00	$37.00–$193.00	2% above	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy, Therapeutic (Sep Proc)	$161.00	$214.00	$38.00–$196.00	4% above	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella Virus Vaccine, Live, Subq Use	$119.00	$158.00	$28.00–$145.00	18% below	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella Vaccine Adult 0.5ml	$1,090.00	$1,453.00	$256.00–$1,329.00	655% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Fluarix Triv	$24.00	$32.00	$6.00–$29.00	8% above	25%
Hepatitis A vaccine, adult dose CPT 90632 Hep A, Adult Dosage	$98.00	$131.00	$23.00–$120.00	14% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B Vaccine Adult 20mcg/ml	$613.00	$817.00	$144.00–$748.00	888% above	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles, Mumps & Rubella Virus Vaccine (	$68.00	$91.00	$16.00–$83.00	34% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles, Mumps, Rubella Vaccine	$613.00	$817.00	$144.00–$748.00	491% above	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Menactra	$155.00	$207.00	$36.00–$189.00	29% above	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Bexsero, Hospital Supply	$242.00	$322.00	$57.00–$295.00	64% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal Vaccine, 23-valent, Adult,	$131.00	$174.00	$31.00–$159.00	29% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Zz Menactra 0.5ml	$752.00	$1,002.00	$176.00–$917.00	640% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumonococcal Vaccine 0.5ml	$758.00	$1,010.00	$178.00–$924.00	646% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Zz Gardasil Vaccine 0.5ml	$868.00	$1,157.00	$204.00–$1,059.00	755% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Ccppmeningococcal B Vaccine 0.5ml	$995.00	$1,327.00	$234.00–$1,214.00	880% above	25%
Rabies vaccine, one dose CPT 90675 Rabies Vaccination Im	$317.00	$423.00	$74.00–$387.00	13% below	25%
Rabies vaccine, one dose CPT 90675 Rabies Vaccine 2.5iu/ml	$1,691.00	$2,254.00	$397.00–$2,062.00	366% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus & Diphtheria Toxoids (Td) Adsorb Tetanus & Diphtheria Toxoids (Td)	$23.00	$31.00	$5.00–$28.00	45% below	26%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus And Diptheria Toxoid Im >7y	$68.00	$90.00	$16.00–$82.00	63% above	24%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap (19-64) Hospital Supply	$46.00	$61.00	$11.00–$56.00	3% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus Diptheria Pertussis Vaccine >7y	$68.00	$90.00	$16.00–$82.00	52% above	24%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus-diphtheria Toxoid Adsorbed: Inj	$252.00	$336.00	$59.00–$307.00	464% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus/diphtheria/pertussis Inj 0.5ml	$496.00	$661.00	$116.00–$605.00	1010% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Ccpphuman Papilloma Vaccine 0.5ml	$1,375.00	$1,833.00	$323.00–$1,677.00	2977% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Immunization-first	$17.00	$23.00	$4.00–$21.00	at median	26%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Administration	$71.00	$94.00	$17.00–$86.00	318% above	24%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Ea Addtl Immunization	$14.00	$19.00	$3.00–$17.00	12% below	26%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Administration Additional	$51.00	$68.00	$12.00–$62.00	221% above	25%

Source file: https://secure.claraprice.net/price-transparency/IJLS-1755124586280/machine-readable/862728785_calais-community-hospital_standardcharges.json