Hospital Bellefontaine, OH

Mary Rutan Hospital

Mary Rutan Hospital in Bellefontaine, OH publishes cash prices for 275 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Ohio median for 170 of 273 procedures and below it for 101. By typical cash price it ranks #99 of 131 Ohio hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

205 Palmer Avenue, Bellefontaine, OH 43311 Collected Sep 29, 2026 Source price file (937) 651-3257

Acute care hospital Emergency department CMS star rating 4 of 5 CCN 360197 · CMS hospital register NPI 1548254931

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 3 actions for a hospital named Mary Rutan Hospital in Bellefontaine, OH:

Feb 25, 2026 Warning notice
Jun 1, 2026 Corrective action plan requested
Jun 10, 2026 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Ankle X-ray, complete, 3 or more views both sides CPT 73610 Xray Bilat Ankle 3 View	$571.20	$714.00	—	—	20%
Ankle X-ray, complete, 3 or more views CPT 73610 Xray Ankle 3 Or > Vws	$489.60	$612.00	—	41% above	20%
Ankle X-ray, complete, 3 or more views CPT 73610 Xray Ankle Complete 3 Views	$489.60	$612.00	—	41% above	20%
Ankle X-ray, complete, 3 or more views CPT 73610 Ankle Bil	$571.20	$714.00	—	64% above	20%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 Xray Bilat Ankle 3 View	$571.20	$714.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 Xray Ankle Complete 3 Views	$489.60	$612.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 Xray Ankle 3 Or > Vws	$489.60	$612.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 Ankle Bil	$571.20	$714.00	—	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Upr/L Xtremity Art 2 Levels	$248.80	$311.00	—	48% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Art Exam Single Level	$352.80	$441.00	—	27% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Upr/L Xtremity Art 2 Lvls	$352.80	$441.00	—	27% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Upr/L Xtremity Art 2 Levels	$248.80	$311.00	—	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Upr/L Xtremity Art 2 Lvls	$352.80	$441.00	—	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Art Exam Single Level	$352.80	$441.00	—	—	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Esophogram	$804.00	$1,005.00	—	87% above	20%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Esophogram	$804.00	$1,005.00	—	—	20%
Bone scan, whole body (nuclear medicine) CPT 78306 Bone Scan	$1,616.00	$2,020.00	—	5% above	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Bone Scan	$1,616.00	$2,020.00	—	—	20%
Breast ultrasound, complete, one breast CPT 76641 Unil Brst Sono Inc Axilla Cmpt	$1,072.00	$1,340.00	—	125% above	20%
Breast ultrasound, complete, one breast CPT 76641 Bil Brst Sono Inc Axilla Cmplt	$1,414.40	$1,768.00	—	196% above	20%
Breast ultrasound, complete, one breast inpatient CPT 76641 Unil Brst Sono Inc Axilla Cmpt	$1,072.00	$1,340.00	—	—	20%
Breast ultrasound, complete, one breast inpatient CPT 76641 Bil Brst Sono Inc Axilla Cmplt	$1,414.40	$1,768.00	—	—	20%
Breast ultrasound, limited (one breast or one area) CPT 76642 Unil Brst Sono Inc Axilla Ltd	$634.40	$793.00	—	50% above	20%
Breast ultrasound, limited (one breast or one area) CPT 76642 Bil Breast Sono Inc Axilla Ltd	$1,103.20	$1,379.00	—	161% above	20%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Unil Brst Sono Inc Axilla Ltd	$634.40	$793.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Bil Breast Sono Inc Axilla Ltd	$1,103.20	$1,379.00	—	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct Chest(Pe)	$2,081.60	$2,602.00	—	47% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct Chest Angio W/Wo	$2,895.20	$3,619.00	—	104% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Ct Chest(Pe)	$2,081.60	$2,602.00	—	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Ct Chest Angio W/Wo	$2,895.20	$3,619.00	—	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abd & Pelvis Wo	$2,642.40	$3,303.00	—	68% above	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Ct Abd & Pelvis Wo	$2,642.40	$3,303.00	—	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct Abd & Pelvis W	$3,092.80	$3,866.00	—	59% above	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct Abd & Pelvis W	$3,092.80	$3,866.00	—	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd & Pelvis W/Wo	$3,548.00	$4,435.00	—	56% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct Abd & Pelvis W/Wo	$3,548.00	$4,435.00	—	—	20%
CT scan of the abdomen with contrast CPT 74160 Abdomen W Contrast	$2,443.20	$3,054.00	—	109% above	20%
CT scan of the abdomen with contrast inpatient CPT 74160 Abdomen W Contrast	$2,443.20	$3,054.00	—	—	20%
CT scan of the abdomen without contrast CPT 74150 Abdomen Wo Contrast	$1,585.60	$1,982.00	—	51% above	20%
CT scan of the abdomen without contrast inpatient CPT 74150 Abdomen Wo Contrast	$1,585.60	$1,982.00	—	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 Sinuses Limited	$615.20	$769.00	—	30% below	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Maxofacial Wo (Full Sn	$1,585.60	$1,982.00	—	81% above	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Sinuses Limited	$615.20	$769.00	—	—	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Ct Maxofacial Wo (Full Sn	$1,585.60	$1,982.00	—	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 Head Wo Contrast	$968.00	$1,210.00	—	16% above	20%
CT scan of the head or brain, no contrast dye CPT 70450 Ct Head Stroke	$968.00	$1,210.00	—	16% above	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 Head Wo Contrast	$968.00	$1,210.00	—	—	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct Head Stroke	$968.00	$1,210.00	—	—	20%
CT scan of the head with contrast CPT 70460 Head W Contrast	$1,569.60	$1,962.00	—	56% above	20%
CT scan of the head with contrast inpatient CPT 70460 Head W Contrast	$1,569.60	$1,962.00	—	—	20%
CT scan of the head without and with contrast CPT 70470 Head W/Wo Contrast	$2,092.00	$2,615.00	—	86% above	20%
CT scan of the head without and with contrast inpatient CPT 70470 Head W/Wo Contrast	$2,092.00	$2,615.00	—	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Spine Lumbar Wo Contrast	$1,585.60	$1,982.00	—	45% above	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 Spine Lumbar Wo Contrast	$1,585.60	$1,982.00	—	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Spine Cerv Wo Contrast	$1,440.80	$1,801.00	—	34% above	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 Spine Cerv Wo Contrast	$1,440.80	$1,801.00	—	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 Pelvis W Contrast	$2,443.20	$3,054.00	—	109% above	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 Pelvis W Contrast	$2,443.20	$3,054.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Extracranial Bilat 93880	$94.40	$118.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Bilat Carotid Duplex	$792.80	$991.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Extracranial Bilat 93880	$94.40	$118.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Bilat Carotid Duplex	$792.80	$991.00	—	—	20%
Chest X-ray, 2 views CPT 71046 Xray Chest 2 Views 71046	$103.20	$129.00	—	61% below	20%
Chest X-ray, 2 views CPT 71046 Xray Chest 2 Vws	$104.00	$130.00	—	61% below	20%
Chest X-ray, 2 views inpatient CPT 71046 Xray Chest 2 Views 71046	$103.20	$129.00	—	—	20%
Chest X-ray, 2 views inpatient CPT 71046 Xray Chest 2 Vws	$104.00	$130.00	—	—	20%
Chest X-ray, single view CPT 71045 Xray Chest 1 View	$131.60	$164.50	—	39% below	20%
Chest X-ray, single view CPT 71045 Chest 1 View	$432.00	$540.00	—	99% above	20%
Chest X-ray, single view inpatient CPT 71045 Xray Chest 1 View	$131.60	$164.50	—	—	20%
Chest X-ray, single view inpatient CPT 71045 Chest 1 View	$432.00	$540.00	—	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Retroperitoneal Son	$1,191.20	$1,489.00	—	68% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Retroperitoneal Son	$1,191.20	$1,489.00	—	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Dexa Axial W/Peripheral Sameda	$653.60	$817.00	—	44% above	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Dexa/Bone Density	$768.00	$960.00	—	70% above	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Dexa Axial W/Peripheral Sameda	$653.60	$817.00	—	—	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Dexa/Bone Density	$768.00	$960.00	—	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Thorax Wo Contrast	$1,485.60	$1,857.00	—	60% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Card Ct Chest Wo	$1,856.80	$2,321.00	—	100% above	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Thorax Wo Contrast	$1,485.60	$1,857.00	—	—	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Card Ct Chest Wo	$1,856.80	$2,321.00	—	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Thorax W Contrast	$1,734.40	$2,168.00	—	52% above	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Thorax W Contrast	$1,734.40	$2,168.00	—	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 Bilateral Post Biopsy Mamm 2D	$614.40	$768.00	—	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 Bilat Diag 2D	$614.40	$768.00	—	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Bilateral Post Biopsy Mamm 2D	$614.40	$768.00	—	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Bilat Diag 2D	$614.40	$768.00	—	—	20%
Diagnostic mammogram, one breast one side CPT 77065 Unilat Diag 2D	$484.80	$606.00	—	42% above	20%
Diagnostic mammogram, one breast one side CPT 77065 Unilateral Post Biopsy Mamm 2D	$484.80	$606.00	—	42% above	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Unilat Diag 2D	$484.80	$606.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Unilateral Post Biopsy Mamm 2D	$484.80	$606.00	—	—	20%
Duplex ultrasound of the leg arteries, both legs CPT 93925 Lower Extr Comp Bil 93925	$288.00	$360.00	—	67% below	20%
Duplex ultrasound of the leg arteries, both legs CPT 93925 Le Bil Arterial Duplex	$1,055.20	$1,319.00	—	22% above	20%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 Lower Extr Comp Bil 93925	$288.00	$360.00	—	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 Le Bil Arterial Duplex	$1,055.20	$1,319.00	—	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Dup Scan Extremity Bilat 93970	$225.60	$282.00	—	—	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 Bil Le Venous Duplex	$1,499.20	$1,874.00	—	67% above	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 Bi Le Venous Duplex Tech	$1,499.20	$1,874.00	—	67% above	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Dup Scan Extremity Bilat 93970	$225.60	$282.00	—	—	20%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Bil Le Venous Duplex	$1,499.20	$1,874.00	—	—	20%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Bi Le Venous Duplex Tech	$1,499.20	$1,874.00	—	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Tte W/Doppler Complete	$280.80	$351.00	—	83% below	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echocardiogram Complete Tte	$1,836.80	$2,296.00	—	9% above	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Tte W/Doppler Complete	$280.80	$351.00	—	—	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Echocardiogram Complete Tte	$1,836.80	$2,296.00	—	—	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hb Scan Gallbladder	$1,616.00	$2,020.00	—	7% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hb Scan Gallbladder	$1,616.00	$2,020.00	—	—	20%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Unattended Sleep Study	$946.40	$1,183.00	—	35% above	20%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Unattended Sleep Study	$946.40	$1,183.00	—	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysom W/Cpap Reduced	$2,840.00	$3,550.00	—	21% below	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysom W/Cpap Titration	$6,419.20	$8,024.00	—	78% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysom W/Cpap Reduced	$2,840.00	$3,550.00	—	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysom W/Cpap Titration	$6,419.20	$8,024.00	—	—	20%
Knee X-ray, 3 views both sides CPT 73562 Knee 3 View Bilat	$748.80	$936.00	—	—	20%
Knee X-ray, 3 views CPT 73562 Xray Knee 3 Vws	$489.60	$612.00	—	37% above	20%
Knee X-ray, 3 views CPT 73562 Knee 3V	$489.60	$612.00	—	37% above	20%
Knee X-ray, 3 views inpatient both sides CPT 73562 Knee 3 View Bilat	$748.80	$936.00	—	—	20%
Knee X-ray, 3 views inpatient CPT 73562 Xray Knee 3 Vws	$489.60	$612.00	—	—	20%
Knee X-ray, 3 views inpatient CPT 73562 Knee 3V	$489.60	$612.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Abdomen Lin Orga Or Quadf	$1,191.20	$1,489.00	—	116% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Abdomen Lin Orga Or Quadf	$1,191.20	$1,489.00	—	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct Lung Screening	$93.60	$117.00	—	65% below	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Ct Lung Screening	$93.60	$117.00	—	—	20%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 Mri Bilat Screening Brst Wow	$992.80	$1,241.00	—	—	20%
MRI of both breasts, without and then with contrast dye CPT 77049 Mri Bil Breast W/Wo Diagn	$4,240.80	$5,301.00	—	9% above	20%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 Mri Bilat Screening Brst Wow	$992.80	$1,241.00	—	—	20%
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 Mri Bil Breast W/Wo Diagn	$4,240.80	$5,301.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 Mri Ankle Bilat	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 Mri Knee Bilat	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 Mri Hip Bilat	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Mri Bil Low Ext Jt Wo	$2,086.40	$2,608.00	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Mri Ankle	$2,086.40	$2,608.00	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Mri Knee To Include Visionaire	$2,086.40	$2,608.00	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Mri Hip	$2,086.40	$2,608.00	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Mri Knee Biomet	$2,086.40	$2,608.00	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Mri Knee	$2,086.40	$2,608.00	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Mri Knee Visionary Only	$2,086.40	$2,608.00	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Mri Low Ext Jt Wo	$2,086.40	$2,608.00	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 Mri Hip Bilat	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 Mri Ankle Bilat	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 Mri Knee Bilat	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Mri Hip	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Mri Ankle	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Mri Knee Biomet	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Mri Knee To Include Visionaire	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Mri Knee	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Mri Knee Visionary Only	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Mri Low Ext Jt Wo	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Mri Bil Low Ext Jt Wo	$2,086.40	$2,608.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri Hip Wow	$3,283.20	$4,104.00	—	37% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri Low Ext Jt W/Wo	$3,283.20	$4,104.00	—	37% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri Knee Wow	$3,283.20	$4,104.00	—	37% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri Ankle Wow	$3,283.20	$4,104.00	—	37% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Mri Ankle Wow	$3,283.20	$4,104.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Mri Hip Wow	$3,283.20	$4,104.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Mri Knee Wow	$3,283.20	$4,104.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Mri Low Ext Jt W/Wo	$3,283.20	$4,104.00	—	—	20%
MRI of the abdomen without contrast CPT 74181 Mri Abdomen Wo	$984.80	$1,231.00	—	45% below	20%
MRI of the abdomen without contrast inpatient CPT 74181 Mri Abdomen Wo	$984.80	$1,231.00	—	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Abdomen Wow Contrast Mrcp	$3,609.60	$4,512.00	—	70% above	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Abd W/Wo	$3,609.60	$4,512.00	—	70% above	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Mri Abdomen Wow Contrast Mrcp	$3,609.60	$4,512.00	—	—	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Mri Abd W/Wo	$3,609.60	$4,512.00	—	—	20%
MRI of the brain, no contrast dye CPT 70551 Mri Brain Wo	$1,897.60	$2,372.00	—	22% above	20%
MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain Wo	$1,897.60	$2,372.00	—	—	20%
MRI of the brain, with and without contrast dye CPT 70553 Brain W&Wo Contrast Mri	$3,609.60	$4,512.00	—	76% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 Brain W&Wo Contrast Mri	$3,609.60	$4,512.00	—	—	20%
MRI of the lower back, no contrast dye CPT 72148 Mri Lumbar Wo	$2,086.40	$2,608.00	—	34% above	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 Mri Lumbar Wo	$2,086.40	$2,608.00	—	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 Lumbar Spine W/Wo Con Mri	$3,934.40	$4,918.00	—	73% above	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 Lumbar Spine W/Wo Con Mri	$3,934.40	$4,918.00	—	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri Thoracic Wo	$1,976.80	$2,471.00	—	32% above	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 Mri Thoracic Wo	$1,976.80	$2,471.00	—	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 Cerv Spine W&Wo Contr Mri	$3,620.00	$4,525.00	—	62% above	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 Cerv Spine W&Wo Contr Mri	$3,620.00	$4,525.00	—	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri Cervical Wo	$2,086.40	$2,608.00	—	47% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 Mri Cervical Wo	$2,086.40	$2,608.00	—	—	20%
MRI of the pelvis without and with contrast CPT 72197 Mri Pelvis W/Wo	$3,609.60	$4,512.00	—	86% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 Mri Pelvis W/Wo	$3,609.60	$4,512.00	—	—	20%
MRI of the pelvis, no contrast dye CPT 72195 Mri Pelvis Wo	$2,086.40	$2,608.00	—	45% above	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 Mri Pelvis Wo	$2,086.40	$2,608.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 Mri Elbow Bilat	$1,948.00	$2,435.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 Mri Wrist Bilat	$1,948.00	$2,435.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 Mri Shoulder Bilat	$1,948.00	$2,435.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri Bil Upper Ext Jt Wo	$1,948.00	$2,435.00	—	29% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Upper Extremity Joint Mri	$2,086.40	$2,608.00	—	39% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri Wrist	$2,086.40	$2,608.00	—	39% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri Shoulder	$2,086.40	$2,608.00	—	39% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri Elbow	$2,086.40	$2,608.00	—	39% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 Mri Elbow Bilat	$1,948.00	$2,435.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 Mri Wrist Bilat	$1,948.00	$2,435.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 Mri Shoulder Bilat	$1,948.00	$2,435.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 Mri Bil Upper Ext Jt Wo	$1,948.00	$2,435.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 Mri Elbow	$2,086.40	$2,608.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 Mri Shoulder	$2,086.40	$2,608.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 Mri Wrist	$2,086.40	$2,608.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 Upper Extremity Joint Mri	$2,086.40	$2,608.00	—	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Ht Muscle Image Spect Mult	$1,044.00	$1,305.00	—	73% below	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Spect Ex Or Pharm Mibi	$6,027.20	$7,534.00	—	58% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Pharmacologic Thallium	$6,027.20	$7,534.00	—	58% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Stress Thallium	$6,027.20	$7,534.00	—	58% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Ht Muscle Image Spect Mult	$1,044.00	$1,305.00	—	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Stress Thallium	$6,027.20	$7,534.00	—	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Spect Ex Or Pharm Mibi	$6,027.20	$7,534.00	—	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Pharmacologic Thallium	$6,027.20	$7,534.00	—	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Bladder Only Measurement	$690.40	$863.00	—	56% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us Pelvic Limited Fu	$690.40	$863.00	—	56% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Bladder Only Measurement	$690.40	$863.00	—	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Us Pelvic Limited Fu	$690.40	$863.00	—	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us Pelvic Nonpregnant Complete	$1,191.20	$1,489.00	—	143% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Us Pelvic Nonpregnant Complete	$1,191.20	$1,489.00	—	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Preg >14 Wks. Single	$1,309.60	$1,637.00	—	139% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Preg >14 Wks. Single	$1,309.60	$1,637.00	—	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Pelvis Preg<14 Wks Single	$1,191.20	$1,489.00	—	132% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Pelvis Preg<14 Wks Single	$1,191.20	$1,489.00	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Ultrasound Fetal Position	$673.60	$842.00	—	41% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Pelvic Preg Limited	$673.60	$842.00	—	41% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Ultrasound Sonography	$673.60	$842.00	—	41% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Ultrasound Fetal Position	$673.60	$842.00	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Ultrasound Sonography	$673.60	$842.00	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Pelvic Preg Limited	$673.60	$842.00	—	—	20%
Screening mammogram, both breasts both sides CPT 77067 Bilat Screen 2D	$494.40	$618.00	—	—	20%
Screening mammogram, both breasts one side CPT 77067 Unilat Screen 2D	$450.40	$563.00	—	146% above	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 Bilat Screen 2D	$494.40	$618.00	—	—	20%
Screening mammogram, both breasts inpatient one side CPT 77067 Unilat Screen 2D	$450.40	$563.00	—	—	20%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 Bilat Shoulder Min 2 Views Xra	$588.00	$735.00	—	—	20%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 Xray Shoulder Min 2 Vws Bilat	$588.00	$735.00	—	—	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 Xray Shoulder Min 2 Views	$489.60	$612.00	—	39% above	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 Xray Shoulder Min 2 Vws Unil	$489.60	$612.00	—	39% above	20%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 Bilat Shoulder Min 2 Views Xra	$588.00	$735.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 Xray Shoulder Min 2 Vws Bilat	$588.00	$735.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 Xray Shoulder Min 2 Vws Unil	$489.60	$612.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 Xray Shoulder Min 2 Views	$489.60	$612.00	—	—	20%
Sleep study in a lab (polysomnography) CPT 95810 Polysom 6/> Yrs 4/> Param	$928.80	$1,161.00	—	73% below	20%
Sleep study in a lab (polysomnography) CPT 95810 Polysom Stage 4 Reduced	$2,547.20	$3,184.00	—	25% below	20%
Sleep study in a lab (polysomnography) CPT 95810 Sleep Stage=4 Parameters	$5,557.60	$6,947.00	—	63% above	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysom 6/> Yrs 4/> Param	$928.80	$1,161.00	—	—	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysom Stage 4 Reduced	$2,547.20	$3,184.00	—	—	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Sleep Stage=4 Parameters	$5,557.60	$6,947.00	—	—	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Modified Barium Swallow	$731.20	$914.00	—	41% above	20%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Modified Barium Swallow	$731.20	$914.00	—	—	20%
Transvaginal pelvic ultrasound CPT 76830 Transvaginal Echography	$1,191.20	$1,489.00	—	121% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 Transvaginal Echography	$1,191.20	$1,489.00	—	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 Pregnant Transvaginal	$1,191.20	$1,489.00	—	138% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 Pregnant Transvaginal	$1,191.20	$1,489.00	—	—	20%
Ultrasound of the abdomen, complete CPT 76700 Abdom Comp Gb Liv Pan Sp	$1,204.00	$1,505.00	—	108% above	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 Abdom Comp Gb Liv Pan Sp	$1,204.00	$1,505.00	—	—	20%
Ultrasound of the scrotum and testicles CPT 76870 Scrotum	$1,191.20	$1,489.00	—	133% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 Scrotum	$1,191.20	$1,489.00	—	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Soft Tissue Neck (Thyroid	$1,191.20	$1,489.00	—	111% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Soft Tissue Neck (Thyroid	$1,191.20	$1,489.00	—	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Ugi No Air	$651.20	$814.00	—	10% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Ugi/Small Bowell/No Air	$1,609.60	$2,012.00	—	172% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Ugi No Air	$651.20	$814.00	—	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Ugi/Small Bowell/No Air	$1,609.60	$2,012.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Extremity Study Uni Lmtd 93971	$144.00	$180.00	—	80% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Lue Venous Duplex Tech	$999.20	$1,249.00	—	39% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Unilat Venous Duplex	$999.20	$1,249.00	—	39% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Extremity Study Uni Lmtd 93971	$144.00	$180.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Lue Venous Duplex Tech	$999.20	$1,249.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Unilat Venous Duplex	$999.20	$1,249.00	—	—	20%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 Xray Wrist W Navicular Bilat	$489.60	$612.00	—	—	20%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 Xray Wrist 3 Vws Bilat	$562.40	$703.00	—	—	20%
Wrist X-ray, complete, 3 or more views CPT 73110 Wrist 3 View	$489.60	$612.00	—	42% above	20%
Wrist X-ray, complete, 3 or more views CPT 73110 Wrist W Navicular	$489.60	$612.00	—	42% above	20%
Wrist X-ray, complete, 3 or more views CPT 73110 Xray Wrist Complete 3 Vws	$489.60	$612.00	—	42% above	20%
Wrist X-ray, complete, 3 or more views CPT 73110 Wrist 3V Bil	$562.40	$703.00	—	63% above	20%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 Xray Wrist W Navicular Bilat	$489.60	$612.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 Xray Wrist 3 Vws Bilat	$562.40	$703.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 Xray Wrist Complete 3 Vws	$489.60	$612.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 Wrist 3 View	$489.60	$612.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 Wrist W Navicular	$489.60	$612.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 Wrist 3V Bil	$562.40	$703.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-Ray Exam Hip Uni 2-3 Views	$400.80	$501.00	—	14% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 Xray Hip Unila W Pelvis 2-3Vws	$480.00	$600.00	—	37% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 Hip Unil W/Pelv 2-3 Views Xray	$489.60	$612.00	—	39% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 X-Ray Exam Hip Uni 2-3 Views	$400.80	$501.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 Xray Hip Unila W Pelvis 2-3Vws	$480.00	$600.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 Hip Unil W/Pelv 2-3 Views Xray	$489.60	$612.00	—	—	20%
X-ray of the abdomen, 1 view CPT 74018 Xray Abdomen Ap Kub	$428.80	$536.00	—	69% above	20%
X-ray of the abdomen, 1 view CPT 74018 Xray Abdomen 1 View	$428.80	$536.00	—	69% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 Xray Abdomen 1 View	$428.80	$536.00	—	—	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 Xray Abdomen Ap Kub	$428.80	$536.00	—	—	20%
X-ray of the ankle, 2 views CPT 73600 Ankle 2 View	$489.60	$612.00	—	76% above	20%
X-ray of the ankle, 2 views CPT 73600 Xray Ankle 2 Vws	$489.60	$612.00	—	76% above	20%
X-ray of the ankle, 2 views CPT 73600 Ankle 2V Bil	$540.80	$676.00	—	95% above	20%
X-ray of the ankle, 2 views inpatient CPT 73600 Xray Ankle 2 Vws	$489.60	$612.00	—	—	20%
X-ray of the ankle, 2 views inpatient CPT 73600 Ankle 2 View	$489.60	$612.00	—	—	20%
X-ray of the ankle, 2 views inpatient CPT 73600 Ankle 2V Bil	$540.80	$676.00	—	—	20%
X-ray of the finger(s), 2 or more views CPT 73140 Xray Finger(S) Min 2 Vws	$489.60	$612.00	—	89% above	20%
X-ray of the finger(s), 2 or more views CPT 73140 Xray Finger	$489.60	$612.00	—	89% above	20%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 Xray Finger(S) Min 2 Vws	$489.60	$612.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 Xray Finger	$489.60	$612.00	—	—	20%
X-ray of the foot, 2 views both sides CPT 73620 Xray Bilat Foot 2 Vws	$597.60	$747.00	—	—	20%
X-ray of the foot, 2 views CPT 73620 Xray Foot 2 Vws	$489.60	$612.00	—	85% above	20%
X-ray of the foot, 2 views CPT 73620 Foot 2 View	$489.60	$612.00	—	85% above	20%
X-ray of the foot, 2 views CPT 73620 Foot 2V Bil	$597.60	$747.00	—	125% above	20%
X-ray of the foot, 2 views inpatient both sides CPT 73620 Xray Bilat Foot 2 Vws	$597.60	$747.00	—	—	20%
X-ray of the foot, 2 views inpatient CPT 73620 Foot 2 View	$489.60	$612.00	—	—	20%
X-ray of the foot, 2 views inpatient CPT 73620 Xray Foot 2 Vws	$489.60	$612.00	—	—	20%
X-ray of the foot, 2 views inpatient CPT 73620 Foot 2V Bil	$597.60	$747.00	—	—	20%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 Xray Bilat Foot 3 View	$574.40	$718.00	—	—	20%
X-ray of the foot, complete, 3 or more views CPT 73630 Xray Foot	$489.60	$612.00	—	49% above	20%
X-ray of the foot, complete, 3 or more views CPT 73630 Xray Foot 3 Or > Vws	$489.60	$612.00	—	49% above	20%
X-ray of the foot, complete, 3 or more views CPT 73630 Foot Bil	$574.40	$718.00	—	74% above	20%
X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 Xray Bilat Foot 3 View	$574.40	$718.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 Xray Foot	$489.60	$612.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 Xray Foot 3 Or > Vws	$489.60	$612.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 Foot Bil	$574.40	$718.00	—	—	20%
X-ray of the hand, 3 or more views both sides CPT 73130 Xray Hand Min 3 Vws Bilat	$569.60	$712.00	—	—	20%
X-ray of the hand, 3 or more views CPT 73130 Xray Hand Min 3 Vws Unil	$489.60	$612.00	—	41% above	20%
X-ray of the hand, 3 or more views CPT 73130 Xray Hand	$489.60	$612.00	—	41% above	20%
X-ray of the hand, 3 or more views CPT 73130 Hand Bil	$569.60	$712.00	—	64% above	20%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 Xray Hand Min 3 Vws Bilat	$569.60	$712.00	—	—	20%
X-ray of the hand, 3 or more views inpatient CPT 73130 Xray Hand	$489.60	$612.00	—	—	20%
X-ray of the hand, 3 or more views inpatient CPT 73130 Xray Hand Min 3 Vws Unil	$489.60	$612.00	—	—	20%
X-ray of the hand, 3 or more views inpatient CPT 73130 Hand Bil	$569.60	$712.00	—	—	20%
X-ray of the knee, 1 or 2 views both sides CPT 73560 Xray Knee 1 Or 2 Vws Bilat	$477.60	$597.00	—	—	20%
X-ray of the knee, 1 or 2 views CPT 73560 Xray Knee 1 Or 2 Vws Unil	$443.20	$554.00	—	57% above	20%
X-ray of the knee, 1 or 2 views CPT 73560 Knee 2 View	$443.20	$554.00	—	57% above	20%
X-ray of the knee, 1 or 2 views CPT 73560 Knee 2V Bil	$477.60	$597.00	—	69% above	20%
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 Xray Knee 1 Or 2 Vws Bilat	$477.60	$597.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 Knee 2 View	$443.20	$554.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 Xray Knee 1 Or 2 Vws Unil	$443.20	$554.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 Knee 2V Bil	$477.60	$597.00	—	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Xray Lumbar Spine 2View	$538.40	$673.00	—	70% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Xray Lumbosacral Spine Ap Lat	$538.40	$673.00	—	70% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Xray Lumbosacral Spine Ap Lat	$538.40	$673.00	—	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Xray Lumbar Spine 2View	$538.40	$673.00	—	—	20%
X-ray of the lower back, 4 or more views CPT 72110 Xray Lumbar Spine 5 View	$752.80	$941.00	—	61% above	20%
X-ray of the lower back, 4 or more views CPT 72110 Xray Lumbar Spine 4+ Vws	$752.80	$941.00	—	61% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 Xray Lumbar Spine 4+ Vws	$752.80	$941.00	—	—	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 Xray Lumbar Spine 5 View	$752.80	$941.00	—	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Thoracic Spine 2 V	$417.60	$522.00	—	42% above	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Xray Thoracic Spine 2 Vws	$417.60	$522.00	—	42% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Thoracic Spine 2 V	$417.60	$522.00	—	—	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Xray Thoracic Spine 2 Vws	$417.60	$522.00	—	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 Nasal Bones	$549.60	$687.00	—	90% above	20%
X-ray of the nasal bones, 3 or more views CPT 70160 Xray Nasal Bones Min 3 Vws	$549.60	$687.00	—	90% above	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Xray Nasal Bones Min 3 Vws	$549.60	$687.00	—	—	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Nasal Bones	$549.60	$687.00	—	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xray Cspine Or Less	$444.80	$556.00	—	38% above	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xray C Spine 3 Or Less Views	$444.80	$556.00	—	38% above	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Cervical Spine 2 View	$489.60	$612.00	—	52% above	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xray Cervical Spine Ap Lat	$489.60	$612.00	—	52% above	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Xray Cspine Or Less	$444.80	$556.00	—	—	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Xray C Spine 3 Or Less Views	$444.80	$556.00	—	—	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Cervical Spine 2 View	$489.60	$612.00	—	—	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Xray Cervical Spine Ap Lat	$489.60	$612.00	—	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 Xray Pelvis 1 Or 2 Views	$240.00	$300.00	—	3% below	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 Xray Pelvis Ap Only	$240.00	$300.00	—	3% below	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Xray Pelvis 1 Or 2 Views	$240.00	$300.00	—	—	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Xray Pelvis Ap Only	$240.00	$300.00	—	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Xray Sacrum Coccyx Min 2Vws	$435.20	$544.00	—	48% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Xray Sacrum & Coccyx Min 2View	$443.20	$554.00	—	51% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Xray Sacrum Coccyx Min 2Vws	$435.20	$544.00	—	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Xray Sacrum & Coccyx Min 2View	$443.20	$554.00	—	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alt	$20.00	$25.00	—	28% below	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Sgpt	$20.00	$25.00	—	28% below	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Sgpt	$20.00	$25.00	—	—	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alt	$20.00	$25.00	—	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 Sgot	$18.40	$23.00	—	27% below	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 Ast	$18.40	$23.00	—	27% below	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 Uric Acid	$18.40	$23.00	—	27% below	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Uric Acid	$18.40	$23.00	—	—	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Ast	$18.40	$23.00	—	—	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Sgot	$18.40	$23.00	—	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Acute Profile	$478.40	$598.00	—	120% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Acute Profile	$478.40	$598.00	—	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergern Individual Rast	$60.80	$76.00	—	160% above	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergern Individual Rast	$60.80	$76.00	—	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Ccp Igg	$164.00	$205.00	—	183% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Ccp Igg	$164.00	$205.00	—	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 So-Ana Confirmation	$174.40	$218.00	—	223% above	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 So-Ana Confirmation	$174.40	$218.00	—	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Lab Nt-Probnp 83880	$134.40	$168.00	—	9% below	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Lab Nt-Probnp 83880	$134.40	$168.00	—	—	20%
Basic metabolic panel (blood test) CPT 80048 Lab Bmp 80048	$133.60	$167.00	—	108% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 Lab Bmp 80048	$133.60	$167.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Cell Block	$133.60	$167.00	—	26% below	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Pathology Tissue Surg Iv	$464.00	$580.00	—	156% above	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Cell Block	$133.60	$167.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Pathology Tissue Surg Iv	$464.00	$580.00	—	—	20%
Blood culture for bacteria CPT 87040 Lab Cult Blood 87040	$136.80	$171.00	—	46% above	20%
Blood culture for bacteria inpatient CPT 87040 Lab Cult Blood 87040	$136.80	$171.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture	$8.00	$10.00	—	48% below	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Lab Venipuncture 36415	$8.00	$10.00	—	48% below	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture Pac	$10.40	$13.00	—	32% below	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Lab Venipuncture 36415	$8.00	$10.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture	$8.00	$10.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture Pac	$10.40	$13.00	—	—	20%
Blood glucose (sugar) test CPT 82947 Glucose	$18.40	$23.00	—	18% below	20%
Blood glucose (sugar) test inpatient CPT 82947 Glucose	$18.40	$23.00	—	—	20%
Blood lead test CPT 83655 Lead Lab Test	$25.60	$32.00	—	43% below	20%
Blood lead test CPT 83655 Lead	$42.40	$53.00	—	6% below	20%
Blood lead test inpatient CPT 83655 Lead Lab Test	$25.60	$32.00	—	—	20%
Blood lead test inpatient CPT 83655 Lead	$42.40	$53.00	—	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hcg Urine	$54.40	$68.00	—	at median	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Lab Hcg Serum	$54.40	$68.00	—	at median	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Hcg Urine	$54.40	$68.00	—	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Lab Hcg Serum	$54.40	$68.00	—	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo Bld Type 86900.	$86.40	$108.00	—	51% above	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Abo Bld Type 86900.	$86.40	$108.00	—	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein, Quant	$93.60	$117.00	—	89% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein, Quant	$93.60	$117.00	—	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium Difficile Pcr	$172.80	$216.00	—	33% above	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Clostridium Difficile Pcr	$172.80	$216.00	—	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 Ca 19 9	$197.60	$247.00	—	191% above	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Ca 19 9	$197.60	$247.00	—	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 Ca 125	$197.60	$247.00	—	111% above	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Ca 125	$197.60	$247.00	—	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Sars-Cov-2 Mrh Pcr Covid	$64.00	$80.00	—	55% below	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Covid Pcr Rapid Test Mrhc	$64.00	$80.00	—	55% below	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Covid Pcr Rapid Urgent Care	$86.40	$108.00	—	39% below	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Sars-Cov-2 Mrh Pcr Covid	$64.00	$80.00	—	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Covid Pcr Rapid Test Mrhc	$64.00	$80.00	—	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Covid Pcr Rapid Urgent Care	$86.40	$108.00	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Dna Chlamydia	$152.80	$191.00	—	63% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Genital By Pcr	$152.80	$191.00	—	63% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis Ua Pcr	$152.80	$191.00	—	63% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Trachomatis Ua Pcr	$152.80	$191.00	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Genital By Pcr	$152.80	$191.00	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Dna Chlamydia	$152.80	$191.00	—	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lab Lipid Profile 80061	$32.00	$40.00	—	40% below	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lab Lipid Profile 80061	$32.00	$40.00	—	—	20%
Complete blood count (CBC) with differential CPT 85025 Lab Cbc 85025.	$8.00	$10.00	—	77% below	20%
Complete blood count (CBC) with differential inpatient CPT 85025 Lab Cbc 85025.	$8.00	$10.00	—	—	20%
Complete blood count (CBC), no differential CPT 85027 Lab Hemogram 85027	$30.40	$38.00	—	6% below	20%
Complete blood count (CBC), no differential CPT 85027 Lab Hemogram Diff 85027	$30.40	$38.00	—	6% below	20%
Complete blood count (CBC), no differential inpatient CPT 85027 Lab Hemogram Diff 85027	$30.40	$38.00	—	—	20%
Complete blood count (CBC), no differential inpatient CPT 85027 Lab Hemogram 85027	$30.40	$38.00	—	—	20%
D-dimer blood test (blood clot marker) CPT 85379 D Dimer	$88.80	$111.00	—	23% above	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D Dimer	$88.80	$111.00	—	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dhea-Sulfate	$127.20	$159.00	—	28% above	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dhea-Sulfate	$127.20	$159.00	—	—	20%
Estradiol blood test CPT 82670 Estradiol	$173.60	$217.00	—	65% above	20%
Estradiol blood test inpatient CPT 82670 Estradiol	$173.60	$217.00	—	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 Fsh	$74.40	$93.00	—	13% below	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Fsh	$74.40	$93.00	—	—	20%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin	$351.20	$439.00	—	135% above	20%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin	$351.20	$439.00	—	—	20%
Ferritin blood test (iron stores) CPT 82728 Lab Ferritin	$56.00	$70.00	—	24% below	20%
Ferritin blood test (iron stores) inpatient CPT 82728 Lab Ferritin	$56.00	$70.00	—	—	20%
Folate (folic acid) blood test CPT 82746 Folate	$60.00	$75.00	—	9% below	20%
Folate (folic acid) blood test inpatient CPT 82746 Folate	$60.00	$75.00	—	—	20%
Free T3 thyroid hormone test CPT 84481 T3 Free	$72.00	$90.00	—	2% above	20%
Free T3 thyroid hormone test inpatient CPT 84481 T3 Free	$72.00	$90.00	—	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Lab T4 Free 84439	$55.20	$69.00	—	36% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Lab T4 Free 84439	$55.20	$69.00	—	—	20%
Free testosterone test CPT 84402 Lab Testosterone Free 84402	$167.20	$209.00	—	77% above	20%
Free testosterone test inpatient CPT 84402 Lab Testosterone Free 84402	$167.20	$209.00	—	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 2Nd Hr Wmodifier	$38.40	$48.00	—	32% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 1Hr Non-Fasting	$38.40	$48.00	—	32% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Post Prandial	$38.40	$48.00	—	32% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 1Hr Non-Fasting	$38.40	$48.00	—	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 2Nd Hr Wmodifier	$38.40	$48.00	—	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose Post Prandial	$38.40	$48.00	—	—	20%
Glucose tolerance test, 3 samples CPT 82951 Gluc Tol 6Hr 1St 3 Spec	$103.20	$129.00	—	70% above	20%
Glucose tolerance test, 3 samples CPT 82951 Gluc Tol 2Hr 1St 3 Spec	$103.20	$129.00	—	70% above	20%
Glucose tolerance test, 3 samples CPT 82951 Gluc Tol 3Hr 1St 3 Spec	$103.20	$129.00	—	70% above	20%
Glucose tolerance test, 3 samples CPT 82951 Gluc Tol Ob Ist 3 Specs	$103.20	$129.00	—	70% above	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 Gluc Tol 6Hr 1St 3 Spec	$103.20	$129.00	—	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 Gluc Tol 3Hr 1St 3 Spec	$103.20	$129.00	—	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 Gluc Tol 2Hr 1St 3 Spec	$103.20	$129.00	—	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 Gluc Tol Ob Ist 3 Specs	$103.20	$129.00	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Gc Gential By Pcr	$136.80	$171.00	—	47% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Gonorrhoeae Urine Pcr	$136.80	$171.00	—	47% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Dna Gonococcus	$136.80	$171.00	—	47% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Gc Gential By Pcr	$136.80	$171.00	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Gonorrhoeae Urine Pcr	$136.80	$171.00	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Dna Gonococcus	$136.80	$171.00	—	—	20%
H. pylori stool antigen test CPT 87338 H Pylori Antigen	$182.40	$228.00	—	167% above	20%
H. pylori stool antigen test inpatient CPT 87338 H Pylori Antigen	$182.40	$228.00	—	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hiv1/Hiv2 Abs 87389.	$41.60	$52.00	—	41% below	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Hiv1/Hiv2 Abs 87389.	$41.60	$52.00	—	—	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Hpv High Risk	$128.80	$161.00	—	15% above	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Hpv High Risk	$128.80	$161.00	—	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Lab Hemoglobin A1C 83036	$56.00	$70.00	—	23% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Lab A1C Poc Endocrinology	$56.00	$70.00	—	23% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Lab Hemoglobin A1C 83036	$56.00	$70.00	—	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Lab A1C Poc Endocrinology	$56.00	$70.00	—	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab	$68.80	$86.00	—	43% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Ab	$68.80	$86.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surf Ag I 87340.	$113.60	$142.00	—	146% above	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag 87340	$113.60	$142.00	—	146% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Ag 87340	$113.60	$142.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surf Ag I 87340.	$113.60	$142.00	—	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab 86803	$168.00	$210.00	—	164% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Ab 86803	$168.00	$210.00	—	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Rna Quant	$500.00	$625.00	—	160% above	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Rna Quant	$500.00	$625.00	—	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 Hsv 1 Ab Igm	$89.60	$112.00	—	51% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex I Igg	$158.40	$198.00	—	168% above	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Hsv 1 Ab Igm	$89.60	$112.00	—	—	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex I Igg	$158.40	$198.00	—	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 Hsv 2 Ab Igm	$99.20	$124.00	—	50% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Ii Igg	$110.40	$138.00	—	67% above	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Hsv 2 Ab Igm	$99.20	$124.00	—	—	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex Ii Igg	$110.40	$138.00	—	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 Crp Hs/Cardiac	$155.20	$194.00	—	143% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 Crp Hs/Cardiac	$155.20	$194.00	—	—	20%
Homocysteine blood test CPT 83090 Homocystine	$217.60	$272.00	—	170% above	20%
Homocysteine blood test inpatient CPT 83090 Homocystine	$217.60	$272.00	—	—	20%
Insulin blood test CPT 83525 Insulin	$37.60	$47.00	—	27% below	20%
Insulin blood test inpatient CPT 83525 Insulin	$37.60	$47.00	—	—	20%
Iron blood test (serum iron) CPT 83540 Iron Lab	$32.80	$41.00	—	9% below	20%
Iron blood test (serum iron) CPT 83540 Lab Iron 83540	$32.80	$41.00	—	9% below	20%
Iron blood test (serum iron) inpatient CPT 83540 Iron Lab	$32.80	$41.00	—	—	20%
Iron blood test (serum iron) inpatient CPT 83540 Lab Iron 83540	$32.80	$41.00	—	—	20%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity Lab	$40.80	$51.00	—	5% above	20%
Iron-binding capacity (TIBC) test CPT 83550 Lab Iron Binding Capacity	$40.80	$51.00	—	5% above	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Lab Iron Binding Capacity	$40.80	$51.00	—	—	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity Lab	$40.80	$51.00	—	—	20%
Kidney function blood test panel CPT 80069 Renal Functional Panel	$167.20	$209.00	—	144% above	20%
Kidney function blood test panel CPT 80069 Renal Function Panel	$167.20	$209.00	—	144% above	20%
Kidney function blood test panel inpatient CPT 80069 Renal Functional Panel	$167.20	$209.00	—	—	20%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$167.20	$209.00	—	—	20%
LH (luteinizing hormone) test CPT 83002 Lh-Luteinizing Hormone	$73.60	$92.00	—	23% below	20%
LH (luteinizing hormone) test inpatient CPT 83002 Lh-Luteinizing Hormone	$73.60	$92.00	—	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 Lab Lipase	$53.60	$67.00	—	7% below	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lab Lipase	$53.60	$67.00	—	—	20%
Liver function blood test panel CPT 80076 Hepatic Function Panel 80076	$29.60	$37.00	—	50% below	20%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel 80076	$29.60	$37.00	—	—	20%
Magnesium blood test CPT 83735 Magnesium 24Hr Ur	$43.20	$54.00	—	30% above	20%
Magnesium blood test CPT 83735 Lab Magnesium 83735	$43.20	$54.00	—	30% above	20%
Magnesium blood test CPT 83735 Magnesium Ur	$43.20	$54.00	—	30% above	20%
Magnesium blood test inpatient CPT 83735 Magnesium 24Hr Ur	$43.20	$54.00	—	—	20%
Magnesium blood test inpatient CPT 83735 Magnesium Ur	$43.20	$54.00	—	—	20%
Magnesium blood test inpatient CPT 83735 Lab Magnesium 83735	$43.20	$54.00	—	—	20%
Measles (rubeola) antibody test CPT 86765 Rubeola Ab Igm	$20.00	$25.00	—	62% below	20%
Measles (rubeola) antibody test CPT 86765 Rubeola Titer	$20.00	$25.00	—	62% below	20%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola Ab Igm	$20.00	$25.00	—	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola Titer	$20.00	$25.00	—	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Test	$83.20	$104.00	—	61% above	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Test	$83.20	$104.00	—	—	20%
Obstetric blood test panel CPT 80055 Ob Panel 80055	$204.80	$256.00	—	at median	20%
Obstetric blood test panel inpatient CPT 80055 Ob Panel 80055	$204.80	$256.00	—	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 Lab Free Psa 84154	$30.40	$38.00	—	62% below	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Lab Free Psa 84154	$30.40	$38.00	—	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 Lab Total Psa 84153	$30.40	$38.00	—	60% below	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen	$30.40	$38.00	—	60% below	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Lab Total Psa 84153	$30.40	$38.00	—	—	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen	$30.40	$38.00	—	—	20%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap Test	$63.20	$79.00	—	34% below	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap Test	$63.20	$79.00	—	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone	$136.80	$171.00	—	3% below	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone	$136.80	$171.00	—	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 Ptt	$36.00	$45.00	—	1% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 So-Ptt	$36.00	$45.00	—	1% below	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 So-Ptt	$36.00	$45.00	—	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Ptt	$36.00	$45.00	—	—	20%
Progesterone blood test CPT 84144 Progesterone	$65.60	$82.00	—	9% below	20%
Progesterone blood test inpatient CPT 84144 Progesterone	$65.60	$82.00	—	—	20%
Prolactin blood test CPT 84146 Prolactin	$177.60	$222.00	—	104% above	20%
Prolactin blood test inpatient CPT 84146 Prolactin	$177.60	$222.00	—	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time	$27.20	$34.00	—	13% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time	$27.20	$34.00	—	—	20%
Rapid flu test (influenza antigen) CPT 87804 Influenza A Ag	$76.80	$96.00	—	17% above	20%
Rapid flu test (influenza antigen) CPT 87804 Influenza B Ag Child Code	$76.80	$96.00	—	17% above	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza B Ag Child Code	$76.80	$96.00	—	—	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza A Ag	$76.80	$96.00	—	—	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep A Assay W/Optic	$36.00	$45.00	—	37% below	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Strep A Assay W/Optic	$36.00	$45.00	—	—	20%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Quant.Rheuma	$107.20	$134.00	—	230% above	20%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor Quant.Rheuma	$107.20	$134.00	—	—	20%
Rubella antibody test (immunity check) CPT 86762 Rubella Ab-Igg 86762.	$22.40	$28.00	—	42% below	20%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Ab-Igg 86762.	$22.40	$28.00	—	—	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Esr-Westegren	$40.00	$50.00	—	15% above	20%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Esr-Westegren	$40.00	$50.00	—	—	20%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Analysis	$152.80	$191.00	—	15% above	20%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen Analysis	$152.80	$191.00	—	—	20%
Stool ova and parasites exam CPT 87177 Ova & Parasites	$96.00	$120.00	—	142% above	20%
Stool ova and parasites exam inpatient CPT 87177 Ova & Parasites	$96.00	$120.00	—	—	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood (Screening)	$22.40	$28.00	—	14% below	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood (Screening)	$22.40	$28.00	—	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Lab Rpr Syphilis 86592.	$52.00	$65.00	—	133% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rpr Reflex To Titer 86592	$66.40	$83.00	—	198% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 So-Rpr	$70.40	$88.00	—	216% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl (Csf Or Confirm) 86592	$115.20	$144.00	—	417% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Lab Rpr Syphilis 86592.	$52.00	$65.00	—	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rpr Reflex To Titer 86592	$66.40	$83.00	—	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 So-Rpr	$70.40	$88.00	—	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Vdrl (Csf Or Confirm) 86592	$115.20	$144.00	—	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon Gold Tb Test	$84.00	$105.00	—	24% below	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon Gold Tb Test	$84.00	$105.00	—	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total	$75.20	$94.00	—	11% below	20%
Testosterone blood test, total (not free testosterone) CPT 84403 Lab Testosterone 84403	$75.20	$94.00	—	11% below	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total	$75.20	$94.00	—	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Lab Testosterone 84403	$75.20	$94.00	—	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomosal Antibody	$185.60	$232.00	—	186% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Microsomosal Antibody	$185.60	$232.00	—	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Lab Tsh 84443	$69.60	$87.00	—	6% below	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Cascade	$69.60	$87.00	—	6% below	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Cascade	$69.60	$87.00	—	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Lab Tsh 84443	$69.60	$87.00	—	—	20%
Trichomonas test (NAAT) CPT 87661 T Vaginalis By Pcr Urine	$48.80	$61.00	—	43% below	20%
Trichomonas test (NAAT) inpatient CPT 87661 T Vaginalis By Pcr Urine	$48.80	$61.00	—	—	20%
Uric acid blood test CPT 84550 Lab Uric Acid 84450	$29.60	$37.00	—	16% below	20%
Uric acid blood test inpatient CPT 84550 Lab Uric Acid 84450	$29.60	$37.00	—	—	20%
Urinalysis with microscope exam, automated CPT 81001 Lab Urinalysis 81001	$44.80	$56.00	—	66% above	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 Lab Urinalysis 81001	$44.80	$56.00	—	—	20%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis W/O Micro	$41.60	$52.00	—	78% above	20%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Auto W/O Scope	$41.60	$52.00	—	78% above	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Auto W/O Scope	$41.60	$52.00	—	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis W/O Micro	$41.60	$52.00	—	—	20%
Urine culture for bacteria, with colony count CPT 87086 Lab Culture Urine 87086	$106.40	$133.00	—	87% above	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 Lab Culture Urine 87086	$106.40	$133.00	—	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 Lab Vitamin B12 82607	$60.80	$76.00	—	15% below	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Lab Vitamin B12 82607	$60.80	$76.00	—	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Lab 25-Oh Vitamin D 82306	$90.40	$113.00	—	at median	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D2 And D3	$90.40	$113.00	—	at median	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D2 And D3	$90.40	$113.00	—	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Lab 25-Oh Vitamin D 82306	$90.40	$113.00	—	—	20%
Zinc blood test CPT 84630 Zinc Urine	$73.60	$92.00	—	56% above	20%
Zinc blood test CPT 84630 Zinc	$73.60	$92.00	—	56% above	20%
Zinc blood test inpatient CPT 84630 Zinc	$73.60	$92.00	—	—	20%
Zinc blood test inpatient CPT 84630 Zinc Urine	$73.60	$92.00	—	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Quantitation	$92.00	$115.00	—	36% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hcg Quantitation	$92.00	$115.00	—	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Bx Breast Stereo 1St Lesion	$4,768.80	$5,961.00	—	18% above	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Bx Breast Stereo 1St Lesion	$4,768.80	$5,961.00	—	—	20%
Cardiac catheterization with coronary angiogram CPT 93458 Lhc Artery/Ventr Angio 93458	$16,820.00	$21,025.00	—	40% above	20%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 Lhc Artery/Ventr Angio 93458	$16,820.00	$21,025.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Elective Cardioversion	$486.40	$608.00	—	76% below	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Elective Cardioversion Icu	$3,306.40	$4,133.00	—	60% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Elective Cardioversion Cardiol	$3,306.40	$4,133.00	—	60% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Electric Ext Ed	$3,306.40	$4,133.00	—	60% above	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Elective Cardioversion	$486.40	$608.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Elective Cardioversion Icu	$3,306.40	$4,133.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Electric Ext Ed	$3,306.40	$4,133.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Elective Cardioversion Cardiol	$3,306.40	$4,133.00	—	—	20%
Colonoscopy with endoscopic ultrasound CPT 45391 Eus Colonoscopy	$2,734.40	$3,418.00	—	9% below	20%
Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Eus Colonoscopy	$2,734.40	$3,418.00	—	—	20%
Coronary stent placement, one artery CPT 92928 Prq Card Stent W/Angio 1Vsl Rc	$24,735.20	$30,919.00	—	106% above	20%
Coronary stent placement, one artery CPT 92928 Prq Card Stent W/Angio 1Vsl Ri	$24,735.20	$30,919.00	—	106% above	20%
Coronary stent placement, one artery CPT 92928 Prq Card Stent W/Angio 1Vsl Lc	$24,735.20	$30,919.00	—	106% above	20%
Coronary stent placement, one artery CPT 92928 Prq Card Stent W/Angio 1Vsl Ld	$24,735.20	$30,919.00	—	106% above	20%
Coronary stent placement, one artery CPT 92928 Prq Card Stent W/Angio 1Vsl Lm	$25,709.60	$32,137.00	—	114% above	20%
Coronary stent placement, one artery inpatient CPT 92928 Prq Card Stent W/Angio 1Vsl Rc	$24,735.20	$30,919.00	—	—	20%
Coronary stent placement, one artery inpatient CPT 92928 Prq Card Stent W/Angio 1Vsl Ld	$24,735.20	$30,919.00	—	—	20%
Coronary stent placement, one artery inpatient CPT 92928 Prq Card Stent W/Angio 1Vsl Lc	$24,735.20	$30,919.00	—	—	20%
Coronary stent placement, one artery inpatient CPT 92928 Prq Card Stent W/Angio 1Vsl Ri	$24,735.20	$30,919.00	—	—	20%
Coronary stent placement, one artery inpatient CPT 92928 Prq Card Stent W/Angio 1Vsl Lm	$25,709.60	$32,137.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Remove Impct Wax Lav Unil Uc	$64.80	$81.00	—	58% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Er Remove Impacted Ear Wax Uni	$228.80	$286.00	—	48% above	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Remove Impct Wax Lav Unil Uc	$64.80	$81.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Er Remove Impacted Ear Wax Uni	$228.80	$286.00	—	—	20%
Earwax removal with instruments, one ear both sides CPT 69210 Remove Impcted Wax Inst Bilat	$64.80	$81.00	—	—	20%
Earwax removal with instruments, one ear CPT 69210 Remove Impcted Wax Inst Unil	$64.80	$81.00	—	58% below	20%
Earwax removal with instruments, one ear CPT 69210 Removal Impact Cerumen	$132.00	$165.00	—	15% below	20%
Earwax removal with instruments, one ear CPT 69210 Ear Irrigation	$132.00	$165.00	—	15% below	20%
Earwax removal with instruments, one ear inpatient both sides CPT 69210 Remove Impcted Wax Inst Bilat	$64.80	$81.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 Remove Impcted Wax Inst Unil	$64.80	$81.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 Ear Irrigation	$132.00	$165.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 Removal Impact Cerumen	$132.00	$165.00	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Epidular Inj Crv/Thracic Wimgu	$2,417.60	$3,022.00	—	8% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Cesi	$2,417.60	$3,022.00	—	8% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Cervical Facet Mbnb 2Nd	$2,417.60	$3,022.00	—	8% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Cesi	$2,417.60	$3,022.00	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Epidular Inj Crv/Thracic Wimgu	$2,417.60	$3,022.00	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Cervical Facet Mbnb 2Nd	$2,417.60	$3,022.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 Bilat Lumbar Facet 1St	$5,062.40	$6,328.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Lumbar Facet 1St	$2,531.20	$3,164.00	—	21% above	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Ct L-Spine Nerve Block Paraver	$2,531.20	$3,164.00	—	21% above	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 Bilat Lumbar Facet 1St	$5,062.40	$6,328.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Lumbar Facet 1St	$2,531.20	$3,164.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Ct L-Spine Nerve Block Paraver	$2,531.20	$3,164.00	—	—	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy Flx Dx W/Collj	$1,856.00	$2,320.00	—	28% below	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Sigmoidoscopy Flx Dx W/Collj	$1,856.00	$2,320.00	—	—	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoidectomy Internal Rb	$1,495.20	$1,869.00	—	22% below	20%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 Hemorrhoidectomy Internal Rb	$1,495.20	$1,869.00	—	—	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Inj For Hystero	$417.60	$522.00	—	9% above	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Inj For Hystero	$417.60	$522.00	—	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 Urgcare I&D Abscess Single Sim	$179.20	$224.00	—	53% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Abscess Single Or Simpl	$579.20	$724.00	—	52% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Abscess (Simple)	$579.20	$724.00	—	52% above	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Urgcare I&D Abscess Single Sim	$179.20	$224.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Abscess Single Or Simpl	$579.20	$724.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Abscess (Simple)	$579.20	$724.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Single Tendon Sheath	$122.40	$153.00	—	64% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj Single Tendon Sheath	$122.40	$153.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 Bilat Major Joint	$1,968.00	$2,460.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain Inj Jnt Bursa Wo Us Majo	$148.80	$186.00	—	79% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Large	$984.00	$1,230.00	—	41% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Major Joint	$984.00	$1,230.00	—	41% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain Inj Jnt Bursa Wo Us Hip	$984.00	$1,230.00	—	41% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient both sides CPT 20610 Bilat Major Joint	$1,968.00	$2,460.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Drain Inj Jnt Bursa Wo Us Majo	$148.80	$186.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis Large	$984.00	$1,230.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Major Joint	$984.00	$1,230.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Drain Inj Jnt Bursa Wo Us Hip	$984.00	$1,230.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain/Inj Jnt/Bursa Wo Us	$138.40	$173.00	—	77% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Ankle Inj Asp Bx	$1,344.00	$1,680.00	—	121% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain Inj Jnt/Bursa Wo Us Med	$1,344.00	$1,680.00	—	121% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain/Inj Jnt/Bursa Wo Us Medi	$1,344.00	$1,680.00	—	121% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Sacrococcygeal Injection Pain	$1,344.00	$1,680.00	—	121% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Drain/Inj Jnt/Bursa Wo Us	$138.40	$173.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Drain/Inj Jnt/Bursa Wo Us Medi	$1,344.00	$1,680.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Sacrococcygeal Injection Pain	$1,344.00	$1,680.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Drain Inj Jnt/Bursa Wo Us Med	$1,344.00	$1,680.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Ankle Inj Asp Bx	$1,344.00	$1,680.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Drain/Inj Jnt/Bursa Wo Us Smal	$783.20	$979.00	—	59% above	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Drain/Inj Jnt/Bursa Wo Us Smal	$783.20	$979.00	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Intmd Wnd Repair S/Tr/Ext	$110.40	$138.00	—	78% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Lac Int Body 0-2.5 Cm	$546.40	$683.00	—	10% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Intmd Wnd Repair S/Tr/Ext	$110.40	$138.00	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Lac Int Body 0-2.5 Cm	$546.40	$683.00	—	—	20%
Left heart catheterization, diagnostic one side CPT 93452 Cath Lt Hrt W/Njx L Ventriculo	$13,852.80	$17,316.00	—	51% above	20%
Left heart catheterization, diagnostic inpatient one side CPT 93452 Cath Lt Hrt W/Njx L Ventriculo	$13,852.80	$17,316.00	—	—	20%
Lower-back epidural injection, with imaging guidance CPT 62323 Epidural Inj Lumbar Mult Areas	$2,249.60	$2,812.00	—	10% above	20%
Lower-back epidural injection, with imaging guidance CPT 62323 Lesi Njx Interlaminar Lmbr/Sac	$2,249.60	$2,812.00	—	10% above	20%
Lower-back epidural injection, with imaging guidance CPT 62323 Epidural Inj Lumbar W Img Guid	$2,249.60	$2,812.00	—	10% above	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Lesi Njx Interlaminar Lmbr/Sac	$2,249.60	$2,812.00	—	—	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Epidural Inj Lumbar W Img Guid	$2,249.60	$2,812.00	—	—	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Epidural Inj Lumbar Mult Areas	$2,249.60	$2,812.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 Bilat Tfesi 1St	$4,979.20	$6,224.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Transformanial Nerve Block	$2,136.80	$2,671.00	—	12% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Tfesi 1St	$2,490.40	$3,113.00	—	31% above	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 Bilat Tfesi 1St	$4,979.20	$6,224.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Transformanial Nerve Block	$2,136.80	$2,671.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Tfesi 1St	$2,490.40	$3,113.00	—	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc Skin Lesion < 0.5 Cm	$1,268.00	$1,585.00	—	8% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Exc Skin Lesion < 0.5 Cm	$1,268.00	$1,585.00	—	—	20%
Nail removal (partial or complete), one nail CPT 11730 Surg Proc Nail	$149.60	$187.00	—	53% below	20%
Nail removal (partial or complete), one nail CPT 11730 Remove Nail Plate	$524.00	$655.00	—	64% above	20%
Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate	$524.00	$655.00	—	64% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 Surg Proc Nail	$149.60	$187.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 Remove Nail Plate	$524.00	$655.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion Nail Plate	$524.00	$655.00	—	—	20%
Occipital nerve block (injection for headaches) both sides CPT 64405 Bilat Periph Nerve Occipital	$2,111.20	$2,639.00	—	—	20%
Occipital nerve block (injection for headaches) CPT 64405 Peripheral Nerve Occipital	$1,056.00	$1,320.00	—	5% above	20%
Occipital nerve block (injection for headaches) inpatient both sides CPT 64405 Bilat Periph Nerve Occipital	$2,111.20	$2,639.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Peripheral Nerve Occipital	$1,056.00	$1,320.00	—	—	20%
Pacemaker implant (dual chamber) CPT 33208 Perm Pace W Dual Leads	$20,338.40	$25,423.00	—	49% above	20%
Pacemaker implant (dual chamber) inpatient CPT 33208 Perm Pace W Dual Leads	$20,338.40	$25,423.00	—	—	20%
Paracentesis with imaging guidance CPT 49083 Paracentesis Inp/Obs	$1,880.80	$2,351.00	—	8% above	20%
Paracentesis with imaging guidance CPT 49083 Abd Paracentesis W/Imaging	$1,880.80	$2,351.00	—	8% above	20%
Paracentesis with imaging guidance CPT 49083 Paracentesis W Imaging	$1,880.80	$2,351.00	—	8% above	20%
Paracentesis with imaging guidance inpatient CPT 49083 Paracentesis W Imaging	$1,880.80	$2,351.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 Paracentesis Inp/Obs	$1,880.80	$2,351.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 Abd Paracentesis W/Imaging	$1,880.80	$2,351.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Nail Excision	$452.00	$565.00	—	42% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Permanent Nail Removal	$452.00	$565.00	—	42% below	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Permanent Nail Removal	$452.00	$565.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Nail Excision	$452.00	$565.00	—	—	20%
Prostate biopsy CPT 55700 Prostate Biopsy Radiology	$4,666.40	$5,833.00	—	156% above	20%
Prostate biopsy inpatient CPT 55700 Prostate Biopsy Radiology	$4,666.40	$5,833.00	—	—	20%
Removal of a foreign object under the skin, simple CPT 10120 Urgcare Remove Fb Subq Simpl	$238.40	$298.00	—	63% below	20%
Removal of a foreign object under the skin, simple CPT 10120 Incision & Removal Fb Simple	$864.80	$1,081.00	—	33% above	20%
Removal of a foreign object under the skin, simple CPT 10120 Fb Removal Sq Simple	$864.80	$1,081.00	—	33% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Urgcare Remove Fb Subq Simpl	$238.40	$298.00	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision & Removal Fb Simple	$864.80	$1,081.00	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Fb Removal Sq Simple	$864.80	$1,081.00	—	—	20%
Short arm cast (elbow to hand) CPT 29075 Application Of Forearm Cast	$234.40	$293.00	—	22% below	20%
Short arm cast (elbow to hand) inpatient CPT 29075 Application Of Forearm Cast	$234.40	$293.00	—	—	20%
Short arm splint (forearm and hand) CPT 29125 Ur Car Splint Arm Short	$161.60	$202.00	—	44% below	20%
Short arm splint (forearm and hand) CPT 29125 Er Splint Arm Short	$458.40	$573.00	—	59% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 Ur Car Splint Arm Short	$161.60	$202.00	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 Er Splint Arm Short	$458.40	$573.00	—	—	20%
Short leg splint (calf to foot) CPT 29515 Application Lower Leg Splint	$573.60	$717.00	—	95% above	20%
Short leg splint (calf to foot) CPT 29515 Splint Leg Short	$573.60	$717.00	—	95% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 Splint Leg Short	$573.60	$717.00	—	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 Application Lower Leg Splint	$573.60	$717.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Rpr S/N/Ax/Gen/Trnk 2.5Cm Or L	$524.00	$655.00	—	59% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Rpr Simp S/N/Ax/Gen/Tr 2.5Cm/<	$524.00	$655.00	—	59% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Rpr S/N/Ax/Gen/Trnk 2.5Cm Or L	$524.00	$655.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Rpr Simp S/N/Ax/Gen/Tr 2.5Cm/<	$524.00	$655.00	—	—	20%
Skin biopsy, punch, one lesion CPT 11104 Punch Bx Skin 1 Lesion	$524.00	$655.00	—	17% above	20%
Skin biopsy, punch, one lesion CPT 11104 Punch Bx Skin Lesion	$524.00	$655.00	—	17% above	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Bx Skin Lesion	$524.00	$655.00	—	—	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Bx Skin 1 Lesion	$524.00	$655.00	—	—	20%
Skin tag removal, up to 15 tags CPT 11200 Removal Skn Tags Area Upw/15	$131.20	$164.00	—	55% below	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 Removal Skn Tags Area Upw/15	$131.20	$164.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar Puncture	$1,379.20	$1,724.00	—	29% above	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Lumbar Puncture	$1,379.20	$1,724.00	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Rpr Simp S/N/Ax/Gen/Tr 2.6-7.5	$524.00	$655.00	—	49% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Rpr Simp S/N/Ax/Gen/Tr 2.6-7.5	$524.00	$655.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Rpr F/E/E/N/L/M 2.5 Cm/<	$188.00	$235.00	—	41% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Rpr F/E/E/N/L/M 2.5 Cm Or Less	$203.20	$254.00	—	36% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Lac Simp Face 0-2.5Cm	$700.80	$876.00	—	121% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Rpr F/E/E/N/L/M 2.5 Cm/<	$188.00	$235.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Rpr F/E/E/N/L/M 2.5 Cm Or Less	$203.20	$254.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Lac Simp Face 0-2.5Cm	$700.80	$876.00	—	—	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangntl Bx Skin 1 Lesion	$524.00	$655.00	—	75% above	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangntl Bx Skin 1 Lesion	$524.00	$655.00	—	—	20%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis/Sone	$2,437.60	$3,047.00	—	34% above	20%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis Inp/Obs	$2,437.60	$3,047.00	—	34% above	20%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis	$2,437.60	$3,047.00	—	34% above	20%
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis/Sone	$2,437.60	$3,047.00	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis	$2,437.60	$3,047.00	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis Inp/Obs	$2,437.60	$3,047.00	—	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Trigger Point Inj	$651.20	$814.00	—	8% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Points 1 Or 2 Musc	$651.20	$814.00	—	8% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Injection Single Multiple Trig	$651.20	$814.00	—	8% below	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Trigger Points 1 Or 2 Musc	$651.20	$814.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Injection Single Multiple Trig	$651.20	$814.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Trigger Point Inj	$651.20	$814.00	—	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Breast Bx U/S	$3,748.00	$4,685.00	—	15% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Breast Bx U/S	$3,748.00	$4,685.00	—	—	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Esoph Egd Dilation <30 Mm	$2,568.00	$3,210.00	—	27% below	20%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 Esoph Egd Dilation <30 Mm	$2,568.00	$3,210.00	—	—	20%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Egd Insert Guide Wire	$2,347.20	$2,934.00	—	16% below	20%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 Egd Insert Guide Wire	$2,347.20	$2,934.00	—	—	20%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 Eus Egd Transmural Drain Cyst	$4,500.00	$5,625.00	—	1% below	20%
Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 Eus Egd Transmural Drain Cyst	$4,500.00	$5,625.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Sq Tissue 1St 20 Sqcm	$954.40	$1,193.00	—	22% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 1St 20 Sq Cm Debbr Sq Tissue	$954.40	$1,193.00	—	22% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 1St 20 Sq Cm Debbr Sq Tissue	$954.40	$1,193.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride Sq Tissue 1St 20 Sqcm	$954.40	$1,193.00	—	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfus Unit Sds	$177.60	$222.00	—	85% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion <2Hr Icu	$979.20	$1,224.00	—	16% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion <2Hrs Fbc	$979.20	$1,224.00	—	16% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion <2Hr 4W	$979.20	$1,224.00	—	16% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion	$979.20	$1,224.00	—	16% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion <2 Hr Opd	$979.20	$1,224.00	—	16% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >2Hr 4W	$1,028.80	$1,286.00	—	12% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >2Hrs Fbc	$1,028.80	$1,286.00	—	12% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >2Hr Icu	$1,028.80	$1,286.00	—	12% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >2 Hr Opd	$1,028.80	$1,286.00	—	12% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >2 Er	$1,028.80	$1,286.00	—	12% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >4 Er	$1,076.80	$1,346.00	—	8% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >4 Hr Opd	$1,076.80	$1,346.00	—	8% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion>4Hrs Fbc	$1,076.80	$1,346.00	—	8% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >4Hr Icu	$1,076.80	$1,346.00	—	8% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >4Hr 4W	$1,076.80	$1,346.00	—	8% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion>8 Er	$1,124.80	$1,406.00	—	4% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >8Hr 4W	$1,124.80	$1,406.00	—	4% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >8Hr Icu	$1,124.80	$1,406.00	—	4% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >2Hr 3W	$1,142.40	$1,428.00	—	2% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >4Hr 3W	$1,196.00	$1,495.00	—	3% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfus Unit Sds	$177.60	$222.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion	$979.20	$1,224.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion <2Hr 4W	$979.20	$1,224.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion <2Hrs Fbc	$979.20	$1,224.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion <2Hr Icu	$979.20	$1,224.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion <2 Hr Opd	$979.20	$1,224.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >2 Hr Opd	$1,028.80	$1,286.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >2Hr 4W	$1,028.80	$1,286.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >2Hrs Fbc	$1,028.80	$1,286.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >2 Er	$1,028.80	$1,286.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >2Hr Icu	$1,028.80	$1,286.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >4 Hr Opd	$1,076.80	$1,346.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >4Hr Icu	$1,076.80	$1,346.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >4 Er	$1,076.80	$1,346.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion>4Hrs Fbc	$1,076.80	$1,346.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >4Hr 4W	$1,076.80	$1,346.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >8Hr Icu	$1,124.80	$1,406.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion>8 Er	$1,124.80	$1,406.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >8Hr 4W	$1,124.80	$1,406.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >2Hr 3W	$1,142.40	$1,428.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion >4Hr 3W	$1,196.00	$1,495.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment	$33.60	$42.00	—	82% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Tx Initial	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerogen Aerosol Tx Initial	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Ban Aerosol Tx Initial	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mdi Tx Subseq	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mdi Tx Initial	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Cont Aerosol Adm Subseq	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mdi Treatment	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Cont Aerosol Adm Int	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Tx Subseq	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aersol Tx/Hr Subseq	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aersol Tx/Hr Initial	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerogen Aerosol Tx Subsq	$144.80	$181.00	—	22% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment	$33.60	$42.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aersol Tx/Hr Initial	$144.80	$181.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment	$144.80	$181.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mdi Treatment	$144.80	$181.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Tx Initial	$144.80	$181.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Tx Subseq	$144.80	$181.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Cont Aerosol Adm Int	$144.80	$181.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Cont Aerosol Adm Subseq	$144.80	$181.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mdi Tx Initial	$144.80	$181.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mdi Tx Subseq	$144.80	$181.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aersol Tx/Hr Subseq	$144.80	$181.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Ban Aerosol Tx Initial	$144.80	$181.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerogen Aerosol Tx Initial	$144.80	$181.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerogen Aerosol Tx Subsq	$144.80	$181.00	—	—	20%
Chemotherapy IV infusion, first hour CPT 96413 Chemo Iv Infusion Init Hr	$991.20	$1,239.00	—	30% above	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemo Iv Infusion Init Hr	$991.20	$1,239.00	—	—	20%
Critical care, first 30 to 74 minutes CPT 99291 Critical Care First Hour	$616.00	$770.00	—	79% below	20%
Critical care, first 30 to 74 minutes CPT 99291 Level Critical Care	$3,399.20	$4,249.00	—	16% above	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care First Hour	$616.00	$770.00	—	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Level Critical Care	$3,399.20	$4,249.00	—	—	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 Eeg Awake And Drowsy	$774.40	$968.00	—	27% below	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 Eeg Awake & Drowsy	$2,171.20	$2,714.00	—	106% above	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Eeg Awake And Drowsy	$774.40	$968.00	—	—	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Eeg Awake & Drowsy	$2,171.20	$2,714.00	—	—	20%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram Complete	$64.00	$80.00	—	75% below	20%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Electrocardiogram Complete	$64.00	$80.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram 93005	$70.40	$88.00	—	62% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ecg Rtne Upto 12 Lead Pedsfac	$92.00	$115.00	—	50% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ecg Routine Upto 12 Lead Fac	$92.00	$115.00	—	50% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Infant Ecg	$274.40	$343.00	—	48% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram 93005	$70.40	$88.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Ecg Routine Upto 12 Lead Fac	$92.00	$115.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Ecg Rtne Upto 12 Lead Pedsfac	$92.00	$115.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Infant Ecg	$274.40	$343.00	—	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Level 1 Er W/Proc	$328.00	$410.00	—	5% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Lvl 1 Er	$328.00	$410.00	—	5% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Lvl 1 Er Iv Inf & Or Push	$328.00	$410.00	—	5% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Level 1 Er W/Proc	$328.00	$410.00	—	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Lvl 1 Er Iv Inf & Or Push	$328.00	$410.00	—	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Lvl 1 Er	$328.00	$410.00	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Lvl 2 Er	$627.20	$784.00	—	23% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Level 2 Er W/Proc	$627.20	$784.00	—	23% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Lvl 2 Er Iv Inf & Or Push	$627.20	$784.00	—	23% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Lvl 2 Er Iv Inf & Or Push	$627.20	$784.00	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Lvl 2 Er	$627.20	$784.00	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Level 2 Er W/Proc	$627.20	$784.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Er Level 3 Services Low Mdm	$356.00	$445.00	—	58% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Lvl 3 Er	$972.80	$1,216.00	—	14% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Lvl 3 Er Iv Inf & Or Push	$972.80	$1,216.00	—	14% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Lvl 3 Er W/Proc	$972.80	$1,216.00	—	14% above	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Er Level 3 Services Low Mdm	$356.00	$445.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Lvl 3 Er	$972.80	$1,216.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Lvl 3 Er W/Proc	$972.80	$1,216.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Lvl 3 Er Iv Inf & Or Push	$972.80	$1,216.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Er Level 4 Services Moderate	$571.20	$714.00	—	57% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Lvl 4 Er Iv Inf & Or Push	$1,552.80	$1,941.00	—	16% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Lvl 4 Er	$1,552.80	$1,941.00	—	16% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Level 4 Er W/Proc	$1,552.80	$1,941.00	—	16% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Er Level 4 Services Moderate	$571.20	$714.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Level 4 Er W/Proc	$1,552.80	$1,941.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Lvl 4 Er	$1,552.80	$1,941.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Lvl 4 Er Iv Inf & Or Push	$1,552.80	$1,941.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Er Level 5 Services High Mdm	$1,016.80	$1,271.00	—	41% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Lvl 5 Er Iv Inf & Or Push	$2,224.00	$2,780.00	—	29% above	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Lvl 5 Er	$2,224.00	$2,780.00	—	29% above	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Level 5 Er W/Proc	$2,224.00	$2,780.00	—	29% above	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Er Level 5 Services High Mdm	$1,016.80	$1,271.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Lvl 5 Er	$2,224.00	$2,780.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Lvl 5 Er Iv Inf & Or Push	$2,224.00	$2,780.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Level 5 Er W/Proc	$2,224.00	$2,780.00	—	—	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 Stress Ecg 93017	$200.00	$250.00	—	78% below	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 Rehab Stress Ecg	$1,383.20	$1,729.00	—	54% above	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 Stress Ecg	$1,383.20	$1,729.00	—	54% above	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Stress Ecg 93017	$200.00	$250.00	—	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Rehab Stress Ecg	$1,383.20	$1,729.00	—	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Stress Ecg	$1,383.20	$1,729.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 Iv Hydr Intital 31-60Min	$490.40	$613.00	—	17% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 Iv Hydr Intital 31-60Min	$490.40	$613.00	—	—	20%
IV infusion of a medicine, first hour CPT 96365 96365 Iv Tpd Infus Init Hr Pro	$274.40	$343.00	—	37% below	20%
IV infusion of a medicine, first hour CPT 96365 96365 Immunoglobulin Adm 3W	$490.40	$613.00	—	13% above	20%
IV infusion of a medicine, first hour CPT 96365 96365 Iv Tpd Infusion Init Hr	$490.40	$613.00	—	13% above	20%
IV infusion of a medicine, first hour CPT 96365 96365 Iv Ther Nonchemo 1Sth	$490.40	$613.00	—	13% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 Iv Tpd Infus Init Hr Pro	$274.40	$343.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 Immunoglobulin Adm 3W	$490.40	$613.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 Iv Ther Nonchemo 1Sth	$490.40	$613.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 Iv Tpd Infusion Init Hr	$490.40	$613.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection Subq Or Im	$175.20	$219.00	—	24% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Rabies Admin Immune Globulin	$175.20	$219.00	—	24% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Aminophylline Adm 3W	$175.20	$219.00	—	24% above	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Rabies Admin Immune Globulin	$175.20	$219.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection Subq Or Im	$175.20	$219.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Aminophylline Adm 3W	$175.20	$219.00	—	—	20%
Neuromuscular re-education, 15 minutes CPT 97112 Ota Neuromuscular Reeducation	$176.80	$221.00	—	65% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 Therapeutic Proc Neuro Reeduca	$176.80	$221.00	—	65% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 Pta Neuromuscular Reeducation	$176.80	$221.00	—	65% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 Therapeutic Neuromuscular Reed	$176.80	$221.00	—	65% above	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Ota Neuromuscular Reeducation	$176.80	$221.00	—	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Therapeutic Proc Neuro Reeduca	$176.80	$221.00	—	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Therapeutic Neuromuscular Reed	$176.80	$221.00	—	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Pta Neuromuscular Reeducation	$176.80	$221.00	—	—	20%
New patient office visit, about 30 minutes CPT 99203 New Pt Lvl 3 W Proc	$55.20	$69.00	—	49% below	20%
New patient office visit, about 30 minutes CPT 99203 New Pt Lvl 3 W Proc Rtslp	$55.20	$69.00	—	49% below	20%
New patient office visit, about 30 minutes CPT 99203 Visit New Lvl 3 W Proc	$120.00	$150.00	—	10% above	20%
New patient office visit, about 30 minutes CPT 99203 Uc Visit New Level 3	$120.00	$150.00	—	10% above	20%
New patient office visit, about 30 minutes CPT 99203 New Pt W Proc Lv3	$163.20	$204.00	—	49% above	20%
New patient office visit, about 30 minutes CPT 99203 New Clinic Level 3	$163.20	$204.00	—	49% above	20%
New patient office visit, about 30 minutes CPT 99203 New Vst Lvl 3 W Proc Card	$163.20	$204.00	—	49% above	20%
New patient office visit, about 30 minutes CPT 99203 New Pt Level 3 Dm	$163.20	$204.00	—	49% above	20%
New patient office visit, about 30 minutes CPT 99203 New Pt Lvl 3	$163.20	$204.00	—	49% above	20%
New patient office visit, about 30 minutes CPT 99203 Clinic Visit New Lvl 3 99203	$241.60	$302.00	—	121% above	20%
New patient office visit, about 30 minutes CPT 99203 Th Visit New Lvl 3 99203	$241.60	$302.00	—	121% above	20%
New patient office visit, about 30 minutes CPT 99203 Bh Clinic New Level 3 99203	$241.60	$302.00	—	121% above	20%
New patient office visit, about 30 minutes CPT 99203 New Visit Lvl W/Proc 3 Wc	$276.80	$346.00	—	153% above	20%
New patient office visit, about 30 minutes inpatient CPT 99203 New Pt Lvl 3 W Proc Rtslp	$55.20	$69.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 New Pt Lvl 3 W Proc	$55.20	$69.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 Visit New Lvl 3 W Proc	$120.00	$150.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 Uc Visit New Level 3	$120.00	$150.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 New Clinic Level 3	$163.20	$204.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 New Pt Lvl 3	$163.20	$204.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 New Pt W Proc Lv3	$163.20	$204.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 New Vst Lvl 3 W Proc Card	$163.20	$204.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 New Pt Level 3 Dm	$163.20	$204.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 Clinic Visit New Lvl 3 99203	$241.60	$302.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 Bh Clinic New Level 3 99203	$241.60	$302.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 Th Visit New Lvl 3 99203	$241.60	$302.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 New Visit Lvl W/Proc 3 Wc	$276.80	$346.00	—	—	20%
New patient office visit, about 45 minutes CPT 99204 New Pt Lvl 4 W Proc	$55.20	$69.00	—	60% below	20%
New patient office visit, about 45 minutes CPT 99204 New Pt Lvl 4 W Proc Rtslp	$55.20	$69.00	—	60% below	20%
New patient office visit, about 45 minutes CPT 99204 Cosm Lvl 4 New 99204	$80.00	$100.00	—	42% below	20%
New patient office visit, about 45 minutes CPT 99204 Visit New Level 4	$120.00	$150.00	—	12% below	20%
New patient office visit, about 45 minutes CPT 99204 Visit New Lvl 4 W Proc	$120.00	$150.00	—	12% below	20%
New patient office visit, about 45 minutes CPT 99204 New Visit Lvl 4 Card	$163.20	$204.00	—	19% above	20%
New patient office visit, about 45 minutes CPT 99204 New Pt Lvl 4 W Proc Obop	$163.20	$204.00	—	19% above	20%
New patient office visit, about 45 minutes CPT 99204 New Pt Lvl 4	$163.20	$204.00	—	19% above	20%
New patient office visit, about 45 minutes CPT 99204 New Pt Level 4 Dm	$163.20	$204.00	—	19% above	20%
New patient office visit, about 45 minutes CPT 99204 New Pt W Proc Lvl 4	$163.20	$204.00	—	19% above	20%
New patient office visit, about 45 minutes CPT 99204 O/P Visit New Level 4	$163.20	$204.00	—	19% above	20%
New patient office visit, about 45 minutes CPT 99204 New Vst Lvl 4 W Proc Card	$163.20	$204.00	—	19% above	20%
New patient office visit, about 45 minutes CPT 99204 New Pt Lvl 4 W Proc Opd	$163.20	$204.00	—	19% above	20%
New patient office visit, about 45 minutes CPT 99204 New Visit Lvl W/Proc 4 Wc	$276.80	$346.00	—	102% above	20%
New patient office visit, about 45 minutes CPT 99204 New Visit Lvl 4 Wc	$276.80	$346.00	—	102% above	20%
New patient office visit, about 45 minutes CPT 99204 Clinic Visit New Lvl 4 99204	$367.20	$459.00	—	168% above	20%
New patient office visit, about 45 minutes CPT 99204 Bh Clinic New Level 4 99204	$367.20	$459.00	—	168% above	20%
New patient office visit, about 45 minutes inpatient CPT 99204 New Pt Lvl 4 W Proc Rtslp	$55.20	$69.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 New Pt Lvl 4 W Proc	$55.20	$69.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 Cosm Lvl 4 New 99204	$80.00	$100.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 Visit New Lvl 4 W Proc	$120.00	$150.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 Visit New Level 4	$120.00	$150.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 New Pt W Proc Lvl 4	$163.20	$204.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 O/P Visit New Level 4	$163.20	$204.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 New Pt Lvl 4	$163.20	$204.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 New Pt Level 4 Dm	$163.20	$204.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 New Pt Lvl 4 W Proc Obop	$163.20	$204.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 New Visit Lvl 4 Card	$163.20	$204.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 New Pt Lvl 4 W Proc Opd	$163.20	$204.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 New Vst Lvl 4 W Proc Card	$163.20	$204.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 New Visit Lvl W/Proc 4 Wc	$276.80	$346.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 New Visit Lvl 4 Wc	$276.80	$346.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 Clinic Visit New Lvl 4 99204	$367.20	$459.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 Bh Clinic New Level 4 99204	$367.20	$459.00	—	—	20%
New patient office visit, about 60 minutes CPT 99205 New Pt Lvl 5 W Proc	$55.20	$69.00	—	71% below	20%
New patient office visit, about 60 minutes CPT 99205 New Pt Lvl 5 W Proc Rtslp	$55.20	$69.00	—	71% below	20%
New patient office visit, about 60 minutes CPT 99205 Cosm Lvl 5 New 99205	$80.00	$100.00	—	58% below	20%
New patient office visit, about 60 minutes CPT 99205 Visit New Level 5 99215	$120.00	$150.00	—	37% below	20%
New patient office visit, about 60 minutes CPT 99205 New Pt Level 5 Opd	$163.20	$204.00	—	15% below	20%
New patient office visit, about 60 minutes CPT 99205 New Pt Lvl 5 W Proc Obop	$163.20	$204.00	—	15% below	20%
New patient office visit, about 60 minutes CPT 99205 New Pt Lvl 5	$163.20	$204.00	—	15% below	20%
New patient office visit, about 60 minutes CPT 99205 New Pt W Proc Lvl 5	$163.20	$204.00	—	15% below	20%
New patient office visit, about 60 minutes CPT 99205 New Pt Lvl 5 W Proc Opd	$163.20	$204.00	—	15% below	20%
New patient office visit, about 60 minutes CPT 99205 New Visit Lvl 5 Card	$163.20	$204.00	—	15% below	20%
New patient office visit, about 60 minutes CPT 99205 New Vst Lvl 5 W Proc Card	$163.20	$204.00	—	15% below	20%
New patient office visit, about 60 minutes CPT 99205 O/P Visit New Level 5	$163.20	$204.00	—	15% below	20%
New patient office visit, about 60 minutes CPT 99205 New Pt Level 5 Dm	$163.20	$204.00	—	15% below	20%
New patient office visit, about 60 minutes CPT 99205 New Visit Lvl 5 Wc	$276.80	$346.00	—	45% above	20%
New patient office visit, about 60 minutes CPT 99205 New Visit Lvl W/Proc 5 Wc	$276.80	$346.00	—	45% above	20%
New patient office visit, about 60 minutes CPT 99205 Bh Clinic New Level 5 99205	$461.60	$577.00	—	141% above	20%
New patient office visit, about 60 minutes CPT 99205 Clinic Visit New Lvl 5 99205	$461.60	$577.00	—	141% above	20%
New patient office visit, about 60 minutes inpatient CPT 99205 New Pt Lvl 5 W Proc Rtslp	$55.20	$69.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 New Pt Lvl 5 W Proc	$55.20	$69.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 Cosm Lvl 5 New 99205	$80.00	$100.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 Visit New Level 5 99215	$120.00	$150.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 New Vst Lvl 5 W Proc Card	$163.20	$204.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 New Pt Lvl 5 W Proc Obop	$163.20	$204.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 New Pt W Proc Lvl 5	$163.20	$204.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 New Pt Lvl 5	$163.20	$204.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 New Pt Level 5 Opd	$163.20	$204.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 New Pt Lvl 5 W Proc Opd	$163.20	$204.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 New Visit Lvl 5 Card	$163.20	$204.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 New Pt Level 5 Dm	$163.20	$204.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 O/P Visit New Level 5	$163.20	$204.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 New Visit Lvl W/Proc 5 Wc	$276.80	$346.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 New Visit Lvl 5 Wc	$276.80	$346.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 Clinic Visit New Lvl 5 99205	$461.60	$577.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 Bh Clinic New Level 5 99205	$461.60	$577.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Pt Lvl 2 W Proc Rtslp	$55.20	$69.00	—	43% below	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Visit New Lvl 2 W Proc	$120.00	$150.00	—	24% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Visit New Level 2 Uc	$120.00	$150.00	—	24% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Clinic Level Ii	$163.20	$204.00	—	69% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Pt Lvl 2	$163.20	$204.00	—	69% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Pt Level 2 Opd	$163.20	$204.00	—	69% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Pt W Proc Lv2	$163.20	$204.00	—	69% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Pt Lvl 2 W Proc Opd	$163.20	$204.00	—	69% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Pt Lvl 2 W Proc Obop	$163.20	$204.00	—	69% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Pt Level 2 Dm	$163.20	$204.00	—	69% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Th Visit New Lvl 2 99202	$167.20	$209.00	—	73% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Clinic Visit New Lvl 2 99200	$167.20	$209.00	—	73% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Visit Lvl W/Proc 2 Wc	$276.80	$346.00	—	187% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Visit Lvl 2 Wc	$276.80	$346.00	—	187% above	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Pt Lvl 2 W Proc Rtslp	$55.20	$69.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Visit New Lvl 2 W Proc	$120.00	$150.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Visit New Level 2 Uc	$120.00	$150.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Pt Lvl 2	$163.20	$204.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Clinic Level Ii	$163.20	$204.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Pt Level 2 Dm	$163.20	$204.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Pt Lvl 2 W Proc Opd	$163.20	$204.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Pt Level 2 Opd	$163.20	$204.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Pt Lvl 2 W Proc Obop	$163.20	$204.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Pt W Proc Lv2	$163.20	$204.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Clinic Visit New Lvl 2 99200	$167.20	$209.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Th Visit New Lvl 2 99202	$167.20	$209.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Visit Lvl 2 Wc	$276.80	$346.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Visit Lvl W/Proc 2 Wc	$276.80	$346.00	—	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Th Nutr Coun Mnt Int 15 97802	$100.00	$125.00	—	53% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Medical Nutrition Indiv In	$100.00	$125.00	—	53% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Nutr Counsel Mnt Int 15Mi	$100.00	$125.00	—	53% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Medical Nutrition Indiv In	$100.00	$125.00	—	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Nutr Counsel Mnt Int 15Mi	$100.00	$125.00	—	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Th Nutr Coun Mnt Int 15 97802	$100.00	$125.00	—	—	20%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Low Complex Eval	$385.60	$482.00	—	48% above	20%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Ot Eval Low Complex Eval	$385.60	$482.00	—	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval High Complex	$465.60	$582.00	—	56% above	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Pt Eval High Complex	$465.60	$582.00	—	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Low Complex. Crutch-Use Eva	$192.80	$241.00	—	26% below	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Low Complex	$385.60	$482.00	—	49% above	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Pt Low Complex. Crutch-Use Eva	$192.80	$241.00	—	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Pt Eval Low Complex	$385.60	$482.00	—	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Moderate Complex	$428.80	$536.00	—	55% above	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Pt Eval Moderate Complex	$428.80	$536.00	—	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy	$189.60	$237.00	—	77% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Pta Manual Therapy	$189.60	$237.00	—	77% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Ota Manual Therapy	$189.60	$237.00	—	77% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Pta Manual Therapy	$189.60	$237.00	—	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Ota Manual Therapy	$189.60	$237.00	—	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy	$189.60	$237.00	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Pta Therapeutic Exer 97110	$171.20	$214.00	—	51% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ota Therapeutic Exercise 97110	$171.20	$214.00	—	51% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Pt 97110	$171.20	$214.00	—	51% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercises Ot 97110	$171.20	$214.00	—	51% above	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Pta Therapeutic Exer 97110	$171.20	$214.00	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Pt 97110	$171.20	$214.00	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Ota Therapeutic Exercise 97110	$171.20	$214.00	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercises Ot 97110	$171.20	$214.00	—	—	20%
Preventive checkup, new patient aged 18–39 CPT 99385 New Preventitive Visit 18-39	$192.00	$240.00	—	61% above	20%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 New Preventitive Visit 18-39	$192.00	$240.00	—	—	20%
Preventive checkup, new patient aged 65 or older CPT 99387 New Preventative Vsit 65 & Ovr	$160.00	$200.00	—	2% above	20%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 New Preventative Vsit 65 & Ovr	$160.00	$200.00	—	—	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 Prev Visit Est 18-39	$149.60	$187.00	—	19% above	20%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 Prev Visit Est 18-39	$149.60	$187.00	—	—	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 Periodic Prev Med Est Pt 40-64	$149.60	$187.00	—	19% above	20%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 Periodic Prev Med Est Pt 40-64	$149.60	$187.00	—	—	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 Per Pm Reeval Est Pt 65+ Yr	$147.20	$184.00	—	14% above	20%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 Per Pm Reeval Est Pt 65+ Yr	$147.20	$184.00	—	—	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Behav Chng Smoking 3-10 Min	$66.40	$83.00	—	53% above	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking Cessation Limited	$66.40	$83.00	—	53% above	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Behav Chng Smoking 3-10 Min	$66.40	$83.00	—	—	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Smoking Cessation Limited	$66.40	$83.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est Pt Lvl 5 W Proc Rtslp	$55.20	$69.00	—	67% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Visit Est Level 5 Uc	$120.00	$150.00	—	29% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Visit Est Lvl 5 W Proc Uc	$120.00	$150.00	—	29% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 O/P Visit Est Level 5	$163.20	$204.00	—	3% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est Pt Lvl 5 W Proc Obop 25	$163.20	$204.00	—	3% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est Visit Lvl 5 W Proc Card	$163.20	$204.00	—	3% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est Pt Lvl 5 W Proc Opd	$163.20	$204.00	—	3% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est Visit Lvl 5 Wc 99215	$276.80	$346.00	—	64% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est Visit Lvl W/Proc 5 Wc	$276.80	$346.00	—	64% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Bh Clinic Est Level 5 99215	$323.20	$404.00	—	92% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Clinic Visit Est Lvl 5 99215	$323.20	$404.00	—	92% above	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Est Pt Lvl 5 W Proc Rtslp	$55.20	$69.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Visit Est Level 5 Uc	$120.00	$150.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Visit Est Lvl 5 W Proc Uc	$120.00	$150.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 O/P Visit Est Level 5	$163.20	$204.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Est Pt Lvl 5 W Proc Obop 25	$163.20	$204.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Est Visit Lvl 5 W Proc Card	$163.20	$204.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Est Pt Lvl 5 W Proc Opd	$163.20	$204.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Est Visit Lvl 5 Wc 99215	$276.80	$346.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Est Visit Lvl W/Proc 5 Wc	$276.80	$346.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Clinic Visit Est Lvl 5 99215	$323.20	$404.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Bh Clinic Est Level 5 99215	$323.20	$404.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Pt Lvl 3 W Proc	$55.20	$69.00	—	52% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Pt Level 3 Rtslp	$55.20	$69.00	—	52% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Pt Lvl 3	$55.20	$69.00	—	52% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Pt Lvl 3 W Proc Rtslp	$61.60	$77.00	—	46% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Visit Est Level 3 Uc 99213	$120.00	$150.00	—	5% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Visit Est Lvl 3 W Proc Uc	$120.00	$150.00	—	5% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Pt Level 3 Opd	$163.20	$204.00	—	43% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Bh Clinic Est Level 3 99213	$163.20	$204.00	—	43% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Th Visit Est Lvl 3 99213	$163.20	$204.00	—	43% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 O/P Visit Est Level 3 Wmc Clin	$163.20	$204.00	—	43% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Visit Lvl 3 Card	$163.20	$204.00	—	43% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Clinic Visit Est Lvl 3 99213	$163.20	$204.00	—	43% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Pt Lvl 3 W Proc Obop	$276.80	$346.00	—	142% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Clinic Level 3 Ob	$276.80	$346.00	—	142% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Visit Lvl W/Proc 3 Wc	$276.80	$346.00	—	142% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Visit Lvl 3 Wc	$276.80	$346.00	—	142% above	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Pt Lvl 3 W Proc	$55.20	$69.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Pt Lvl 3	$55.20	$69.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Pt Level 3 Rtslp	$55.20	$69.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Pt Lvl 3 W Proc Rtslp	$61.60	$77.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Visit Est Lvl 3 W Proc Uc	$120.00	$150.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Visit Est Level 3 Uc 99213	$120.00	$150.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 O/P Visit Est Level 3 Wmc Clin	$163.20	$204.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Clinic Visit Est Lvl 3 99213	$163.20	$204.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Bh Clinic Est Level 3 99213	$163.20	$204.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Th Visit Est Lvl 3 99213	$163.20	$204.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Pt Level 3 Opd	$163.20	$204.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Visit Lvl 3 Card	$163.20	$204.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Visit Lvl 3 Wc	$276.80	$346.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Pt Lvl 3 W Proc Obop	$276.80	$346.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Visit Lvl W/Proc 3 Wc	$276.80	$346.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Clinic Level 3 Ob	$276.80	$346.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Pt Level 4 Rtslp	$55.20	$69.00	—	61% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Pt Lvl 4	$55.20	$69.00	—	61% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Pt Lvl 4 W Proc	$55.20	$69.00	—	61% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Visit Est Lvl 4 W Proc Uc	$120.00	$150.00	—	16% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Visit Est Level 4 Uc 99214	$120.00	$150.00	—	16% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Pt Lvl 4 W Proc Obop	$163.20	$204.00	—	15% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Established Clinic Level 4	$163.20	$204.00	—	15% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Visit Lvl 4 W Proc Card	$163.20	$204.00	—	15% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Bh Clinic Est Level 4 99214	$239.20	$299.00	—	68% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Clinic Visit Est Lvl 4 99214	$239.20	$299.00	—	68% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Visit Lvl 4 Wc	$276.80	$346.00	—	95% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Visit Lvl W/Proc 4 Wc	$276.80	$346.00	—	95% above	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Est Pt Lvl 4 W Proc	$55.20	$69.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Est Pt Lvl 4	$55.20	$69.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Est Pt Level 4 Rtslp	$55.20	$69.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Visit Est Level 4 Uc 99214	$120.00	$150.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Visit Est Lvl 4 W Proc Uc	$120.00	$150.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Est Pt Lvl 4 W Proc Obop	$163.20	$204.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Established Clinic Level 4	$163.20	$204.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Est Visit Lvl 4 W Proc Card	$163.20	$204.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Clinic Visit Est Lvl 4 99214	$239.20	$299.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Bh Clinic Est Level 4 99214	$239.20	$299.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Est Visit Lvl 4 Wc	$276.80	$346.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Est Visit Lvl W/Proc 4 Wc	$276.80	$346.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Observation Direct 3W	$52.80	$66.00	—	46% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Observation Direct 4W	$55.20	$69.00	—	43% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Pt Lvl 2	$55.20	$69.00	—	43% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Pt Level 2 Rtslp	$55.20	$69.00	—	43% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Pt Lvl 2 W Proc	$55.20	$69.00	—	43% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Pt Lvl 2 W Proc Obop	$55.20	$69.00	—	43% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Established Clinic Level 2	$55.20	$69.00	—	43% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Obsvation Direct Sds	$60.00	$75.00	—	38% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Pt Lvl 2 W Proc Rtslp	$61.60	$77.00	—	37% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Observation Direct Fbc	$68.00	$85.00	—	30% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Th Indiv. Gestational 15 Minu	$89.60	$112.00	—	8% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Group Diabetes	$89.60	$112.00	—	8% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Individual Gestational 15 Minu	$89.60	$112.00	—	8% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Th Visit Est Lvl 2 99212	$97.60	$122.00	—	at median	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Clinic Visit Est Lvl 2 99212	$97.60	$122.00	—	at median	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Bh Clinic Est Level 2 99212	$97.60	$122.00	—	at median	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Visit Est Lvl 2 W Proc Uc	$120.00	$150.00	—	23% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Visit Est Level 2 Uc 99212	$120.00	$150.00	—	23% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Pt Level 2 Opd	$163.20	$204.00	—	67% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Visit Lvl W/Proc 2 Wc	$276.80	$346.00	—	184% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Visit Lvl 2 Wc	$276.80	$346.00	—	184% above	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Observation Direct 3W	$52.80	$66.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Pt Lvl 2 W Proc Obop	$55.20	$69.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Established Clinic Level 2	$55.20	$69.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Pt Lvl 2 W Proc	$55.20	$69.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Pt Level 2 Rtslp	$55.20	$69.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Pt Lvl 2	$55.20	$69.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Observation Direct 4W	$55.20	$69.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Obsvation Direct Sds	$60.00	$75.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Pt Lvl 2 W Proc Rtslp	$61.60	$77.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Observation Direct Fbc	$68.00	$85.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Group Diabetes	$89.60	$112.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Th Indiv. Gestational 15 Minu	$89.60	$112.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Individual Gestational 15 Minu	$89.60	$112.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Th Visit Est Lvl 2 99212	$97.60	$122.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Bh Clinic Est Level 2 99212	$97.60	$122.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Clinic Visit Est Lvl 2 99212	$97.60	$122.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Visit Est Lvl 2 W Proc Uc	$120.00	$150.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Visit Est Level 2 Uc 99212	$120.00	$150.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Pt Level 2 Opd	$163.20	$204.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Visit Lvl W/Proc 2 Wc	$276.80	$346.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Visit Lvl 2 Wc	$276.80	$346.00	—	—	20%
Speech and language evaluation CPT 92523 Speech Lang Eval	$782.40	$978.00	—	141% above	20%
Speech and language evaluation inpatient CPT 92523 Speech Lang Eval	$782.40	$978.00	—	—	20%
Speech therapy session, individual CPT 92507 Speech Lang Therapy- Hh	$154.40	$193.00	—	30% below	20%
Speech therapy session, individual CPT 92507 Th Speech Lang Tx	$319.20	$399.00	—	44% above	20%
Speech therapy session, individual CPT 92507 Speech Lang Tx	$319.20	$399.00	—	44% above	20%
Speech therapy session, individual inpatient CPT 92507 Speech Lang Therapy- Hh	$154.40	$193.00	—	—	20%
Speech therapy session, individual inpatient CPT 92507 Speech Lang Tx	$319.20	$399.00	—	—	20%
Speech therapy session, individual inpatient CPT 92507 Th Speech Lang Tx	$319.20	$399.00	—	—	20%
Spirometry (breathing test) CPT 94010 Pft Spirometry 94010	$79.20	$99.00	—	72% below	20%
Spirometry (breathing test) CPT 94010 Pft Breath Capac Spirome 94010	$80.00	$100.00	—	72% below	20%
Spirometry (breathing test) CPT 94010 Peds Breathing Capacity Test	$412.80	$516.00	—	43% above	20%
Spirometry (breathing test) CPT 94010 Spirometry And Staging	$412.80	$516.00	—	43% above	20%
Spirometry (breathing test) inpatient CPT 94010 Pft Spirometry 94010	$79.20	$99.00	—	—	20%
Spirometry (breathing test) inpatient CPT 94010 Pft Breath Capac Spirome 94010	$80.00	$100.00	—	—	20%
Spirometry (breathing test) inpatient CPT 94010 Peds Breathing Capacity Test	$412.80	$516.00	—	—	20%
Spirometry (breathing test) inpatient CPT 94010 Spirometry And Staging	$412.80	$516.00	—	—	20%
Spirometry before and after a bronchodilator CPT 94060 Spiro Pre&Post Card Screening	$446.40	$558.00	—	20% below	20%
Spirometry before and after a bronchodilator CPT 94060 Evaluation Of Wheezing 94060	$767.20	$959.00	—	38% above	20%
Spirometry before and after a bronchodilator CPT 94060 Pft Pre & Post Bd	$767.20	$959.00	—	38% above	20%
Spirometry before and after a bronchodilator CPT 94060 Spirometry B&A Bronchdltor	$767.20	$959.00	—	38% above	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 Spiro Pre&Post Card Screening	$446.40	$558.00	—	—	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 Evaluation Of Wheezing 94060	$767.20	$959.00	—	—	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 Spirometry B&A Bronchdltor	$767.20	$959.00	—	—	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 Pft Pre & Post Bd	$767.20	$959.00	—	—	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 Cardiac Rehab Phase I	$110.40	$138.00	—	10% below	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Pt	$178.40	$223.00	—	46% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 Ther Activities	$178.40	$223.00	—	46% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 Pta Therapeutic Activities	$178.40	$223.00	—	46% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 Ota Ther Activities	$178.40	$223.00	—	46% above	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Cardiac Rehab Phase I	$110.40	$138.00	—	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Ota Ther Activities	$178.40	$223.00	—	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Pta Therapeutic Activities	$178.40	$223.00	—	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Ther Activities	$178.40	$223.00	—	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Pt	$178.40	$223.00	—	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy	$222.40	$278.00	—	6% below	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy	$222.40	$278.00	—	—	20%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 Cardiovascular St 93015	$270.40	$338.00	—	64% below	20%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 Cardiovascular St 93015	$270.40	$338.00	—	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 Fluad: 10 Syringe, Glass In 1 Carton (70461-024-03) / .5 Ml In 1 Syringe, Glass (70461-024-04)	$63.60	$79.50	—	10% below	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 Fluad: 10 Syringe, Glass In 1 Carton (70461-024-03) / .5 Ml In 1 Syringe, Glass (70461-024-04)	$63.60	$79.50	—	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 M-M-R Ii: 10 Vial, Single-Dose In 1 Carton (0006-4681-00) / .5 Ml In 1 Vial, Single-Dose (0006-4681-01)	$163.66	$204.58	—	21% below	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 M-M-R Ii: 10 Vial, Single-Dose In 1 Carton (0006-4681-00) / .5 Ml In 1 Vial, Single-Dose (0006-4681-01)	$163.66	$204.58	—	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02) / .5 Ml In 1 Syringe (0005-2000-01)	$1,152.48	$1,440.60	—	74% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02) / .5 Ml In 1 Syringe (0005-2000-01)	$1,152.48	$1,440.60	—	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal Vacc-23 (1)	$468.32	$585.40	—	70% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal Vacc-23 (1)	$468.32	$585.40	—	—	20%
Rabies vaccine, one dose CPT 90675 Rabies Vaccine Im Use (1)	$1,961.16	$2,451.45	—	105% above	20%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vaccine Im Use (1)	$1,961.16	$2,451.45	—	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tet Diph Tox Pf (Td) 7/>	$156.58	$195.73	—	74% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tet Diph Tox Pf (Td) 7/>	$156.58	$195.73	—	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap Tet Diph Pert 7YRS/>Im	$193.06	$241.33	—	75% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tdap Tet Diph Pert 7YRS/>Im	$193.06	$241.33	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Flu Only Vaccine Admin 3W	$62.40	$78.00	—	63% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Flu Only Vaccine Admin Fbc	$62.40	$78.00	—	63% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Flu Only Vaccine Admin Icu	$62.40	$78.00	—	63% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Flu Only Vaccine Admin 4W	$62.40	$78.00	—	63% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Rabies Admin Vaccine Inj 90471	$70.40	$88.00	—	84% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin Vaccine Fbc	$70.40	$88.00	—	84% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pneu Only Vaccine Admin 4W	$70.40	$88.00	—	84% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin Vaccine 4W	$70.40	$88.00	—	84% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vacc 1St Not Day Of Flu Pneu	$70.40	$88.00	—	84% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pneu Only Vaccine Admin Icu	$70.40	$88.00	—	84% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pneu Only Vaccine Admin Fbc	$70.40	$88.00	—	84% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immun Admin Er	$70.40	$88.00	—	84% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Init (Not Flu/Pneu) Uc	$70.40	$88.00	—	84% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Flu Only Vaccine Admin 4W	$62.40	$78.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Flu Only Vaccine Admin 3W	$62.40	$78.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Flu Only Vaccine Admin Fbc	$62.40	$78.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Flu Only Vaccine Admin Icu	$62.40	$78.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Init (Not Flu/Pneu) Uc	$70.40	$88.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immun Admin Er	$70.40	$88.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin Vaccine 4W	$70.40	$88.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pneu Only Vaccine Admin 4W	$70.40	$88.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin Vaccine Fbc	$70.40	$88.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pneu Only Vaccine Admin Fbc	$70.40	$88.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vacc 1St Not Day Of Flu Pneu	$70.40	$88.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Rabies Admin Vaccine Inj 90471	$70.40	$88.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pneu Only Vaccine Admin Icu	$70.40	$88.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Pneu W/Other Vaccine Admin 4W	$50.40	$63.00	—	45% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Pneu W/Other Vaccine Admin Fbc	$50.40	$63.00	—	45% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Pneu W/Other Vaccine Admin Icu	$50.40	$63.00	—	45% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin Each Additi	$50.40	$63.00	—	45% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin Each Add	$50.40	$63.00	—	45% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Ea Addtl (Not Flu/Pne	$50.40	$63.00	—	45% above	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Admin Each Add	$50.40	$63.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Pneu W/Other Vaccine Admin 4W	$50.40	$63.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Pneu W/Other Vaccine Admin Fbc	$50.40	$63.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Ea Addtl (Not Flu/Pne	$50.40	$63.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Admin Each Additi	$50.40	$63.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Pneu W/Other Vaccine Admin Icu	$50.40	$63.00	—	—	20%

Source file: https://res.cloudinary.com/dpmykpsih/raw/upload/mary-rutan-redesign-site-505/media/42319e350c4244218295200023f73fad/341407259_mary-rutan-hospital_standardcharges.json