Hospital

Hospital Development

Listed in its price file as “Hospital Development Co”.

Hospital Development in Spencer, WV publishes cash prices for 408 common procedures listed here, from its own machine-readable price file updated Sep 11, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the West Virginia median for 374 of 395 procedures and below it for 18. By typical cash price it ranks #33 of 35 West Virginia hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

200 Hospital Drive, , Spencer, West Virginia 25276 Collected Oct 3, 2026 Source price file Check a bill from this hospital (304) 927-4444

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 511306 · CMS hospital register NPI 1316907322

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

Hospital Development is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs West Virginia	Off list
Abdominal CT scan without and with contrast CPT 74170 Ct abdomen w/o & w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	60% above	40%
Abdominal CT scan without and with contrast inpatient CPT 74170 Ct abdomen w/o & w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	—	40%
Abdominal X-ray, 2 views CPT 74019 X-ray exam abdomen 2 views	$347.85	$579.75	$107.64–$315.59	60% above	40%
Abdominal X-ray, 2 views inpatient CPT 74019 X-ray exam abdomen 2 views	$347.85	$579.75	$107.64–$315.59	—	40%
Ankle X-ray, complete, 3 or more views CPT 73610 X-ray exam of ankle	$258.60	$431.00	$89.60–$262.70	43% above	40%
Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr ankle left 3 vw	$258.60	$431.00	$89.60–$262.70	43% above	40%
Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr ankle right 3 vw	$258.60	$431.00	$89.60–$262.70	43% above	40%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 X-ray exam of ankle	$258.60	$431.00	$89.60–$262.70	—	40%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Xr ankle right 3 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Xr ankle left 3 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Abi upper lower extremity	$560.10	$933.50	$136.99–$401.63	94% above	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Upr/l xtremity art 2 levels	$560.10	$933.50	$136.99–$401.63	94% above	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Upr/l xtremity art 2 levels	$560.10	$933.50	$136.99–$401.63	—	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Abi upper lower extremity	$560.10	$933.50	$136.99–$401.63	—	40%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 Ct upper extremity w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	70% above	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct upper ext lt wo cm	$1,197.30	$1,995.50	$227.83–$667.97	70% above	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct upper ext rt wo cm	$1,197.30	$1,995.50	$227.83–$667.97	70% above	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 Ct upper extremity w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct upper ext rt wo cm	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct upper ext lt wo cm	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
Bone scan, whole body (nuclear medicine) CPT 78306 Bone imaging whole body	$1,003.05	$1,671.75	$411.61–$1,206.79	16% above	40%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Bone imaging whole body	$1,003.05	$1,671.75	$411.61–$1,206.79	—	40%
Breast ultrasound, complete, one breast CPT 76641 Ultrasound breast complete	$540.75	$901.25	$107.64–$315.59	86% above	40%
Breast ultrasound, complete, one breast one side CPT 76641 Us breast rt complete	$540.75	$901.25	$107.64–$315.59	86% above	40%
Breast ultrasound, complete, one breast one side CPT 76641 Us breast lt complete	$540.75	$901.25	$107.64–$315.59	86% above	40%
Breast ultrasound, complete, one breast inpatient CPT 76641 Ultrasound breast complete	$540.75	$901.25	$107.64–$315.59	—	40%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 Us breast lt complete	$540.75	$901.25	$107.64–$315.59	—	40%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 Us breast rt complete	$540.75	$901.25	$107.64–$315.59	—	40%
Breast ultrasound, limited (one breast or one area) CPT 76642 Ultrasound breast limited	$600.30	$1,000.50	$89.60–$262.70	128% above	40%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us breast limited lt	$401.85	$669.75	$89.60–$262.70	53% above	40%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us breast limited rt	$401.85	$669.75	$89.60–$262.70	53% above	40%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Ultrasound breast limited	$600.30	$1,000.50	$89.60–$262.70	—	40%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Us breast limited rt	$401.85	$669.75	$89.60–$262.70	—	40%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Us breast limited lt	$401.85	$669.75	$89.60–$262.70	—	40%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 Ct angio abd&pelv w/o&w/dye	$2,708.85	$4,514.75	$359.20–$1,053.15	58% above	40%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 Ct angio abd&pelv w/o&w/dye	$2,708.85	$4,514.75	$359.20–$1,053.15	—	40%
CT angiography (CTA) of the head CPT 70496 Ct angiography head	$1,964.25	$3,273.75	$442.31–$1,296.82	67% above	40%
CT angiography (CTA) of the head inpatient CPT 70496 Ct angiography head	$1,964.25	$3,273.75	$442.31–$1,296.82	—	40%
CT angiography (CTA) of the neck CPT 70498 Ct angiography neck	$1,964.25	$3,273.75	$442.31–$1,296.82	75% above	40%
CT angiography (CTA) of the neck inpatient CPT 70498 Ct angiography neck	$1,964.25	$3,273.75	$442.31–$1,296.82	—	40%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct angiography chest	$1,964.25	$3,273.75	$442.31–$1,296.82	56% above	40%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Ct angiography chest	$1,964.25	$3,273.75	$442.31–$1,296.82	—	40%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Ct angio hrt w/3d image	$1,530.00	$2,550.00	$359.20–$1,053.15	38% above	40%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 Ct angio hrt w/3d image	$1,530.00	$2,550.00	$359.20–$1,053.15	—	40%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 Ct hrt w/o dye w/ca test	$30.00	$50.00	$89.60–$262.70	70% below	40%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 Ct hrt w/o dye w/ca test	$30.00	$50.00	$89.60–$262.70	—	40%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct abd & pelvis w/o contrast	$2,361.60	$3,936.00	$227.83–$667.97	76% above	40%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Ct abd & pelvis w/o contrast	$2,361.60	$3,936.00	$227.83–$667.97	—	40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct abd & pelv w/contrast	$2,708.85	$4,514.75	$442.31–$1,296.82	69% above	40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct abd & pelv w/contrast	$2,708.85	$4,514.75	$442.31–$1,296.82	—	40%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct abd & pelv 1/> regns	$2,708.85	$4,514.75	$442.31–$1,296.82	59% above	40%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct abd & pelv 1/> regns	$2,708.85	$4,514.75	$442.31–$1,296.82	—	40%
CT scan of the abdomen with contrast CPT 74160 Ct abdomen w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	87% above	40%
CT scan of the abdomen with contrast inpatient CPT 74160 Ct abdomen w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	—	40%
CT scan of the abdomen without contrast CPT 74150 Ct abdomen w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	67% above	40%
CT scan of the abdomen without contrast inpatient CPT 74150 Ct abdomen w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct maxillofacial w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	74% above	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Ct maxillofacial w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
CT scan of the head or brain, no contrast dye CPT 70450 Ct head/brain w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	74% above	40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct head/brain w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
CT scan of the head with contrast CPT 70460 Ct head/brain w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	105% above	40%
CT scan of the head with contrast inpatient CPT 70460 Ct head/brain w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	—	40%
CT scan of the head without and with contrast CPT 70470 Ct head/brain w/o & w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	69% above	40%
CT scan of the head without and with contrast inpatient CPT 70470 Ct head/brain w/o & w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	—	40%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct lumbar spine w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	44% above	40%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 Ct lumbar spine w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct neck spine w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	48% above	40%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 Ct neck spine w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
CT scan of the pelvis, with contrast dye CPT 72193 Ct pelvis w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	110% above	40%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct pelvis w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	—	40%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Extracranial bilat study	$764.10	$1,273.50	$245.67–$720.27	—	40%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Extracranial bilat study	$764.10	$1,273.50	$245.67–$720.27	—	40%
Chest CT scan without and with contrast CPT 71270 Ct thorax w/o & w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	59% above	40%
Chest CT scan without and with contrast inpatient CPT 71270 Ct thorax w/o & w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	—	40%
Chest X-ray, 2 views CPT 71046 X-ray exam chest 2 views	$258.60	$431.00	$850.48–$2,493.54	37% above	40%
Chest X-ray, 2 views inpatient CPT 71046 X-ray exam chest 2 views	$258.60	$431.00	$850.48–$2,493.54	—	40%
Chest X-ray, single view CPT 71045 X-ray exam chest 1 view	$258.60	$431.00	$850.48–$2,493.54	49% above	40%
Chest X-ray, single view inpatient CPT 71045 X-ray exam chest 1 view	$258.60	$431.00	$850.48–$2,493.54	—	40%
Collarbone (clavicle) X-ray, complete CPT 73000 X-ray exam of collar bone	$258.60	$431.00	$89.60–$262.70	48% above	40%
Collarbone (clavicle) X-ray, complete one side CPT 73000 Xr clavicle compl right	$258.60	$431.00	$89.60–$262.70	48% above	40%
Collarbone (clavicle) X-ray, complete one side CPT 73000 Xr clavicle compl left	$258.60	$431.00	$89.60–$262.70	48% above	40%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 X-ray exam of collar bone	$258.60	$431.00	$89.60–$262.70	—	40%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Xr clavicle compl left	$258.60	$431.00	$89.60–$262.70	—	40%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Xr clavicle compl right	$258.60	$431.00	$89.60–$262.70	—	40%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Dxa bone density axial	$347.85	$579.75	$107.64–$315.59	12% above	40%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Dxa bone density axial	$347.85	$579.75	$107.64–$315.59	—	40%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Dxa bone density/peripheral	$258.60	$431.00	$89.60–$262.70	31% above	40%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 Dxa bone density/peripheral	$258.60	$431.00	$89.60–$262.70	—	40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct thorax w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	53% above	40%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Ct thorax w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct thorax w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	79% above	40%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Ct thorax w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	—	40%
Diagnostic mammogram, both breasts both sides CPT 77066 Dx mammo incl cad bi	$414.15	$690.25	$140.79–$412.78	—	40%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Dx mammo incl cad bi	$414.15	$690.25	$140.79–$412.78	—	40%
Diagnostic mammogram, one breast CPT 77065 Dx mammo incl cad uni	$325.05	$541.75	$111.15–$325.87	49% above	40%
Diagnostic mammogram, one breast one side CPT 77065 Dx mammo w cad uni left	$325.05	$541.75	—	49% above	40%
Diagnostic mammogram, one breast one side CPT 77065 Dx mammo w cad uni right	$325.05	$541.75	—	49% above	40%
Diagnostic mammogram, one breast inpatient CPT 77065 Dx mammo incl cad uni	$325.05	$541.75	$111.15–$325.87	—	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Dx mammo w cad uni left	$325.05	$541.75	—	—	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Dx mammo w cad uni right	$325.05	$541.75	—	—	40%
Duplex ultrasound of the leg arteries, both legs CPT 93925 Lower extremity study	$1,142.70	$1,904.50	$245.67–$720.27	87% above	40%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 Lower extremity study	$1,142.70	$1,904.50	$245.67–$720.27	—	40%
Duplex ultrasound of the leg veins, both legs CPT 93970 Extremity study	$764.10	$1,273.50	$245.67–$720.27	28% above	40%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Extremity study	$764.10	$1,273.50	$245.67–$720.27	—	40%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Tte w/doppler complete	$1,597.65	$2,662.75	$562.59–$1,649.47	41% above	40%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Tte w/doppler complete	$1,597.65	$2,662.75	$562.59–$1,649.47	—	40%
Elbow X-ray, 2 views CPT 73070 X-ray exam of elbow	$258.60	$431.00	$89.60–$262.70	35% above	40%
Elbow X-ray, 2 views one side CPT 73070 Xr elbow left 2 vw	$258.60	$431.00	$89.60–$262.70	35% above	40%
Elbow X-ray, 2 views one side CPT 73070 Xr elbow right 2 vw	$258.60	$431.00	$89.60–$262.70	35% above	40%
Elbow X-ray, 2 views inpatient CPT 73070 X-ray exam of elbow	$258.60	$431.00	$89.60–$262.70	—	40%
Elbow X-ray, 2 views inpatient one side CPT 73070 Xr elbow right 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Elbow X-ray, 2 views inpatient one side CPT 73070 Xr elbow left 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Elbow X-ray, complete, 3 or more views CPT 73080 X-ray exam of elbow	$258.60	$431.00	$89.60–$262.70	44% above	40%
Elbow X-ray, complete, 3 or more views one side CPT 73080 Xr elbow left 3> vw	$258.60	$431.00	$89.60–$262.70	44% above	40%
Elbow X-ray, complete, 3 or more views one side CPT 73080 Xr elbow right 3> vw	$258.60	$431.00	$89.60–$262.70	44% above	40%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 X-ray exam of elbow	$258.60	$431.00	$89.60–$262.70	—	40%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Xr elbow left 3> vw	$258.60	$431.00	$89.60–$262.70	—	40%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Xr elbow right 3> vw	$258.60	$431.00	$89.60–$262.70	—	40%
Eye socket (orbit) CT scan without contrast CPT 70480 Ct orbit/ear/fossa w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	74% above	40%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Ct orbit/ear/fossa w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
Facial bones X-ray, complete, 3 or more views CPT 70150 X-ray exam of facial bones	$347.85	$579.75	$107.64–$315.59	52% above	40%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 X-ray exam of facial bones	$347.85	$579.75	$107.64–$315.59	—	40%
Forearm X-ray (radius and ulna), 2 views CPT 73090 X-ray exam of forearm	$258.60	$431.00	$89.60–$262.70	45% above	40%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Xr forearm right 2 vw	$258.60	$431.00	$89.60–$262.70	45% above	40%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Xr forearm left 2 vw	$258.60	$431.00	$89.60–$262.70	45% above	40%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 X-ray exam of forearm	$258.60	$431.00	$89.60–$262.70	—	40%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Xr forearm right 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Xr forearm left 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary system imaging	$1,003.05	$1,671.75	$411.61–$1,206.79	20% above	40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hepatobiliary system imaging	$1,003.05	$1,671.75	$411.61–$1,206.79	—	40%
Hand X-ray, 2 views CPT 73120 X-ray exam of hand	$347.85	$579.75	$107.64–$315.59	78% above	40%
Hand X-ray, 2 views one side CPT 73120 Xr hand right 2 vw	$347.85	$579.75	$107.64–$315.59	78% above	40%
Hand X-ray, 2 views one side CPT 73120 Xr hand left 2 vw	$347.85	$579.75	$107.64–$315.59	78% above	40%
Hand X-ray, 2 views inpatient CPT 73120 X-ray exam of hand	$347.85	$579.75	$107.64–$315.59	—	40%
Hand X-ray, 2 views inpatient one side CPT 73120 Xr hand right 2 vw	$347.85	$579.75	$107.64–$315.59	—	40%
Hand X-ray, 2 views inpatient one side CPT 73120 Xr hand left 2 vw	$347.85	$579.75	$107.64–$315.59	—	40%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 X-ray exam of heel	$258.60	$431.00	$89.60–$262.70	50% above	40%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Xr calcutaneous left 2 vw	$258.60	$431.00	$89.60–$262.70	50% above	40%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Xr calcutaneous right 2 vw	$258.60	$431.00	$89.60–$262.70	50% above	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 X-ray exam of heel	$258.60	$431.00	$89.60–$262.70	—	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Xr calcutaneous right 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Xr calcutaneous left 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep study unatt&resp efft	$297.30	$495.50	$222.31–$651.81	13% below	40%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Sleep study unatt&resp efft	$297.30	$495.50	$222.31–$651.81	—	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysom 6/>yrs cpap 4/> parm	$3,328.80	$5,548.00	$884.16–$2,592.29	17% above	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysom 6/>yrs cpap 4/> parm	$3,328.80	$5,548.00	$884.16–$2,592.29	—	40%
Knee X-ray, 3 views CPT 73562 X-ray exam of knee 3	$258.60	$431.00	$89.60–$262.70	30% above	40%
Knee X-ray, 3 views one side CPT 73562 Xr knee left 3 vw	$258.60	$431.00	$89.60–$262.70	30% above	40%
Knee X-ray, 3 views one side CPT 73562 Xr knee right 3 vw	$258.60	$431.00	$89.60–$262.70	30% above	40%
Knee X-ray, 3 views inpatient CPT 73562 X-ray exam of knee 3	$258.60	$431.00	$89.60–$262.70	—	40%
Knee X-ray, 3 views inpatient one side CPT 73562 Xr knee left 3 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Knee X-ray, 3 views inpatient one side CPT 73562 Xr knee right 3 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Knee X-ray, complete, 4 or more views CPT 73564 X-ray exam knee 4 or more	$347.85	$579.75	$107.64–$315.59	30% above	40%
Knee X-ray, complete, 4 or more views one side CPT 73564 Xr knee left w obliques	$347.85	$579.75	$107.64–$315.59	30% above	40%
Knee X-ray, complete, 4 or more views one side CPT 73564 Xr knee right with obliques	$347.85	$579.75	$107.64–$315.59	30% above	40%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 X-ray exam knee 4 or more	$347.85	$579.75	$107.64–$315.59	—	40%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Xr knee right with obliques	$347.85	$579.75	$107.64–$315.59	—	40%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Xr knee left w obliques	$347.85	$579.75	$107.64–$315.59	—	40%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 Ct lower extremity w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	66% above	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct lower ext lt wo cm	$1,197.30	$1,995.50	$227.83–$667.97	66% above	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct lower ext rt wo cm	$1,197.30	$1,995.50	$227.83–$667.97	66% above	40%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 Ct lower extremity w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct lower ext lt wo cm	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct lower ext rt wo cm	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Echo exam of abdomen	$540.75	$901.25	$302.91–$888.10	38% above	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Echo exam of abdomen	$540.75	$901.25	$302.91–$888.10	—	40%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Us lmtd jt/nonvasc xtr strux	$540.75	$901.25	$107.64–$315.59	83% above	40%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 Us lmtd jt/nonvasc xtr strux	$540.75	$901.25	$107.64–$315.59	—	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ldct for lung ca screen	$1,197.30	$1,995.50	$107.64–$315.59	677% above	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct thorax lung cancer scr c-	$1,197.30	$1,995.50	$107.64–$315.59	677% above	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Ldct for lung ca screen	$1,197.30	$1,995.50	$107.64–$315.59	—	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Ct thorax lung cancer scr c-	$1,197.30	$1,995.50	$107.64–$315.59	—	40%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 X-ray exam of lower leg	$258.60	$431.00	$89.60–$262.70	35% above	40%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Xr tib fib left 2vw	$258.60	$431.00	$89.60–$262.70	35% above	40%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Xr tib fib left 2 vw	$258.60	$431.00	$89.60–$262.70	35% above	40%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 X-ray exam of lower leg	$258.60	$431.00	$89.60–$262.70	—	40%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Xr tib fib left 2vw	$258.60	$431.00	$89.60–$262.70	—	40%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Xr tib fib left 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
MR angiography (MRA) of the head without contrast CPT 70544 Mr angiography head w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	71% above	40%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 Mr angiography head w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Mri jnt of lwr extre w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	76% above	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mri ankle lt wo cm	$2,285.25	$3,808.75	$542.03–$1,589.19	76% above	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mri hip rt wo cm	$2,285.25	$3,808.75	$542.03–$1,589.19	76% above	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Mri jnt of lwr extre w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mri hip rt wo cm	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mri ankle lt wo cm	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri joint lwr extr w/o&w/dye	$3,657.45	$6,095.75	$873.82–$2,561.97	97% above	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri hip rt w wo cm	$3,657.45	$6,095.75	$873.82–$2,561.97	97% above	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri ankle lt w wo cm	$3,657.45	$6,095.75	$873.82–$2,561.97	97% above	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Mri joint lwr extr w/o&w/dye	$3,657.45	$6,095.75	$873.82–$2,561.97	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mri ankle lt w wo cm	$3,657.45	$6,095.75	$873.82–$2,561.97	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mri hip rt w wo cm	$3,657.45	$6,095.75	$873.82–$2,561.97	—	40%
MRI of the abdomen without contrast CPT 74181 Mri abdomen w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	87% above	40%
MRI of the abdomen without contrast inpatient CPT 74181 Mri abdomen w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
MRI of the abdomen, without and then with contrast dye CPT 74183 Mri abdomen w/o & w/dye	$3,657.45	$6,095.75	$873.82–$2,561.97	88% above	40%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Mri abdomen w/o & w/dye	$3,657.45	$6,095.75	$873.82–$2,561.97	—	40%
MRI of the brain, no contrast dye CPT 70551 Mri brain stem w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	71% above	40%
MRI of the brain, no contrast dye inpatient CPT 70551 Mri brain stem w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
MRI of the brain, with and without contrast dye CPT 70553 Mri brain stem w/o & w/dye	$3,657.45	$6,095.75	$873.82–$2,561.97	88% above	40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri brain stem w/o & w/dye	$3,657.45	$6,095.75	$873.82–$2,561.97	—	40%
MRI of the lower back, no contrast dye CPT 72148 Mri lumbar spine w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	69% above	40%
MRI of the lower back, no contrast dye inpatient CPT 72148 Mri lumbar spine w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
MRI of the lower back, without and then with contrast dye CPT 72158 Mri lumbar spine w/o & w/dye	$3,657.45	$6,095.75	$873.82–$2,561.97	94% above	40%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 Mri lumbar spine w/o & w/dye	$3,657.45	$6,095.75	$873.82–$2,561.97	—	40%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri chest spine w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	70% above	40%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 Mri chest spine w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri neck spine w/o & w/dye	$3,657.45	$6,095.75	$873.82–$2,561.97	97% above	40%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 Mri neck spine w/o & w/dye	$3,657.45	$6,095.75	$873.82–$2,561.97	—	40%
MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri neck spine w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	57% above	40%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 Mri neck spine w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
MRI of the pelvis without and with contrast CPT 72197 Mri pelvis w/o & w/dye	$3,657.45	$6,095.75	$873.82–$2,561.97	90% above	40%
MRI of the pelvis without and with contrast inpatient CPT 72197 Mri pelvis w/o & w/dye	$3,657.45	$6,095.75	$873.82–$2,561.97	—	40%
MRI of the pelvis, no contrast dye CPT 72195 Mri pelvis w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	72% above	40%
MRI of the pelvis, no contrast dye inpatient CPT 72195 Mri pelvis w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri joint upr extrem w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	71% above	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri shoulder rt wo cm	$2,285.25	$3,808.75	$542.03–$1,589.19	71% above	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri elbow lt wo cm	$2,285.25	$3,808.75	$542.03–$1,589.19	71% above	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 Mri joint upr extrem w/o dye	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mri shoulder rt wo cm	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mri elbow lt wo cm	$2,285.25	$3,808.75	$542.03–$1,589.19	—	40%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 X-ray exam neck spine 4/5vws	$347.85	$579.75	$107.64–$315.59	27% above	40%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 X-ray exam neck spine 4/5vws	$347.85	$579.75	$107.64–$315.59	—	40%
Neck soft tissue CT scan with contrast CPT 70491 Ct soft tissue neck w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	82% above	40%
Neck soft tissue CT scan with contrast inpatient CPT 70491 Ct soft tissue neck w/dye	$1,964.25	$3,273.75	$442.31–$1,296.82	—	40%
Neck soft tissue CT scan without contrast CPT 70490 Ct soft tissue neck w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	74% above	40%
Neck soft tissue CT scan without contrast inpatient CPT 70490 Ct soft tissue neck w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
Neck soft tissue X-ray CPT 70360 X-ray exam of neck	$258.60	$431.00	$89.60–$262.70	42% above	40%
Neck soft tissue X-ray inpatient CPT 70360 X-ray exam of neck	$258.60	$431.00	$89.60–$262.70	—	40%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Ht muscle image spect mult	$3,476.55	$5,794.25	$1,332.97–$3,908.17	24% above	40%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Ht muscle image spect mult	$3,476.55	$5,794.25	$1,332.97–$3,908.17	—	40%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet image w/ct skull-thigh	$4,138.20	$6,897.00	$1,472.28–$4,316.60	23% above	40%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet imaging wct skull to thigh	$4,138.20	$6,897.00	$1,472.28–$4,316.60	23% above	40%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Pet image w/ct skull-thigh	$4,138.20	$6,897.00	$1,472.28–$4,316.60	—	40%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Pet imaging wct skull to thigh	$4,138.20	$6,897.00	$1,472.28–$4,316.60	—	40%
Pelvic CT scan without contrast CPT 72192 Ct pelvis w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	51% above	40%
Pelvic CT scan without contrast inpatient CPT 72192 Ct pelvis w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us exam pelvic limited	$540.75	$901.25	$302.91–$888.10	77% above	40%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Us exam pelvic limited	$540.75	$901.25	$302.91–$888.10	—	40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us exam pelvic complete	$540.75	$901.25	$302.91–$888.10	32% above	40%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Us exam pelvic complete	$540.75	$901.25	$302.91–$888.10	—	40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ob us >= 14 wks sngl fetus	$540.75	$901.25	$107.64–$315.59	28% above	40%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Ob us >= 14 wks sngl fetus	$540.75	$901.25	$107.64–$315.59	—	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Ob us < 14 wks single fetus	$540.75	$901.25	$107.64–$315.59	33% above	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Ob us < 14 wks single fetus	$540.75	$901.25	$107.64–$315.59	—	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Ob us limited fetus(s)	$540.75	$901.25	$107.64–$315.59	79% above	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Ob us limited fetus(s)	$540.75	$901.25	$107.64–$315.59	—	40%
Rib X-ray, one side, 2 views CPT 71100 X-ray exam ribs uni 2 views	$258.60	$431.00	$89.60–$262.70	34% above	40%
Rib X-ray, one side, 2 views one side CPT 71100 Xr ribs left 2 vw	$258.60	$431.00	$89.60–$262.70	34% above	40%
Rib X-ray, one side, 2 views one side CPT 71100 Xr ribs right 2vw	$258.60	$431.00	$89.60–$262.70	34% above	40%
Rib X-ray, one side, 2 views inpatient CPT 71100 X-ray exam ribs uni 2 views	$258.60	$431.00	$89.60–$262.70	—	40%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Xr ribs left 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Xr ribs right 2vw	$258.60	$431.00	$89.60–$262.70	—	40%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 X-ray exam unilat ribs/chest	$347.85	$579.75	$107.64–$315.59	50% above	40%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Xr ribs right w pa chest	$347.85	$579.75	$107.64–$315.59	50% above	40%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Xr ribs left 2vw w pa chest	$347.85	$579.75	$107.64–$315.59	50% above	40%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Xr ribs right w pa chest	$347.85	$579.75	$107.64–$315.59	—	40%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Xr ribs left 2vw w pa chest	$347.85	$579.75	$107.64–$315.59	—	40%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 X-ray exam unilat ribs/chest	$347.85	$579.75	$107.64–$315.59	—	40%
Screening mammogram, both breasts both sides CPT 77067 Scr mammo bi incl cad	$416.85	$694.75	$112.75–$330.58	—	40%
Screening mammogram, both breasts inpatient both sides CPT 77067 Scr mammo bi incl cad	$416.85	$694.75	$112.75–$330.58	—	40%
Shoulder X-ray, complete, 2 or more views CPT 73030 X-ray exam of shoulder	$258.60	$431.00	$89.60–$262.70	44% above	40%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr shoulder right 2/> vw	$258.60	$431.00	$89.60–$262.70	44% above	40%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr shoulder 2/> vw	$258.60	$431.00	$89.60–$262.70	44% above	40%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X-ray exam of shoulder	$258.60	$431.00	$89.60–$262.70	—	40%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Xr shoulder right 2/> vw	$258.60	$431.00	$89.60–$262.70	—	40%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Xr shoulder 2/> vw	$258.60	$431.00	$89.60–$262.70	—	40%
Sinus X-ray, complete, 3 or more views CPT 70220 X-ray exam of sinuses	$258.60	$431.00	$89.60–$262.70	18% above	40%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 X-ray exam of sinuses	$258.60	$431.00	$89.60–$262.70	—	40%
Skull X-ray, fewer than 4 views CPT 70250 X-ray exam of skull	$347.85	$579.75	$107.64–$315.59	77% above	40%
Skull X-ray, fewer than 4 views inpatient CPT 70250 X-ray exam of skull	$347.85	$579.75	$107.64–$315.59	—	40%
Sleep study in a lab (polysomnography) CPT 95810 Polysom 6/> yrs 4/> param	$3,230.85	$5,384.75	$884.16–$2,592.29	29% above	40%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysom 6/> yrs 4/> param	$3,230.85	$5,384.75	$884.16–$2,592.29	—	40%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 X-ray exam of femur 2/>	$258.60	$431.00	$89.60–$262.70	38% above	40%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Xr femur left 2 vw	$258.60	$431.00	$89.60–$262.70	38% above	40%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Xr femur right 2 vw	$258.60	$431.00	$89.60–$262.70	38% above	40%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 X-ray exam of femur 2/>	$258.60	$431.00	$89.60–$262.70	—	40%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Xr femur right 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Xr femur left 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Thoracic spine (mid back) CT scan without contrast CPT 72128 Ct chest spine w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	45% above	40%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 Ct chest spine w/o dye	$1,197.30	$1,995.50	$227.83–$667.97	—	40%
Toe X-ray, 2 or more views CPT 73660 X-ray exam of toe(s)	$258.60	$431.00	$89.60–$262.70	50% above	40%
Toe X-ray, 2 or more views one side CPT 73660 Xr toes right min 2 vw	$258.60	$431.00	$89.60–$262.70	50% above	40%
Toe X-ray, 2 or more views one side CPT 73660 Xr toes left min 2 vw	$258.60	$431.00	$89.60–$262.70	50% above	40%
Toe X-ray, 2 or more views inpatient CPT 73660 X-ray exam of toe(s)	$258.60	$431.00	$89.60–$262.70	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 Xr toes right min 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 Xr toes left min 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Transvaginal pelvic ultrasound CPT 76830 Transvaginal us non-ob	$540.75	$901.25	$107.64–$315.59	34% above	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 Transvaginal us non-ob	$540.75	$901.25	$107.64–$315.59	—	40%
Transvaginal ultrasound during pregnancy CPT 76817 Transvaginal us obstetric	$540.75	$901.25	$107.64–$315.59	87% above	40%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 Transvaginal us obstetric	$540.75	$901.25	$107.64–$315.59	—	40%
Ultrasound of the abdomen, complete CPT 76700 Us exam abdom complete	$540.75	$901.25	$302.91–$888.10	23% above	40%
Ultrasound of the abdomen, complete inpatient CPT 76700 Us exam abdom complete	$540.75	$901.25	$302.91–$888.10	—	40%
Ultrasound of the scrotum and testicles CPT 76870 Us exam scrotum	$540.75	$901.25	$107.64–$315.59	44% above	40%
Ultrasound of the scrotum and testicles inpatient CPT 76870 Us exam scrotum	$540.75	$901.25	$107.64–$315.59	—	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us exam of head and neck	$540.75	$901.25	$107.64–$315.59	47% above	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Us exam of head and neck	$540.75	$901.25	$107.64–$315.59	—	40%
Upper arm X-ray (humerus), 2 views CPT 73060 X-ray exam of humerus	$258.60	$431.00	$89.60–$262.70	43% above	40%
Upper arm X-ray (humerus), 2 views one side CPT 73060 Xr humerus right 2 vw	$258.60	$431.00	$89.60–$262.70	43% above	40%
Upper arm X-ray (humerus), 2 views one side CPT 73060 Xr humerus left 2 vw	$258.60	$431.00	$89.60–$262.70	43% above	40%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 X-ray exam of humerus	$258.60	$431.00	$89.60–$262.70	—	40%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Xr humerus left 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Xr humerus right 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Extremity study	$540.75	$901.25	$107.64–$315.59	41% above	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Venous dopplr up/low ext left	$540.75	$901.25	$107.64–$315.59	41% above	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Venous doppler lower ext rt	$540.75	$901.25	$107.64–$315.59	41% above	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Extremity study	$540.75	$901.25	$107.64–$315.59	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Venous doppler lower ext rt	$540.75	$901.25	$107.64–$315.59	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Venous dopplr up/low ext left	$540.75	$901.25	$107.64–$315.59	—	40%
Wrist X-ray, 2 views CPT 73100 X-ray exam of wrist	$258.60	$431.00	$89.60–$262.70	62% above	40%
Wrist X-ray, 2 views one side CPT 73100 Xr wrist left 2 vw	$258.60	$431.00	$89.60–$262.70	62% above	40%
Wrist X-ray, 2 views one side CPT 73100 Xr wrist 2 vw	$258.60	$431.00	$89.60–$262.70	62% above	40%
Wrist X-ray, 2 views inpatient CPT 73100 X-ray exam of wrist	$258.60	$431.00	$89.60–$262.70	—	40%
Wrist X-ray, 2 views inpatient one side CPT 73100 Xr wrist 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Wrist X-ray, 2 views inpatient one side CPT 73100 Xr wrist left 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
Wrist X-ray, complete, 3 or more views CPT 73110 X-ray exam of wrist	$258.60	$431.00	$89.60–$262.70	46% above	40%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr wrist left 3/> vw	$258.60	$431.00	$89.60–$262.70	46% above	40%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr wrist right 3/> view	$258.60	$431.00	$89.60–$262.70	46% above	40%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 X-ray exam of wrist	$258.60	$431.00	$89.60–$262.70	—	40%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Xr wrist left 3/> vw	$258.60	$431.00	$89.60–$262.70	—	40%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Xr wrist right 3/> view	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-ray exam hip uni 2-3 views	$258.60	$431.00	$89.60–$262.70	37% above	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-ray hip uni 2-3 vw left	$258.60	$431.00	$89.60–$262.70	37% above	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-ray hip uni 2-3 vw right	$258.60	$431.00	$89.60–$262.70	37% above	40%
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	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 X-ray hip uni 2-3 vw left	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 X-ray hip uni 2-3 vw right	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the abdomen, 1 view CPT 74018 X-ray exam abdomen 1 view	$258.60	$431.00	$89.60–$262.70	40% above	40%
X-ray of the abdomen, 1 view inpatient CPT 74018 X-ray exam abdomen 1 view	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the ankle, 2 views CPT 73600 X-ray exam of ankle	$258.60	$431.00	$89.60–$262.70	46% above	40%
X-ray of the ankle, 2 views one side CPT 73600 Xr ankle left 2 vw	$258.60	$431.00	$89.60–$262.70	46% above	40%
X-ray of the ankle, 2 views one side CPT 73600 Xr ankle right 2 vw	$258.60	$431.00	$89.60–$262.70	46% above	40%
X-ray of the ankle, 2 views inpatient CPT 73600 X-ray exam of ankle	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the ankle, 2 views inpatient one side CPT 73600 Xr ankle left 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the ankle, 2 views inpatient one side CPT 73600 Xr ankle right 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the finger(s), 2 or more views CPT 73140 X-ray exam of finger(s)	$258.60	$431.00	$89.60–$262.70	46% above	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr finger left 2 vw	$258.60	$431.00	$89.60–$262.70	46% above	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr finger right 2 vw	$258.60	$431.00	$89.60–$262.70	46% above	40%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 X-ray exam of finger(s)	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Xr finger left 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Xr finger right 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the foot, 2 views CPT 73620 X-ray exam of foot	$258.60	$431.00	$89.60–$262.70	61% above	40%
X-ray of the foot, 2 views one side CPT 73620 Xr foot left 2 vw	$258.60	$431.00	$89.60–$262.70	61% above	40%
X-ray of the foot, 2 views one side CPT 73620 Xr foot right 2 vw	$258.60	$431.00	$89.60–$262.70	61% above	40%
X-ray of the foot, 2 views inpatient CPT 73620 X-ray exam of foot	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the foot, 2 views inpatient one side CPT 73620 Xr foot left 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the foot, 2 views inpatient one side CPT 73620 Xr foot right 2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the foot, complete, 3 or more views CPT 73630 X-ray exam of foot	$258.60	$431.00	$89.60–$262.70	46% above	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr foot left 3 vw	$258.60	$431.00	$89.60–$262.70	46% above	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr foot right 3 vw	$258.60	$431.00	$89.60–$262.70	46% above	40%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 X-ray exam of foot	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Xr foot right 3 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Xr foot left 3 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the hand, 3 or more views CPT 73130 X-ray exam of hand	$258.60	$431.00	$89.60–$262.70	42% above	40%
X-ray of the hand, 3 or more views one side CPT 73130 Xr hand right 3 vw	$258.60	$431.00	$89.60–$262.70	42% above	40%
X-ray of the hand, 3 or more views one side CPT 73130 Xr hand left 3 vw	$258.60	$431.00	$89.60–$262.70	42% above	40%
X-ray of the hand, 3 or more views inpatient CPT 73130 X-ray exam of hand	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 Xr hand left 3 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 Xr hand right 3 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the knee, 1 or 2 views CPT 73560 X-ray exam of knee 1 or 2	$258.60	$431.00	$89.60–$262.70	43% above	40%
X-ray of the knee, 1 or 2 views one side CPT 73560 Xr knee right 1/2 vw	$258.60	$431.00	$89.60–$262.70	43% above	40%
X-ray of the knee, 1 or 2 views one side CPT 73560 Xr knee left 1/2 vw	$258.60	$431.00	$89.60–$262.70	43% above	40%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 X-ray exam of knee 1 or 2	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Xr knee left 1/2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Xr knee right 1/2 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-ray exam l-s spine 2/3 vws	$347.85	$579.75	$107.64–$315.59	63% above	40%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 X-ray exam l-s spine 2/3 vws	$347.85	$579.75	$107.64–$315.59	—	40%
X-ray of the lower back, 4 or more views CPT 72110 X-ray exam l-2 spine 4/>vws	$347.85	$579.75	$107.64–$315.59	23% above	40%
X-ray of the lower back, 4 or more views inpatient CPT 72110 X-ray exam l-2 spine 4/>vws	$347.85	$579.75	$107.64–$315.59	—	40%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-ray exam thorac spine 2vws	$347.85	$579.75	$107.64–$315.59	55% above	40%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 X-ray exam thorac spine 2vws	$347.85	$579.75	$107.64–$315.59	—	40%
X-ray of the nasal bones, 3 or more views CPT 70160 X-ray exam of nasal bones	$258.60	$431.00	$89.60–$262.70	40% above	40%
X-ray of the nasal bones, 3 or more views CPT 70160 Xr nose 3 vw	$258.60	$431.00	$89.60–$262.70	40% above	40%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Xr nose 3 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 X-ray exam of nasal bones	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-ray exam neck spine 2-3 vw	$258.60	$431.00	$89.60–$262.70	33% above	40%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-ray exam neck spine 2-3 vw	$258.60	$431.00	$89.60–$262.70	—	40%
X-ray of the pelvis, 1 or 2 views CPT 72170 X-ray exam of pelvis	$347.85	$579.75	$107.64–$315.59	84% above	40%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-ray exam of pelvis	$347.85	$579.75	$107.64–$315.59	—	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-ray exam sacrum tailbone	$258.60	$431.00	$89.60–$262.70	44% above	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 X-ray exam sacrum tailbone	$258.60	$431.00	$89.60–$262.70	—	40%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs West Virginia	Off list
ACTH blood test CPT 82024 Assay of acth	$416.10	$693.50	—	132% above	40%
ACTH blood test CPT 82024 Adrenocorticotropic hormone	$416.10	$693.50	—	132% above	40%
ACTH blood test inpatient CPT 82024 Adrenocorticotropic hormone	$416.10	$693.50	—	—	40%
ACTH blood test inpatient CPT 82024 Assay of acth	$416.10	$693.50	—	—	40%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine amino (alt) (sgpt)	$57.45	$95.75	—	103% above	40%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 S g p t (alt)	$57.45	$95.75	—	103% above	40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 S g p t (alt)	$57.45	$95.75	—	—	40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine amino (alt) (sgpt)	$57.45	$95.75	—	—	40%
AST (aspartate aminotransferase) enzyme test CPT 84450 Transferase (ast) (sgot)	$55.95	$93.25	—	85% above	40%
AST (aspartate aminotransferase) enzyme test CPT 84450 S g o t (ast)	$55.95	$93.25	—	85% above	40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Transferase (ast) (sgot)	$55.95	$93.25	—	—	40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 S g o t (ast)	$55.95	$93.25	—	—	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute hepatitis panel	$513.00	$855.00	—	132% above	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis profile	$513.00	$855.00	—	132% above	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis profile	$513.00	$855.00	—	—	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute hepatitis panel	$513.00	$855.00	—	—	40%
Albumin blood test CPT 82040 Assay of serum albumin	$53.55	$89.25	—	206% above	40%
Albumin blood test CPT 82040 Albumin	$53.55	$89.25	—	206% above	40%
Albumin blood test inpatient CPT 82040 Albumin	$53.55	$89.25	—	—	40%
Albumin blood test inpatient CPT 82040 Assay of serum albumin	$53.55	$89.25	—	—	40%
Aldosterone blood test CPT 82088 Aldosterone serum	$438.90	$731.50	—	1162% above	40%
Aldosterone blood test CPT 82088 Assay of aldosterone	$438.90	$731.50	—	1162% above	40%
Aldosterone blood test inpatient CPT 82088 Assay of aldosterone	$438.90	$731.50	—	—	40%
Aldosterone blood test inpatient CPT 82088 Aldosterone serum	$438.90	$731.50	—	—	40%
Alkaline phosphatase (ALP) blood test CPT 84075 Assay alkaline phosphatase	$55.95	$93.25	—	187% above	40%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline phosphatase	$55.95	$93.25	—	187% above	40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Assay alkaline phosphatase	$55.95	$93.25	—	—	40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline phosphatase	$55.95	$93.25	—	—	40%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen specific ige (rast)	$56.25	$93.75	—	233% above	40%
Allergy blood test, specific IgE, per allergen CPT 86003 Allg spec ige crude xtrc ea	$56.25	$93.75	—	233% above	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allg spec ige crude xtrc ea	$56.25	$93.75	—	—	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen specific ige (rast)	$56.25	$93.75	—	—	40%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-fetoprotein serum	$180.75	$301.25	—	138% above	40%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha fetoprotein	$180.75	$301.25	—	138% above	40%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha fetoprotein	$180.75	$301.25	—	—	40%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha-fetoprotein serum	$180.75	$301.25	—	—	40%
Ammonia blood test CPT 82140 Ammonia	$157.05	$261.75	—	244% above	40%
Ammonia blood test CPT 82140 Assay of ammonia	$157.05	$261.75	—	244% above	40%
Ammonia blood test inpatient CPT 82140 Ammonia	$157.05	$261.75	—	—	40%
Ammonia blood test inpatient CPT 82140 Assay of ammonia	$157.05	$261.75	—	—	40%
Amylase blood test CPT 82150 Assay of amylase	$70.05	$116.75	—	84% above	40%
Amylase blood test CPT 82150 Amylase	$70.05	$116.75	—	84% above	40%
Amylase blood test inpatient CPT 82150 Assay of amylase	$70.05	$116.75	—	—	40%
Amylase blood test inpatient CPT 82150 Amylase	$70.05	$116.75	—	—	40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Anti-ccp ab igg + i	$81.00	$135.00	—	95% above	40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Ccp antibody	$81.00	$135.00	—	95% above	40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Ccp antibody	$81.00	$135.00	—	—	40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Anti-ccp ab igg + i	$81.00	$135.00	—	—	40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear antibodies	$193.35	$322.25	—	225% above	40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Anti-jo-1	$193.35	$322.25	—	225% above	40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Anti-jo-1	$193.35	$322.25	—	—	40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear antibodies	$193.35	$322.25	—	—	40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Assay of natriuretic peptide	$422.85	$704.75	—	252% above	40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Brain natriuretic peptide	$422.85	$704.75	—	252% above	40%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Brain natriuretic peptide	$422.85	$704.75	—	—	40%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Assay of natriuretic peptide	$422.85	$704.75	—	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture othr specimn aerobic	$93.15	$155.25	—	84% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial culture - othr sourc	$93.15	$155.25	—	84% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bacterial culture - othr sourc	$93.15	$155.25	—	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture othr specimn aerobic	$93.15	$155.25	—	—	40%
Basic metabolic panel (blood test) CPT 80048 Metabolic panel total ca	$96.00	$160.00	—	94% above	40%
Basic metabolic panel (blood test) CPT 80048 Erpanel(basic metabolic panel)	$96.00	$160.00	—	94% above	40%
Basic metabolic panel (blood test) inpatient CPT 80048 Erpanel(basic metabolic panel)	$96.00	$160.00	—	—	40%
Basic metabolic panel (blood test) inpatient CPT 80048 Metabolic panel total ca	$96.00	$160.00	—	—	40%
Bilirubin blood test, total CPT 82247 Bilirubin total	$54.30	$90.50	—	124% above	40%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin total	$54.30	$90.50	—	—	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Tissue exam by pathologist	$546.60	$911.00	$53.65–$157.31	408% above	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Tissue exam by pathologist	$546.60	$911.00	$53.65–$157.31	—	40%
Blood culture for bacteria CPT 87040 Culture blood	$111.30	$185.50	—	50% above	40%
Blood culture for bacteria CPT 87040 Blood culture for bacteria	$111.30	$185.50	—	50% above	40%
Blood culture for bacteria inpatient CPT 87040 Blood culture for bacteria	$111.30	$185.50	—	—	40%
Blood culture for bacteria inpatient CPT 87040 Culture blood	$111.30	$185.50	—	—	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Routine venipuncture	$32.55	$54.25	—	210% above	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture routine	$32.55	$54.25	—	210% above	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture routine	$32.55	$54.25	—	—	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Routine venipuncture	$32.55	$54.25	—	—	40%
Blood glucose (sugar) test CPT 82947 Glucose (fbs)	$42.45	$70.75	$3.89–$11.41	85% above	40%
Blood glucose (sugar) test CPT 82947 Assay glucose blood quant	$42.45	$70.75	$3.89–$11.41	85% above	40%
Blood glucose (sugar) test inpatient CPT 82947 Assay glucose blood quant	$42.45	$70.75	$3.89–$11.41	—	40%
Blood glucose (sugar) test inpatient CPT 82947 Glucose (fbs)	$42.45	$70.75	$3.89–$11.41	—	40%
Blood lead test CPT 83655 Lead level	$130.65	$217.75	—	351% above	40%
Blood lead test CPT 83655 Assay of lead	$130.65	$217.75	—	351% above	40%
Blood lead test inpatient CPT 83655 Assay of lead	$130.65	$217.75	—	—	40%
Blood lead test inpatient CPT 83655 Lead level	$130.65	$217.75	—	—	40%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Chorionic gonadotropin assay	$81.15	$135.25	—	100% above	40%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Chronic gonadotropin (hcg)	$81.15	$135.25	—	100% above	40%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Chronic gonadotropin (hcg)	$81.15	$135.25	—	—	40%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Chorionic gonadotropin assay	$81.15	$135.25	—	—	40%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood typing serologic abo	$200.25	$333.75	$136.99–$401.63	427% above	40%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo typing	$200.25	$333.75	$136.99–$401.63	427% above	40%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Abo typing	$200.25	$333.75	$136.99–$401.63	—	40%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood typing serologic abo	$200.25	$333.75	$136.99–$401.63	—	40%
Blood urea nitrogen (BUN) test CPT 84520 B u n (blood urea nitrogen)	$42.75	$71.25	—	57% above	40%
Blood urea nitrogen (BUN) test CPT 84520 Assay of urea nitrogen	$42.75	$71.25	—	57% above	40%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Assay of urea nitrogen	$42.75	$71.25	—	—	40%
Blood urea nitrogen (BUN) test inpatient CPT 84520 B u n (blood urea nitrogen)	$42.75	$71.25	—	—	40%
C-peptide blood test CPT 84681 Assay of c-peptide	$224.25	$373.75	—	205% above	40%
C-peptide blood test CPT 84681 C-peptide	$224.25	$373.75	—	205% above	40%
C-peptide blood test inpatient CPT 84681 Assay of c-peptide	$224.25	$373.75	—	—	40%
C-peptide blood test inpatient CPT 84681 C-peptide	$224.25	$373.75	—	—	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive protein	$55.95	$93.25	—	96% above	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C r p (c-reactive protein)	$55.95	$93.25	—	96% above	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-reactive protein	$55.95	$93.25	—	—	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C r p (c-reactive protein)	$55.95	$93.25	—	—	40%
CA-125 blood test (ovarian cancer marker) CPT 86304 Immunoassay tumor anti (ca125)	$224.25	$373.75	—	121% above	40%
CA-125 blood test (ovarian cancer marker) CPT 86304 Immunoassay tumor ca 125	$224.25	$373.75	—	121% above	40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Immunoassay tumor ca 125	$224.25	$373.75	—	—	40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Immunoassay tumor anti (ca125)	$224.25	$373.75	—	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Covid-19 pcr non-cdc test	$264.00	$440.00	$50.80–$148.93	146% above	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Sars-cov-2 covid-19 amp prb	$264.00	$440.00	$50.80–$148.93	146% above	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Covid-19 pcr non-cdc test	$264.00	$440.00	$50.80–$148.93	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Sars-cov-2 covid-19 amp prb	$264.00	$440.00	$50.80–$148.93	—	40%
Calcium blood test, total CPT 82310 Calcium	$55.65	$92.75	—	126% above	40%
Calcium blood test, total CPT 82310 Assay of calcium	$55.65	$92.75	—	126% above	40%
Calcium blood test, total inpatient CPT 82310 Calcium	$55.65	$92.75	—	—	40%
Calcium blood test, total inpatient CPT 82310 Assay of calcium	$55.65	$92.75	—	—	40%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic antigen	$204.30	$340.50	—	97% above	40%
Carcinoembryonic antigen (CEA) test CPT 82378 C e a	$204.30	$340.50	—	97% above	40%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic antigen	$204.30	$340.50	—	—	40%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 C e a	$204.30	$340.50	—	—	40%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella zoster titer	$138.90	$231.50	—	263% above	40%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella-zoster antibody	$138.90	$231.50	—	263% above	40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella-zoster antibody	$138.90	$231.50	—	—	40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella zoster titer	$138.90	$231.50	—	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chylmd trach dna amp probe	$378.00	$630.00	—	567% above	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia nat	$378.00	$630.00	—	567% above	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia nat	$378.00	$630.00	—	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chylmd trach dna amp probe	$378.00	$630.00	—	—	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid panel	$144.30	$240.50	$13.26–$38.87	131% above	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid panel	$144.30	$240.50	$13.26–$38.87	—	40%
Complete blood count (CBC) with differential CPT 85025 Complete cbc w/auto diff wbc	$83.85	$139.75	—	102% above	40%
Complete blood count (CBC) with differential CPT 85025 Cbc with auto differential	$83.85	$139.75	—	102% above	40%
Complete blood count (CBC) with differential inpatient CPT 85025 Cbc with auto differential	$83.85	$139.75	—	—	40%
Complete blood count (CBC) with differential inpatient CPT 85025 Complete cbc w/auto diff wbc	$83.85	$139.75	—	—	40%
Complete blood count (CBC), no differential CPT 85027 Cbc	$70.05	$116.75	—	100% above	40%
Complete blood count (CBC), no differential CPT 85027 Complete cbc automated	$70.05	$116.75	—	100% above	40%
Complete blood count (CBC), no differential inpatient CPT 85027 Complete cbc automated	$70.05	$116.75	—	—	40%
Complete blood count (CBC), no differential inpatient CPT 85027 Cbc	$70.05	$116.75	—	—	40%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehen metabolic panel	$146.10	$243.50	—	198% above	40%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive metabolic panel	$146.10	$243.50	—	198% above	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive metabolic panel	$146.10	$243.50	—	—	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehen metabolic panel	$146.10	$243.50	—	—	40%
Cortisol blood test, total CPT 82533 Total cortisol	$175.80	$293.00	—	176% above	40%
Cortisol blood test, total CPT 82533 Cortisol total	$175.80	$293.00	—	176% above	40%
Cortisol blood test, total inpatient CPT 82533 Cortisol total	$175.80	$293.00	—	—	40%
Cortisol blood test, total inpatient CPT 82533 Total cortisol	$175.80	$293.00	—	—	40%
Creatine kinase (CK) blood test, total CPT 82550 C k	$70.35	$117.25	—	63% above	40%
Creatine kinase (CK) blood test, total CPT 82550 Assay of ck (cpk)	$70.35	$117.25	—	63% above	40%
Creatine kinase (CK) blood test, total inpatient CPT 82550 C k	$70.35	$117.25	—	—	40%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Assay of ck (cpk)	$70.35	$117.25	—	—	40%
Creatinine blood test CPT 82565 Creatinine blood	$55.35	$92.25	—	94% above	40%
Creatinine blood test CPT 82565 Assay of creatinine	$55.35	$92.25	—	94% above	40%
Creatinine blood test inpatient CPT 82565 Creatinine blood	$55.35	$92.25	—	—	40%
Creatinine blood test inpatient CPT 82565 Assay of creatinine	$55.35	$92.25	—	—	40%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomeg virus-igg	$155.10	$258.50	—	217% above	40%
Cytomegalovirus (CMV) antibody test CPT 86644 Cmv antibody	$155.10	$258.50	—	217% above	40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cmv antibody	$155.10	$258.50	—	—	40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomeg virus-igg	$155.10	$258.50	—	—	40%
D-dimer blood test (blood clot marker) CPT 85379 D-dimer plasma quantitative	$109.80	$183.00	—	72% above	40%
D-dimer blood test (blood clot marker) CPT 85379 Fibrin degradation quant	$109.80	$183.00	—	72% above	40%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-dimer plasma quantitative	$109.80	$183.00	—	—	40%
D-dimer blood test (blood clot marker) inpatient CPT 85379 Fibrin degradation quant	$109.80	$183.00	—	—	40%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone (s04)	$239.70	$399.50	—	158% above	40%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone	$239.70	$399.50	—	158% above	40%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone	$239.70	$399.50	—	—	40%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone (s04)	$239.70	$399.50	—	—	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 C-o-c drug screen	$101.85	$169.75	—	249% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug test prsmv chem anlyzr	$101.85	$169.75	—	249% above	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug test prsmv chem anlyzr	$101.85	$169.75	—	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 C-o-c drug screen	$101.85	$169.75	—	—	40%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Lytes (electrolytes panel)	$75.60	$126.00	—	133% above	40%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte panel	$75.60	$126.00	—	133% above	40%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Lytes (electrolytes panel)	$75.60	$126.00	—	—	40%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte panel	$75.60	$126.00	—	—	40%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein-barr capsid vca	$195.60	$326.00	—	229% above	40%
Epstein-Barr virus (EBV) antibody test CPT 86665 Eb vca igg	$195.60	$326.00	—	229% above	40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein-barr capsid vca	$195.60	$326.00	—	—	40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Eb vca igg	$195.60	$326.00	—	—	40%
Estradiol blood test CPT 82670 Estradiol total	$300.90	$501.50	—	251% above	40%
Estradiol blood test CPT 82670 Assay of estradiol	$300.90	$501.50	—	251% above	40%
Estradiol blood test inpatient CPT 82670 Estradiol total	$300.90	$501.50	—	—	40%
Estradiol blood test inpatient CPT 82670 Assay of estradiol	$300.90	$501.50	—	—	40%
FSH (follicle-stimulating hormone) test CPT 83001 Assay of gonadotropin (fsh)	$200.25	$333.75	—	139% above	40%
FSH (follicle-stimulating hormone) test CPT 83001 Fsh (serum)	$200.25	$333.75	—	139% above	40%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Fsh (serum)	$200.25	$333.75	—	—	40%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Assay of gonadotropin (fsh)	$200.25	$333.75	—	—	40%
Fecal calprotectin (stool inflammation test) CPT 83993 Assay for calprotectin fecal	$211.50	$352.50	—	134% above	40%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotection fecal	$211.50	$352.50	—	134% above	40%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotection fecal	$211.50	$352.50	—	—	40%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Assay for calprotectin fecal	$211.50	$352.50	—	—	40%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$147.00	$245.00	—	113% above	40%
Ferritin blood test (iron stores) CPT 82728 Assay of ferritin	$147.00	$245.00	—	113% above	40%
Ferritin blood test (iron stores) inpatient CPT 82728 Assay of ferritin	$147.00	$245.00	—	—	40%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$147.00	$245.00	—	—	40%
Fibrinogen blood test CPT 85384 Fibrinogen	$104.85	$174.75	—	114% above	40%
Fibrinogen blood test CPT 85384 Fibrinogen activity	$104.85	$174.75	—	114% above	40%
Fibrinogen blood test inpatient CPT 85384 Fibrinogen	$104.85	$174.75	—	—	40%
Fibrinogen blood test inpatient CPT 85384 Fibrinogen activity	$104.85	$174.75	—	—	40%
Folate (folic acid) blood test CPT 82746 Assay of folic acid serum	$158.40	$264.00	—	126% above	40%
Folate (folic acid) blood test CPT 82746 Folic acid; serum	$158.40	$264.00	—	126% above	40%
Folate (folic acid) blood test inpatient CPT 82746 Assay of folic acid serum	$158.40	$264.00	—	—	40%
Folate (folic acid) blood test inpatient CPT 82746 Folic acid; serum	$158.40	$264.00	—	—	40%
Free T3 thyroid hormone test CPT 84481 Triiodothyronine free serum t3	$182.55	$304.25	—	110% above	40%
Free T3 thyroid hormone test CPT 84481 Free assay (ft-3)	$182.55	$304.25	—	110% above	40%
Free T3 thyroid hormone test inpatient CPT 84481 Triiodothyronine free serum t3	$182.55	$304.25	—	—	40%
Free T3 thyroid hormone test inpatient CPT 84481 Free assay (ft-3)	$182.55	$304.25	—	—	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine free	$97.35	$162.25	—	84% above	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Assay of free thyroxine	$97.35	$162.25	—	84% above	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Thyroxine free	$97.35	$162.25	—	—	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Assay of free thyroxine	$97.35	$162.25	—	—	40%
Free testosterone test CPT 84402 Testosterone free	$274.50	$457.50	—	289% above	40%
Free testosterone test CPT 84402 Assay of free testosterone	$274.50	$457.50	—	289% above	40%
Free testosterone test inpatient CPT 84402 Testosterone free	$274.50	$457.50	—	—	40%
Free testosterone test inpatient CPT 84402 Assay of free testosterone	$274.50	$457.50	—	—	40%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Glutamyltransferasegamma ggt	$77.70	$129.50	—	125% above	40%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Assay of ggt	$77.70	$129.50	—	125% above	40%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Glutamyltransferasegamma ggt	$77.70	$129.50	—	—	40%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Assay of ggt	$77.70	$129.50	—	—	40%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General health panel	$289.80	$483.00	—	27% above	40%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General health panel	$289.80	$483.00	—	—	40%
Glucose tolerance test, 3 samples CPT 82951 Glucose tolerance test (gtt)	$138.60	$231.00	$12.74–$37.36	115% above	40%
Glucose tolerance test, 3 samples CPT 82951 Glucose tolerance 3hr	$138.60	$231.00	$12.74–$37.36	115% above	40%
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose tolerance test (gtt)	$138.60	$231.00	$12.74–$37.36	—	40%
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose tolerance 3hr	$138.60	$231.00	$12.74–$37.36	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Gonorrhoeae nat	$378.00	$630.00	—	521% above	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.gonorrhoeae dna amp prob	$378.00	$630.00	—	521% above	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Gonorrhoeae nat	$378.00	$630.00	—	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.gonorrhoeae dna amp prob	$378.00	$630.00	—	—	40%
H. pylori antibody blood test CPT 86677 Helicobacter pylori antibody	$181.50	$302.50	—	263% above	40%
H. pylori antibody blood test CPT 86677 Helicobacter pylori (stool)	$181.50	$302.50	—	263% above	40%
H. pylori antibody blood test inpatient CPT 86677 Helicobacter pylori (stool)	$181.50	$302.50	—	—	40%
H. pylori antibody blood test inpatient CPT 86677 Helicobacter pylori antibody	$181.50	$302.50	—	—	40%
HIV-1 and HIV-2 antibody test CPT 86703 Hiv i and ii antibody	$147.75	$246.25	—	133% above	40%
HIV-1 and HIV-2 antibody test CPT 86703 Hiv-1/hiv-2 1 result antbdy	$147.75	$246.25	—	133% above	40%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Hiv-1/hiv-2 1 result antbdy	$147.75	$246.25	—	—	40%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Hiv i and ii antibody	$147.75	$246.25	—	—	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Glycosylated hemoglobin test	$104.85	$174.75	—	110% above	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Glycosylated hemoglobin	$104.85	$174.75	—	110% above	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Glycosylated hemoglobin test	$104.85	$174.75	—	—	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Glycosylated hemoglobin	$104.85	$174.75	—	—	40%
Hemoglobin blood test CPT 85018 Hemoglobin	$25.80	$43.00	—	91% above	40%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin	$25.80	$43.00	—	—	40%
Hepatitis B core antibody test (total) CPT 86704 Ab; hbcab - total	$130.05	$216.75	—	173% above	40%
Hepatitis B core antibody test (total) CPT 86704 Hep b core antibody total	$130.05	$216.75	—	173% above	40%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hep b core antibody total	$130.05	$216.75	—	—	40%
Hepatitis B core antibody test (total) inpatient CPT 86704 Ab; hbcab - total	$130.05	$216.75	—	—	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis b surface antibody	$115.80	$193.00	—	149% above	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep b surface antibody	$115.80	$193.00	—	149% above	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis b surface antibody	$115.80	$193.00	—	—	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hep b surface antibody	$115.80	$193.00	—	—	40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hbsag	$111.45	$185.75	—	116% above	40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis b surface ag ia	$111.45	$185.75	—	116% above	40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis b surface ag ia	$111.45	$185.75	—	—	40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hbsag	$111.45	$185.75	—	—	40%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis c ab test	$153.75	$256.25	—	181% above	40%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis c virus ab	$153.75	$256.25	—	181% above	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis c ab test	$153.75	$256.25	—	—	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis c virus ab	$153.75	$256.25	—	—	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis c revrs trnscrpj	$385.20	$642.00	—	97% above	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hcv rna by pcr qn r	$385.20	$642.00	—	97% above	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis c revrs trnscrpj	$385.20	$642.00	—	—	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hcv rna by pcr qn r	$385.20	$642.00	—	—	40%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes simplex type 1 test	$79.20	$132.00	—	84% above	40%
Herpes blood test, HSV-1 antibody CPT 86695 Hsv 1 ab igg	$79.20	$132.00	—	84% above	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes simplex type 1 test	$79.20	$132.00	—	—	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Hsv 1 ab igg	$79.20	$132.00	—	—	40%
Herpes blood test, HSV-2 antibody CPT 86696 Hsv 2 ab igg	$115.80	$193.00	—	149% above	40%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes simplex type 2 test	$115.80	$193.00	—	149% above	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes simplex type 2 test	$115.80	$193.00	—	—	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Hsv 2 ab igg	$115.80	$193.00	—	—	40%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-reactive protein hs	$139.80	$233.00	—	127% above	40%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-reactive protein (hscrp)	$139.80	$233.00	—	127% above	40%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-reactive protein hs	$139.80	$233.00	—	—	40%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-reactive protein (hscrp)	$139.80	$233.00	—	—	40%
Homocysteine blood test CPT 83090 Homocystine	$193.20	$322.00	—	120% above	40%
Homocysteine blood test CPT 83090 Assay of homocystine	$193.20	$322.00	—	120% above	40%
Homocysteine blood test inpatient CPT 83090 Homocystine	$193.20	$322.00	—	—	40%
Homocysteine blood test inpatient CPT 83090 Assay of homocystine	$193.20	$322.00	—	—	40%
Insulin blood test CPT 83525 Insulin total	$123.45	$205.75	—	126% above	40%
Insulin blood test CPT 83525 Assay of insulin	$123.45	$205.75	—	126% above	40%
Insulin blood test inpatient CPT 83525 Insulin total	$123.45	$205.75	—	—	40%
Insulin blood test inpatient CPT 83525 Assay of insulin	$123.45	$205.75	—	—	40%
Iron blood test (serum iron) CPT 83540 Iron (fe)	$70.05	$116.75	—	66% above	40%
Iron blood test (serum iron) CPT 83540 Assay of iron	$70.05	$116.75	—	66% above	40%
Iron blood test (serum iron) inpatient CPT 83540 Iron (fe)	$70.05	$116.75	—	—	40%
Iron blood test (serum iron) inpatient CPT 83540 Assay of iron	$70.05	$116.75	—	—	40%
Iron-binding capacity (TIBC) test CPT 83550 Iron binding test	$94.20	$157.00	—	112% above	40%
Iron-binding capacity (TIBC) test CPT 83550 T i b c	$94.20	$157.00	—	112% above	40%
Iron-binding capacity (TIBC) test inpatient CPT 83550 T i b c	$94.20	$157.00	—	—	40%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron binding test	$94.20	$157.00	—	—	40%
Kidney function blood test panel CPT 80069 Renal panel	$93.75	$156.25	—	126% above	40%
Kidney function blood test panel CPT 80069 Renal function panel	$93.75	$156.25	—	126% above	40%
Kidney function blood test panel inpatient CPT 80069 Renal panel	$93.75	$156.25	—	—	40%
Kidney function blood test panel inpatient CPT 80069 Renal function panel	$93.75	$156.25	—	—	40%
LH (luteinizing hormone) test CPT 83002 Lutenizing hormone	$199.65	$332.75	—	138% above	40%
LH (luteinizing hormone) test CPT 83002 Assay of gonadotropin (lh)	$199.65	$332.75	—	138% above	40%
LH (luteinizing hormone) test inpatient CPT 83002 Lutenizing hormone	$199.65	$332.75	—	—	40%
LH (luteinizing hormone) test inpatient CPT 83002 Assay of gonadotropin (lh)	$199.65	$332.75	—	—	40%
Lactate (lactic acid) blood test CPT 83605 Latic acid	$124.80	$208.00	—	121% above	40%
Lactate (lactic acid) blood test CPT 83605 Assay of lactic acid	$124.80	$208.00	—	121% above	40%
Lactate (lactic acid) blood test inpatient CPT 83605 Latic acid	$124.80	$208.00	—	—	40%
Lactate (lactic acid) blood test inpatient CPT 83605 Assay of lactic acid	$124.80	$208.00	—	—	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 L d h	$65.25	$108.75	—	264% above	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate (ld) (ldh) enzyme	$65.25	$108.75	—	264% above	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 L d h	$65.25	$108.75	—	—	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate (ld) (ldh) enzyme	$65.25	$108.75	—	—	40%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase	$74.40	$124.00	—	77% above	40%
Lipase blood test (pancreas enzyme) CPT 83690 Assay of lipase	$74.40	$124.00	—	77% above	40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase	$74.40	$124.00	—	—	40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Assay of lipase	$74.40	$124.00	—	—	40%
Liver function blood test panel CPT 80076 Hepatic function panel	$88.05	$146.75	—	110% above	40%
Liver function blood test panel inpatient CPT 80076 Hepatic function panel	$88.05	$146.75	—	—	40%
Lyme disease antibody test CPT 86618 Lyme disease antibody	$183.60	$306.00	—	483% above	40%
Lyme disease antibody test CPT 86618 Lyme disease ab screen	$183.60	$306.00	—	483% above	40%
Lyme disease antibody test inpatient CPT 86618 Lyme disease ab screen	$183.60	$306.00	—	—	40%
Lyme disease antibody test inpatient CPT 86618 Lyme disease antibody	$183.60	$306.00	—	—	40%
Magnesium blood test CPT 83735 Assay of magnesium	$72.30	$120.50	—	271% above	40%
Magnesium blood test CPT 83735 Magnesium	$72.30	$120.50	—	271% above	40%
Magnesium blood test inpatient CPT 83735 Assay of magnesium	$72.30	$120.50	—	—	40%
Magnesium blood test inpatient CPT 83735 Magnesium	$72.30	$120.50	—	—	40%
Measles (rubeola) antibody test CPT 86765 Rubeola igg antibody	$138.90	$231.50	—	263% above	40%
Measles (rubeola) antibody test CPT 86765 Rubeola antibody	$138.90	$231.50	—	263% above	40%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola igg antibody	$138.90	$231.50	—	—	40%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola antibody	$138.90	$231.50	—	—	40%
Mumps immunity blood test CPT 86735 Mumps virus antibody	$140.70	$234.50	—	187% above	40%
Mumps immunity blood test CPT 86735 Mumps antibody	$140.70	$234.50	—	187% above	40%
Mumps immunity blood test inpatient CPT 86735 Mumps virus antibody	$140.70	$234.50	—	—	40%
Mumps immunity blood test inpatient CPT 86735 Mumps antibody	$140.70	$234.50	—	—	40%
Obstetric blood test panel CPT 80055 Prenatal profile b	$514.95	$858.25	—	132% above	40%
Obstetric blood test panel CPT 80055 Obstetric panel	$514.95	$858.25	—	132% above	40%
Obstetric blood test panel inpatient CPT 80055 Prenatal profile b	$514.95	$858.25	—	—	40%
Obstetric blood test panel inpatient CPT 80055 Obstetric panel	$514.95	$858.25	—	—	40%
PSA (prostate-specific antigen) blood test, free CPT 84154 Assay of psa free	$198.15	$330.25	—	246% above	40%
PSA (prostate-specific antigen) blood test, free CPT 84154 Psa free	$198.15	$330.25	—	246% above	40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Psa free	$198.15	$330.25	—	—	40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Assay of psa free	$198.15	$330.25	—	—	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 Psa screening	$198.15	$330.25	—	208% above	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 Assay of psa total	$198.15	$330.25	—	208% above	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Psa screening	$198.15	$330.25	—	—	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Assay of psa total	$198.15	$330.25	—	—	40%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid c-terminal	$444.75	$741.25	—	194% above	40%
Parathyroid hormone (PTH) blood test CPT 83970 Assay of parathormone	$444.75	$741.25	—	194% above	40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid c-terminal	$444.75	$741.25	—	—	40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Assay of parathormone	$444.75	$741.25	—	—	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplastin time partial	$64.95	$108.25	—	64% above	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 P t t partial thromboplastin	$64.95	$108.25	—	64% above	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 P t t partial thromboplastin	$64.95	$108.25	—	—	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thromboplastin time partial	$64.95	$108.25	—	—	40%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus	$51.30	$85.50	—	64% above	40%
Phosphorus (phosphate) blood test CPT 84100 Assay of phosphorus	$51.30	$85.50	—	64% above	40%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus	$51.30	$85.50	—	—	40%
Phosphorus (phosphate) blood test inpatient CPT 84100 Assay of phosphorus	$51.30	$85.50	—	—	40%
Potassium blood test CPT 84132 Assay of serum potassium	$51.45	$85.75	—	102% above	40%
Potassium blood test CPT 84132 Potassium (k) serum	$51.45	$85.75	—	102% above	40%
Potassium blood test inpatient CPT 84132 Assay of serum potassium	$51.45	$85.75	—	—	40%
Potassium blood test inpatient CPT 84132 Potassium (k) serum	$51.45	$85.75	—	—	40%
Progesterone blood test CPT 84144 Progesterone	$224.70	$374.50	—	127% above	40%
Progesterone blood test CPT 84144 Assay of progesterone	$224.70	$374.50	—	127% above	40%
Progesterone blood test inpatient CPT 84144 Progesterone	$224.70	$374.50	—	—	40%
Progesterone blood test inpatient CPT 84144 Assay of progesterone	$224.70	$374.50	—	—	40%
Prolactin blood test CPT 84146 Prolactin	$208.95	$348.25	—	235% above	40%
Prolactin blood test CPT 84146 Assay of prolactin	$208.95	$348.25	—	235% above	40%
Prolactin blood test inpatient CPT 84146 Assay of prolactin	$208.95	$348.25	—	—	40%
Prolactin blood test inpatient CPT 84146 Prolactin	$208.95	$348.25	—	—	40%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin time	$46.35	$77.25	—	72% above	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin time	$46.35	$77.25	—	—	40%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug screen non tlc devices	$136.05	$226.75	—	274% above	40%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug test prsmv dir opt obs	$136.05	$226.75	—	274% above	40%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug screen non tlc devices	$136.05	$226.75	—	—	40%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug test prsmv dir opt obs	$136.05	$226.75	—	—	40%
Rapid flu test (influenza antigen) CPT 87804 Influenza assay w/optic	$178.35	$297.25	—	292% above	40%
Rapid flu test (influenza antigen) CPT 87804 Immunoassay w dir oo influenza	$178.35	$297.25	—	292% above	40%
Rapid flu test (influenza antigen) inpatient CPT 87804 Immunoassay w dir oo influenza	$178.35	$297.25	—	—	40%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza assay w/optic	$178.35	$297.25	—	—	40%
Renin blood test CPT 84244 Assay of renin	$237.00	$395.00	—	336% above	40%
Renin blood test CPT 84244 Renin (angiostensin)	$237.00	$395.00	—	336% above	40%
Renin blood test inpatient CPT 84244 Renin (angiostensin)	$237.00	$395.00	—	—	40%
Renin blood test inpatient CPT 84244 Assay of renin	$237.00	$395.00	—	—	40%
Rh blood typing CPT 86901 Rbc antigens (du)	$60.30	$100.50	$38.46–$112.75	114% above	40%
Rh blood typing CPT 86901 Blood typing serologic rh(d)	$60.30	$100.50	$38.46–$112.75	114% above	40%
Rh blood typing inpatient CPT 86901 Blood typing serologic rh(d)	$60.30	$100.50	$38.46–$112.75	—	40%
Rh blood typing inpatient CPT 86901 Rbc antigens (du)	$60.30	$100.50	$38.46–$112.75	—	40%
Rubella antibody test (immunity check) CPT 86762 Rubella titer	$124.50	$207.50	—	152% above	40%
Rubella antibody test (immunity check) CPT 86762 Rubella antibody	$124.50	$207.50	—	152% above	40%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella antibody	$124.50	$207.50	—	—	40%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella titer	$124.50	$207.50	—	—	40%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Rbc sed rate automated	$29.25	$48.75	—	89% above	40%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 E s r (sed rate)	$29.25	$48.75	—	89% above	40%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 E s r (sed rate)	$29.25	$48.75	—	—	40%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Rbc sed rate automated	$29.25	$48.75	—	—	40%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen anal vol/count/mot	$132.90	$221.50	—	66% above	40%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen complete analysis	$132.90	$221.50	—	66% above	40%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen anal vol/count/mot	$132.90	$221.50	—	—	40%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen complete analysis	$132.90	$221.50	—	—	40%
Sodium blood test CPT 84295 Assay of serum sodium	$52.05	$86.75	—	104% above	40%
Sodium blood test CPT 84295 Sodium (na)	$52.05	$86.75	—	104% above	40%
Sodium blood test inpatient CPT 84295 Assay of serum sodium	$52.05	$86.75	—	—	40%
Sodium blood test inpatient CPT 84295 Sodium (na)	$52.05	$86.75	—	—	40%
Stool ova and parasites exam CPT 87177 Ova and parasites smears	$96.00	$160.00	—	109% above	40%
Stool ova and parasites exam CPT 87177 Giardia ag by if	$96.00	$160.00	—	109% above	40%
Stool ova and parasites exam inpatient CPT 87177 Giardia ag by if	$96.00	$160.00	—	—	40%
Stool ova and parasites exam inpatient CPT 87177 Ova and parasites smears	$96.00	$160.00	—	—	40%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult blood feces	$47.55	$79.25	$4.34–$12.71	207% above	40%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Colopak per 1-3 screen	$47.55	$79.25	$4.34–$12.71	207% above	40%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Colopak per 1-3 screen	$47.55	$79.25	$4.34–$12.71	—	40%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult blood feces	$47.55	$79.25	$4.34–$12.71	—	40%
Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema pallidum	$142.80	$238.00	$13.11–$38.43	368% above	40%
Syphilis antibody test (Treponema pallidum) CPT 86780 F t a	$142.80	$238.00	$13.11–$38.43	368% above	40%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 F t a	$142.80	$238.00	$13.11–$38.43	—	40%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema pallidum	$142.80	$238.00	$13.11–$38.43	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis test non-trep qual	$46.05	$76.75	$4.23–$12.39	77% above	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rpr	$46.05	$76.75	$4.23–$12.39	77% above	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis test non-trep qual	$46.05	$76.75	$4.23–$12.39	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rpr	$46.05	$76.75	$4.23–$12.39	—	40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon b test cell immun	$667.35	$1,112.25	—	263% above	40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tb test cell immun measure	$667.35	$1,112.25	—	263% above	40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon b test cell immun	$667.35	$1,112.25	—	—	40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Tb test cell immun measure	$667.35	$1,112.25	—	—	40%
Testosterone blood test, total (not free testosterone) CPT 84403 Assay of total testosterone	$278.25	$463.75	—	244% above	40%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone total	$278.25	$463.75	—	244% above	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone total	$278.25	$463.75	—	—	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Assay of total testosterone	$278.25	$463.75	—	—	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibody each	$156.90	$261.50	—	124% above	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 Anti-microsomal ab	$156.90	$261.50	—	124% above	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Anti-microsomal ab	$156.90	$261.50	—	—	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Microsomal antibody each	$156.90	$261.50	—	—	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Assay thyroid stim hormone	$121.65	$202.75	—	89% above	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 T s h	$121.65	$202.75	—	89% above	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 T s h	$121.65	$202.75	—	—	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Assay thyroid stim hormone	$121.65	$202.75	—	—	40%
Total IgE blood test CPT 82785 Assay of ige	$177.45	$295.75	—	228% above	40%
Total IgE blood test CPT 82785 I g e quantitative	$177.45	$295.75	—	228% above	40%
Total IgE blood test inpatient CPT 82785 Assay of ige	$177.45	$295.75	—	—	40%
Total IgE blood test inpatient CPT 82785 I g e quantitative	$177.45	$295.75	—	—	40%
Total cholesterol blood test CPT 82465 Assay bld/serum cholesterol	$47.10	$78.50	$4.31–$12.63	107% above	40%
Total cholesterol blood test CPT 82465 Cholesterol blood	$47.10	$78.50	$4.31–$12.63	107% above	40%
Total cholesterol blood test inpatient CPT 82465 Cholesterol blood	$47.10	$78.50	$4.31–$12.63	—	40%
Total cholesterol blood test inpatient CPT 82465 Assay bld/serum cholesterol	$47.10	$78.50	$4.31–$12.63	—	40%
Total thyroxine (T4) blood test CPT 84436 Assay of total thyroxine	$74.25	$123.75	—	60% above	40%
Total thyroxine (T4) blood test CPT 84436 Thyroxine (pku)	$74.25	$123.75	—	60% above	40%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine (pku)	$74.25	$123.75	—	—	40%
Total thyroxine (T4) blood test inpatient CPT 84436 Assay of total thyroxine	$74.25	$123.75	—	—	40%
Total triiodothyronine (T3) blood test CPT 84480 Assay triiodothyronine (t3)	$153.00	$255.00	—	95% above	40%
Total triiodothyronine (T3) blood test CPT 84480 T3 ira	$153.00	$255.00	—	95% above	40%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 ira	$153.00	$255.00	—	—	40%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Assay triiodothyronine (t3)	$153.00	$255.00	—	—	40%
Transferrin blood test CPT 84466 Transferrin	$137.55	$229.25	—	148% above	40%
Transferrin blood test CPT 84466 Assay of transferrin	$137.55	$229.25	—	148% above	40%
Transferrin blood test inpatient CPT 84466 Assay of transferrin	$137.55	$229.25	—	—	40%
Transferrin blood test inpatient CPT 84466 Transferrin	$137.55	$229.25	—	—	40%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis amplif	$378.00	$630.00	—	389% above	40%
Trichomonas test (NAAT) CPT 87661 Trichomonas - direct probe	$378.00	$630.00	—	389% above	40%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis amplif	$378.00	$630.00	—	—	40%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas - direct probe	$378.00	$630.00	—	—	40%
Triglycerides blood test CPT 84478 Assay of triglycerides	$61.95	$103.25	$5.68–$16.66	113% above	40%
Triglycerides blood test CPT 84478 Triglycerides	$61.95	$103.25	$5.68–$16.66	113% above	40%
Triglycerides blood test inpatient CPT 84478 Assay of triglycerides	$61.95	$103.25	$5.68–$16.66	—	40%
Triglycerides blood test inpatient CPT 84478 Triglycerides	$61.95	$103.25	$5.68–$16.66	—	40%
Troponin test, quantitative CPT 84484 Troponin-i	$134.40	$224.00	—	80% above	40%
Troponin test, quantitative CPT 84484 Assay of troponin quant	$134.40	$224.00	—	80% above	40%
Troponin test, quantitative inpatient CPT 84484 Troponin-i	$134.40	$224.00	—	—	40%
Troponin test, quantitative inpatient CPT 84484 Assay of troponin quant	$134.40	$224.00	—	—	40%
Uric acid blood test CPT 84550 Assay of blood/uric acid	$48.90	$81.50	—	54% above	40%
Uric acid blood test CPT 84550 Uric acid	$48.90	$81.50	—	54% above	40%
Uric acid blood test inpatient CPT 84550 Assay of blood/uric acid	$48.90	$81.50	—	—	40%
Uric acid blood test inpatient CPT 84550 Uric acid	$48.90	$81.50	—	—	40%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis routine	$34.35	$57.25	—	16% above	40%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis auto w/scope	$34.35	$57.25	—	16% above	40%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis routine	$34.35	$57.25	—	—	40%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis auto w/scope	$34.35	$57.25	—	—	40%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis auto w/o scope	$37.65	$62.75	—	159% above	40%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis w/o microscopy	$37.65	$62.75	—	159% above	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis w/o microscopy	$37.65	$62.75	—	—	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis auto w/o scope	$37.65	$62.75	—	—	40%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis w/o microscopy	$37.65	$62.75	—	204% above	40%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis nonauto w/o scope	$37.65	$62.75	—	204% above	40%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis nonauto w/o scope	$37.65	$62.75	—	—	40%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis w/o microscopy	$37.65	$62.75	—	—	40%
Urine culture for bacteria, with colony count CPT 87086 Urine culture/colony count	$87.15	$145.25	—	53% above	40%
Urine culture for bacteria, with colony count CPT 87086 Culture urine	$87.15	$145.25	—	53% above	40%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine culture/colony count	$87.15	$145.25	—	—	40%
Urine culture for bacteria, with colony count inpatient CPT 87086 Culture urine	$87.15	$145.25	—	—	40%
Urine microalbumin (albumin) test CPT 82043 Urine microalbumin	$62.40	$104.00	—	95% above	40%
Urine microalbumin (albumin) test CPT 82043 Ur albumin quantitative	$62.40	$104.00	—	95% above	40%
Urine microalbumin (albumin) test inpatient CPT 82043 Ur albumin quantitative	$62.40	$104.00	—	—	40%
Urine microalbumin (albumin) test inpatient CPT 82043 Urine microalbumin	$62.40	$104.00	—	—	40%
Urine pregnancy test, read by color change CPT 81025 Urine pregnancy test	$16.65	$27.75	—	25% below	40%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine pregnancy test	$16.65	$27.75	—	—	40%
Vitamin B12 (cobalamin) blood test CPT 82607 B12 assay	$162.60	$271.00	—	102% above	40%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin b-12	$162.60	$271.00	—	102% above	40%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin b-12	$162.60	$271.00	—	—	40%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 B12 assay	$162.60	$271.00	—	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Calcifediol 25 oh vit d 3	$318.90	$531.50	—	282% above	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin d 25 hydroxy	$318.90	$531.50	—	282% above	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Calcifediol 25 oh vit d 3	$318.90	$531.50	—	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin d 25 hydroxy	$318.90	$531.50	—	—	40%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vit d 1 25-dihydroxy	$414.75	$691.25	—	599% above	40%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Dihydroxyvitamin d 125	$414.75	$691.25	—	599% above	40%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Dihydroxyvitamin d 125	$414.75	$691.25	—	—	40%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Vit d 1 25-dihydroxy	$414.75	$691.25	—	—	40%
Zinc blood test CPT 84630 Assay of zinc	$122.85	$204.75	—	224% above	40%
Zinc blood test CPT 84630 Zinc level	$122.85	$204.75	—	224% above	40%
Zinc blood test inpatient CPT 84630 Zinc level	$122.85	$204.75	—	—	40%
Zinc blood test inpatient CPT 84630 Assay of zinc	$122.85	$204.75	—	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Chorionic gonadotropin test	$162.15	$270.25	—	130% above	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Quantitative h c g	$162.15	$270.25	—	130% above	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Quantitative h c g	$162.15	$270.25	—	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Chorionic gonadotropin test	$162.15	$270.25	—	—	40%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs West Virginia	Off list
Appendectomy, open surgery CPT 44950 Appendectomy	$1,345.05	$2,241.75	$6,665.46–$19,542.58	57% below	40%
Appendectomy, open surgery inpatient CPT 44950 Appendectomy	$1,345.05	$2,241.75	$6,665.46–$19,542.58	—	40%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Arthroscopy acl rpr	$17,773.20	$29,622.00	$7,471.01–$21,904.40	130% above	40%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Knee arthroscopy/surgery	$17,773.20	$29,622.00	$7,471.01–$21,904.40	130% above	40%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 Knee arthroscopy/surgery	$17,773.20	$29,622.00	$7,471.01–$21,904.40	—	40%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 Arthroscopy acl rpr	$17,773.20	$29,622.00	$7,471.01–$21,904.40	—	40%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 Arthroscop rotator cuff repr	$31,282.95	$52,138.25	$7,471.01–$21,904.40	530% above	40%
Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 Arthroscop rotator cuff repr	$27,568.84	$45,948.07	$7,471.01–$21,904.40	455% above	40%
Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 Arthroscop rotator cuff repr	$30,500.08	$50,833.47	$7,471.01–$21,904.40	514% above	40%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 Arthroscop rotator cuff repr	$31,282.95	$52,138.25	$7,471.01–$21,904.40	—	40%
Arthroscopic rotator cuff repair of the shoulder inpatient one side CPT 29827 Arthroscop rotator cuff repr	$27,568.84	$45,948.07	$7,471.01–$21,904.40	—	40%
Arthroscopic rotator cuff repair of the shoulder inpatient one side CPT 29827 Arthroscop rotator cuff repr	$30,500.08	$50,833.47	$7,471.01–$21,904.40	—	40%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Correction hallux valgus	$4,922.70	$8,204.50	$3,368.86–$9,877.22	at median	40%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Correct hallus valgus dis met	$4,922.70	$8,204.50	$3,368.86–$9,877.22	at median	40%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 Correction hallux valgus	$4,922.70	$8,204.50	$3,368.86–$9,877.22	—	40%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 Correct hallus valgus dis met	$4,922.70	$8,204.50	$3,368.86–$9,877.22	—	40%
Bunion correction with removal of part of the big toe joint CPT 28292 Correction hallux valgus	$5,100.30	$8,500.50	$3,368.86–$9,877.22	36% above	40%
Bunion correction with removal of part of the big toe joint CPT 28292 Correct hallus vgs prx phlx bs	$5,100.30	$8,500.50	$3,368.86–$9,877.22	36% above	40%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 Correct hallus vgs prx phlx bs	$5,100.30	$8,500.50	$3,368.86–$9,877.22	—	40%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 Correction hallux valgus	$6,737.06	$11,228.44	$3,368.86–$9,877.22	—	40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion elective	$1,295.40	$2,159.00	$680.51–$1,995.20	22% above	40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion electric ext	$1,295.40	$2,159.00	$680.51–$1,995.20	22% above	40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion electric ext	$1,295.40	$2,159.00	$680.51–$1,995.20	—	40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion elective	$1,295.40	$2,159.00	$680.51–$1,995.20	—	40%
Carpal tunnel release, open surgery CPT 64721 Carpal tunnel surgery	$8,051.35	$13,418.91	$2,010.53–$5,894.71	196% above	40%
Carpal tunnel release, open surgery one side CPT 64721 Carpal tunnel surgery	$7,401.67	$12,336.12	$2,010.53–$5,894.71	172% above	40%
Carpal tunnel release, open surgery one side CPT 64721 Carpal tunnel surgery	$7,519.16	$12,531.94	$2,010.53–$5,894.71	176% above	40%
Carpal tunnel release, open surgery inpatient CPT 64721 Carpal tunnel surgery	$8,051.35	$13,418.91	$2,010.53–$5,894.71	—	40%
Carpal tunnel release, open surgery inpatient one side CPT 64721 Carpal tunnel surgery	$7,401.67	$12,336.12	$2,010.53–$5,894.71	—	40%
Carpal tunnel release, open surgery inpatient one side CPT 64721 Carpal tunnel surgery	$7,519.16	$12,531.94	$2,010.53–$5,894.71	—	40%
Cataract surgery with lens implant CPT 66984 Xcapsl ctrc rmvl w/o ecp	$7,457.11	$12,428.52	$2,376.14–$6,966.65	171% above	40%
Cataract surgery with lens implant one side CPT 66984 Xcapsl ctrc rmvl w/o ecp	$7,419.29	$12,365.49	$2,376.14–$6,966.65	169% above	40%
Cataract surgery with lens implant one side CPT 66984 Xcapsl ctrc rmvl w/o ecp	$7,457.11	$12,428.52	$2,376.14–$6,966.65	171% above	40%
Cataract surgery with lens implant inpatient CPT 66984 Xcapsl ctrc rmvl w/o ecp	$7,457.11	$12,428.52	$2,376.14–$6,966.65	—	40%
Cataract surgery with lens implant inpatient one side CPT 66984 Xcapsl ctrc rmvl w/o ecp	$7,419.29	$12,365.49	$2,376.14–$6,966.65	—	40%
Cataract surgery with lens implant inpatient one side CPT 66984 Xcapsl ctrc rmvl w/o ecp	$7,457.11	$12,428.52	$2,376.14–$6,966.65	—	40%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Circum 28 days or older	$343.35	$572.25	$2,152.26–$6,310.26	87% below	40%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 Circum 28 days or older	$343.35	$572.25	$2,152.26–$6,310.26	—	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision w/regionl block	$5,814.66	$9,691.10	$2,152.26–$6,310.26	142% above	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision w/regionl block	$5,814.66	$9,691.10	$2,152.26–$6,310.26	—	40%
Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Colonoscopy w/endoscope us	$9,794.90	$16,324.83	$1,232.06–$3,612.31	—	40%
Colonoscopy with polyp removal CPT 45385 Colonoscopy w/lesion removal	$7,480.99	$12,468.32	$1,232.06–$3,612.31	414% above	40%
Colonoscopy with polyp removal inpatient CPT 45385 Colonoscopy w/lesion removal	$7,480.99	$12,468.32	$1,232.06–$3,612.31	—	40%
Colonoscopy with tissue sample CPT 45380 Colonoscopy and biopsy	$6,910.37	$11,517.29	$1,232.06–$3,612.31	334% above	40%
Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy and biopsy	$26,855.52	$44,759.20	$1,232.06–$3,612.31	—	40%
Colonoscopy, diagnostic CPT 45378 Diagnostic colonoscopy	$4,608.36	$7,680.60	$957.49–$2,807.27	278% above	40%
Colonoscopy, diagnostic inpatient CPT 45378 Diagnostic colonoscopy	$9,794.90	$16,324.83	$957.49–$2,807.27	—	40%
Complex cataract surgery with lens implant CPT 66982 Xcapsl ctrc rmvl cplx wo ecp	$7,737.17	$12,895.29	$2,376.14–$6,966.65	150% above	40%
Complex cataract surgery with lens implant one side CPT 66982 Xcapsl ctrc rmvl cplx wo ecp	$7,298.42	$12,164.04	$2,376.14–$6,966.65	136% above	40%
Complex cataract surgery with lens implant one side CPT 66982 Xcapsl ctrc rmvl cplx wo ecp	$7,737.17	$12,895.29	$2,376.14–$6,966.65	150% above	40%
Complex cataract surgery with lens implant inpatient CPT 66982 Xcapsl ctrc rmvl cplx wo ecp	$7,737.17	$12,895.29	$2,376.14–$6,966.65	—	40%
Complex cataract surgery with lens implant inpatient one side CPT 66982 Xcapsl ctrc rmvl cplx wo ecp	$7,298.42	$12,164.04	$2,376.14–$6,966.65	—	40%
Complex cataract surgery with lens implant inpatient one side CPT 66982 Xcapsl ctrc rmvl cplx wo ecp	$7,737.17	$12,895.29	$2,376.14–$6,966.65	—	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Remove impacted ear wax uni	$128.40	$214.00	$60.74–$178.08	52% above	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Uni removal impacted ear wax	$128.40	$214.00	$60.74–$178.08	52% above	40%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Uni removal impacted ear wax	$128.40	$214.00	$60.74–$178.08	—	40%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Remove impacted ear wax uni	$128.40	$214.00	$60.74–$178.08	—	40%
Earwax removal with instruments, one ear CPT 69210 Remove impacted ear wax uni	$128.40	$214.00	$60.74–$178.08	81% above	40%
Earwax removal with instruments, one ear CPT 69210 Uni remove imp ear wax w instr	$128.40	$214.00	$60.74–$178.08	81% above	40%
Earwax removal with instruments, one ear inpatient CPT 69210 Uni remove imp ear wax w instr	$128.40	$214.00	$60.74–$178.08	—	40%
Earwax removal with instruments, one ear inpatient CPT 69210 Remove impacted ear wax uni	$128.40	$214.00	$60.74–$178.08	—	40%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Njx interlaminar crv/thrc	$2,574.11	$4,290.19	$726.78–$2,130.85	157% above	40%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Njx interlaminar crv/thrc	$2,574.11	$4,290.19	$726.78–$2,130.85	—	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj paravert f jnt l/s 1 lev	$6,636.59	$11,060.99	$910.65–$2,669.97	552% above	40%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 Inj paravert f jnt l/s 1 lev	$2,896.68	$4,827.80	$910.65–$2,669.97	185% above	40%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 Inj paravert f jnt l/s 1 lev	$2,981.96	$4,969.94	$910.65–$2,669.97	193% above	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Inj paravert f jnt l/s 1 lev	$6,636.59	$11,060.99	$910.65–$2,669.97	—	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 Inj paravert f jnt l/s 1 lev	$2,896.68	$4,827.80	$910.65–$2,669.97	—	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 Inj paravert f jnt l/s 1 lev	$2,981.96	$4,969.94	$910.65–$2,669.97	—	40%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Rpr aa hrn 1st 3-10 rdc	$20,502.93	$34,171.55	$6,665.46–$19,542.58	145% above	40%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 Rpr aa hrn 1st 3-10 rdc	$20,502.93	$34,171.55	$6,665.46–$19,542.58	—	40%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 Rpr aa hrn 1st > 10 rdc	$35,919.77	$59,866.29	$6,665.46–$19,542.58	80% above	40%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 Rpr aa hrn 1st > 10 rdc	$35,919.77	$59,866.29	$6,665.46–$19,542.58	—	40%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Rpr aa hrn 1st < 3 cm rdc	$14,434.72	$24,057.87	$3,686.39–$10,808.19	148% above	40%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 Rpr aa hrn 1st < 3 cm rdc	$14,434.72	$24,057.87	$3,686.39–$10,808.19	—	40%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Diagnostic sigmoidoscopy	$224.70	$374.50	$957.49–$2,807.27	74% below	40%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy dx	$224.70	$374.50	$957.49–$2,807.27	74% below	40%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Sigmoidoscopy dx	$224.70	$374.50	$957.49–$2,807.27	—	40%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Diagnostic sigmoidoscopy	$9,794.90	$16,324.83	$957.49–$2,807.27	—	40%
Gallbladder removal, laparoscopic CPT 47562 Laparoscopic cholecystectomy	$16,512.67	$27,521.11	$6,224.48–$18,249.69	70% above	40%
Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopic cholecystectomy	$41,543.32	$69,238.86	$6,224.48–$18,249.69	—	40%
Gallbladder removal, open surgery through a larger incision CPT 47600 Cholectstectomy	$1,823.10	$3,038.50	—	at median	40%
Gallbladder removal, open surgery through a larger incision CPT 47600 Removal of gallbladder	$1,823.10	$3,038.50	—	at median	40%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 Cholectstectomy	$1,823.10	$3,038.50	—	—	40%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 Removal of gallbladder	$6,227.92	$10,379.87	—	—	40%
Hammertoe correction surgery CPT 28285 Repair of hammertoe	$22,808.89	$38,014.82	$3,368.86–$9,877.22	574% above	40%
Hammertoe correction surgery inpatient CPT 28285 Repair of hammertoe	$6,737.06	$11,228.44	$3,368.86–$9,877.22	—	40%
Hemorrhoid banding (rubber band ligation) CPT 46221 Ligation of hemorrhoid(s)	$6,993.90	$11,656.50	$957.49–$2,807.27	492% above	40%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 Ligation of hemorrhoid(s)	$6,993.90	$11,656.50	$957.49–$2,807.27	—	40%
Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorrhoidectomy int ext sing	$626.85	$1,044.75	$2,857.82–$8,378.91	88% below	40%
Hemorrhoidectomy (internal and external), one area CPT 46255 Remove int/ext hem 1 group	$626.85	$1,044.75	$2,857.82–$8,378.91	88% below	40%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 Hemorrhoidectomy int ext sing	$626.85	$1,044.75	$2,857.82–$8,378.91	—	40%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 Remove int/ext hem 1 group	$626.85	$1,044.75	$2,857.82–$8,378.91	—	40%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 Total hip arthroplasty	$55,997.21	$93,328.69	$13,218.73–$38,756.24	—	40%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 Total hysterectomy	$26,862.34	$44,770.57	—	—	40%
Incision and drainage of a simple or single skin abscess CPT 10060 Drainage of skin abscess	$311.10	$518.50	$206.57–$605.66	34% above	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Drainage of skin abscess	$17,962.00	$29,936.66	$206.57–$605.66	—	40%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Prp i/hern init reduc >5 yr	$19,000.28	$31,667.13	$3,686.39–$10,808.19	281% above	40%
Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 Prp i/hern init reduc >5 yr	$15,820.93	$26,368.21	$3,686.39–$10,808.19	217% above	40%
Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 Prp i/hern init reduc >5 yr	$19,000.28	$31,667.13	$3,686.39–$10,808.19	281% above	40%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Prp i/hern init reduc >5 yr	$19,000.28	$31,667.13	$3,686.39–$10,808.19	—	40%
Inguinal (groin) hernia repair, age 5 or older inpatient one side CPT 49505 Prp i/hern init reduc >5 yr	$15,820.93	$26,368.21	$3,686.39–$10,808.19	—	40%
Inguinal (groin) hernia repair, age 5 or older inpatient one side CPT 49505 Prp i/hern init reduc >5 yr	$19,000.28	$31,667.13	$3,686.39–$10,808.19	—	40%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj tendon sheath/ligament	$741.60	$1,236.00	$316.04–$926.60	123% above	40%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj sgl tendon shth/ligament	$741.60	$1,236.00	$316.04–$926.60	123% above	40%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj tendon sheath/ligament	$741.60	$1,236.00	$316.04–$926.60	—	40%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj sgl tendon shth/ligament	$741.60	$1,236.00	$316.04–$926.60	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain/inj joint/bursa w/o us	$2,648.30	$4,413.83	$316.04–$926.60	696% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Drain/inj joint/bursa w/o us	$1,754.62	$2,924.37	$316.04–$926.60	428% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Drain/inj joint/bursa w/o us	$1,935.93	$3,226.55	$316.04–$926.60	482% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Drain/inj joint/bursa w/o us	$9,939.08	$16,565.13	$316.04–$926.60	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Drain/inj joint/bursa w/o us	$1,754.62	$2,924.37	$316.04–$926.60	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Drain/inj joint/bursa w/o us	$1,935.93	$3,226.55	$316.04–$926.60	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain/inj joint/bursa w/o us	$741.60	$1,236.00	$316.04–$926.60	116% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Aspiration inj interm jnt burs	$741.60	$1,236.00	$316.04–$926.60	116% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Aspiration inj interm jnt burs	$741.60	$1,236.00	$316.04–$926.60	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Drain/inj joint/bursa w/o us	$9,939.08	$16,565.13	$316.04–$926.60	—	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Drain/inj joint/bursa w/o us	$741.60	$1,236.00	$316.04–$926.60	112% above	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Aspiration inj sml jnt bursa	$741.60	$1,236.00	$316.04–$926.60	112% above	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Aspiration inj sml jnt bursa	$741.60	$1,236.00	$316.04–$926.60	—	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Drain/inj joint/bursa w/o us	$9,939.08	$16,565.13	$316.04–$926.60	—	40%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Knee arthroscopy/surgery	$15,222.35	$25,370.59	$3,368.86–$9,877.22	175% above	40%
Knee arthroscopy with meniscus repair (one side of the knee) one side CPT 29882 Knee arthroscopy/surgery	$12,076.48	$20,127.46	$3,368.86–$9,877.22	118% above	40%
Knee arthroscopy with meniscus repair (one side of the knee) one side CPT 29882 Knee arthroscopy/surgery	$13,334.83	$22,224.71	$3,368.86–$9,877.22	141% above	40%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 Knee arthroscopy/surgery	$15,222.35	$25,370.59	$3,368.86–$9,877.22	—	40%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient one side CPT 29882 Knee arthroscopy/surgery	$12,076.48	$20,127.46	$3,368.86–$9,877.22	—	40%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient one side CPT 29882 Knee arthroscopy/surgery	$13,334.83	$22,224.71	$3,368.86–$9,877.22	—	40%
Knee arthroscopy with meniscus trim CPT 29881 Knee arthroscopy/surgery	$12,044.82	$20,074.70	$3,368.86–$9,877.22	145% above	40%
Knee arthroscopy with meniscus trim one side CPT 29881 Knee arthroscopy/surgery	$11,537.56	$19,229.26	$3,368.86–$9,877.22	134% above	40%
Knee arthroscopy with meniscus trim one side CPT 29881 Knee arthroscopy/surgery	$11,869.82	$19,783.04	$3,368.86–$9,877.22	141% above	40%
Knee arthroscopy with meniscus trim inpatient CPT 29881 Knee arthroscopy/surgery	$12,044.82	$20,074.70	$3,368.86–$9,877.22	—	40%
Knee arthroscopy with meniscus trim inpatient one side CPT 29881 Knee arthroscopy/surgery	$11,537.56	$19,229.26	$3,368.86–$9,877.22	—	40%
Knee arthroscopy with meniscus trim inpatient one side CPT 29881 Knee arthroscopy/surgery	$11,869.82	$19,783.04	$3,368.86–$9,877.22	—	40%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Knee arthroscopy/surgery	$11,976.23	$19,960.38	$3,368.86–$9,877.22	160% above	40%
Knee arthroscopy with removal of both torn meniscus parts one side CPT 29880 Knee arthroscopy/surgery	$12,593.26	$20,988.77	$3,368.86–$9,877.22	174% above	40%
Knee arthroscopy with removal of both torn meniscus parts one side CPT 29880 Knee arthroscopy/surgery	$13,111.22	$21,852.03	$3,368.86–$9,877.22	185% above	40%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 Knee arthroscopy/surgery	$11,976.23	$19,960.38	$3,368.86–$9,877.22	—	40%
Knee arthroscopy with removal of both torn meniscus parts inpatient one side CPT 29880 Knee arthroscopy/surgery	$12,593.26	$20,988.77	$3,368.86–$9,877.22	—	40%
Knee arthroscopy with removal of both torn meniscus parts inpatient one side CPT 29880 Knee arthroscopy/surgery	$13,111.22	$21,852.03	$3,368.86–$9,877.22	—	40%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Knee arthroscopy/surgery	$33,566.95	$55,944.91	$3,368.86–$9,877.22	610% above	40%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) one side CPT 29877 Knee arthroscopy/surgery	$33,566.95	$55,944.91	$3,368.86–$9,877.22	610% above	40%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 Knee arthroscopy/surgery	$33,566.95	$55,944.91	$3,368.86–$9,877.22	—	40%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient one side CPT 29877 Knee arthroscopy/surgery	$33,566.95	$55,944.91	$3,368.86–$9,877.22	—	40%
Laparoscopic Roux-en-Y gastric bypass, standard limb length inpatient CPT 43644 Lap gastric bypass/roux-en-y	$21,300.46	$35,500.77	—	—	40%
Laparoscopic adjustable gastric band placement (Lap-Band) inpatient CPT 43770 Lap place gastr adj device	$21,300.46	$35,500.77	$10,944.49–$32,088.37	—	40%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Laparoscopy appendectomy	$24,780.80	$41,301.33	$6,224.48–$18,249.69	240% above	40%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 Laparoscopy appendectomy	$12,685.66	$21,142.77	$6,224.48–$18,249.69	—	40%
Laparoscopic removal of an adjustable gastric band and its port inpatient CPT 43774 Lap rmvl gastr adj all parts	$21,300.46	$35,500.77	$3,969.60–$11,638.55	—	40%
Laparoscopic sleeve gastrectomy for weight loss inpatient CPT 43775 Lap sleeve gastrectomy	$21,300.46	$35,500.77	—	—	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Layer closure <2.5cm sat	$796.95	$1,328.25	$418.55–$1,227.15	88% above	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Intmd rpr s/a/t/ext 2.5 cm/<	$796.95	$1,328.25	$418.55–$1,227.15	88% above	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Intmd rpr s/a/t/ext 2.5 cm/<	$796.95	$1,328.25	$418.55–$1,227.15	—	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Layer closure <2.5cm sat	$796.95	$1,328.25	$418.55–$1,227.15	—	40%
Lower-back epidural injection, with imaging guidance CPT 62323 Njx interlaminar lmbr/sac	$2,550.97	$4,251.62	$726.78–$2,130.85	130% above	40%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Njx interlaminar lmbr/sac	$2,550.97	$4,251.62	$726.78–$2,130.85	—	40%
Lower-back epidural injection, without imaging guidance CPT 62322 Njx interlaminar lmbr/sac	$1,802.10	$3,003.50	$910.65–$2,669.97	56% above	40%
Lower-back epidural injection, without imaging guidance CPT 62322 Inj spine l/s wo imaging	$1,802.10	$3,003.50	$910.65–$2,669.97	56% above	40%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Njx interlaminar lmbr/sac	$1,802.10	$3,003.50	$910.65–$2,669.97	—	40%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Inj spine l/s wo imaging	$1,802.10	$3,003.50	$910.65–$2,669.97	—	40%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj foramen epidural l/s	$2,925.77	$4,876.29	$910.65–$2,669.97	114% above	40%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 Inj foramen epidural l/s	$3,053.64	$5,089.40	$910.65–$2,669.97	123% above	40%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 Inj foramen epidural l/s	$3,067.88	$5,113.13	$910.65–$2,669.97	124% above	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Inj foramen epidural l/s	$2,925.77	$4,876.29	$910.65–$2,669.97	—	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 Inj foramen epidural l/s	$3,053.64	$5,089.40	$910.65–$2,669.97	—	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 Inj foramen epidural l/s	$3,067.88	$5,113.13	$910.65–$2,669.97	—	40%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 Low back disk surgery	$26,670.70	$44,451.17	$7,471.01–$21,904.40	366% above	40%
Lumbar discectomy or laminotomy to free a nerve root, one level one side CPT 63030 Low back disk surgery	$26,670.70	$44,451.17	$7,471.01–$21,904.40	366% above	40%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 Low back disk surgery	$26,670.70	$44,451.17	$7,471.01–$21,904.40	—	40%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient one side CPT 63030 Low back disk surgery	$26,670.70	$44,451.17	$7,471.01–$21,904.40	—	40%
Lumbar laminectomy (spinal decompression), one level CPT 63047 Remove spine lamina 1 lmbr	$26,956.15	$44,926.92	$7,471.01–$21,904.40	182% above	40%
Lumbar laminectomy (spinal decompression), one level inpatient CPT 63047 Remove spine lamina 1 lmbr	$26,956.15	$44,926.92	$7,471.01–$21,904.40	—	40%
Lumbar spinal fusion (posterior), one level CPT 22612 Lumbar spine fusion	$34,988.25	$58,313.75	$18,052.85–$52,929.49	155% above	40%
Lumbar spinal fusion (posterior), one level inpatient CPT 22612 Lumbar spine fusion	$34,988.25	$58,313.75	$18,052.85–$52,929.49	—	40%
Lumpectomy (partial mastectomy) CPT 19301 Partial mastectomy	$11,624.55	$19,374.25	$4,031.34–$11,819.55	162% above	40%
Lumpectomy (partial mastectomy) one side CPT 19301 Partial mastectomy	$11,624.55	$19,374.25	$4,031.34–$11,819.55	162% above	40%
Lumpectomy (partial mastectomy) inpatient CPT 19301 Partial mastectomy	$11,624.55	$19,374.25	$4,031.34–$11,819.55	—	40%
Lumpectomy (partial mastectomy) inpatient one side CPT 19301 Partial mastectomy	$11,624.55	$19,374.25	$4,031.34–$11,819.55	—	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc tr-ext b9+marg 0.5 cm<	$156.00	$260.00	$729.09–$2,137.65	76% below	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc benign lesion tal =<0.5cm	$156.00	$260.00	$729.09–$2,137.65	76% below	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Exc tr-ext b9+marg 0.5 cm<	$156.00	$260.00	$729.09–$2,137.65	—	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Exc benign lesion tal =<0.5cm	$156.00	$260.00	$729.09–$2,137.65	—	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Exc face-mm b9+marg 0.5 cm/<	$9,336.00	$15,560.00	$729.09–$2,137.65	1261% above	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Exc face-mm b9+marg 0.5 cm/<	$9,336.00	$15,560.00	$729.09–$2,137.65	—	40%
Nail removal (partial or complete), one nail CPT 11730 Removal of nail plate	$414.30	$690.50	$206.57–$605.66	59% above	40%
Nail removal (partial or complete), one nail CPT 11730 Removal nail plate	$414.30	$690.50	$206.57–$605.66	59% above	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 Removal nail plate	$414.30	$690.50	$206.57–$605.66	—	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 Removal of nail plate	$414.30	$690.50	$206.57–$605.66	—	40%
Occipital nerve block (injection for headaches) CPT 64405 Njx aa&/strd gr ocpl nrv	$1,152.00	$1,920.00	$316.04–$926.60	214% above	40%
Occipital nerve block (injection for headaches) one side CPT 64405 Njx aa&/strd gr ocpl nrv	$1,152.00	$1,920.00	$316.04–$926.60	214% above	40%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Njx aa&/strd gr ocpl nrv	$1,152.00	$1,920.00	$316.04–$926.60	—	40%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 Njx aa&/strd gr ocpl nrv	$1,152.00	$1,920.00	$316.04–$926.60	—	40%
Paracentesis with imaging guidance CPT 49083 Abd paracentesis w/imaging	$1,365.30	$2,275.50	$933.83–$2,737.92	1% below	40%
Paracentesis with imaging guidance CPT 49083 Abdominal paracentesis w image	$1,365.30	$2,275.50	$933.83–$2,737.92	1% below	40%
Paracentesis with imaging guidance inpatient CPT 49083 Abdominal paracentesis w image	$1,365.30	$2,275.50	$933.83–$2,737.92	—	40%
Paracentesis with imaging guidance inpatient CPT 49083 Abd paracentesis w/imaging	$1,365.30	$2,275.50	$933.83–$2,737.92	—	40%
Partial knee replacement (one compartment) CPT 27446 Arthroscopy knee medial/lat	$34,988.25	$58,313.75	$13,218.73–$38,756.24	327% above	40%
Partial knee replacement (one compartment) CPT 27446 Revision of knee joint	$34,988.25	$58,313.75	$13,218.73–$38,756.24	327% above	40%
Partial knee replacement (one compartment) inpatient CPT 27446 Revision of knee joint	$34,988.25	$58,313.75	$13,218.73–$38,756.24	—	40%
Partial knee replacement (one compartment) inpatient CPT 27446 Arthroscopy knee medial/lat	$34,988.25	$58,313.75	$13,218.73–$38,756.24	—	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Removal of nail bed	$1,726.47	$2,877.45	$418.55–$1,227.15	270% above	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Removal of nail bed	$1,726.47	$2,877.45	$418.55–$1,227.15	—	40%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Destroy lumb/sac facet jnt	$18,274.56	$30,457.60	$2,010.53–$5,894.71	732% above	40%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 Destroy lumb/sac facet jnt	$9,053.59	$15,089.32	$2,010.53–$5,894.71	312% above	40%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 Destroy lumb/sac facet jnt	$9,077.99	$15,129.98	$2,010.53–$5,894.71	313% above	40%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Destroy lumb/sac facet jnt	$18,274.56	$30,457.60	$2,010.53–$5,894.71	—	40%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient one side CPT 64635 Destroy lumb/sac facet jnt	$9,053.59	$15,089.32	$2,010.53–$5,894.71	—	40%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient one side CPT 64635 Destroy lumb/sac facet jnt	$9,077.99	$15,129.98	$2,010.53–$5,894.71	—	40%
Removal of a breast lump, open surgery CPT 19120 Removal of breast lesion	$5,650.35	$9,417.25	$4,031.34–$11,819.55	31% above	40%
Removal of a breast lump, open surgery one side CPT 19120 Removal of breast lesion	$5,650.35	$9,417.25	$4,031.34–$11,819.55	31% above	40%
Removal of a breast lump, open surgery inpatient CPT 19120 Removal of breast lesion	$5,650.35	$9,417.25	$4,031.34–$11,819.55	—	40%
Removal of a breast lump, open surgery inpatient one side CPT 19120 Removal of breast lesion	$5,650.35	$9,417.25	$4,031.34–$11,819.55	—	40%
Removal of a foreign object under the skin, simple CPT 10120 Remove foreign body	$613.20	$1,022.00	$418.55–$1,227.15	58% above	40%
Removal of a foreign object under the skin, simple CPT 10120 Incision & removal fb simple	$613.20	$1,022.00	$418.55–$1,227.15	58% above	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision & removal fb simple	$613.20	$1,022.00	$418.55–$1,227.15	—	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Remove foreign body	$17,962.00	$29,936.66	$418.55–$1,227.15	—	40%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colon ca scrn not hi rsk ind	$3,357.63	$5,596.05	$957.49–$2,807.27	124% above	40%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 Colon ca scrn not hi rsk ind	$3,357.63	$5,596.05	$957.49–$2,807.27	—	40%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal scrn; hi risk ind	$3,448.58	$5,747.63	$957.49–$2,807.27	149% above	40%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 Colorectal scrn; hi risk ind	$3,448.58	$5,747.63	$957.49–$2,807.27	—	40%
Short arm cast (elbow to hand) CPT 29075 Cast application short arm	$18,317.25	$30,528.75	$287.97–$844.31	6260% above	40%
Short arm cast (elbow to hand) CPT 29075 Application of forearm cast	$18,317.25	$30,528.75	$287.97–$844.31	6260% above	40%
Short arm cast (elbow to hand) inpatient CPT 29075 Application of forearm cast	$18,317.25	$30,528.75	$287.97–$844.31	—	40%
Short arm cast (elbow to hand) inpatient CPT 29075 Cast application short arm	$18,317.25	$30,528.75	$287.97–$844.31	—	40%
Short arm splint (forearm and hand) CPT 29125 Application short arm splint	$260.10	$433.50	$136.99–$401.63	41% above	40%
Short arm splint (forearm and hand) CPT 29125 Apply forearm splint	$260.10	$433.50	$136.99–$401.63	41% above	40%
Short arm splint (forearm and hand) inpatient CPT 29125 Application short arm splint	$260.10	$433.50	$136.99–$401.63	—	40%
Short arm splint (forearm and hand) inpatient CPT 29125 Apply forearm splint	$260.10	$433.50	$136.99–$401.63	—	40%
Short leg cast (below the knee) CPT 29405 Apply short leg cast	$556.50	$927.50	$287.97–$844.31	75% above	40%
Short leg cast (below the knee) CPT 29405 Application short leg cast	$556.50	$927.50	$287.97–$844.31	75% above	40%
Short leg cast (below the knee) inpatient CPT 29405 Apply short leg cast	$556.50	$927.50	$287.97–$844.31	—	40%
Short leg cast (below the knee) inpatient CPT 29405 Application short leg cast	$556.50	$927.50	$287.97–$844.31	—	40%
Short leg splint (calf to foot) CPT 29515 Application lower leg splint	$325.95	$543.25	$167.31–$490.54	41% above	40%
Short leg splint (calf to foot) CPT 29515 Application short leg cast	$325.95	$543.25	$167.31–$490.54	41% above	40%
Short leg splint (calf to foot) inpatient CPT 29515 Application short leg cast	$325.95	$543.25	$167.31–$490.54	—	40%
Short leg splint (calf to foot) inpatient CPT 29515 Application lower leg splint	$325.95	$543.25	$167.31–$490.54	—	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Shoulder arthroscopy/surgery	$36,659.33	$61,098.88	$3,368.86–$9,877.22	1831% above	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) one side CPT 29824 Shoulder arthroscopy/surgery	$36,946.18	$61,576.97	$3,368.86–$9,877.22	1846% above	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) one side CPT 29824 Shoulder arthroscopy/surgery	$38,805.09	$64,675.15	$3,368.86–$9,877.22	1944% above	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 Shoulder arthroscopy/surgery	$36,659.33	$61,098.88	$3,368.86–$9,877.22	—	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient one side CPT 29824 Shoulder arthroscopy/surgery	$36,946.18	$61,576.97	$3,368.86–$9,877.22	—	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient one side CPT 29824 Shoulder arthroscopy/surgery	$38,805.09	$64,675.15	$3,368.86–$9,877.22	—	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shoulder arthroscopy/surgery	$29,625.85	$49,376.41	—	1398% above	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 Shoulder arthroscopy/surgery	$28,760.38	$47,933.97	—	1354% above	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 Shoulder arthroscopy/surgery	$30,529.07	$50,881.79	—	1444% above	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Shoulder arthroscopy/surgery	$29,625.85	$49,376.41	—	—	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient one side CPT 29826 Shoulder arthroscopy/surgery	$28,760.38	$47,933.97	—	—	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient one side CPT 29826 Shoulder arthroscopy/surgery	$30,529.07	$50,881.79	—	—	40%
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/<	$414.30	$690.50	$206.57–$605.66	46% above	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Rpr superficial wnd 2.5cm less	$414.30	$690.50	$206.57–$605.66	46% above	40%
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/<	$414.30	$690.50	$206.57–$605.66	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Rpr superficial wnd 2.5cm less	$414.30	$690.50	$206.57–$605.66	—	40%
Skin biopsy, punch, one lesion CPT 11104 Punch biopsy skin 1 lesion	$613.20	$1,022.00	$418.55–$1,227.15	62% above	40%
Skin biopsy, punch, one lesion CPT 11104 Punch bx skin single lesion	$613.20	$1,022.00	$418.55–$1,227.15	62% above	40%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch biopsy skin 1 lesion	$613.20	$1,022.00	$418.55–$1,227.15	—	40%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch bx skin single lesion	$613.20	$1,022.00	$418.55–$1,227.15	—	40%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Exc tr-ext mal+marg 0.5 cm/<	$265.95	$443.25	$729.09–$2,137.65	67% below	40%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Exc mal lesion tal =<0.5 cm	$265.95	$443.25	$729.09–$2,137.65	67% below	40%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Exc mal lesion tal =<0.5 cm	$265.95	$443.25	$729.09–$2,137.65	—	40%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Exc tr-ext mal+marg 0.5 cm/<	$5,492.16	$9,153.60	$729.09–$2,137.65	—	40%
Skin tag removal, up to 15 tags CPT 11200 Removal of skin tags <w/15	$509.85	$849.75	$206.57–$605.66	160% above	40%
Skin tag removal, up to 15 tags CPT 11200 Rem skin tags <=15 lesions	$509.85	$849.75	$206.57–$605.66	160% above	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 Rem skin tags <=15 lesions	$509.85	$849.75	$206.57–$605.66	—	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 Removal of skin tags <w/15	$8,496.85	$14,161.42	$206.57–$605.66	—	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Dx lmbr spi pnxr	$1,464.15	$2,440.25	$726.78–$2,130.85	47% above	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal puncture lumbar dx	$1,464.15	$2,440.25	$726.78–$2,130.85	47% above	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal puncture lumbar dx	$1,464.15	$2,440.25	$726.78–$2,130.85	—	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Dx lmbr spi pnxr	$1,464.15	$2,440.25	$726.78–$2,130.85	—	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Rpr superficial wnd 2.6-7.5 cm	$414.30	$690.50	$206.57–$605.66	60% above	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Rpr s/n/ax/gen/trnk2.6-7.5cm	$414.30	$690.50	$206.57–$605.66	60% above	40%
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 superficial wnd 2.6-7.5 cm	$414.30	$690.50	$206.57–$605.66	—	40%
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 s/n/ax/gen/trnk2.6-7.5cm	$414.30	$690.50	$206.57–$605.66	—	40%
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/<	$414.30	$690.50	$206.57–$605.66	44% above	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Repair simple <2-5cm feenl	$414.30	$690.50	$206.57–$605.66	44% above	40%
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/<	$414.30	$690.50	$206.57–$605.66	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Repair simple <2-5cm feenl	$414.30	$690.50	$206.57–$605.66	—	40%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential biopsy skin 1 les	$318.75	$531.25	$418.55–$1,227.15	4% below	40%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangntl bx skin single les	$318.75	$531.25	$418.55–$1,227.15	4% below	40%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangntl bx skin single les	$318.75	$531.25	$418.55–$1,227.15	—	40%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential biopsy skin 1 les	$318.75	$531.25	$418.55–$1,227.15	—	40%
Thoracentesis with imaging guidance CPT 32555 Aspirate pleura w/ imaging	$10,556.39	$17,593.98	$645.87–$1,893.65	782% above	40%
Thoracentesis with imaging guidance inpatient CPT 32555 Aspirate pleura w/ imaging	$10,556.39	$17,593.98	$645.87–$1,893.65	—	40%
Tonsil and adenoid removal, age 12 or older CPT 42821 Remove tonsils and adenoids	$517.50	$862.50	$3,413.60–$10,008.41	87% below	40%
Tonsil and adenoid removal, age 12 or older CPT 42821 Tonsillectomy & adenoid 12+	$517.50	$862.50	$3,413.60–$10,008.41	87% below	40%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 Tonsillectomy & adenoid 12+	$517.50	$862.50	$3,413.60–$10,008.41	—	40%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 Remove tonsils and adenoids	$517.50	$862.50	$3,413.60–$10,008.41	—	40%
Tonsil and adenoid removal, child under 12 CPT 42820 Tonsillectomy & adenoid <12 yr	$496.95	$828.25	$6,095.07–$17,870.24	86% below	40%
Tonsil and adenoid removal, child under 12 CPT 42820 Remove tonsils and adenoids	$496.95	$828.25	$6,095.07–$17,870.24	86% below	40%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 Remove tonsils and adenoids	$496.95	$828.25	$6,095.07–$17,870.24	—	40%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 Tonsillectomy & adenoid <12 yr	$496.95	$828.25	$6,095.07–$17,870.24	—	40%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Removal of tonsils	$429.30	$715.50	$3,413.60–$10,008.41	88% below	40%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Tonsillectomy age 12+	$429.30	$715.50	$3,413.60–$10,008.41	88% below	40%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 Removal of tonsils	$429.30	$715.50	$3,413.60–$10,008.41	—	40%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 Tonsillectomy age 12+	$429.30	$715.50	$3,413.60–$10,008.41	—	40%
Total hip replacement CPT 27130 Total hip arthroplasty	$60,643.57	$101,072.62	$13,218.73–$38,756.24	496% above	40%
Total hip replacement one side CPT 27130 Total hip arthroplasty	$58,997.09	$98,328.49	$13,218.73–$38,756.24	480% above	40%
Total hip replacement one side CPT 27130 Total hip arthroplasty	$62,351.76	$103,919.60	$13,218.73–$38,756.24	513% above	40%
Total hip replacement inpatient CPT 27130 Total hip arthroplasty	$55,997.21	$93,328.69	$13,218.73–$38,756.24	—	40%
Total hip replacement inpatient one side CPT 27130 Total hip arthroplasty	$58,997.09	$98,328.49	$13,218.73–$38,756.24	—	40%
Total hip replacement inpatient one side CPT 27130 Total hip arthroplasty	$62,351.76	$103,919.60	$13,218.73–$38,756.24	—	40%
Total knee replacement CPT 27447 Total knee arthroplasty	$47,427.75	$79,046.25	$13,218.73–$38,756.24	366% above	40%
Total knee replacement one side CPT 27447 Total knee arthroplasty	$46,996.97	$78,328.28	$13,218.73–$38,756.24	362% above	40%
Total knee replacement one side CPT 27447 Total knee arthroplasty	$48,657.31	$81,095.52	$13,218.73–$38,756.24	378% above	40%
Total knee replacement inpatient CPT 27447 Total knee arthroplasty	$24,084.96	$40,141.60	$13,218.73–$38,756.24	—	40%
Total knee replacement inpatient one side CPT 27447 Total knee arthroplasty	$46,996.97	$78,328.28	$13,218.73–$38,756.24	—	40%
Total knee replacement inpatient one side CPT 27447 Total knee arthroplasty	$48,657.31	$81,095.52	$13,218.73–$38,756.24	—	40%
Total shoulder replacement CPT 23472 Reconstruct shoulder joint	$27,623.87	$46,039.78	$18,052.85–$52,929.49	178% above	40%
Total shoulder replacement one side CPT 23472 Reconstruct shoulder joint	$26,868.02	$44,780.04	$18,052.85–$52,929.49	170% above	40%
Total shoulder replacement one side CPT 23472 Reconstruct shoulder joint	$27,623.87	$46,039.78	$18,052.85–$52,929.49	178% above	40%
Total shoulder replacement inpatient CPT 23472 Reconstruct shoulder joint	$27,623.87	$46,039.78	$18,052.85–$52,929.49	—	40%
Total shoulder replacement inpatient one side CPT 23472 Reconstruct shoulder joint	$26,868.02	$44,780.04	$18,052.85–$52,929.49	—	40%
Total shoulder replacement inpatient one side CPT 23472 Reconstruct shoulder joint	$27,623.87	$46,039.78	$18,052.85–$52,929.49	—	40%
Trigger finger release surgery CPT 26055 Incise finger tendon sheath	$10,000.06	$16,666.77	$1,655.59–$4,854.06	436% above	40%
Trigger finger release surgery inpatient CPT 26055 Incise finger tendon sheath	$10,000.06	$16,666.77	$1,655.59–$4,854.06	—	40%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj trigger point 1/2 muscl	$2,998.95	$4,998.25	$316.04–$926.60	920% above	40%
Trigger point injections, 1 or 2 muscles one side CPT 20552 Inj trigger point 1/2 muscl	$984.68	$1,641.13	$316.04–$926.60	235% above	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj trigger point 1/2 muscl	$2,998.95	$4,998.25	$316.04–$926.60	—	40%
Trigger point injections, 1 or 2 muscles inpatient one side CPT 20552 Inj trigger point 1/2 muscl	$984.68	$1,641.13	$316.04–$926.60	—	40%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 Laparoscopy tubal cautery	$15,424.46	$25,707.43	$6,224.48–$18,249.69	10% above	40%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 Laparoscopy tubal cautery	$15,424.46	$25,707.43	$6,224.48–$18,249.69	—	40%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Esoph egd dilation <30 mm	$25,195.83	$41,993.05	$1,975.71–$5,792.62	1506% above	40%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 Esoph egd dilation <30 mm	$21,300.46	$35,500.77	$1,975.71–$5,792.62	—	40%
Upper endoscopy (EGD) with biopsy CPT 43239 Egd biopsy single/multiple	$6,739.51	$11,232.51	$933.83–$2,737.92	537% above	40%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Egd biopsy single/multiple	$26,866.05	$44,776.75	$933.83–$2,737.92	—	40%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 Uppr gi scope w/submuc inj	$21,300.46	$35,500.77	$933.83–$2,737.92	—	40%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Egd remove lesion snare	$8,271.05	$13,785.08	$1,975.71–$5,792.62	469% above	40%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 Egd remove lesion snare	$21,300.46	$35,500.77	$1,975.71–$5,792.62	—	40%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 Egd guide wire insertion	$21,300.46	$35,500.77	$933.83–$2,737.92	—	40%
Upper endoscopy (EGD), diagnostic CPT 43235 Egd diagnostic brush wash	$5,952.70	$9,921.17	$933.83–$2,737.92	438% above	40%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Egd diagnostic brush wash	$26,866.05	$44,776.75	$933.83–$2,737.92	—	40%
Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 Egd w/transmural drain cyst	$21,300.46	$35,500.77	$6,250.61–$18,326.27	—	40%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Removal of sperm duct(s)	$7,648.84	$12,748.06	$2,152.26–$6,310.26	201% above	40%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 Removal of sperm duct(s)	$7,648.84	$12,748.06	$2,152.26–$6,310.26	—	40%
Wart removal, up to 14 warts CPT 17110 Destruct b9 lesion 1-14	$4,664.91	$7,774.85	$206.57–$605.66	2162% above	40%
Wart removal, up to 14 warts inpatient CPT 17110 Destruct b9 lesion 1-14	$4,664.91	$7,774.85	$206.57–$605.66	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Deb subq tissue 20 sq cm/<	$716.45	$1,194.09	$418.55–$1,227.15	91% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Deb subq tissue 20 sq cm/<	$8,496.85	$14,161.42	$418.55–$1,227.15	—	40%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 Txx fx radial ex articular fx	$17,773.20	$29,622.00	$7,471.01–$21,904.40	147% above	40%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 Treat fx rad extra-articul	$17,773.20	$29,622.00	$7,471.01–$21,904.40	147% above	40%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 Treat fx rad extra-articul	$17,773.20	$29,622.00	$7,471.01–$21,904.40	—	40%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 Txx fx radial ex articular fx	$17,773.20	$29,622.00	$7,471.01–$21,904.40	—	40%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs West Virginia	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Blood transfusion	$704.10	$1,173.50	$454.23–$1,331.78	11% above	40%
Blood transfusion (giving blood or blood components) CPT 36430 Blood transfusion service	$704.10	$1,173.50	$454.23–$1,331.78	11% above	40%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood transfusion	$704.10	$1,173.50	$454.23–$1,331.78	—	40%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood transfusion service	$13,739.67	$22,899.45	$454.23–$1,331.78	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation tx sputum induction	$200.25	$333.75	$225.46–$661.03	19% above	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway inhalation treatment	$200.25	$333.75	$225.46–$661.03	19% above	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway inhalation treatment	$200.25	$333.75	$225.46–$661.03	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Inhalation tx sputum induction	$200.25	$333.75	$225.46–$661.03	—	40%
Chemotherapy IV infusion, first hour CPT 96413 Chemo iv infusion 1 hr	$735.30	$1,225.50	$340.08–$997.10	20% above	40%
Chemotherapy IV infusion, first hour CPT 96413 Infusion chemo iv 1 hr	$735.30	$1,225.50	$340.08–$997.10	20% above	40%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Infusion chemo iv 1 hr	$735.30	$1,225.50	$340.08–$997.10	—	40%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemo iv infusion 1 hr	$735.30	$1,225.50	$340.08–$997.10	—	40%
Critical care, first 30 to 74 minutes CPT 99291 Critical care first hour	$1,717.65	$2,862.75	$850.48–$2,493.54	37% above	40%
Critical care, first 30 to 74 minutes CPT 99291 Critical care 30-74 min er tc	$1,717.65	$2,862.75	$850.48–$2,493.54	37% above	40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical care 30-74 min er tc	$1,717.65	$2,862.75	$850.48–$2,493.54	—	40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical care first hour	$1,717.65	$2,862.75	$850.48–$2,493.54	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram tracing	$149.55	$249.25	$60.74–$178.08	25% above	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg tracing only	$149.55	$249.25	$60.74–$178.08	25% above	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Ekg tracing only	$149.55	$249.25	$60.74–$178.08	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram tracing	$149.55	$249.25	$60.74–$178.08	—	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency room minimal	$191.10	$318.50	$86.82–$254.55	20% above	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency dept visit	$191.10	$318.50	$86.82–$254.55	20% above	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency room minimal	$191.10	$318.50	$86.82–$254.55	—	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency dept visit	$191.10	$318.50	$86.82–$254.55	—	40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency room brief	$312.75	$521.25	$158.09–$463.51	24% above	40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency dept visit	$312.75	$521.25	$158.09–$463.51	24% above	40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency dept visit	$312.75	$521.25	$158.09–$463.51	—	40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency room brief	$312.75	$521.25	$158.09–$463.51	—	40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency room intermediate	$555.75	$926.25	$281.06–$824.04	38% above	40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency dept visit	$555.75	$926.25	$281.06–$824.04	38% above	40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency room intermediate	$555.75	$926.25	$281.06–$824.04	—	40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency dept visit	$555.75	$926.25	$281.06–$824.04	—	40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency room extended	$882.30	$1,470.50	$429.61–$1,259.59	29% above	40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency dept visit	$882.30	$1,470.50	$429.61–$1,259.59	29% above	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency room extended	$882.30	$1,470.50	$429.61–$1,259.59	—	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency dept visit	$882.30	$1,470.50	$429.61–$1,259.59	—	40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency dept visit	$1,319.70	$2,199.50	$613.16–$1,797.74	39% above	40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency room comprehensive	$1,319.70	$2,199.50	$613.16–$1,797.74	39% above	40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency room comprehensive	$1,319.70	$2,199.50	$613.16–$1,797.74	—	40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency dept visit	$1,319.70	$2,199.50	$613.16–$1,797.74	—	40%
Exercise stress test, tracing only, the hospital charge CPT 93017 Stress testing	$798.90	$1,331.50	$222.31–$651.81	28% above	40%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiovascular stress test	$798.90	$1,331.50	$222.31–$651.81	28% above	40%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiovascular stress test	$798.90	$1,331.50	$222.31–$651.81	—	40%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Stress testing	$798.90	$1,331.50	$222.31–$651.81	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv infusion hydrat 1st31-60min	$471.75	$786.25	$219.00–$642.09	109% above	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hydration iv infusion init	$471.75	$786.25	$219.00–$642.09	109% above	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hydration iv infusion init	$471.75	$786.25	$219.00–$642.09	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Iv infusion hydrat 1st31-60min	$471.75	$786.25	$219.00–$642.09	—	40%
IV infusion of a medicine, first hour CPT 96365 Iv infusion dx initial 1 hr	$471.75	$786.25	$219.00–$642.09	91% above	40%
IV infusion of a medicine, first hour CPT 96365 Ther/proph/diag iv inf init	$471.75	$786.25	$219.00–$642.09	91% above	40%
IV infusion of a medicine, first hour inpatient CPT 96365 Ther/proph/diag iv inf init	$471.75	$786.25	$219.00–$642.09	—	40%
IV infusion of a medicine, first hour inpatient CPT 96365 Iv infusion dx initial 1 hr	$471.75	$786.25	$219.00–$642.09	—	40%
IV push of a medicine, first drug CPT 96374 Ther/proph/diag inj iv push	$471.75	$786.25	$219.00–$642.09	131% above	40%
IV push of a medicine, first drug CPT 96374 Iv push single or int drug	$471.75	$786.25	$219.00–$642.09	131% above	40%
IV push of a medicine, first drug inpatient CPT 96374 Iv push single or int drug	$471.75	$786.25	$219.00–$642.09	—	40%
IV push of a medicine, first drug inpatient CPT 96374 Ther/proph/diag inj iv push	$471.75	$786.25	$219.00–$642.09	—	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Ther/proph/diag inj sc/im	$143.25	$238.75	$74.13–$217.35	100% above	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection sq or im diagnostic	$143.25	$238.75	$74.13–$217.35	100% above	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Ther/proph/diag inj sc/im	$143.25	$238.75	$74.13–$217.35	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection sq or im diagnostic	$143.25	$238.75	$74.13–$217.35	—	40%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 Nrv cndj test 7-8 studies	$469.65	$782.75	$384.20–$1,126.45	9% above	40%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 Nrv cndj test 7-8 studies	$469.65	$782.75	$384.20–$1,126.45	—	40%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular reeducation	$79.80	$133.00	$30.51–$89.46	3% above	40%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular reeducation	$79.80	$133.00	$30.51–$89.46	—	40%
New patient office visit, about 30 minutes CPT 99203 Office/outpatient visit new	$163.50	$272.50	—	97% above	40%
New patient office visit, about 30 minutes inpatient CPT 99203 Office/outpatient visit new	$163.50	$272.50	—	—	40%
New patient office visit, about 45 minutes CPT 99204 Wound care new op visit 45 min	$263.85	$439.75	—	188% above	40%
New patient office visit, about 45 minutes CPT 99204 Office/outpatient visit new	$263.85	$439.75	—	188% above	40%
New patient office visit, about 45 minutes inpatient CPT 99204 Office/outpatient visit new	$263.85	$439.75	—	—	40%
New patient office visit, about 45 minutes inpatient CPT 99204 Wound care new op visit 45 min	$263.85	$439.75	—	—	40%
New patient office visit, about 60 minutes CPT 99205 Office/outpatient visit new	$361.20	$602.00	—	195% above	40%
New patient office visit, about 60 minutes CPT 99205 Consult new op visit 60 min	$361.20	$602.00	—	195% above	40%
New patient office visit, about 60 minutes inpatient CPT 99205 Consult new op visit 60 min	$361.20	$602.00	—	—	40%
New patient office visit, about 60 minutes inpatient CPT 99205 Office/outpatient visit new	$361.20	$602.00	—	—	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Consult new op visit 15 min	$97.35	$162.25	—	42% above	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office/outpatient visit new	$97.35	$162.25	—	42% above	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office/outpatient visit new	$97.35	$162.25	—	—	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Consult new op visit 15 min	$97.35	$162.25	—	—	40%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Mnt int assessment ea 15 min	$58.35	$97.25	$25.19–$73.84	22% above	40%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Medical nutrition indiv in	$58.35	$97.25	$25.19–$73.84	22% above	40%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Medical nutrition indiv in	$58.35	$97.25	$25.19–$73.84	—	40%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Mnt int assessment ea 15 min	$58.35	$97.25	$25.19–$73.84	—	40%
Occupational therapy evaluation, low complexity CPT 97165 Ot eval low complex 30 min	$208.50	$347.50	$93.35–$273.69	13% above	40%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Ot eval low complex 30 min	$208.50	$347.50	$93.35–$273.69	—	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt eval high complex 45 min	$250.20	$417.00	$91.05–$266.95	18% above	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Pt eval high complex 45 min	$250.20	$417.00	$91.05–$266.95	—	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt eval low complex 20 min	$208.50	$347.50	$91.05–$266.95	13% above	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Pt eval low complex 20 min	$208.50	$347.50	$91.05–$266.95	—	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt eval mod complex 30 min	$234.30	$390.50	$91.05–$266.95	12% above	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Pt eval mod complex 30 min	$234.30	$390.50	$91.05–$266.95	—	40%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual therapy 1/> regions	$63.75	$106.25	$25.90–$75.93	at median	40%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual therapy 1/> regions	$63.75	$106.25	$25.90–$75.93	—	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic exercises	$83.55	$139.25	$27.14–$79.56	19% above	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic exercises	$83.55	$139.25	$27.14–$79.56	—	40%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco cess cnslng 3-10 min	$46.80	$78.00	$38.58–$113.11	28% above	40%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Behav chng smoking 3-10 min	$46.80	$78.00	$38.58–$113.11	28% above	40%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Behav chng smoking 3-10 min	$46.80	$78.00	$38.58–$113.11	—	40%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco cess cnslng 3-10 min	$46.80	$78.00	$38.58–$113.11	—	40%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office/outpatient visit est	$282.90	$471.50	—	233% above	40%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office/outpatient visit est	$282.90	$471.50	—	—	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office/outpatient visit est	$130.20	$217.00	—	67% above	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office/outpatient visit est	$130.20	$217.00	—	—	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office/outpatient visit est	$190.35	$317.25	—	95% above	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office/outpatient visit est	$190.35	$317.25	—	—	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office/outpatient visit est	$71.10	$118.50	—	10% above	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office/outpatient visit est	$71.10	$118.50	—	—	40%
Specialist consultation, low complexity or 30+ minutes CPT 99243 Op cnslt new/est low 30 min	$279.30	$465.50	—	148% above	40%
Specialist consultation, low complexity or 30+ minutes CPT 99243 Office consultation	$279.30	$465.50	—	148% above	40%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Op cnslt new/est low 30 min	$279.30	$465.50	—	—	40%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office consultation	$279.30	$465.50	—	—	40%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Op cnslt new/est mod 40 min	$424.80	$708.00	—	328% above	40%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office consultation	$424.80	$708.00	—	328% above	40%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office consultation	$424.80	$708.00	—	—	40%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Op cnslt new/est mod 40 min	$424.80	$708.00	—	—	40%
Speech and language evaluation CPT 92523 Speech sound lang comprehen	$305.85	$509.75	$211.64–$620.52	10% above	40%
Speech and language evaluation inpatient CPT 92523 Speech sound lang comprehen	$305.85	$509.75	$211.64–$620.52	—	40%
Speech therapy session, individual CPT 92507 Speech/hearing therapy	$180.75	$301.25	$71.33–$209.13	17% above	40%
Speech therapy session, individual inpatient CPT 92507 Speech/hearing therapy	$180.75	$301.25	$71.33–$209.13	—	40%
Spirometry (breathing test) CPT 94010 Breathing capacity test	$198.15	$330.25	$222.31–$651.81	4% below	40%
Spirometry (breathing test) inpatient CPT 94010 Breathing capacity test	$198.15	$330.25	$222.31–$651.81	—	40%
Spirometry before and after a bronchodilator CPT 94060 Evaluation of wheezing	$375.75	$626.25	$384.20–$1,126.45	at median	40%
Spirometry before and after a bronchodilator inpatient CPT 94060 Evaluation of wheezing	$375.75	$626.25	$384.20–$1,126.45	—	40%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic activities	$90.45	$150.75	$32.26–$94.60	19% above	40%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic activities	$90.45	$150.75	$32.26–$94.60	—	40%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy	$260.10	$433.50	$136.99–$401.63	73% above	40%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy therapeutic	$260.10	$433.50	$136.99–$401.63	73% above	40%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy therapeutic	$260.10	$433.50	$136.99–$401.63	—	40%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy	$260.10	$433.50	$136.99–$401.63	—	40%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs West Virginia	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Vaccine varivax varicella inj	$1,157.40	$1,929.00	—	468% above	40%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Var vaccine live subq	$1,157.40	$1,929.00	—	468% above	40%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Var vaccine live subq	$1,157.40	$1,929.00	—	—	40%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Vaccine varivax varicella inj	$1,157.40	$1,929.00	—	—	40%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 Vaccine dtap hepb ipv 0.5 ml	$619.20	$1,032.00	—	577% above	40%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 Dtap-hep b-ipv vaccine im	$619.20	$1,032.00	—	577% above	40%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 Vaccine dtap hepb ipv 0.5 ml	$619.20	$1,032.00	—	—	40%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 Dtap-hep b-ipv vaccine im	$619.20	$1,032.00	—	—	40%
Hepatitis A vaccine, adult dose CPT 90632 Hepatitis a vaccine adult	$184.20	$307.00	—	89% above	40%
Hepatitis A vaccine, adult dose CPT 90632 Hepa vaccine adult im	$184.20	$307.00	—	89% above	40%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis a vaccine adult	$184.20	$307.00	—	—	40%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepa vaccine adult im	$184.20	$307.00	—	—	40%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepb vaccine 3 dose adult im	$428.40	$714.00	—	544% above	40%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Vaccine engerix adult inj	$428.40	$714.00	—	544% above	40%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Vaccine engerix adult inj	$428.40	$714.00	—	—	40%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepb vaccine 3 dose adult im	$428.40	$714.00	—	—	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepb vacc 3 dose ped/adol im	$169.20	$282.00	—	429% above	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Vaccine engerix hep b peds	$169.20	$282.00	—	429% above	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Vaccine engerix hep b peds	$169.20	$282.00	—	—	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hepb vacc 3 dose ped/adol im	$169.20	$282.00	—	—	40%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Mmr vaccine sc	$568.20	$947.00	—	388% above	40%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Vaccine mmr	$568.20	$947.00	—	388% above	40%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Vaccine mmr	$568.20	$947.00	—	—	40%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Mmr vaccine sc	$568.20	$947.00	—	—	40%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 Vaccine menquadfi 0.5 ml	$1,015.80	$1,693.00	—	409% above	40%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 Menacwy-tt vaccine im	$1,015.80	$1,693.00	—	409% above	40%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 Vaccine menquadfi 0.5 ml	$1,015.80	$1,693.00	—	—	40%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 Menacwy-tt vaccine im	$1,015.80	$1,693.00	—	—	40%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Menb-4c vacc 2 dose im	$1,443.00	$2,405.00	—	530% above	40%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Vaccine menb-4c 2 dose sch	$1,443.00	$2,405.00	—	530% above	40%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Vaccine menb-4c 2 dose sch	$1,443.00	$2,405.00	—	—	40%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Menb-4c vacc 2 dose im	$1,443.00	$2,405.00	—	—	40%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 Vaccine vaxneuvance pneumpcv15	$1,450.80	$2,418.00	—	699% above	40%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 Pcv15 vaccine im	$1,450.80	$2,418.00	—	699% above	40%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 Pcv15 vaccine im	$1,450.80	$2,418.00	—	—	40%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 Vaccine vaxneuvance pneumpcv15	$1,450.80	$2,418.00	—	—	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Prevnar 20 vaccine	$1,720.20	$2,867.00	—	373% above	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pcv20 vaccine im	$1,720.20	$2,867.00	—	373% above	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Prevnar 20 vaccine	$1,720.20	$2,867.00	—	—	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pcv20 vaccine im	$1,720.20	$2,867.00	—	—	40%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Rsv monoc antb seasn 1 ml im	$3,427.80	$5,713.00	—	334% above	40%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Vaccine beyfotus rsv 100mg	$3,427.80	$5,713.00	—	334% above	40%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Vaccine beyfotus rsv 100mg	$3,427.80	$5,713.00	—	—	40%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Rsv monoc antb seasn 1 ml im	$3,427.80	$5,713.00	—	—	40%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Rsv monoc antb seasn .5ml im	$3,427.80	$5,713.00	—	334% above	40%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Vaccine beyfotus rsv 50mg	$3,427.80	$5,713.00	—	334% above	40%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 Vaccine beyfotus rsv 50mg	$3,427.80	$5,713.00	—	—	40%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 Rsv monoc antb seasn .5ml im	$3,427.80	$5,713.00	—	—	40%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 Vaccine arexvy im	$1,849.20	$3,082.00	—	711% above	40%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 Rsv vacc pref recomb adjt im	$1,849.20	$3,082.00	—	711% above	40%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 Vaccine arexvy im	$1,849.20	$3,082.00	—	—	40%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 Rsv vacc pref recomb adjt im	$1,849.20	$3,082.00	—	—	40%
Rabies vaccine, one dose CPT 90675 Vaccine rabies inj	$565.80	$943.00	$312.07–$914.96	16% above	40%
Rabies vaccine, one dose CPT 90675 Rabies vaccine im	$565.80	$943.00	$312.07–$914.96	16% above	40%
Rabies vaccine, one dose inpatient CPT 90675 Vaccine rabies inj	$565.80	$943.00	$312.07–$914.96	—	40%
Rabies vaccine, one dose inpatient CPT 90675 Rabies vaccine im	$565.80	$943.00	$312.07–$914.96	—	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Vaccine td np >= 7 yr im	$255.60	$426.00	—	399% above	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Td vacc no presv 7 yrs+ im	$255.60	$426.00	—	399% above	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Td vacc no presv 7 yrs+ im	$255.60	$426.00	—	—	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Vaccine td np >= 7 yr im	$255.60	$426.00	—	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Vaccine adacel 0.5 ml inj	$281.40	$469.00	—	448% above	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap vaccine 7 yrs/> im	$281.40	$469.00	—	448% above	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Vaccine adacel 0.5 ml inj	$281.40	$469.00	—	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tdap vaccine 7 yrs/> im	$281.40	$469.00	—	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine adm influenza	$13.35	$22.25	$74.13–$217.35	69% below	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization admin	$13.35	$22.25	$74.13–$217.35	69% below	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine adm influenza	$13.35	$22.25	$74.13–$217.35	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization admin	$13.35	$22.25	$74.13–$217.35	—	40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization admin each add	$13.35	$22.25	—	46% below	40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine adm ea addl single com	$13.35	$22.25	—	46% below	40%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization admin each add	$13.35	$22.25	—	—	40%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine adm ea addl single com	$13.35	$22.25	—	—	40%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://cdn.accureg.net/trans/roane/550484469_Hospital-Development-Co_standardcharges.csv