Matagorda Regional Medical Center
Listed in its price file as “Matagorda County Hospital District”.
Matagorda Regional Medical Center in Bay City, TX publishes cash prices for 160 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the Texas median for 157 of 160 procedures and above it for 3. By typical cash price it ranks #48 of 306 Texas hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
104 Seventh Street Bay City, TX 77414 Collected Sep 27, 2026 Source price file (979) 245-6383
Acute care hospital Emergency department CMS star rating 5 of 5 CCN 450465 · CMS hospital register NPI 1679678767
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Texas | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W & W/O CON | $992.50 | $1,985.00 | $176.56–$1,316.78 | 66% below | 50% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W & W/O CON | $992.50 | $1,985.00 | $176.56–$1,316.78 | — | 50% |
| Abdominal X-ray, 2 views CPT 74019 ABDOMEN 2 VIEWS | $283.00 | $566.00 | $105.47–$489.89 | 28% below | 50% |
| Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN 2 VIEWS | $283.00 | $566.00 | $105.47–$489.89 | — | 50% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE RIGHT MIN 3V | $178.00 | $356.00 | $87.33–$267.00 | 53% below | 50% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE LEFT MIN 3V | $178.00 | $356.00 | $87.33–$267.00 | 53% below | 50% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE LEFT MIN 3V | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE RIGHT MIN 3V | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ANKLE BRACHIAL INDEX BIL | $120.00 | $240.00 | $64.18–$335.08 | 80% below | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ARTERIAL EXTREMITY STUDY-2 LEV | $151.00 | $302.00 | $64.18–$335.08 | 75% below | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ANKLE BRACHIAL INDEX BIL | $120.00 | $240.00 | $64.18–$335.08 | — | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ARTERIAL EXTREMITY STUDY-2 LEV | $151.00 | $302.00 | $64.18–$335.08 | — | 50% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXT WO CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | 59% below | 50% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXT WO CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGRAM ONLY | $676.50 | $1,353.00 | $176.56–$1,081.73 | 35% above | 50% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGRAM ONLY | $676.50 | $1,353.00 | $176.56–$1,081.73 | — | 50% |
| Bone scan, whole body (nuclear medicine) CPT 78306 WHOLE BODY BONE SCAN | $719.00 | $1,438.00 | $590.60–$1,181.19 | 59% below | 50% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 WHOLE BODY BONE SCAN | $719.00 | $1,438.00 | $590.60–$1,181.19 | — | 50% |
| Breast ultrasound, complete, one breast one side CPT 76641 BREAST ULTRASOUND RT | $145.00 | $290.00 | $105.47–$489.89 | 67% below | 50% |
| Breast ultrasound, complete, one breast one side CPT 76641 BREAST ULTRASOUND LT | $145.00 | $290.00 | $105.47–$489.89 | 67% below | 50% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 BREAST ULTRASOUND RT | $145.00 | $290.00 | $105.47–$489.89 | — | 50% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 BREAST ULTRASOUND LT | $145.00 | $290.00 | $105.47–$489.89 | — | 50% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 U/S BREAST LIMITED LT | $108.50 | $217.00 | $87.33–$265.87 | 71% below | 50% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 U/S BREAST LIMITED RT | $108.50 | $217.00 | $87.33–$265.87 | 71% below | 50% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 U/S BREAST LIMITED LT | $108.50 | $217.00 | $87.33–$265.87 | — | 50% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 U/S BREAST LIMITED RT | $108.50 | $217.00 | $87.33–$265.87 | — | 50% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABD&PELVIS W CONTRAST | $768.00 | $1,536.00 | $600.00–$1,312.61 | 82% below | 50% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD&PELVIS W/WO CONTRAST | $768.00 | $1,536.00 | $600.00–$1,312.61 | 82% below | 50% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD&PELVIS W/WO CONTRAST | $768.00 | $1,536.00 | $600.00–$1,312.61 | — | 50% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ANGIO ABD&PELVIS W CONTRAST | $768.00 | $1,536.00 | $600.00–$1,312.61 | — | 50% |
| CT angiography (CTA) of the head CPT 70496 CT ANGIO HEAD W CONTRAST | $768.00 | $1,536.00 | $176.56–$1,316.78 | 73% below | 50% |
| CT angiography (CTA) of the head CPT 70496 CT ANGIOGRAPHY HEAD WWO CONTRA | $768.00 | $1,536.00 | $176.56–$1,316.78 | 73% below | 50% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIOGRAPHY HEAD WWO CONTRA | $768.00 | $1,536.00 | $176.56–$1,316.78 | — | 50% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIO HEAD W CONTRAST | $768.00 | $1,536.00 | $176.56–$1,316.78 | — | 50% |
| CT angiography (CTA) of the neck CPT 70498 CT ANGIOGRAPHY NECK WWO CONTRA | $768.00 | $1,536.00 | $176.56–$1,316.78 | 70% below | 50% |
| CT angiography (CTA) of the neck CPT 70498 CT ANGIO NECK W CONTRAST | $768.00 | $1,536.00 | $176.56–$1,316.78 | 70% below | 50% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIOGRAPHY NECK WWO CONTRA | $768.00 | $1,536.00 | $176.56–$1,316.78 | — | 50% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIO NECK W CONTRAST | $768.00 | $1,536.00 | $176.56–$1,316.78 | — | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST W PE PROTOCOL | $768.00 | $1,536.00 | $176.56–$1,316.78 | 73% below | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST W CONTRAST | $768.00 | $1,536.00 | $176.56–$1,316.78 | 73% below | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST WWO CONTR | $768.00 | $1,536.00 | $176.56–$1,316.78 | 73% below | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY CHEST WWO CONTR | $768.00 | $1,536.00 | $176.56–$1,316.78 | — | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST W PE PROTOCOL | $768.00 | $1,536.00 | $176.56–$1,316.78 | — | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST W CONTRAST | $768.00 | $1,536.00 | $176.56–$1,316.78 | — | 50% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT CORONARY CALCIUM SCORING | $110.00 | $220.00 | $87.33–$650.00 | 42% below | 50% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT CORONARY CALCIUM SCORING | $110.00 | $220.00 | $87.33–$650.00 | — | 50% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O | $825.00 | $1,650.00 | $239.73–$1,210.34 | 75% below | 50% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O | $825.00 | $1,650.00 | $239.73–$1,210.34 | — | 50% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W | $915.50 | $1,831.00 | $354.19–$1,316.78 | 76% below | 50% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W | $915.50 | $1,831.00 | $354.19–$1,316.78 | — | 50% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD & PELVIS W&W/O | $1,052.50 | $2,105.00 | $354.19–$1,319.84 | 75% below | 50% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD & PELVIS W&W/O | $1,052.50 | $2,105.00 | $354.19–$1,319.84 | — | 50% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W CONTRAST | $855.50 | $1,711.00 | $176.56–$1,316.78 | 67% below | 50% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W CONTRAST | $855.50 | $1,711.00 | $176.56–$1,316.78 | — | 50% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | 62% below | 50% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT FACIAL/SINUS W/O CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | 54% below | 50% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT FACIAL/SINUS W/O CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | 60% below | 50% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| CT scan of the head with contrast CPT 70460 CT HEAD WITH CONTRAST | $855.50 | $1,711.00 | $176.56–$1,316.78 | 51% below | 50% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD WITH CONTRAST | $855.50 | $1,711.00 | $176.56–$1,316.78 | — | 50% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD W & WO CONTRAST | $992.50 | $1,985.00 | $176.56–$1,316.78 | 56% below | 50% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W & WO CONTRAST | $992.50 | $1,985.00 | $176.56–$1,316.78 | — | 50% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O | $765.00 | $1,530.00 | $105.47–$959.31 | 63% below | 50% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O | $765.00 | $1,530.00 | $105.47–$959.31 | 63% below | 50% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST | $855.50 | $1,711.00 | $176.56–$1,316.78 | 61% below | 50% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST | $855.50 | $1,711.00 | $176.56–$1,316.78 | — | 50% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 CAROTID ARTERIAL DOPPLER BIL | $776.00 | $1,552.00 | $137.54–$1,164.00 | 41% below | 50% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 CAROTID ARTERIAL DOPPLER BIL | $776.00 | $1,552.00 | $137.54–$1,164.00 | — | 50% |
| Chest CT scan without and with contrast CPT 71270 CT CHEST WWO CONTRAST | $992.50 | $1,985.00 | $176.56–$1,316.78 | 64% below | 50% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST WWO CONTRAST | $992.50 | $1,985.00 | $176.56–$1,316.78 | — | 50% |
| Chest X-ray, 2 views CPT 71046 TB CHEST-2 VIEW | $44.00 | $88.00 | $49.28–$265.87 | 89% below | 50% |
| Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS | $184.50 | $369.00 | $87.33–$276.75 | 53% below | 50% |
| Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS,INITIAL | $184.50 | $369.00 | $87.33–$276.75 | 53% below | 50% |
| Chest X-ray, 2 views inpatient CPT 71046 TB CHEST-2 VIEW | $44.00 | $88.00 | $49.28–$265.87 | — | 50% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS,INITIAL | $184.50 | $369.00 | $87.33–$276.75 | — | 50% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS | $184.50 | $369.00 | $87.33–$276.75 | — | 50% |
| Chest X-ray, single view CPT 71045 TB CHEST | $44.00 | $88.00 | $49.28–$265.87 | 86% below | 50% |
| Chest X-ray, single view CPT 71045 CHEST XRAY DECUBITUS | $170.50 | $341.00 | $87.33–$265.87 | 47% below | 50% |
| Chest X-ray, single view CPT 71045 CHEST XRAY DECUBITIS | $170.50 | $341.00 | $87.33–$265.87 | 47% below | 50% |
| Chest X-ray, single view CPT 71045 CHEST 1 VIEW | $170.50 | $341.00 | $87.33–$265.87 | 47% below | 50% |
| Chest X-ray, single view inpatient CPT 71045 TB CHEST | $44.00 | $88.00 | $49.28–$265.87 | — | 50% |
| Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| Chest X-ray, single view inpatient CPT 71045 CHEST XRAY DECUBITUS | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| Chest X-ray, single view inpatient CPT 71045 CHEST XRAY DECUBITIS | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE LEFT | $178.00 | $356.00 | $87.33–$267.00 | 47% below | 50% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE RIGHT | $178.00 | $356.00 | $87.33–$267.00 | 47% below | 50% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE RIGHT | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE LEFT | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA BONE DENSITOMETRY | $182.00 | $364.00 | $69.12–$273.00 | 56% below | 50% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA BONE DENSITOMETRY | $182.00 | $364.00 | $69.12–$273.00 | — | 50% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 U/S DETAILED FETAL ANATOMY | $321.50 | $643.00 | $186.63–$482.25 | 53% below | 50% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 U/S DETAILED FETAL ANATOMY | $321.50 | $643.00 | $186.63–$482.25 | — | 50% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | 54% below | 50% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST WO CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W CONTRAST | $855.50 | $1,711.00 | $176.56–$1,316.78 | 61% below | 50% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W CONTRAST | $855.50 | $1,711.00 | $176.56–$1,316.78 | — | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO BILATERAL DIAGNOSTIC | $297.00 | $594.00 | $261.89–$523.79 | — | 50% |
| Diagnostic mammogram, both breasts CPT 77066 MAMMO BIL DX W/TOMO | $297.00 | $594.00 | $261.89–$523.79 | 19% below | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO BILATERAL DIAGNOSTIC | $297.00 | $594.00 | $261.89–$523.79 | — | 50% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMO BIL DX W/TOMO | $297.00 | $594.00 | $261.89–$523.79 | — | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO DIAGNOSTIC RIGHT W/TOMO | $201.00 | $402.00 | $205.05–$410.11 | 26% below | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO DIAGNOSTIC RIGHT | $254.50 | $509.00 | $205.05–$410.11 | 7% below | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO DIAGNOSTIC LEFT | $254.50 | $509.00 | $205.05–$410.11 | 7% below | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO DIAGNOSTIC RIGHT W/TOMO | $201.00 | $402.00 | $205.05–$410.11 | — | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO DIAGNOSTIC RIGHT | $254.50 | $509.00 | $205.05–$410.11 | — | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO DIAGNOSTIC LEFT | $254.50 | $509.00 | $205.05–$410.11 | — | 50% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 UPPER EXT VENOUS DOPPLER BIL | $601.50 | $1,203.00 | $139.68–$902.25 | 70% below | 50% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 LOWER EXT VENOUS DOPPLER BIL | $601.50 | $1,203.00 | $139.68–$902.25 | 70% below | 50% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 UPPER EXT VENOUS DOPPLER BIL | $601.50 | $1,203.00 | $139.68–$902.25 | — | 50% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 LOWER EXT VENOUS DOPPLER BIL | $601.50 | $1,203.00 | $139.68–$902.25 | — | 50% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHOCARDIOGRAM COMPLETE | $904.50 | $1,809.00 | $115.84–$1,356.75 | 61% below | 50% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHOCARDIOGRAM COMPLETE | $904.50 | $1,809.00 | $115.84–$1,356.75 | — | 50% |
| Elbow X-ray, 2 views one side CPT 73070 ELBOW LEFT 2V | $168.00 | $336.00 | $87.33–$265.87 | 48% below | 50% |
| Elbow X-ray, 2 views one side CPT 73070 ELBOW RIGHT 2V | $168.00 | $336.00 | $87.33–$265.87 | 48% below | 50% |
| Elbow X-ray, 2 views one side CPT 73070 ELBOW;RIGHT 2V | $168.00 | $336.00 | $87.33–$265.87 | 48% below | 50% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW RIGHT 2V | $168.00 | $336.00 | $87.33–$265.87 | — | 50% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW;RIGHT 2V | $168.00 | $336.00 | $87.33–$265.87 | — | 50% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW LEFT 2V | $168.00 | $336.00 | $87.33–$265.87 | — | 50% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW RIGHT 3V | $210.50 | $421.00 | $87.33–$315.75 | 45% below | 50% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW LEFT 3V | $210.50 | $421.00 | $87.33–$315.75 | 45% below | 50% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW RIGHT 3V | $210.50 | $421.00 | $87.33–$315.75 | — | 50% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW LEFT 3V | $210.50 | $421.00 | $87.33–$315.75 | — | 50% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBITS W/O CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | 54% below | 50% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT IAC W/O CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | 54% below | 50% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBITS W/O CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT IAC W/O CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES MIN 3V | $275.00 | $550.00 | $105.47–$489.89 | 35% below | 50% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES MIN 3V | $275.00 | $550.00 | $105.47–$489.89 | — | 50% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM RIGHT 2V | $169.00 | $338.00 | $87.33–$265.87 | 55% below | 50% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM LEFT 2V | $169.00 | $338.00 | $87.33–$265.87 | 55% below | 50% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM LEFT 2V | $169.00 | $338.00 | $87.33–$265.87 | — | 50% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM RIGHT 2V | $169.00 | $338.00 | $87.33–$265.87 | — | 50% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY DUCT WO KINAVAC | $774.00 | $1,548.00 | $665.88–$1,331.76 | 52% below | 50% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY DUCT WO KINAVAC | $774.00 | $1,548.00 | $665.88–$1,331.76 | — | 50% |
| Hand X-ray, 2 views one side CPT 73120 HAND LEFT 2V | $283.00 | $566.00 | $105.47–$489.89 | 14% below | 50% |
| Hand X-ray, 2 views one side CPT 73120 HAND RIGHT 2V | $283.00 | $566.00 | $105.47–$489.89 | 14% below | 50% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HAND RIGHT 2V | $283.00 | $566.00 | $105.47–$489.89 | — | 50% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HAND LEFT 2V | $283.00 | $566.00 | $105.47–$489.89 | — | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 CALCANEUS LEFT 2V | $170.50 | $341.00 | $87.33–$265.87 | 41% below | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 CALCANEUS RIGHT 2V | $170.50 | $341.00 | $87.33–$265.87 | 41% below | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 CALCANEUS RIGHT 2V | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 CALCANEUS LEFT 2V | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAM W/CPAP >=6 YRS | $1,386.00 | $2,772.00 | $1,424.99–$2,079.00 | 68% below | 50% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAM/CPAP SPLIT>=6YRS | $1,386.00 | $2,772.00 | $1,424.99–$2,079.00 | 68% below | 50% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAM W/CPAP >=6 YRS | $1,386.00 | $2,772.00 | $1,424.99–$2,079.00 | — | 50% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAM/CPAP SPLIT>=6YRS | $1,386.00 | $2,772.00 | $1,424.99–$2,079.00 | — | 50% |
| Knee X-ray, 3 views one side CPT 73562 KNEE LEFT 3V | $155.00 | $310.00 | $87.33–$265.87 | 62% below | 50% |
| Knee X-ray, 3 views one side CPT 73562 KNEE RIGHT 3V | $155.00 | $310.00 | $87.33–$265.87 | 62% below | 50% |
| Knee X-ray, 3 views inpatient one side CPT 73562 KNEE LEFT 3V | $155.00 | $310.00 | $87.33–$265.87 | — | 50% |
| Knee X-ray, 3 views inpatient one side CPT 73562 KNEE RIGHT 3V | $155.00 | $310.00 | $87.33–$265.87 | — | 50% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE RIGHT 4V | $311.00 | $622.00 | $105.47–$489.89 | 27% below | 50% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE LEFT 4V | $311.00 | $622.00 | $105.47–$489.89 | 27% below | 50% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE LEFT 4V | $311.00 | $622.00 | $105.47–$489.89 | — | 50% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE RIGHT 4V | $311.00 | $622.00 | $105.47–$489.89 | — | 50% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXT W/O CONT | $765.00 | $1,530.00 | $105.47–$959.31 | 57% below | 50% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXT W/O CONT | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 SPLEEN ULTRASOUND | $459.00 | $918.00 | $105.47–$688.50 | 27% below | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 APPENDIX ULTRASOUND | $459.00 | $918.00 | $105.47–$688.50 | 27% below | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 PYLORIC ULTRA | $459.00 | $918.00 | $105.47–$688.50 | 27% below | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HEPATIC ULTRASOUND | $459.00 | $918.00 | $105.47–$688.50 | 27% below | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 GALL BLADDER ULTRASOUND | $459.00 | $918.00 | $105.47–$688.50 | 27% below | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 LIMITED ORGAN OR QUADRANT U/S | $459.00 | $918.00 | $105.47–$688.50 | 27% below | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 PANCREAS ULTRASOUND | $468.50 | $937.00 | $105.47–$702.75 | 26% below | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 APPENDIX ULTRASOUND | $459.00 | $918.00 | $105.47–$688.50 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 SPLEEN ULTRASOUND | $459.00 | $918.00 | $105.47–$688.50 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 PYLORIC ULTRA | $459.00 | $918.00 | $105.47–$688.50 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 LIMITED ORGAN OR QUADRANT U/S | $459.00 | $918.00 | $105.47–$688.50 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 GALL BLADDER ULTRASOUND | $459.00 | $918.00 | $105.47–$688.50 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HEPATIC ULTRASOUND | $459.00 | $918.00 | $105.47–$688.50 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 PANCREAS ULTRASOUND | $468.50 | $937.00 | $105.47–$702.75 | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 UPPER EXTR SOFT TISSUE LIM | $283.00 | $566.00 | $105.47–$489.89 | 39% below | 50% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 LOWER EXTR SOFT TISSUE LIM | $283.00 | $566.00 | $105.47–$489.89 | 39% below | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 UPPER EXTR SOFT TISSUE LIM | $283.00 | $566.00 | $105.47–$489.89 | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 LOWER EXTR SOFT TISSUE LIM | $283.00 | $566.00 | $105.47–$489.89 | — | 50% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT CHEST-LOW DOSE SCREENING | $765.00 | $1,530.00 | $221.34–$959.31 | 218% above | 50% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT CHEST-LOW DOSE SCREENING | $765.00 | $1,530.00 | $221.34–$959.31 | — | 50% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 RIGHT TIBIA & FIBULA | $178.00 | $356.00 | $87.33–$267.00 | 49% below | 50% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 TIBIA & FIBULA RIGHT 2V | $178.00 | $356.00 | $87.33–$267.00 | 49% below | 50% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 TIBIA & FIBULA LEFT 2V | $178.00 | $356.00 | $87.33–$267.00 | 49% below | 50% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 TIBIA & FIBULA RIGHT 2V | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 TIBIA & FIBULA LEFT 2V | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 RIGHT TIBIA & FIBULA | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD WO CONTRAST | $768.00 | $1,536.00 | $239.73–$1,210.34 | 64% below | 50% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD WO CONTRAST | $768.00 | $1,536.00 | $239.73–$1,210.34 | — | 50% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE RT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | 61% below | 50% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | 61% below | 50% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE RT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | 61% below | 50% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP RT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | 61% below | 50% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE LT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | 61% below | 50% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE LT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | 61% below | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP LT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | — | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE LT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | — | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE RT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | — | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP RT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | — | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE LT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | — | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE RT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | — | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE RT WWO CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | 55% below | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE RT WWO CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | 55% below | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE LT WWO CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | 55% below | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE LT WWO CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | 55% below | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP LT WWO CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | 55% below | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP RT WWO CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | 55% below | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE RT WWO CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | — | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE LT WWO CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | — | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP LT WWO CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | — | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE RT WWO CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | — | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP RT WWO CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | — | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE LT WWO CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | — | 50% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WITHOUT CONTRAST | $908.00 | $1,816.00 | $239.73–$1,210.34 | 59% below | 50% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN WITHOUT CONTRAST | $908.00 | $1,816.00 | $239.73–$1,210.34 | — | 50% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W&W/O CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | 55% below | 50% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W&W/O CONTRAST | $1,437.00 | $2,874.00 | $354.19–$2,377.69 | — | 50% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WITHOUT CONTRAST | $768.00 | $1,536.00 | $239.73–$1,210.34 | 65% below | 50% |
| MRI of the brain, no contrast dye CPT 70551 MRI IAC WO CONTRAST | $768.00 | $1,536.00 | $239.73–$1,210.34 | 65% below | 50% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI IAC WO CONTRAST | $768.00 | $1,536.00 | $239.73–$1,210.34 | — | 50% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WITHOUT CONTRAST | $768.00 | $1,536.00 | $239.73–$1,210.34 | — | 50% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W & WO CONTRAST | $1,381.50 | $2,763.00 | $354.19–$2,377.69 | 54% below | 50% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI IAC W&WO CONTRAST | $1,381.50 | $2,763.00 | $354.19–$2,377.69 | 54% below | 50% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI PITUITARY GLAND W & W/O | $1,381.50 | $2,763.00 | $354.19–$2,377.69 | 54% below | 50% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W & WO CONTRAST | $1,381.50 | $2,763.00 | $354.19–$2,377.69 | — | 50% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI PITUITARY GLAND W & W/O | $1,381.50 | $2,763.00 | $354.19–$2,377.69 | — | 50% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI IAC W&WO CONTRAST | $1,381.50 | $2,763.00 | $354.19–$2,377.69 | — | 50% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE WO CONTRAST | $963.50 | $1,927.00 | $239.73–$1,210.34 | 58% below | 50% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE WO CONTRAST | $963.50 | $1,927.00 | $239.73–$1,210.34 | — | 50% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/WO CONT | $1,263.50 | $2,527.00 | $354.19–$2,377.69 | 60% below | 50% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/WO CONT | $1,263.50 | $2,527.00 | $354.19–$2,377.69 | — | 50% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE WO CONTRAS | $963.50 | $1,927.00 | $239.73–$1,210.34 | 55% below | 50% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE WO CONTRAS | $963.50 | $1,927.00 | $239.73–$1,210.34 | — | 50% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C-SPINE W&WO CONTRAST | $1,381.50 | $2,763.00 | $354.19–$2,377.69 | 58% below | 50% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C-SPINE W&WO CONTRAST | $1,381.50 | $2,763.00 | $354.19–$2,377.69 | — | 50% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE WO CONTRAS | $963.50 | $1,927.00 | $239.73–$1,210.34 | 58% below | 50% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE WO CONTRAS | $963.50 | $1,927.00 | $239.73–$1,210.34 | — | 50% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WWO CONTRAST | $1,381.50 | $2,763.00 | $354.19–$2,377.69 | 59% below | 50% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WWO CONTRAST | $1,381.50 | $2,763.00 | $354.19–$2,377.69 | — | 50% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WITHOUT CONTRAST | $768.00 | $1,536.00 | $239.73–$1,210.34 | 69% below | 50% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS WITHOUT CONTRAST | $768.00 | $1,536.00 | $239.73–$1,210.34 | — | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW RT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | 61% below | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW LT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | 61% below | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST RT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | 61% below | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST LT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | 61% below | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER LT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | 61% below | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER RT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | 61% below | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER RT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | — | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST LT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | — | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST RT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | — | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER LT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | — | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW RT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | — | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW LT WO CONTRAST | $853.50 | $1,707.00 | $239.73–$1,210.34 | — | 50% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERVICAL SPINE MIN 4V | $283.00 | $566.00 | $105.47–$489.89 | 48% below | 50% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERVICAL SPINE MIN 4V | $283.00 | $566.00 | $105.47–$489.89 | — | 50% |
| Neck soft tissue CT scan with contrast CPT 70491 CT NECK WITH CONTRAST | $855.50 | $1,711.00 | $176.56–$1,316.78 | 58% below | 50% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK WITH CONTRAST | $855.50 | $1,711.00 | $176.56–$1,316.78 | — | 50% |
| Neck soft tissue CT scan without contrast CPT 70490 CT NECK SOFT TISSUE W/O CONTR | $765.00 | $1,530.00 | $105.47–$959.31 | 56% below | 50% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK SOFT TISSUE W/O CONTR | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| Neck soft tissue X-ray CPT 70360 NECK SOFT TISSUE | $170.50 | $341.00 | $87.33–$265.87 | 28% below | 50% |
| Neck soft tissue X-ray inpatient CPT 70360 NECK SOFT TISSUE | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MYOC PERF REST & STRESS | $1,747.50 | $3,495.00 | $1,546.97–$2,621.25 | 60% below | 50% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYOC PERF REST & STRESS | $1,747.50 | $3,495.00 | $1,546.97–$2,621.25 | — | 50% |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | 53% below | 50% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PELVIC ULTRASOUND | $411.50 | $823.00 | $105.47–$617.25 | 52% below | 50% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 PELVIC ULTRASOUND | $411.50 | $823.00 | $105.47–$617.25 | — | 50% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB >14 WEEK 1ST FETUS | $385.50 | $771.00 | $201.22–$578.25 | 41% below | 50% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB >14 WEEK 1ST FETUS | $385.50 | $771.00 | $201.22–$578.25 | — | 50% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB <14 WEEK 1ST FETUS | $385.50 | $771.00 | $161.29–$578.25 | 37% below | 50% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB <14 WEEK 1ST FETUS | $385.50 | $771.00 | $161.29–$578.25 | — | 50% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 LIMITED ULTRASOUND;OBSTETRICAL | $283.00 | $566.00 | $105.47–$489.89 | 38% below | 50% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 LIMITED ULTRASOUND;OBSTETRICAL | $283.00 | $566.00 | $105.47–$489.89 | — | 50% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIBS RIGHT 2 VIEWS | $185.00 | $370.00 | $87.33–$277.50 | 48% below | 50% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIBS, UNI LEFT 2 VIEWS | $185.00 | $370.00 | $87.33–$277.50 | 48% below | 50% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS RIGHT 2 VIEWS | $185.00 | $370.00 | $87.33–$277.50 | — | 50% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS, UNI LEFT 2 VIEWS | $185.00 | $370.00 | $87.33–$277.50 | — | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIB UNI LEFT W/PA CHEST 3V | $297.00 | $594.00 | $105.47–$489.89 | 25% below | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS RIGHT W/PA CHEST 3V | $297.00 | $594.00 | $105.47–$489.89 | 25% below | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS RIGHT W/PA CHEST 3V | $297.00 | $594.00 | $105.47–$489.89 | — | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIB UNI LEFT W/PA CHEST 3V | $297.00 | $594.00 | $105.47–$489.89 | — | 50% |
| Screening mammogram, both breasts both sides CPT 77067 MAMMO BILATERAL SCREENING | $49.50 | $99.00 | $55.44–$433.18 | — | 50% |
| Screening mammogram, both breasts CPT 77067 MAMMO BIL SCR W/TOMO | $283.00 | $566.00 | $216.59–$433.18 | 5% below | 50% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO BILATERAL SCREENING | $49.50 | $99.00 | $55.44–$433.18 | — | 50% |
| Screening mammogram, both breasts inpatient CPT 77067 MAMMO BIL SCR W/TOMO | $283.00 | $566.00 | $216.59–$433.18 | — | 50% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER LEFT 2V | $202.00 | $404.00 | $87.33–$303.00 | 41% below | 50% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER RIGHT 2V | $202.00 | $404.00 | $87.33–$303.00 | 41% below | 50% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER LEFT 3V | $206.50 | $413.00 | $87.33–$309.75 | 40% below | 50% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER RIGHT 3V | $206.50 | $413.00 | $87.33–$309.75 | 40% below | 50% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER LEFT 2V | $202.00 | $404.00 | $87.33–$303.00 | — | 50% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER RIGHT 2V | $202.00 | $404.00 | $87.33–$303.00 | — | 50% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER RIGHT 3V | $206.50 | $413.00 | $87.33–$309.75 | — | 50% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER LEFT 3V | $206.50 | $413.00 | $87.33–$309.75 | — | 50% |
| Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES PARANASAL, MIN 3V | $205.00 | $410.00 | $87.33–$307.50 | 51% below | 50% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES PARANASAL, MIN 3V | $205.00 | $410.00 | $87.33–$307.50 | — | 50% |
| Skull X-ray, fewer than 4 views CPT 70250 SKULL LESS THAN 4V | $185.00 | $370.00 | $105.47–$489.89 | 47% below | 50% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL LESS THAN 4V | $185.00 | $370.00 | $105.47–$489.89 | — | 50% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY;4+PARAM 1ST NT | $1,214.00 | $2,428.00 | $1,353.92–$1,821.00 | 71% below | 50% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY;4+PARAM 1ST NT | $1,214.00 | $2,428.00 | $1,353.92–$1,821.00 | — | 50% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 MODIFIED BARIUM SWALLOW | $283.00 | $566.00 | $176.56–$489.89 | 53% below | 50% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 MODIFIED BARIUM SWALLOW | $283.00 | $566.00 | $176.56–$489.89 | — | 50% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR LEFT | $178.00 | $356.00 | $87.33–$267.00 | 49% below | 50% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR RIGHT | $178.00 | $356.00 | $87.33–$267.00 | 49% below | 50% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR LEFT 2V | $178.00 | $356.00 | $87.33–$267.00 | 49% below | 50% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR RIGHT 2V | $178.00 | $356.00 | $87.33–$267.00 | 49% below | 50% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR RIGHT 2V | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR LEFT 2V | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR RIGHT | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR LEFT | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE WO CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | 61% below | 50% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE WO CONTRAST | $765.00 | $1,530.00 | $105.47–$959.31 | — | 50% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE(S) LEFT MIN 2V | $170.50 | $341.00 | $87.33–$265.87 | 42% below | 50% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE(S) RIGHT MIN 2V | $170.50 | $341.00 | $87.33–$265.87 | 42% below | 50% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE(S) LEFT MIN 2V | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE(S) RIGHT MIN 2V | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| Transvaginal pelvic ultrasound CPT 76830 VAGINAL NON OB | $423.50 | $847.00 | $191.23–$635.25 | 34% below | 50% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 VAGINAL NON OB | $423.50 | $847.00 | $191.23–$635.25 | — | 50% |
| Transvaginal ultrasound during pregnancy CPT 76817 OB TRANSVAGINAL | $411.50 | $823.00 | $105.47–$617.25 | 20% below | 50% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 OB TRANSVAGINAL | $411.50 | $823.00 | $105.47–$617.25 | — | 50% |
| Ultrasound of the abdomen, complete CPT 76700 ABDOMINAL ULTRASOUND | $511.50 | $1,023.00 | $105.47–$767.25 | 41% below | 50% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 ABDOMINAL ULTRASOUND | $511.50 | $1,023.00 | $105.47–$767.25 | — | 50% |
| Ultrasound of the scrotum and testicles CPT 76870 TESTICULAR ULTRASOUND | $362.50 | $725.00 | $105.47–$543.75 | 41% below | 50% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 TESTICULAR ULTRASOUND | $362.50 | $725.00 | $105.47–$543.75 | — | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 SOFT TISSUE ULTRA; HEAD & NECK | $355.00 | $710.00 | $105.47–$532.50 | 44% below | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 THYROID ULTRASOUND | $362.50 | $725.00 | $105.47–$543.75 | 43% below | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 SOFT TISSUE ULTRA; HEAD & NECK | $355.00 | $710.00 | $105.47–$532.50 | — | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 THYROID ULTRASOUND | $362.50 | $725.00 | $105.47–$543.75 | — | 50% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI SINGLE CONTRAST | $237.00 | $474.00 | $176.56–$1,081.73 | 68% below | 50% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI SINGLE CONTRAST | $237.00 | $474.00 | $176.56–$1,081.73 | — | 50% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS LEFT 2V | $178.00 | $356.00 | $87.33–$267.00 | 50% below | 50% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS RIGHT 2V | $178.00 | $356.00 | $87.33–$267.00 | 50% below | 50% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS LEFT 2V | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS RIGHT 2V | $178.00 | $356.00 | $87.33–$267.00 | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 UPPER EXT VENOUS DOPPLER UNI | $219.50 | $439.00 | $89.25–$329.25 | 73% below | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 LOWER EXT VENOUS DOPPLER UNI | $601.50 | $1,203.00 | $89.25–$902.25 | 25% below | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 UPPER EXT VENOUS DOPPLER UNI | $219.50 | $439.00 | $89.25–$329.25 | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 LOWER EXT VENOUS DOPPLER UNI | $601.50 | $1,203.00 | $89.25–$902.25 | — | 50% |
| Wrist X-ray, 2 views one side CPT 73100 WRIST RIGHT 2V | $169.00 | $338.00 | $87.33–$265.87 | 47% below | 50% |
| Wrist X-ray, 2 views one side CPT 73100 WRIST LEFT 2V | $169.00 | $338.00 | $87.33–$265.87 | 47% below | 50% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST LEFT 2V | $169.00 | $338.00 | $87.33–$265.87 | — | 50% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST RIGHT 2V | $169.00 | $338.00 | $87.33–$265.87 | — | 50% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST RIGHT 3V | $210.50 | $421.00 | $87.33–$315.75 | 45% below | 50% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST LEFT 3V | $210.50 | $421.00 | $87.33–$315.75 | 45% below | 50% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST LEFT 3V | $210.50 | $421.00 | $87.33–$315.75 | — | 50% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST RIGHT 3V | $210.50 | $421.00 | $87.33–$315.75 | — | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP LT 2V | $194.00 | $388.00 | $87.33–$291.00 | 52% below | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP JOINT RIGHT 2V WITH PELVIS | $194.00 | $388.00 | $87.33–$291.00 | 52% below | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP RT 2V | $194.00 | $388.00 | $87.33–$291.00 | 52% below | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP JOINT LEFT 2V WITH PELVIS | $194.00 | $388.00 | $87.33–$291.00 | 52% below | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP JOINT LEFT 2V WITH PELVIS | $194.00 | $388.00 | $87.33–$291.00 | — | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP LT 2V | $194.00 | $388.00 | $87.33–$291.00 | — | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP RT 2V | $194.00 | $388.00 | $87.33–$291.00 | — | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP JOINT RIGHT 2V WITH PELVIS | $194.00 | $388.00 | $87.33–$291.00 | — | 50% |
| X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW | $170.50 | $341.00 | $87.33–$265.87 | 50% below | 50% |
| X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1V UPRIGHT | $170.50 | $341.00 | $87.33–$265.87 | 50% below | 50% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1V UPRIGHT | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 VIEW | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE RIGHT MIN 2V | $170.50 | $341.00 | $87.33–$265.87 | 43% below | 50% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE LEFT MIN 2V | $170.50 | $341.00 | $87.33–$265.87 | 43% below | 50% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE LEFT MIN 2V | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE RIGHT MIN 2V | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER(S) RIGHT | $152.50 | $305.00 | $87.33–$265.87 | 42% below | 50% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER(S) LEFT | $152.50 | $305.00 | $87.33–$265.87 | 42% below | 50% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER(S) LEFT | $152.50 | $305.00 | $87.33–$265.87 | — | 50% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER(S) RIGHT | $152.50 | $305.00 | $87.33–$265.87 | — | 50% |
| X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEWS RIGHT | $170.50 | $341.00 | $87.33–$265.87 | 49% below | 50% |
| X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEWS LEFT | $170.50 | $341.00 | $87.33–$265.87 | 49% below | 50% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 VIEWS RIGHT | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 VIEWS LEFT | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT LEFT | $170.50 | $341.00 | $87.33–$265.87 | 54% below | 50% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT RIGHT | $170.50 | $341.00 | $87.33–$265.87 | 54% below | 50% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT 3 VIEWS RIGHT | $170.50 | $341.00 | $87.33–$265.87 | 54% below | 50% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT 3 VIEWS LEFT | $170.50 | $341.00 | $87.33–$265.87 | 54% below | 50% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT 3 VIEWS LEFT | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT RIGHT | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT LEFT | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT 3 VIEWS RIGHT | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3V LEFT | $210.50 | $421.00 | $87.33–$315.75 | 46% below | 50% |
| X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3V RIGHT | $210.50 | $421.00 | $87.33–$315.75 | 46% below | 50% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3V LEFT | $210.50 | $421.00 | $87.33–$315.75 | — | 50% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3V RIGHT | $210.50 | $421.00 | $87.33–$315.75 | — | 50% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE LEFT 2V | $170.50 | $341.00 | $87.33–$265.87 | 42% below | 50% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE RIGHT 2V | $170.50 | $341.00 | $87.33–$265.87 | 42% below | 50% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE RIGHT 2V | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE LEFT 2V | $170.50 | $341.00 | $87.33–$265.87 | — | 50% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE 2 OR 3 VIEWS | $283.00 | $566.00 | $105.47–$489.89 | 39% below | 50% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR SPINE 2 OR 3 VIEWS | $283.00 | $566.00 | $105.47–$489.89 | — | 50% |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE;L-S;COMPLETE, W/OBLIQUE | $322.00 | $644.00 | $105.47–$489.89 | 49% below | 50% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE;L-S;COMPLETE, W/OBLIQUE | $322.00 | $644.00 | $105.47–$489.89 | — | 50% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2V | $283.00 | $566.00 | $105.47–$489.89 | 30% below | 50% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 SPINE; THORACIC, AP & LATERAL | $283.00 | $566.00 | $105.47–$489.89 | 30% below | 50% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE 2V | $283.00 | $566.00 | $105.47–$489.89 | — | 50% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 SPINE; THORACIC, AP & LATERAL | $283.00 | $566.00 | $105.47–$489.89 | — | 50% |
| X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES MIN 3V | $152.50 | $305.00 | $87.33–$265.87 | 48% below | 50% |
| X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES, MIN 3V | $152.50 | $305.00 | $87.33–$265.87 | 48% below | 50% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES, MIN 3V | $152.50 | $305.00 | $87.33–$265.87 | — | 50% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES MIN 3V | $152.50 | $305.00 | $87.33–$265.87 | — | 50% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE, CERVICAL;AP & LATERAL3V | $216.50 | $433.00 | $87.33–$324.75 | 42% below | 50% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE - 3 VIEW | $216.50 | $433.00 | $87.33–$324.75 | 42% below | 50% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE - 3 VIEW | $216.50 | $433.00 | $87.33–$324.75 | — | 50% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE, CERVICAL;AP & LATERAL3V | $216.50 | $433.00 | $87.33–$324.75 | — | 50% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS; ANTEROPOSTERIOR | $283.00 | $566.00 | $105.47–$489.89 | 24% below | 50% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS LOW AP 1V | $283.00 | $566.00 | $105.47–$489.89 | 24% below | 50% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS LOW AP 1V | $283.00 | $566.00 | $105.47–$489.89 | — | 50% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS; ANTEROPOSTERIOR | $283.00 | $566.00 | $105.47–$489.89 | — | 50% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM & COCCYX MIN 2V | $228.50 | $457.00 | $87.33–$342.75 | 30% below | 50% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM & COCCYX MIN 2V | $228.50 | $457.00 | $87.33–$342.75 | — | 50% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Texas | Off list |
|---|---|---|---|---|---|
| Cardiac catheterization with coronary angiogram CPT 93458 LHC W CORONARY ANGIOGRAPHY | $6,183.00 | $12,366.00 | $6,924.96–$8,656.20 | 47% below | 50% |
| Cardiac catheterization with coronary angiogram inpatient CPT 93458 LHC W CORONARY ANGIOGRAPHY | $6,183.00 | $12,366.00 | $6,924.96–$8,656.20 | — | 50% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION | $702.00 | $1,404.00 | $786.24–$982.80 | 51% below | 50% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION | $702.00 | $1,404.00 | $786.24–$982.80 | — | 50% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 INJ FOR HYSTEROSALPINGOGRAM | $104.00 | $208.00 | $116.48–$145.60 | 72% below | 50% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 INJ FOR HYSTEROSALPINGOGRAM | $104.00 | $208.00 | $116.48–$145.60 | — | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 MINOR I&D - ICU | $246.00 | $492.00 | $196.80–$369.00 | 47% below | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D-SIMPLE/SINGLE | $246.00 | $492.00 | $196.80–$369.00 | 47% below | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 MINOR I&D - MS | $246.00 | $492.00 | $196.80–$369.00 | 47% below | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 MINOR I&D - MS | $246.00 | $492.00 | $196.80–$369.00 | — | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 MINOR I&D - ICU | $246.00 | $492.00 | $196.80–$369.00 | — | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D-SIMPLE/SINGLE | $246.00 | $492.00 | $196.80–$369.00 | — | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIR/INJ INT JNT BURSA | $350.00 | $700.00 | $280.00–$525.00 | 41% below | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASPIR/INJ INT JNT BURSA | $350.00 | $700.00 | $280.00–$525.00 | — | 50% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASPIR/INJ SM JNT BURSA | $350.00 | $700.00 | $280.00–$525.00 | 24% below | 50% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASPIR/INJ SM JNT BURSA | $350.00 | $700.00 | $280.00–$525.00 | — | 50% |
| Nail removal (partial or complete), one nail CPT 11730 REMOVE NAIL PLATE | $249.50 | $499.00 | $197.07–$394.13 | 19% below | 50% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVE NAIL PLATE | $249.50 | $499.00 | $197.07–$394.13 | — | 50% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 PERMANENT NAIL REMOVAL | $444.00 | $888.00 | $355.20–$666.00 | 16% below | 50% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 PERMANENT NAIL REMOVAL | $444.00 | $888.00 | $355.20–$666.00 | — | 50% |
| Removal of a foreign object under the skin, simple CPT 10120 INC&REM FOREIGN BODY-SIMPLE | $444.00 | $888.00 | $355.20–$666.00 | 17% below | 50% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 INC&REM FOREIGN BODY-SIMPLE | $444.00 | $888.00 | $355.20–$666.00 | — | 50% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION OF SHORT LEG CAST | $191.50 | $383.00 | $153.20–$287.25 | 30% below | 50% |
| Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION OF SHORT LEG CAST | $191.50 | $383.00 | $153.20–$287.25 | — | 50% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR SUPERFIC WOUND < 2.5CM | $249.50 | $499.00 | $197.07–$394.13 | 31% below | 50% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPAIR SUPERFIC WOUND < 2.5CM | $249.50 | $499.00 | $197.07–$394.13 | — | 50% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX-SKIN,1 LESION | $249.50 | $499.00 | $199.60–$374.25 | 45% below | 50% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX-SKIN,1 LESION | $249.50 | $499.00 | $199.60–$374.25 | — | 50% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR SIMPLE 2.6CM - 7.5CM | $249.50 | $499.00 | $197.07–$394.13 | 45% below | 50% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 REPAIR SIMPLE 2.6CM - 7.5CM | $249.50 | $499.00 | $197.07–$394.13 | — | 50% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY-SKIN,1 LESIO | $249.50 | $499.00 | $199.60–$374.25 | 31% below | 50% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENTIAL BIOPSY-SKIN,1 LESIO | $249.50 | $499.00 | $199.60–$374.25 | — | 50% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 IR CORE NDL BIOPSY W GUID&MARK | $1,954.00 | $3,908.00 | $2,188.48–$2,735.60 | 29% below | 50% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 IR CORE NDL BIOPSY W GUID&MARK | $1,954.00 | $3,908.00 | $2,188.48–$2,735.60 | — | 50% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SKIN-SQ TISSUE,1ST 20 SQCM | $449.00 | $898.00 | $359.20–$673.50 | 56% below | 50% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEB SKIN-SQ TISSUE,1ST 20 SQCM | $449.00 | $898.00 | $359.20–$673.50 | — | 50% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Texas | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 OP OB BLOOD ADMIN | $476.00 | $952.00 | $485.52–$2,248.45 | 44% below | 50% |
| Blood transfusion (giving blood or blood components) CPT 36430 ER BLOOD ADMINISTRATION | $476.00 | $952.00 | $485.52–$4,765.46 | 44% below | 50% |
| Blood transfusion (giving blood or blood components) CPT 36430 O/P BLOOD ADMIN | $476.00 | $952.00 | $485.52–$2,248.45 | 44% below | 50% |
| Blood transfusion (giving blood or blood components) CPT 36430 MOBER BLOOD ADMIN | $476.00 | $952.00 | $485.52–$2,248.45 | 44% below | 50% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 ER BLOOD ADMINISTRATION | $476.00 | $952.00 | $485.52–$4,765.46 | — | 50% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 O/P BLOOD ADMIN | $476.00 | $952.00 | $485.52–$2,248.45 | — | 50% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 MOBER BLOOD ADMIN | $476.00 | $952.00 | $485.52–$2,248.45 | — | 50% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 OP OB BLOOD ADMIN | $476.00 | $952.00 | $485.52–$2,248.45 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 COOL MIST AER TREAT; INITIAL | $112.00 | $224.00 | $125.44–$594.55 | 45% below | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INITIAL RESPIRATORY TREATMENT | $226.50 | $453.00 | $201.72–$594.55 | 11% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 COOL MIST AER TREAT; INITIAL | $112.00 | $224.00 | $125.44–$594.55 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INITIAL RESPIRATORY TREATMENT | $226.50 | $453.00 | $201.72–$594.55 | — | 50% |
| Chemotherapy IV infusion, first hour CPT 96413 ADV OP IV INF/IVPB INIT 1ST HR | $324.00 | $648.00 | $362.88–$486.00 | 40% below | 50% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 ADV OP IV INF/IVPB INIT 1ST HR | $324.00 | $648.00 | $362.88–$486.00 | — | 50% |
| Critical care, first 30 to 74 minutes CPT 99291 OB CRITICAL CARE | $940.50 | $1,881.00 | $1,053.36–$3,480.00 | 64% below | 50% |
| Critical care, first 30 to 74 minutes CPT 99291 ER CRITICAL CARE INIT 30-74 MI | $940.50 | $1,881.00 | $1,053.36–$3,480.00 | 64% below | 50% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 ER CRITICAL CARE INIT 30-74 MI | $940.50 | $1,881.00 | $1,053.36–$3,480.00 | — | 50% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 OB CRITICAL CARE | $940.50 | $1,881.00 | $1,053.36–$3,480.00 | — | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG,INITIAL | $162.00 | $324.00 | $5.80–$243.00 | 43% below | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG,INITIAL | $162.00 | $324.00 | $5.80–$243.00 | — | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 OB LEVEL 1 | $99.50 | $199.00 | $111.44–$292.00 | 62% below | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL 1 | $99.50 | $199.00 | $111.44–$292.00 | 62% below | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 OB LEVEL 1 | $99.50 | $199.00 | $111.44–$292.00 | — | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL 1 | $99.50 | $199.00 | $111.44–$292.00 | — | 50% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 OB LEVEL 2 | $176.00 | $352.00 | $197.12–$532.00 | 63% below | 50% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL 2 | $176.00 | $352.00 | $197.12–$532.00 | 63% below | 50% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL 2 | $176.00 | $352.00 | $197.12–$532.00 | — | 50% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 OB LEVEL 2 | $176.00 | $352.00 | $197.12–$532.00 | — | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 OB LEVEL 3 | $253.00 | $506.00 | $283.36–$1,085.00 | 69% below | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL 3 | $254.00 | $508.00 | $284.48–$1,085.00 | 69% below | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 OB LEVEL 3 | $253.00 | $506.00 | $283.36–$1,085.00 | — | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL 3 | $254.00 | $508.00 | $284.48–$1,085.00 | — | 50% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 OB LEVEL 4 | $405.00 | $810.00 | $453.60–$2,860.00 | 69% below | 50% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL 4 | $405.00 | $810.00 | $453.60–$2,860.00 | 69% below | 50% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL 4 | $405.00 | $810.00 | $453.60–$2,860.00 | — | 50% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 OB LEVEL 4 | $405.00 | $810.00 | $453.60–$2,860.00 | — | 50% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL 5 | $605.50 | $1,211.00 | $678.16–$3,480.00 | 70% below | 50% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 OB LEVEL 5 | $606.50 | $1,213.00 | $679.28–$3,480.00 | 70% below | 50% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL 5 | $605.50 | $1,211.00 | $678.16–$3,480.00 | — | 50% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 OB LEVEL 5 | $606.50 | $1,213.00 | $679.28–$3,480.00 | — | 50% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 EKG STRESS TEST | $579.00 | $1,158.00 | $35.15–$868.50 | 54% below | 50% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 EKG STRESS TEST | $579.00 | $1,158.00 | $35.15–$868.50 | — | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OBS IV HYD,INIT 1ST HR(>30MIN) | $215.50 | $431.00 | $125.06–$323.25 | 52% below | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ICU IV HYD,INIT 1ST HR(>30MIN) | $215.50 | $431.00 | $125.06–$323.25 | 52% below | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 O/P IV HYD,INIT 1ST HR(>30MIN) | $215.50 | $431.00 | $125.06–$323.25 | 52% below | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 MOBER IV HYD,IN 1ST HR(>30MIN) | $215.50 | $431.00 | $241.36–$312.04 | 52% below | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ER IV HYD,INIT 1ST HR(>30MIN) | $215.50 | $431.00 | $241.36–$312.04 | 52% below | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 MOBER IV HYD,IN 1ST HR(>30MIN) | $215.50 | $431.00 | $241.36–$312.04 | — | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 O/P IV HYD,INIT 1ST HR(>30MIN) | $215.50 | $431.00 | $125.06–$323.25 | — | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 OBS IV HYD,INIT 1ST HR(>30MIN) | $215.50 | $431.00 | $125.06–$323.25 | — | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ER IV HYD,INIT 1ST HR(>30MIN) | $215.50 | $431.00 | $241.36–$312.04 | — | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ICU IV HYD,INIT 1ST HR(>30MIN) | $215.50 | $431.00 | $125.06–$323.25 | — | 50% |
| IV infusion of a medicine, first hour CPT 96365 OP IV INF,INIT,1ST HR(>15 MIN) | $215.50 | $431.00 | $195.18–$323.25 | 54% below | 50% |
| IV infusion of a medicine, first hour CPT 96365 ICU IV INF,INIT,1ST HR(>15MIN) | $259.00 | $518.00 | $195.18–$388.50 | 45% below | 50% |
| IV infusion of a medicine, first hour CPT 96365 OBS IV INF,INIT,1ST HR(>15MIN) | $259.00 | $518.00 | $195.18–$388.50 | 45% below | 50% |
| IV infusion of a medicine, first hour CPT 96365 ER IV INF,INIT,1ST HR(>15MIN) | $259.00 | $518.00 | $290.08–$375.03 | 45% below | 50% |
| IV infusion of a medicine, first hour CPT 96365 MOBER IV INF,IN,1ST HR(>15MIN) | $259.50 | $519.00 | $290.64–$375.76 | 45% below | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 OP IV INF,INIT,1ST HR(>15 MIN) | $215.50 | $431.00 | $195.18–$323.25 | — | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 ICU IV INF,INIT,1ST HR(>15MIN) | $259.00 | $518.00 | $195.18–$388.50 | — | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 OBS IV INF,INIT,1ST HR(>15MIN) | $259.00 | $518.00 | $195.18–$388.50 | — | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 ER IV INF,INIT,1ST HR(>15MIN) | $259.00 | $518.00 | $290.08–$375.03 | — | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 MOBER IV INF,IN,1ST HR(>15MIN) | $259.50 | $519.00 | $290.64–$375.76 | — | 50% |
| IV push of a medicine, first drug CPT 96374 OBS IV PUSH INJ,INIT SUBSTANCE | $92.00 | $184.00 | $103.04–$149.96 | 60% below | 50% |
| IV push of a medicine, first drug CPT 96374 ICU IV PUSH INJ,INIT SUBSTANCE | $92.00 | $184.00 | $103.04–$149.96 | 60% below | 50% |
| IV push of a medicine, first drug CPT 96374 O/P IV PUSH INJ,INIT SUBSTANCE | $92.00 | $184.00 | $103.04–$149.96 | 60% below | 50% |
| IV push of a medicine, first drug CPT 96374 MOBER IV PUSH INJ,INIT SUBST | $92.00 | $184.00 | $103.04–$133.22 | 60% below | 50% |
| IV push of a medicine, first drug CPT 96374 ER IV PUSH-INITIAL SUBSTANCE | $92.00 | $184.00 | $103.04–$133.22 | 60% below | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 ER IV PUSH-INITIAL SUBSTANCE | $92.00 | $184.00 | $103.04–$133.22 | — | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 OBS IV PUSH INJ,INIT SUBSTANCE | $92.00 | $184.00 | $103.04–$149.96 | — | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 ICU IV PUSH INJ,INIT SUBSTANCE | $92.00 | $184.00 | $103.04–$149.96 | — | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 O/P IV PUSH INJ,INIT SUBSTANCE | $92.00 | $184.00 | $103.04–$149.96 | — | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 MOBER IV PUSH INJ,INIT SUBST | $92.00 | $184.00 | $103.04–$133.22 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 O/P IM/SQ INJECTION | $70.00 | $140.00 | $70.58–$185.66 | 54% below | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 OBS IM/SQ INJECTION | $72.00 | $144.00 | $70.58–$185.66 | 53% below | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 ICU-OBS IM/SQ INJECTION | $72.00 | $144.00 | $70.58–$185.66 | 53% below | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER IM/SQ INJ | $72.00 | $144.00 | $70.58–$141.17 | 53% below | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 MOBER IM ANTIBIOTIC INJECTION | $72.00 | $144.00 | $70.58–$141.17 | 53% below | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 MOBER IM/SQ INJ NON-ANTIBIOTIC | $72.00 | $144.00 | $70.58–$141.17 | 53% below | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 O/P IM/SQ INJECTION | $70.00 | $140.00 | $70.58–$185.66 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ER IM/SQ INJ | $72.00 | $144.00 | $70.58–$141.17 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 OBS IM/SQ INJECTION | $72.00 | $144.00 | $70.58–$185.66 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ICU-OBS IM/SQ INJECTION | $72.00 | $144.00 | $70.58–$185.66 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 MOBER IM/SQ INJ NON-ANTIBIOTIC | $72.00 | $144.00 | $70.58–$141.17 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 MOBER IM ANTIBIOTIC INJECTION | $72.00 | $144.00 | $70.58–$141.17 | — | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 DIETARY CONSULT PER 15 MINUTES | $25.50 | $51.00 | $28.56–$105.33 | 56% below | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 DIETARY CONSULT PER 15 MINUTES | $25.50 | $51.00 | $28.56–$105.33 | — | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 BASIC OFFICE VISIT | $61.00 | $122.00 | $68.32–$254.15 | 71% below | 50% |
| Spirometry (breathing test) CPT 94010 PULMONARY FUNCT W/O BRONCHODIL | $279.00 | $558.00 | $155.17–$434.86 | 22% below | 50% |
| Spirometry (breathing test) inpatient CPT 94010 PULMONARY FUNCT W/O BRONCHODIL | $279.00 | $558.00 | $155.17–$434.86 | — | 50% |
| Spirometry before and after a bronchodilator CPT 94060 PULMONARY FUNCT/BRONCODILATOR | $357.00 | $714.00 | $127.91–$535.50 | 40% below | 50% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 PULMONARY FUNCT/BRONCODILATOR | $357.00 | $714.00 | $127.91–$535.50 | — | 50% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY, THERAPEUTIC | $115.50 | $231.00 | $127.84–$335.08 | 51% below | 50% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY | $123.00 | $246.00 | $127.84–$335.08 | 48% below | 50% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY, THERAPEUTIC | $115.50 | $231.00 | $127.84–$335.08 | — | 50% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY | $123.00 | $246.00 | $127.84–$335.08 | — | 50% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Texas | Off list |
|---|---|---|---|---|---|
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HI DOSE 2025-26 0.5ML | $112.49 | $224.98 | $47.97–$168.74 | 25% below | 50% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HI DOSE 2025-26 0.5ML | $112.49 | $224.98 | $47.97–$168.74 | — | 50% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEOMOCOCCAL VACCINE,ADULT | $34.50 | $69.00 | $38.64–$174.13 | 86% below | 50% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL POLYSACCHARIDES 2 | $228.31 | $456.62 | $102.03–$342.47 | 10% below | 50% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEOMOCOCCAL VACCINE,ADULT | $34.50 | $69.00 | $38.64–$174.13 | — | 50% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL POLYSACCHARIDES 2 | $228.31 | $456.62 | $102.03–$342.47 | — | 50% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP(BEYFORTUS)50MG | $800.83 | $1,601.66 | $742.50–$1,267.20 | 18% below | 50% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP(BEYFORTUS)50MG | $800.83 | $1,601.66 | $742.50–$1,267.20 | — | 50% |
| Rabies vaccine, one dose CPT 90675 IMOVAX RAB VACCINE 1ML VIAL | $624.69 | $1,249.37 | $382.14–$937.03 | 39% below | 50% |
| Rabies vaccine, one dose inpatient CPT 90675 IMOVAX RAB VACCINE 1ML VIAL | $624.69 | $1,249.37 | $382.14–$937.03 | — | 50% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 DECAVAC(TETANUS/DIPH)5ML SYR | $67.26 | $134.51 | $42.00–$100.88 | 45% below | 50% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 DECAVAC(TETANUS/DIPH)5ML SYR | $67.26 | $134.51 | $42.00–$100.88 | — | 50% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 ADACEL 0.5ML VIAL | $99.66 | $199.32 | $58.23–$149.49 | 33% below | 50% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 ADACEL 0.5ML VIAL | $99.66 | $199.32 | $58.23–$149.49 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 FLU VACCINE ADM. | $70.00 | $140.00 | $70.58–$185.66 | 6% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PNEUMONIA VACCINE ADM. | $70.00 | $140.00 | $70.58–$185.66 | 6% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN PNEUMOCOCCAL VACCINE | $70.00 | $140.00 | $70.58–$185.66 | 6% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 O/P VACCINE ADM 1ST VACCINE | $70.00 | $140.00 | $70.58–$185.66 | 6% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ICU-ADMIN PNEUMOCOCCAL VACCINE | $70.00 | $140.00 | $70.58–$185.66 | 6% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ICU-ADM INFLUENZA VIRUS VACC | $70.00 | $140.00 | $70.58–$185.66 | 6% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INFLUENZA VIRUS VACCINE | $70.00 | $140.00 | $70.58–$185.66 | 6% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 OBS VACCINE ADM 1ST VACCINE | $72.00 | $144.00 | $70.58–$185.66 | 4% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ER VACCINE ADMINISTRATION 1ST | $72.00 | $144.00 | $70.58–$185.66 | 4% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ICU VACCINE ADM 1ST VACCINE | $72.00 | $144.00 | $70.58–$185.66 | 4% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 FLU VACCINE ADM. | $70.00 | $140.00 | $70.58–$185.66 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN INFLUENZA VIRUS VACCINE | $70.00 | $140.00 | $70.58–$185.66 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN PNEUMOCOCCAL VACCINE | $70.00 | $140.00 | $70.58–$185.66 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 O/P VACCINE ADM 1ST VACCINE | $70.00 | $140.00 | $70.58–$185.66 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PNEUMONIA VACCINE ADM. | $70.00 | $140.00 | $70.58–$185.66 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ICU-ADM INFLUENZA VIRUS VACC | $70.00 | $140.00 | $70.58–$185.66 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ICU-ADMIN PNEUMOCOCCAL VACCINE | $70.00 | $140.00 | $70.58–$185.66 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ICU VACCINE ADM 1ST VACCINE | $72.00 | $144.00 | $70.58–$185.66 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ER VACCINE ADMINISTRATION 1ST | $72.00 | $144.00 | $70.58–$185.66 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 OBS VACCINE ADM 1ST VACCINE | $72.00 | $144.00 | $70.58–$185.66 | — | 50% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ER VACCINE ADMIN EA ADDITIONAL | $70.00 | $140.00 | $34.11–$105.00 | 31% above | 50% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 OBS VACCINE ADM EA ADDL VACCIN | $70.00 | $140.00 | $34.11–$105.00 | 31% above | 50% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ICU VACCINE ADM EA ADDL VACCIN | $70.00 | $140.00 | $34.11–$105.00 | 31% above | 50% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 OBS VACCINE ADM EA ADDL VACCIN | $70.00 | $140.00 | $34.11–$105.00 | — | 50% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ICU VACCINE ADM EA ADDL VACCIN | $70.00 | $140.00 | $34.11–$105.00 | — | 50% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ER VACCINE ADMIN EA ADDITIONAL | $70.00 | $140.00 | $34.11–$105.00 | — | 50% |
Source file: https://www.matagordaregional.org/documents/746025069_Matagorda-Regional-Medical-Center_standardcharges.zip