Hospital

Henry County Hospital

Henry County Hospital in Napoleon, OH publishes cash prices for 445 common procedures listed here, from its own machine-readable price file updated Dec 29, 2025. Compared with other hospitals in the state, its outpatient cash prices are below the Ohio median for 240 of 439 procedures and above it for 197. By typical cash price it ranks #63 of 138 Ohio hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

1600 E. Riverview Ave, Napoleon, OH 43545 Collected Oct 20, 2026 Source price file Check a bill from this hospital (419) 592-4015

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CMS star rating 2 of 5 CCN 361309 · CMS hospital register NPI 1407880909

Financial assistance

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

Henry County Hospital 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.

State law

This state limits hospital bills for lower-income patients

Ohio's Hospital Care Assurance Program (HCAP): Ohio residents who are not on Medicaid and whose income is at or below 100% of the federal poverty level get basic, medically necessary hospital services free at hospitals in the program; physician bills are not included. Ask the hospital's billing office for an HCAP application. Other states' laws.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Abdominal CT scan without and with contrast CPT 74170 CT-ABD W/WO IV CONTRAST	$3,202.50	$4,270.00	$3,202.50–$4,270.00	141% above	25%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT-ABD W/WO IV CONTRAST	$3,202.50	$4,270.00	$3,202.50–$4,270.00	—	25%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN -2 VIEWS	$300.00	$400.00	$300.00–$400.00	12% below	25%
Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN -2 VIEWS	$300.00	$400.00	$300.00–$400.00	—	25%
Ankle X-ray, complete, 3 or more views CPT 73610 RT ANKLE MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	23% below	25%
Ankle X-ray, complete, 3 or more views CPT 73610 LT ANKLE-MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	23% below	25%
Ankle X-ray, complete, 3 or more views CPT 73610 BIL ANKLE MIN 3 VIEWS	$311.25	$415.00	$311.25–$415.00	3% below	25%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 LT ANKLE-MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RT ANKLE MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 BIL ANKLE MIN 3 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 PHY STUDY UP/LOW ART LMT	$423.75	$565.00	$423.75–$565.00	12% below	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 PHY STUDY UP/LOW ART LMT	$423.75	$565.00	$423.75–$565.00	—	25%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT-BIL UE W/O CONTRAST	$1,196.25	$1,595.00	$1,196.25–$1,595.00	26% above	25%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT RT UE W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	1% above	25%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT-LT UE W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	1% above	25%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT-BIL UE W/O CONTRAST	$1,196.25	$1,595.00	$1,196.25–$1,595.00	—	25%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT-LT UE W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	—	25%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT RT UE W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	—	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGRAM	$502.50	$670.00	$502.50–$670.00	13% above	25%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGRAM	$502.50	$670.00	$502.50–$670.00	—	25%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN	$1,657.50	$2,210.00	$1,657.50–$2,210.00	8% above	25%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE SCAN	$1,657.50	$2,210.00	$1,657.50–$2,210.00	—	25%
Breast ultrasound, complete, one breast CPT 76641 US BIL BREAST COMPLETE	$562.50	$750.00	$562.50–$750.00	18% above	25%
Breast ultrasound, complete, one breast one side CPT 76641 US RT BREAST COMPLETE	$450.00	$600.00	$450.00–$600.00	6% below	25%
Breast ultrasound, complete, one breast one side CPT 76641 US LT BREAST COMPLETE	$450.00	$600.00	$450.00–$600.00	6% below	25%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BIL BREAST COMPLETE	$562.50	$750.00	$562.50–$750.00	—	25%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US LT BREAST COMPLETE	$450.00	$600.00	$450.00–$600.00	—	25%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US RT BREAST COMPLETE	$450.00	$600.00	$450.00–$600.00	—	25%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BIL BREAST LTD	$450.00	$600.00	$450.00–$600.00	9% above	25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US RT BREAST LTD	$360.00	$480.00	$360.00–$480.00	13% below	25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US LT BREAST LTD	$360.00	$480.00	$360.00–$480.00	13% below	25%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BIL BREAST LTD	$450.00	$600.00	$450.00–$600.00	—	25%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US LT BREAST LTD	$360.00	$480.00	$360.00–$480.00	—	25%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US RT BREAST LTD	$360.00	$480.00	$360.00–$480.00	—	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD/PELVIS W/WO CONT	$6,427.50	$8,570.00	$6,427.50–$8,570.00	200% above	25%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD/PELVIS W/WO CONT	$6,427.50	$8,570.00	$6,427.50–$8,570.00	—	25%
CT angiography (CTA) of the head CPT 70496 CTA-HEAD W/WO CON INC IMG	$2,602.50	$3,470.00	$2,602.50–$3,470.00	92% above	25%
CT angiography (CTA) of the head inpatient CPT 70496 CTA-HEAD W/WO CON INC IMG	$2,602.50	$3,470.00	$2,602.50–$3,470.00	—	25%
CT angiography (CTA) of the neck CPT 70498 CTA-NECK W/WO CON INC IMG	$2,602.50	$3,470.00	$2,602.50–$3,470.00	100% above	25%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA-NECK W/WO CON INC IMG	$2,602.50	$3,470.00	$2,602.50–$3,470.00	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA-CHEST W/WO CON INC IM	$3,202.50	$4,270.00	$3,202.50–$4,270.00	126% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA-CHEST W/WO CON INC IM	$3,202.50	$4,270.00	$3,202.50–$4,270.00	—	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONT	$2,175.00	$2,900.00	$2,175.00–$2,900.00	38% above	25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CONT	$2,175.00	$2,900.00	$2,175.00–$2,900.00	—	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD&PEL W-IV CONT	$2,475.00	$3,300.00	$2,475.00–$3,300.00	24% above	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD&PEL W-IV CONT	$2,475.00	$3,300.00	$2,475.00–$3,300.00	—	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PELVIS W/WO IV CONT	$6,427.50	$8,570.00	$6,427.50–$8,570.00	175% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PELVIS W/WO IV CONT	$6,427.50	$8,570.00	$6,427.50–$8,570.00	—	25%
CT scan of the abdomen with contrast CPT 74160 CT ABD W IV CONTRAST	$1,601.25	$2,135.00	$1,601.25–$2,135.00	37% above	25%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABD W IV CONTRAST	$1,601.25	$2,135.00	$1,601.25–$2,135.00	—	25%
CT scan of the abdomen without contrast CPT 74150 CT-ABD W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	9% below	25%
CT scan of the abdomen without contrast inpatient CPT 74150 CT-ABD W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	—	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT-MAX FACIAL W/O CONTR	$900.00	$1,200.00	$900.00–$1,200.00	3% above	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT-MAX FACIAL W/O CONTR	$900.00	$1,200.00	$900.00–$1,200.00	—	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT-BRAIN W/O CONTRAST	$900.00	$1,200.00	$900.00–$1,200.00	7% above	25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT-BRAIN W/O CONTRAST	$900.00	$1,200.00	$900.00–$1,200.00	—	25%
CT scan of the head with contrast CPT 70460 CT-BRAIN W/CONTRAST	$1,301.25	$1,735.00	$1,301.25–$1,735.00	29% above	25%
CT scan of the head with contrast inpatient CPT 70460 CT-BRAIN W/CONTRAST	$1,301.25	$1,735.00	$1,301.25–$1,735.00	—	25%
CT scan of the head without and with contrast CPT 70470 CT-BRAIN W/WO CONTRAST	$2,602.50	$3,470.00	$2,602.50–$3,470.00	119% above	25%
CT scan of the head without and with contrast inpatient CPT 70470 CT-BRAIN W/WO CONTRAST	$2,602.50	$3,470.00	$2,602.50–$3,470.00	—	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT-LUMBAR W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	13% below	25%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT-LUMBAR W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	—	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT-C SPINE W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	11% below	25%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT-C SPINE W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	—	25%
CT scan of the pelvis, with contrast dye CPT 72193 CT-PELVIS W/CONTRAST	$1,601.25	$2,135.00	$1,601.25–$2,135.00	31% above	25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT-PELVIS W/CONTRAST	$1,601.25	$2,135.00	$1,601.25–$2,135.00	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 CAROTID DUPLEX BILATERAL	$678.75	$905.00	$678.75–$905.00	—	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 CAROTID DUPLEX BILATERAL	$678.75	$905.00	$678.75–$905.00	—	25%
Chest CT scan without and with contrast CPT 71270 CT-THORAX W/WO CONTRAST	$3,202.50	$4,270.00	$3,202.50–$4,270.00	114% above	25%
Chest CT scan without and with contrast inpatient CPT 71270 CT-THORAX W/WO CONTRAST	$3,202.50	$4,270.00	$3,202.50–$4,270.00	—	25%
Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS	$191.25	$255.00	$191.25–$255.00	29% below	25%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS	$191.25	$255.00	$191.25–$255.00	—	25%
Chest X-ray, single view CPT 71045 CHEST 1 VIEW	$131.25	$175.00	$131.25–$175.00	42% below	25%
Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW	$131.25	$175.00	$131.25–$175.00	—	25%
Collarbone (clavicle) X-ray, complete both sides CPT 73000 BILAT CLAVICLE	$311.25	$415.00	$311.25–$415.00	—	25%
Collarbone (clavicle) X-ray, complete CPT 73000 LT CLAVICLE	$247.50	$330.00	$247.50–$330.00	10% below	25%
Collarbone (clavicle) X-ray, complete CPT 73000 RT CLAVICLE	$247.50	$330.00	$247.50–$330.00	10% below	25%
Collarbone (clavicle) X-ray, complete inpatient both sides CPT 73000 BILAT CLAVICLE	$311.25	$415.00	$311.25–$415.00	—	25%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 LT CLAVICLE	$247.50	$330.00	$247.50–$330.00	—	25%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 RT CLAVICLE	$247.50	$330.00	$247.50–$330.00	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 RETROPERITONEAL ULTRASOUN	$600.00	$800.00	$600.00–$800.00	15% below	25%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 RETROPERITONEAL ULTRASOUN	$600.00	$800.00	$600.00–$800.00	—	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA BONE DENSITY SP/HIP	$300.00	$400.00	$300.00–$400.00	34% below	25%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA BONE DENSITY SP/HIP	$300.00	$400.00	$300.00–$400.00	—	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA LTD-WRIST ONLY	$247.50	$330.00	$247.50–$330.00	4% below	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA LTD-WRIST ONLY	$247.50	$330.00	$247.50–$330.00	—	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT-THORAX W/O CONTRAST	$1,050.00	$1,400.00	$1,050.00–$1,400.00	10% above	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT-THORAX W/O CONTRAST	$1,050.00	$1,400.00	$1,050.00–$1,400.00	—	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT-THORAX W/CONTRAST	$1,601.25	$2,135.00	$1,601.25–$2,135.00	31% above	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT-THORAX W/CONTRAST	$1,601.25	$2,135.00	$1,601.25–$2,135.00	—	25%
Diagnostic mammogram, both breasts CPT 77066 BIL DIAG IMPLANT DIGITAL+CAD	$300.00	$400.00	$300.00–$400.00	16% below	25%
Diagnostic mammogram, both breasts CPT 77066 BIL DIAG MAMM DIGITAL+CAD	$300.00	$400.00	$300.00–$400.00	16% below	25%
Diagnostic mammogram, both breasts CPT 77066 BIL SCR MAMM CONVERT DIAG +CAD	$300.00	$400.00	$300.00–$400.00	16% below	25%
Diagnostic mammogram, both breasts inpatient CPT 77066 BIL SCR MAMM CONVERT DIAG +CAD	$300.00	$400.00	$300.00–$400.00	—	25%
Diagnostic mammogram, both breasts inpatient CPT 77066 BIL DIAG MAMM DIGITAL+CAD	$300.00	$400.00	$300.00–$400.00	—	25%
Diagnostic mammogram, both breasts inpatient CPT 77066 BIL DIAG IMPLANT DIGITAL+CAD	$300.00	$400.00	$300.00–$400.00	—	25%
Diagnostic mammogram, one breast CPT 77065 RT DIAGNOSTC MAMM DIGITAL+CAD	$195.00	$260.00	$195.00–$260.00	45% below	25%
Diagnostic mammogram, one breast CPT 77065 LT DIAGNOSTC MAMM DIGITAL+CAD	$195.00	$260.00	$195.00–$260.00	45% below	25%
Diagnostic mammogram, one breast CPT 77065 UNI SCR MAMM CONVERT DIAG+CAD	$195.00	$260.00	$195.00–$260.00	45% below	25%
Diagnostic mammogram, one breast inpatient CPT 77065 UNI SCR MAMM CONVERT DIAG+CAD	$195.00	$260.00	$195.00–$260.00	—	25%
Diagnostic mammogram, one breast inpatient CPT 77065 LT DIAGNOSTC MAMM DIGITAL+CAD	$195.00	$260.00	$195.00–$260.00	—	25%
Diagnostic mammogram, one breast inpatient CPT 77065 RT DIAGNOSTC MAMM DIGITAL+CAD	$195.00	$260.00	$195.00–$260.00	—	25%
Duplex ultrasound of the leg arteries, both legs CPT 93925 ART/LOWER DUPLEX BL COMP	$915.00	$1,220.00	$915.00–$1,220.00	2% above	25%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 ART/LOWER DUPLEX BL COMP	$915.00	$1,220.00	$915.00–$1,220.00	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS LE DUPLEX BILAT-PRO	$309.75	$413.00	$309.75–$413.00	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS UE DUPLEX BILAT	$678.75	$905.00	$678.75–$905.00	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS LE DUPLEX BILAT	$678.75	$905.00	$678.75–$905.00	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VENOUS LE DUPLEX BILAT-PRO	$309.75	$413.00	$309.75–$413.00	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VENOUS UE DUPLEX BILAT	$678.75	$905.00	$678.75–$905.00	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VENOUS LE DUPLEX BILAT	$678.75	$905.00	$678.75–$905.00	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO COMP, DOPP, COLOR FLW-PRO	$329.25	$439.00	$329.25–$439.00	81% below	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHOCARDIOGRAM	$1,848.75	$2,465.00	$1,848.75–$2,465.00	9% above	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO COMP, DOPP, COLOR FLW-PRO	$329.25	$439.00	$329.25–$439.00	—	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHOCARDIOGRAM	$1,848.75	$2,465.00	$1,848.75–$2,465.00	—	25%
Elbow X-ray, 2 views CPT 73070 RT ELBOW MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	6% below	25%
Elbow X-ray, 2 views CPT 73070 LT ELBOW MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	6% below	25%
Elbow X-ray, 2 views CPT 73070 BIL ELBOW MIN 2 VIEWS	$311.25	$415.00	$311.25–$415.00	18% above	25%
Elbow X-ray, 2 views inpatient CPT 73070 LT ELBOW MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Elbow X-ray, 2 views inpatient CPT 73070 RT ELBOW MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Elbow X-ray, 2 views inpatient CPT 73070 BIL ELBOW MIN 2 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
Elbow X-ray, complete, 3 or more views CPT 73080 RT ELBOW 3 VIEWS	$247.50	$330.00	$247.50–$330.00	22% below	25%
Elbow X-ray, complete, 3 or more views CPT 73080 LT ELBOW 3 VIEWS	$247.50	$330.00	$247.50–$330.00	22% below	25%
Elbow X-ray, complete, 3 or more views CPT 73080 BIL ELBOW 3 VIEWS	$311.25	$415.00	$311.25–$415.00	1% below	25%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 LT ELBOW 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 RT ELBOW 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 BIL ELBOW 3 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
Eye socket (orbit) CT scan without contrast CPT 70480 CT-ORBS POST FOSSA W/O	$900.00	$1,200.00	$900.00–$1,200.00	4% above	25%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT-ORBS POST FOSSA W/O	$900.00	$1,200.00	$900.00–$1,200.00	—	25%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES MIN 3 VIEWS	$300.00	$400.00	$300.00–$400.00	22% below	25%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES MIN 3 VIEWS	$300.00	$400.00	$300.00–$400.00	—	25%
Forearm X-ray (radius and ulna), 2 views CPT 73090 RT FOREARM 2 VIEWS	$247.50	$330.00	$247.50–$330.00	9% below	25%
Forearm X-ray (radius and ulna), 2 views CPT 73090 LT FOREARM 2 VIEWS	$247.50	$330.00	$247.50–$330.00	9% below	25%
Forearm X-ray (radius and ulna), 2 views CPT 73090 BIL FOREARM 2 VIEWS	$311.25	$415.00	$311.25–$415.00	14% above	25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 RT FOREARM 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 LT FOREARM 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 BIL FOREARM 2 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SCAN	$1,657.50	$2,210.00	$1,657.50–$2,210.00	3% above	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SCAN	$1,657.50	$2,210.00	$1,657.50–$2,210.00	—	25%
Hand X-ray, 2 views CPT 73120 RT HAND MIN 2 VIEWS	$300.00	$400.00	$300.00–$400.00	13% above	25%
Hand X-ray, 2 views CPT 73120 LT HAND, MIN 2 VIEWS	$300.00	$400.00	$300.00–$400.00	13% above	25%
Hand X-ray, 2 views CPT 73120 BIL HAND MIN 2 VIEWS	$375.00	$500.00	$375.00–$500.00	41% above	25%
Hand X-ray, 2 views inpatient CPT 73120 LT HAND, MIN 2 VIEWS	$300.00	$400.00	$300.00–$400.00	—	25%
Hand X-ray, 2 views inpatient CPT 73120 RT HAND MIN 2 VIEWS	$300.00	$400.00	$300.00–$400.00	—	25%
Hand X-ray, 2 views inpatient CPT 73120 BIL HAND MIN 2 VIEWS	$375.00	$500.00	$375.00–$500.00	—	25%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 LT CALCANEOUS MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	9% below	25%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 RT CALCANEOUS MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	9% below	25%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 BIL CALCANEOUS MIN 2 VIEWS	$311.25	$415.00	$311.25–$415.00	14% above	25%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 LT CALCANEOUS MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 RT CALCANEOUS MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 BIL CALCANEOUS MIN 2 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HOME SLEEPSTUDY UNAT&RESP EFFT	$918.75	$1,225.00	$918.75–$1,225.00	31% above	25%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HOME SLEEPSTUDY UNAT&RESP EFFT	$918.75	$1,225.00	$918.75–$1,225.00	—	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 PSG WITH CPAP/BPAP TITRATION	$5,981.25	$7,975.00	$5,981.25–$7,975.00	44% above	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 PSG WITH CPAP/BPAP TITRATION	$5,981.25	$7,975.00	$5,981.25–$7,975.00	—	25%
Knee X-ray, 3 views CPT 73562 LT KNEE MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	30% below	25%
Knee X-ray, 3 views CPT 73562 RT KNEE MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	30% below	25%
Knee X-ray, 3 views CPT 73562 BIL KNEES MIN 3 VIEWS	$311.25	$415.00	$311.25–$415.00	12% below	25%
Knee X-ray, 3 views inpatient CPT 73562 RT KNEE MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Knee X-ray, 3 views inpatient CPT 73562 LT KNEE MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Knee X-ray, 3 views inpatient CPT 73562 BIL KNEES MIN 3 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
Knee X-ray, complete, 4 or more views CPT 73564 LT KNEE 4 VIEWS	$300.00	$400.00	$300.00–$400.00	24% below	25%
Knee X-ray, complete, 4 or more views CPT 73564 RT KNEE 4 VIEWS	$300.00	$400.00	$300.00–$400.00	24% below	25%
Knee X-ray, complete, 4 or more views CPT 73564 BIL KNEE 4 VIEWS	$375.00	$500.00	$375.00–$500.00	5% below	25%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 RT KNEE 4 VIEWS	$300.00	$400.00	$300.00–$400.00	—	25%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 LT KNEE 4 VIEWS	$300.00	$400.00	$300.00–$400.00	—	25%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 BIL KNEE 4 VIEWS	$375.00	$500.00	$375.00–$500.00	—	25%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT-BIL LOW EXT W/O CONT	$1,196.25	$1,595.00	$1,196.25–$1,595.00	27% above	25%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT-RT LOW EXT W/O CONT	$956.25	$1,275.00	$956.25–$1,275.00	1% above	25%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT-LT LOW EXT W/O CONT	$956.25	$1,275.00	$956.25–$1,275.00	1% above	25%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT-BIL LOW EXT W/O CONT	$1,196.25	$1,595.00	$1,196.25–$1,595.00	—	25%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT-RT LOW EXT W/O CONT	$956.25	$1,275.00	$956.25–$1,275.00	—	25%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT-LT LOW EXT W/O CONT	$956.25	$1,275.00	$956.25–$1,275.00	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LTD ONE ORGAN	$600.00	$800.00	$600.00–$800.00	9% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LTD 2 ORGANS	$600.00	$800.00	$600.00–$800.00	9% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LTD 3 ORGANS	$600.00	$800.00	$600.00–$800.00	9% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LTD 3 ORGANS	$600.00	$800.00	$600.00–$800.00	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LTD 2 ORGANS	$600.00	$800.00	$600.00–$800.00	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LTD ONE ORGAN	$600.00	$800.00	$600.00–$800.00	—	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US BIL EXT NON-VASCULAR	$600.00	$800.00	$600.00–$800.00	26% above	25%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US LT EXT NON VASCULAR	$480.00	$640.00	$480.00–$640.00	1% above	25%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US RT EXT NON-VASCULAR	$480.00	$640.00	$480.00–$640.00	1% above	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US BIL EXT NON-VASCULAR	$600.00	$800.00	$600.00–$800.00	—	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US LT EXT NON VASCULAR	$480.00	$640.00	$480.00–$640.00	—	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US RT EXT NON-VASCULAR	$480.00	$640.00	$480.00–$640.00	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LOWDOSE FOR LUNG CA SCREEN	$956.25	$1,275.00	$956.25–$1,275.00	225% above	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LOWDOSE FOR LUNG CA SCREEN	$956.25	$1,275.00	$956.25–$1,275.00	—	25%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 RT LOWER LEG 2 VIEWS TIB/FIB	$247.50	$330.00	$247.50–$330.00	10% below	25%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 LT LOW LEG 2 VIEWS TIB/FIB	$247.50	$330.00	$247.50–$330.00	10% below	25%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 BIL LOWER LEG 2 VIEWS TIB/FIB	$311.25	$415.00	$311.25–$415.00	13% above	25%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 LT LOW LEG 2 VIEWS TIB/FIB	$247.50	$330.00	$247.50–$330.00	—	25%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 RT LOWER LEG 2 VIEWS TIB/FIB	$247.50	$330.00	$247.50–$330.00	—	25%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 BIL LOWER LEG 2 VIEWS TIB/FIB	$311.25	$415.00	$311.25–$415.00	—	25%
MR angiography (MRA) of the head without contrast CPT 70544 MRA-HEAD W/O CONTRAST	$2,493.75	$3,325.00	$2,493.75–$3,325.00	70% above	25%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA-HEAD W/O CONTRAST	$2,493.75	$3,325.00	$2,493.75–$3,325.00	—	25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI BIL LE JOINT W/O CONT	$2,437.50	$3,250.00	$2,437.50–$3,250.00	37% above	25%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI-LT LE JOINT W/O CONTR	$1,950.00	$2,600.00	$1,950.00–$2,600.00	9% above	25%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI RT LE JOINT W/O CONT	$1,950.00	$2,600.00	$1,950.00–$2,600.00	9% above	25%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI BIL LE JOINT W/O CONT	$2,437.50	$3,250.00	$2,437.50–$3,250.00	—	25%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI RT LE JOINT W/O CONT	$1,950.00	$2,600.00	$1,950.00–$2,600.00	—	25%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI-LT LE JOINT W/O CONTR	$1,950.00	$2,600.00	$1,950.00–$2,600.00	—	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI BIL LE JOINT W/WO CON	$3,600.00	$4,800.00	$3,600.00–$4,800.00	51% above	25%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI RT LE JOINT W/WO CONT	$2,880.00	$3,840.00	$2,880.00–$3,840.00	20% above	25%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LT LE JOINT W/WO CONT	$2,880.00	$3,840.00	$2,880.00–$3,840.00	20% above	25%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI BIL LE JOINT W/WO CON	$3,600.00	$4,800.00	$3,600.00–$4,800.00	—	25%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI RT LE JOINT W/WO CONT	$2,880.00	$3,840.00	$2,880.00–$3,840.00	—	25%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LT LE JOINT W/WO CONT	$2,880.00	$3,840.00	$2,880.00–$3,840.00	—	25%
MRI of the abdomen without contrast CPT 74181 MRI CHOLPANCRGRAPHY W/O C-PRO	$337.50	$450.00	$337.50–$450.00	82% below	25%
MRI of the abdomen without contrast CPT 74181 MRI-ABDOMEN W/O CONTRAST	$1,950.00	$2,600.00	$1,950.00–$2,600.00	6% above	25%
MRI of the abdomen without contrast CPT 74181 MRI CHOLPANCRGRAPHY W/O C	$1,950.00	$2,600.00	$1,950.00–$2,600.00	6% above	25%
MRI of the abdomen without contrast inpatient CPT 74181 MRI CHOLPANCRGRAPHY W/O C-PRO	$337.50	$450.00	$337.50–$450.00	—	25%
MRI of the abdomen without contrast inpatient CPT 74181 MRI-ABDOMEN W/O CONTRAST	$1,950.00	$2,600.00	$1,950.00–$2,600.00	—	25%
MRI of the abdomen without contrast inpatient CPT 74181 MRI CHOLPANCRGRAPHY W/O C	$1,950.00	$2,600.00	$1,950.00–$2,600.00	—	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/WO CONTRAST-PRO	$581.25	$775.00	$581.25–$775.00	74% below	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI-ABDOMEN W/WO CONTRAST	$2,880.00	$3,840.00	$2,880.00–$3,840.00	27% above	25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/WO CONTRAST-PRO	$581.25	$775.00	$581.25–$775.00	—	25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI-ABDOMEN W/WO CONTRAST	$2,880.00	$3,840.00	$2,880.00–$3,840.00	—	25%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/INC STEM W/O CO-PRO	$339.00	$452.00	$339.00–$452.00	79% below	25%
MRI of the brain, no contrast dye CPT 70551 MRI-BRAIN/INC STEM W/O CO	$1,995.00	$2,660.00	$1,995.00–$2,660.00	24% above	25%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN/INC STEM W/O CO-PRO	$339.00	$452.00	$339.00–$452.00	—	25%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI-BRAIN/INC STEM W/O CO	$1,995.00	$2,660.00	$1,995.00–$2,660.00	—	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/INC STEM W/WO C-PRO	$549.75	$733.00	$549.75–$733.00	75% below	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI-BRAIN/INC STEM W/WO C	$2,947.50	$3,930.00	$2,947.50–$3,930.00	35% above	25%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN/INC STEM W/WO C-PRO	$549.75	$733.00	$549.75–$733.00	—	25%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI-BRAIN/INC STEM W/WO C	$2,947.50	$3,930.00	$2,947.50–$3,930.00	—	25%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR W/O CONTRAST-PRO	$330.00	$440.00	$330.00–$440.00	80% below	25%
MRI of the lower back, no contrast dye CPT 72148 MRI-LUMBAR W/O CONTRAST	$1,995.00	$2,660.00	$1,995.00–$2,660.00	20% above	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR W/O CONTRAST-PRO	$330.00	$440.00	$330.00–$440.00	—	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI-LUMBAR W/O CONTRAST	$1,995.00	$2,660.00	$1,995.00–$2,660.00	—	25%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR W/WO CONTRAST-PRO	$550.50	$734.00	$550.50–$734.00	76% below	25%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI-LUMBAR W/WO CONTRAST	$2,508.75	$3,345.00	$2,508.75–$3,345.00	7% above	25%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR W/WO CONTRAST-PRO	$550.50	$734.00	$550.50–$734.00	—	25%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI-LUMBAR W/WO CONTRAST	$2,508.75	$3,345.00	$2,508.75–$3,345.00	—	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O C-PRO	$330.00	$440.00	$330.00–$440.00	80% below	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI-THORACIC SPINE W/O C	$1,995.00	$2,660.00	$1,995.00–$2,660.00	21% above	25%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE W/O C-PRO	$330.00	$440.00	$330.00–$440.00	—	25%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI-THORACIC SPINE W/O C	$1,995.00	$2,660.00	$1,995.00–$2,660.00	—	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE W/WO CONTRAST-PRO	$552.00	$736.00	$552.00–$736.00	76% below	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI-C SPINE W/WO CONTRAST	$2,947.50	$3,930.00	$2,947.50–$3,930.00	30% above	25%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE W/WO CONTRAST-PRO	$552.00	$736.00	$552.00–$736.00	—	25%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI-C SPINE W/WO CONTRAST	$2,947.50	$3,930.00	$2,947.50–$3,930.00	—	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C SPINE W/O CONTRAST-PRO	$329.25	$439.00	$329.25–$439.00	80% below	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI-C SPINE W/O CONTRAST	$1,995.00	$2,660.00	$1,995.00–$2,660.00	22% above	25%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C SPINE W/O CONTRAST-PRO	$329.25	$439.00	$329.25–$439.00	—	25%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI-C SPINE W/O CONTRAST	$1,995.00	$2,660.00	$1,995.00–$2,660.00	—	25%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/WO CONTRAST-PRO	$579.00	$772.00	$579.00–$772.00	71% below	25%
MRI of the pelvis without and with contrast CPT 72197 MRI-PELVIS W/WO CONTRAST	$2,880.00	$3,840.00	$2,880.00–$3,840.00	46% above	25%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/WO CONTRAST-PRO	$579.00	$772.00	$579.00–$772.00	—	25%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI-PELVIS W/WO CONTRAST	$2,880.00	$3,840.00	$2,880.00–$3,840.00	—	25%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST-PRO	$392.25	$523.00	$392.25–$523.00	74% below	25%
MRI of the pelvis, no contrast dye CPT 72195 MRI-PELVIS W/O CONTRAST	$1,950.00	$2,600.00	$1,950.00–$2,600.00	28% above	25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST-PRO	$392.25	$523.00	$392.25–$523.00	—	25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI-PELVIS W/O CONTRAST	$1,950.00	$2,600.00	$1,950.00–$2,600.00	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI BIL UE JOINT W/O CONT	$2,437.50	$3,250.00	$2,437.50–$3,250.00	61% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI-LT UE JOINT W/O CONTR	$1,950.00	$2,600.00	$1,950.00–$2,600.00	29% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI RT UE JOINT W/O CONT	$1,950.00	$2,600.00	$1,950.00–$2,600.00	29% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI BIL UE JOINT W/O CONT	$2,437.50	$3,250.00	$2,437.50–$3,250.00	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI RT UE JOINT W/O CONT	$1,950.00	$2,600.00	$1,950.00–$2,600.00	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI-LT UE JOINT W/O CONTR	$1,950.00	$2,600.00	$1,950.00–$2,600.00	—	25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERVICAL SPINE MIN 4 VIEW	$300.00	$400.00	$300.00–$400.00	33% below	25%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERVICAL SPINE MIN 4 VIEW	$300.00	$400.00	$300.00–$400.00	—	25%
Neck soft tissue CT scan with contrast CPT 70491 CT-SOFT TISS NECK W/CONTR	$1,301.25	$1,735.00	$1,301.25–$1,735.00	10% above	25%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT-SOFT TISS NECK W/CONTR	$1,301.25	$1,735.00	$1,301.25–$1,735.00	—	25%
Neck soft tissue CT scan without contrast CPT 70490 CT-SOFT TISS NECK W/O CON	$900.00	$1,200.00	$900.00–$1,200.00	5% below	25%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT-SOFT TISS NECK W/O CON	$900.00	$1,200.00	$900.00–$1,200.00	—	25%
Neck soft tissue X-ray CPT 70360 SOFT TISSUE NECK	$247.50	$330.00	$247.50–$330.00	5% below	25%
Neck soft tissue X-ray inpatient CPT 70360 SOFT TISSUE NECK	$247.50	$330.00	$247.50–$330.00	—	25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MYOCARDIAL PERF SPECT	$2,955.00	$3,940.00	$2,955.00–$3,940.00	27% below	25%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYOCARDIAL PERF SPECT	$2,955.00	$3,940.00	$2,955.00–$3,940.00	—	25%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT-TORSO	$5,250.00	$7,000.00	$5,250.00–$7,000.00	8% above	25%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT-TORSO	$5,250.00	$7,000.00	$5,250.00–$7,000.00	—	25%
Pelvic CT scan without contrast CPT 72192 CT-PELVIS W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	5% below	25%
Pelvic CT scan without contrast inpatient CPT 72192 CT-PELVIS W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	—	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC/TV LTD OR F/U	$600.00	$800.00	$600.00–$800.00	38% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC/TV LTD OR F/U	$600.00	$800.00	$600.00–$800.00	—	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC(NONOB)COMPLETE	$600.00	$800.00	$600.00–$800.00	17% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC(NONOB)COMPLETE	$600.00	$800.00	$600.00–$800.00	—	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US FA PREG UT COMP EVAL	$600.00	$800.00	$600.00–$800.00	at median	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US FA PREG UT COMP EVAL	$600.00	$800.00	$600.00–$800.00	—	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG UT<14WK TA SING	$600.00	$800.00	$600.00–$800.00	9% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG UT<14WK TA SING	$600.00	$800.00	$600.00–$800.00	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 LIMITED OB STUDY	$600.00	$800.00	$600.00–$800.00	26% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 LIMITED OB STUDY	$600.00	$800.00	$600.00–$800.00	—	25%
Rib X-ray, one side, 2 views one side CPT 71100 RT RIBS UNILAT 2 VIEW	$247.50	$330.00	$247.50–$330.00	19% below	25%
Rib X-ray, one side, 2 views one side CPT 71100 LT RIBS UNILAT 2 VIEW	$247.50	$330.00	$247.50–$330.00	19% below	25%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 LT RIBS UNILAT 2 VIEW	$247.50	$330.00	$247.50–$330.00	—	25%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RT RIBS UNILAT 2 VIEW	$247.50	$330.00	$247.50–$330.00	—	25%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 RT RIBS/CHEST MIN 3 VIEW	$300.00	$400.00	$300.00–$400.00	24% below	25%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 LT RIBS/CHEST MIN 3 VIEW	$300.00	$400.00	$300.00–$400.00	24% below	25%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 RT RIBS/CHEST MIN 3 VIEW	$300.00	$400.00	$300.00–$400.00	—	25%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 LT RIBS/CHEST MIN 3 VIEW	$300.00	$400.00	$300.00–$400.00	—	25%
Screening mammogram, both breasts CPT 77067 LT SCREENING MAMM DIGITAL+CAD	$112.50	$150.00	$112.50–$150.00	41% below	25%
Screening mammogram, both breasts CPT 77067 RT SCREENING MAMM DIGITAL+CAD	$112.50	$150.00	$112.50–$150.00	41% below	25%
Screening mammogram, both breasts CPT 77067 BIL SCREEN MAMM-DIGITAL+CAD	$225.00	$300.00	$225.00–$300.00	17% above	25%
Screening mammogram, both breasts CPT 77067 BIL SCRN IMPLANT DIGITAL+CAD	$225.00	$300.00	$225.00–$300.00	17% above	25%
Screening mammogram, both breasts inpatient CPT 77067 RT SCREENING MAMM DIGITAL+CAD	$112.50	$150.00	$112.50–$150.00	—	25%
Screening mammogram, both breasts inpatient CPT 77067 LT SCREENING MAMM DIGITAL+CAD	$112.50	$150.00	$112.50–$150.00	—	25%
Screening mammogram, both breasts inpatient CPT 77067 BIL SCRN IMPLANT DIGITAL+CAD	$225.00	$300.00	$225.00–$300.00	—	25%
Screening mammogram, both breasts inpatient CPT 77067 BIL SCREEN MAMM-DIGITAL+CAD	$225.00	$300.00	$225.00–$300.00	—	25%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 BILATERAL SHOULDER 2 VIEW	$311.25	$415.00	$311.25–$415.00	—	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 LT SHOULDER - 2 VIEW	$247.50	$330.00	$247.50–$330.00	27% below	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 RT SHOULDER 2 VIEW	$247.50	$330.00	$247.50–$330.00	27% below	25%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 BILATERAL SHOULDER 2 VIEW	$311.25	$415.00	$311.25–$415.00	—	25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 LT SHOULDER - 2 VIEW	$247.50	$330.00	$247.50–$330.00	—	25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RT SHOULDER 2 VIEW	$247.50	$330.00	$247.50–$330.00	—	25%
Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES-MINIMUM 3 VIEWS	$247.50	$330.00	$247.50–$330.00	32% below	25%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES-MINIMUM 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Skull X-ray, fewer than 4 views CPT 70250 SKULL < 3 VIEWS	$300.00	$400.00	$300.00–$400.00	4% above	25%
Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL < 3 VIEWS	$300.00	$400.00	$300.00–$400.00	—	25%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY (PSG)	$5,981.25	$7,975.00	$5,981.25–$7,975.00	66% above	25%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY (PSG)	$5,981.25	$7,975.00	$5,981.25–$7,975.00	—	25%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 DOBUTAM/STR ECHO PHYS SERV-PRO	$390.00	$520.00	$390.00–$520.00	81% below	25%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 DOBUTAM/STR ECHO PHYS SERV-PRO	$390.00	$520.00	$390.00–$520.00	—	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 BARIUM SWALLOW STDY DYSPH	$502.50	$670.00	$502.50–$670.00	at median	25%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 BARIUM SWALLOW STDY DYSPH	$502.50	$670.00	$502.50–$670.00	—	25%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 LT FEMUR 2 VIEWS	$247.50	$330.00	$247.50–$330.00	9% below	25%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 RT FEMUR 2 VIEWS	$247.50	$330.00	$247.50–$330.00	9% below	25%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 BIL FEMUR 2 VIEWS	$311.25	$415.00	$311.25–$415.00	15% above	25%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 RT FEMUR 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 LT FEMUR 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 BIL FEMUR 2 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT-THORACIC W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	7% above	25%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT-THORACIC W/O CONTRAST	$956.25	$1,275.00	$956.25–$1,275.00	—	25%
Toe X-ray, 2 or more views CPT 73660 RT TOES MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	1% below	25%
Toe X-ray, 2 or more views CPT 73660 LT TOES MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	1% below	25%
Toe X-ray, 2 or more views CPT 73660 BIL TOES, MIN 2 VIEWS	$311.25	$415.00	$311.25–$415.00	25% above	25%
Toe X-ray, 2 or more views inpatient CPT 73660 RT TOES MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Toe X-ray, 2 or more views inpatient CPT 73660 LT TOES MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Toe X-ray, 2 or more views inpatient CPT 73660 BIL TOES, MIN 2 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL ULTRASOUND	$600.00	$800.00	$600.00–$800.00	6% above	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL ULTRASOUND	$600.00	$800.00	$600.00–$800.00	—	25%
Transvaginal ultrasound during pregnancy CPT 76817 US PREG UT TRANSVAG	$600.00	$800.00	$600.00–$800.00	20% above	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREG UT TRANSVAG	$600.00	$800.00	$600.00–$800.00	—	25%
Ultrasound of the abdomen, complete CPT 76700 ABDOMINAL ULTRASOUND	$600.00	$800.00	$600.00–$800.00	5% below	25%
Ultrasound of the abdomen, complete inpatient CPT 76700 ABDOMINAL ULTRASOUND	$600.00	$800.00	$600.00–$800.00	—	25%
Ultrasound of the scrotum and testicles CPT 76870 SCROTAL ULTRASOUND	$600.00	$800.00	$600.00–$800.00	11% above	25%
Ultrasound of the scrotum and testicles inpatient CPT 76870 SCROTAL ULTRASOUND	$600.00	$800.00	$600.00–$800.00	—	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SFT TISSUE HEAD/NECK	$600.00	$800.00	$600.00–$800.00	4% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SFT TISSUE HEAD/NECK	$600.00	$800.00	$600.00–$800.00	—	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI W/O AC W/O KUB	$502.50	$670.00	$502.50–$670.00	15% below	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI W/O AC W/O KUB	$502.50	$670.00	$502.50–$670.00	—	25%
Upper arm X-ray (humerus), 2 views both sides CPT 73060 BILATERAL HUMERUS MIN 2 VW	$311.25	$415.00	$311.25–$415.00	—	25%
Upper arm X-ray (humerus), 2 views CPT 73060 LT HUMERUS-2 VIEWS	$247.50	$330.00	$247.50–$330.00	11% below	25%
Upper arm X-ray (humerus), 2 views CPT 73060 RT HUMERUS - 2 VIEW	$247.50	$330.00	$247.50–$330.00	11% below	25%
Upper arm X-ray (humerus), 2 views inpatient both sides CPT 73060 BILATERAL HUMERUS MIN 2 VW	$311.25	$415.00	$311.25–$415.00	—	25%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 RT HUMERUS - 2 VIEW	$247.50	$330.00	$247.50–$330.00	—	25%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 LT HUMERUS-2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VENOUS LE DUPLEX UL-PRO	$198.75	$265.00	$198.75–$265.00	73% below	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 RT VENOUS LE DUPLEX UL	$540.00	$720.00	$540.00–$720.00	27% below	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 LT VENOUS UE DUPLEX UNILA	$540.00	$720.00	$540.00–$720.00	27% below	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 LT VENOUS LE DUPLEX UNILA	$540.00	$720.00	$540.00–$720.00	27% below	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 RT VENOUS UE DUPLEX UL	$540.00	$720.00	$540.00–$720.00	27% below	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 VENOUS LE DUPLEX UL-PRO	$198.75	$265.00	$198.75–$265.00	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 LT VENOUS UE DUPLEX UNILA	$540.00	$720.00	$540.00–$720.00	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 RT VENOUS UE DUPLEX UL	$540.00	$720.00	$540.00–$720.00	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 LT VENOUS LE DUPLEX UNILA	$540.00	$720.00	$540.00–$720.00	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 RT VENOUS LE DUPLEX UL	$540.00	$720.00	$540.00–$720.00	—	25%
Wrist X-ray, 2 views CPT 73100 LT WRIST MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	5% below	25%
Wrist X-ray, 2 views CPT 73100 RT WRIST MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	5% below	25%
Wrist X-ray, 2 views CPT 73100 BIL WRIST MIN 2 VIEWS	$311.25	$415.00	$311.25–$415.00	19% above	25%
Wrist X-ray, 2 views inpatient CPT 73100 LT WRIST MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Wrist X-ray, 2 views inpatient CPT 73100 RT WRIST MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Wrist X-ray, 2 views inpatient CPT 73100 BIL WRIST MIN 2 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
Wrist X-ray, complete, 3 or more views CPT 73110 LT WRIST-MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	28% below	25%
Wrist X-ray, complete, 3 or more views CPT 73110 RT WRIST MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	28% below	25%
Wrist X-ray, complete, 3 or more views CPT 73110 BIL WRIST MIN 3 VIEWS	$311.25	$415.00	$311.25–$415.00	9% below	25%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 LT WRIST-MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RT WRIST MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 BIL WRIST MIN 3 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 RT HIP MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	20% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 LT HIP MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	20% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 RT HIP MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 LT HIP MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN- 1 VIEW	$247.50	$330.00	$247.50–$330.00	4% below	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN- 1 VIEW	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the ankle, 2 views CPT 73600 LT ANKLE, 2 VIEWS	$247.50	$330.00	$247.50–$330.00	1% below	25%
X-ray of the ankle, 2 views CPT 73600 RT ANKLE 2 VIEWS	$247.50	$330.00	$247.50–$330.00	1% below	25%
X-ray of the ankle, 2 views CPT 73600 BIL ANKLE 2 VIEWS	$311.25	$415.00	$311.25–$415.00	24% above	25%
X-ray of the ankle, 2 views inpatient CPT 73600 LT ANKLE, 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the ankle, 2 views inpatient CPT 73600 RT ANKLE 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the ankle, 2 views inpatient CPT 73600 BIL ANKLE 2 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
X-ray of the finger(s), 2 or more views CPT 73140 RT FINGERS MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	4% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 LT FINGERS MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	4% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 BIL FINGERS, MIN 2 VIEWS	$311.25	$415.00	$311.25–$415.00	20% above	25%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 LT FINGERS MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 RT FINGERS MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 BIL FINGERS, MIN 2 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
X-ray of the foot, 2 views CPT 73620 LT FOOT, 2 VIEWS	$247.50	$330.00	$247.50–$330.00	6% above	25%
X-ray of the foot, 2 views CPT 73620 RT FOOT 2 VIEWS	$247.50	$330.00	$247.50–$330.00	6% above	25%
X-ray of the foot, 2 views CPT 73620 BIL FOOT 2 VIEWS	$311.25	$415.00	$311.25–$415.00	33% above	25%
X-ray of the foot, 2 views inpatient CPT 73620 LT FOOT, 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the foot, 2 views inpatient CPT 73620 RT FOOT 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the foot, 2 views inpatient CPT 73620 BIL FOOT 2 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
X-ray of the foot, complete, 3 or more views CPT 73630 LT FOOT MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	19% below	25%
X-ray of the foot, complete, 3 or more views CPT 73630 RT FOOT MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	19% below	25%
X-ray of the foot, complete, 3 or more views CPT 73630 BIL FOOT MIN 3 VIEWS	$311.25	$415.00	$311.25–$415.00	2% above	25%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 LT FOOT MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RT FOOT MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 BIL FOOT MIN 3 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
X-ray of the hand, 3 or more views CPT 73130 LT HAND MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	24% below	25%
X-ray of the hand, 3 or more views CPT 73130 RT HAND MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	24% below	25%
X-ray of the hand, 3 or more views CPT 73130 BIL HAND MIN 3 VIEWS	$311.25	$415.00	$311.25–$415.00	5% below	25%
X-ray of the hand, 3 or more views inpatient CPT 73130 RT HAND MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the hand, 3 or more views inpatient CPT 73130 LT HAND MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the hand, 3 or more views inpatient CPT 73130 BIL HAND MIN 3 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
X-ray of the knee, 1 or 2 views CPT 73560 LT KNEE 1-2 VIEWS	$247.50	$330.00	$247.50–$330.00	11% below	25%
X-ray of the knee, 1 or 2 views CPT 73560 RT KNEE 1-2 VIEWS	$247.50	$330.00	$247.50–$330.00	11% below	25%
X-ray of the knee, 1 or 2 views CPT 73560 BIL KNEES 1-2 VIEWS	$311.25	$415.00	$311.25–$415.00	12% above	25%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 RT KNEE 1-2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 LT KNEE 1-2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 BIL KNEES 1-2 VIEWS	$311.25	$415.00	$311.25–$415.00	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE 2-3 VIEW	$300.00	$400.00	$300.00–$400.00	7% below	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR SPINE 2-3 VIEW	$300.00	$400.00	$300.00–$400.00	—	25%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE-MIN 4 VIEWS	$300.00	$400.00	$300.00–$400.00	36% below	25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPINE-MIN 4 VIEWS	$300.00	$400.00	$300.00–$400.00	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	15% below	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES MIN 3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 2-3 VIEWS	$247.50	$330.00	$247.50–$330.00	26% below	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE 2-3 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 OR 2 VIEW	$300.00	$400.00	$300.00–$400.00	19% above	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1 OR 2 VIEW	$300.00	$400.00	$300.00–$400.00	—	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM/COCCYX-MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	17% below	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM/COCCYX-MIN 2 VIEWS	$247.50	$330.00	$247.50–$330.00	—	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
ACTH blood test CPT 82024 ACTH(ADRENOCORTICOTROPIC)	$277.50	$370.00	$277.50–$370.00	110% above	25%
ACTH blood test inpatient CPT 82024 ACTH(ADRENOCORTICOTROPIC)	$277.50	$370.00	$277.50–$370.00	—	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT - ALT	$37.50	$50.00	$37.50–$50.00	33% above	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT - ALT	$37.50	$50.00	$37.50–$50.00	—	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT - AST	$37.50	$50.00	$37.50–$50.00	49% above	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT - AST	$37.50	$50.00	$37.50–$50.00	—	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL	$341.25	$455.00	$341.25–$455.00	58% above	25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL	$341.25	$455.00	$341.25–$455.00	—	25%
Albumin blood test CPT 82040 ALBUMIN-SERUM	$33.75	$45.00	$33.75–$45.00	53% above	25%
Albumin blood test inpatient CPT 82040 ALBUMIN-SERUM	$33.75	$45.00	$33.75–$45.00	—	25%
Aldosterone blood test CPT 82088 ALDOSTERONE	$292.50	$390.00	$292.50–$390.00	108% above	25%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE	$292.50	$390.00	$292.50–$390.00	—	25%
Alkaline phosphatase (ALP) blood test CPT 84075 ALK PHOS	$37.50	$50.00	$37.50–$50.00	56% above	25%
Alkaline phosphatase (ALP) blood test CPT 84075 ALK PHOS, BONE SPECIFIC	$37.50	$50.00	$37.50–$50.00	56% above	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALK PHOS	$37.50	$50.00	$37.50–$50.00	—	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALK PHOS, BONE SPECIFIC	$37.50	$50.00	$37.50–$50.00	—	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IgE	$41.25	$55.00	$41.25–$55.00	76% above	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IgE	$41.25	$55.00	$41.25–$55.00	—	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN SERUM	$120.00	$160.00	$120.00–$160.00	87% above	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN SERUM	$120.00	$160.00	$120.00–$160.00	—	25%
Ammonia blood test CPT 82140 AMMONIA	$105.00	$140.00	$105.00–$140.00	92% above	25%
Ammonia blood test inpatient CPT 82140 AMMONIA	$105.00	$140.00	$105.00–$140.00	—	25%
Amylase blood test CPT 82150 AMYLASE	$45.00	$60.00	$45.00–$60.00	8% below	25%
Amylase blood test CPT 82150 AMYLASE ISOENZYME/SALIVAR	$45.00	$60.00	$45.00–$60.00	8% below	25%
Amylase blood test CPT 82150 AMYLASE NON-BLOOD	$45.00	$60.00	$45.00–$60.00	8% below	25%
Amylase blood test inpatient CPT 82150 AMYLASE ISOENZYME/SALIVAR	$45.00	$60.00	$45.00–$60.00	—	25%
Amylase blood test inpatient CPT 82150 AMYLASE	$45.00	$60.00	$45.00–$60.00	—	25%
Amylase blood test inpatient CPT 82150 AMYLASE NON-BLOOD	$45.00	$60.00	$45.00–$60.00	—	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULL PEPTIDE AB	$101.25	$135.00	$101.25–$135.00	75% above	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULL PEPTIDE AB	$101.25	$135.00	$101.25–$135.00	—	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA SCREEN W/ REFLEX TITER	$97.50	$130.00	$97.50–$130.00	74% above	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA SCREEN W/ REFLEX TITER	$97.50	$130.00	$97.50–$130.00	—	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 PRO-BNP	$281.25	$375.00	$281.25–$375.00	88% above	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP CONG HEART FAILURE	$281.25	$375.00	$281.25–$375.00	88% above	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 PRO-BNP	$281.25	$375.00	$281.25–$375.00	—	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP CONG HEART FAILURE	$281.25	$375.00	$281.25–$375.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE SPUTUM	$41.25	$55.00	$41.25–$55.00	39% below	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, ANY OTHER SOURCE	$41.25	$55.00	$41.25–$55.00	39% below	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE CSF	$41.25	$55.00	$41.25–$55.00	39% below	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, ANY OTHER SOURCE	$41.25	$55.00	$41.25–$55.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE CSF	$41.25	$55.00	$41.25–$55.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE SPUTUM	$41.25	$55.00	$41.25–$55.00	—	25%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$60.00	$80.00	$60.00–$80.00	9% below	25%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$60.00	$80.00	$60.00–$80.00	—	25%
Bilirubin blood test, total CPT 82247 TOTAL BILIRUBIN	$37.50	$50.00	$37.50–$50.00	56% above	25%
Bilirubin blood test, total inpatient CPT 82247 TOTAL BILIRUBIN	$37.50	$50.00	$37.50–$50.00	—	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LVL IV-SURG PATH GYNECOR	$93.75	$125.00	$93.75–$125.00	54% below	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO 3 LEVEL 4	$93.75	$125.00	$93.75–$125.00	54% below	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 BONE MARROW-BIOSPY-ONC	$93.75	$125.00	$93.75–$125.00	54% below	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO 3 LEVEL 4	$93.75	$125.00	$93.75–$125.00	—	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 BONE MARROW-BIOSPY-ONC	$93.75	$125.00	$93.75–$125.00	—	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LVL IV-SURG PATH GYNECOR	$93.75	$125.00	$93.75–$125.00	—	25%
Blood culture for bacteria CPT 87040 CULTURE, BLOOD	$48.75	$65.00	$48.75–$65.00	48% below	25%
Blood culture for bacteria inpatient CPT 87040 CULTURE, BLOOD	$48.75	$65.00	$48.75–$65.00	—	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 SPECIMEN COLLECTION FEE	$15.00	$20.00	$15.00–$20.00	6% below	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECT VEN BLD-VENIPUNCT-TOT	$17.25	$23.00	$17.25–$23.00	8% above	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 SPECIMEN COLLECTION FEE	$15.00	$20.00	$15.00–$20.00	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECT VEN BLD-VENIPUNCT-TOT	$17.25	$23.00	$17.25–$23.00	—	25%
Blood glucose (sugar) test CPT 82947 GLUCOSE QUANTITATIVE	$30.00	$40.00	$30.00–$40.00	26% above	25%
Blood glucose (sugar) test CPT 82947 GLUCOSE 2HR P/MEAL	$30.00	$40.00	$30.00–$40.00	26% above	25%
Blood glucose (sugar) test CPT 82947 GLUCOSE QUANT BLOOD-TOT	$30.00	$40.00	$30.00–$40.00	26% above	25%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANTITATIVE	$30.00	$40.00	$30.00–$40.00	—	25%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE 2HR P/MEAL	$30.00	$40.00	$30.00–$40.00	—	25%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANT BLOOD-TOT	$30.00	$40.00	$30.00–$40.00	—	25%
Blood lead test CPT 83655 LEAD	$86.25	$115.00	$86.25–$115.00	71% above	25%
Blood lead test inpatient CPT 83655 LEAD	$86.25	$115.00	$86.25–$115.00	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY SERUM	$52.50	$70.00	$52.50–$70.00	4% below	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY SERUM	$52.50	$70.00	$52.50–$70.00	—	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO TYPE	$22.50	$30.00	$22.50–$30.00	61% below	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING	$22.50	$30.00	$22.50–$30.00	61% below	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO TYPE	$22.50	$30.00	$22.50–$30.00	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING	$22.50	$30.00	$22.50–$30.00	—	25%
Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN (BUN)	$30.00	$40.00	$30.00–$40.00	28% above	25%
Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN (BUN)	$30.00	$40.00	$30.00–$40.00	—	25%
C-peptide blood test CPT 84681 C PEPTIDE	$150.00	$200.00	$150.00–$200.00	94% above	25%
C-peptide blood test inpatient CPT 84681 C PEPTIDE	$150.00	$200.00	$150.00–$200.00	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN/CRP	$41.25	$55.00	$41.25–$55.00	18% below	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN/CRP	$41.25	$55.00	$41.25–$55.00	—	25%
C. difficile toxin gene test (stool PCR) CPT 87493 C-DIFF TOXIN BY PCR-STOOL	$176.25	$235.00	$176.25–$235.00	35% above	25%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C-DIFF TOXIN BY PCR-STOOL	$176.25	$235.00	$176.25–$235.00	—	25%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$165.00	$220.00	$165.00–$220.00	127% above	25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$165.00	$220.00	$165.00–$220.00	—	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$165.00	$220.00	$165.00–$220.00	76% above	25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$165.00	$220.00	$165.00–$220.00	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 RNA, Rapid	$243.75	$325.00	$243.75–$325.00	73% above	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 RNA, Rapid	$243.75	$325.00	$243.75–$325.00	—	25%
Calcium blood test, total CPT 82310 CALCIUM TOTAL	$37.50	$50.00	$37.50–$50.00	19% above	25%
Calcium blood test, total inpatient CPT 82310 CALCIUM TOTAL	$37.50	$50.00	$37.50–$50.00	—	25%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINOEMBRYONIC ANTI/CEA	$135.00	$180.00	$135.00–$180.00	55% above	25%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA - NON BLOOD	$135.00	$180.00	$135.00–$180.00	55% above	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINOEMBRYONIC ANTI/CEA	$135.00	$180.00	$135.00–$180.00	—	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA - NON BLOOD	$135.00	$180.00	$135.00–$180.00	—	25%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA IGG	$101.25	$135.00	$101.25–$135.00	75% above	25%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA IgM	$101.25	$135.00	$101.25–$135.00	75% above	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA IGG	$101.25	$135.00	$101.25–$135.00	—	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA IgM	$101.25	$135.00	$101.25–$135.00	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA DNA URINE	$165.00	$220.00	$165.00–$220.00	78% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA THIN PREP	$165.00	$220.00	$165.00–$220.00	78% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA SWAB	$165.00	$220.00	$165.00–$220.00	78% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA THIN PREP	$165.00	$220.00	$165.00–$220.00	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA DNA URINE	$165.00	$220.00	$165.00–$220.00	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA SWAB	$165.00	$220.00	$165.00–$220.00	—	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$97.50	$130.00	$97.50–$130.00	83% above	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$97.50	$130.00	$97.50–$130.00	—	25%
Complete blood count (CBC) with differential CPT 85025 CBC W/AUTOMATED DIFF	$48.75	$65.00	$48.75–$65.00	32% above	25%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/AUTOMATED DIFF	$48.75	$65.00	$48.75–$65.00	—	25%
Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT HEMOGRAM	$41.25	$55.00	$41.25–$55.00	24% above	25%
Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT HEMOGRAM	$41.25	$55.00	$41.25–$55.00	—	25%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL	$75.00	$100.00	$75.00–$100.00	18% above	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL	$75.00	$100.00	$75.00–$100.00	—	25%
Cortisol blood test, total CPT 82533 CORTISOL TOTAL	$116.25	$155.00	$116.25–$155.00	61% above	25%
Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL	$116.25	$155.00	$116.25–$155.00	—	25%
Creatine kinase (CK) blood test, total CPT 82550 CPK CK TOTAL	$45.00	$60.00	$45.00–$60.00	28% above	25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK CK TOTAL	$45.00	$60.00	$45.00–$60.00	—	25%
Creatinine blood test CPT 82565 CREATININE-SERUM	$37.50	$50.00	$37.50–$50.00	53% above	25%
Creatinine blood test inpatient CPT 82565 CREATININE-SERUM	$37.50	$50.00	$37.50–$50.00	—	25%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV TOTAL IGG	$112.50	$150.00	$112.50–$150.00	64% above	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV TOTAL IGG	$112.50	$150.00	$112.50–$150.00	—	25%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER	$63.75	$85.00	$63.75–$85.00	8% below	25%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER	$63.75	$85.00	$63.75–$85.00	—	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S	$161.25	$215.00	$161.25–$215.00	62% above	25%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S	$161.25	$215.00	$161.25–$215.00	—	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN, SINGLE DRUG	$108.75	$145.00	$108.75–$145.00	13% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 MEDICAL DRUG SCRN - BLOOD	$446.25	$595.00	$446.25–$595.00	364% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 PAIN MGMT- MEDICAL DRUG SCRN	$446.25	$595.00	$446.25–$595.00	364% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN PAIN MANAGEMENT	$446.25	$595.00	$446.25–$595.00	364% above	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN, SINGLE DRUG	$108.75	$145.00	$108.75–$145.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MEDICAL DRUG SCRN - BLOOD	$446.25	$595.00	$446.25–$595.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN PAIN MANAGEMENT	$446.25	$595.00	$446.25–$595.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 PAIN MGMT- MEDICAL DRUG SCRN	$446.25	$595.00	$446.25–$595.00	—	25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL	$48.75	$65.00	$48.75–$65.00	3% above	25%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL	$48.75	$65.00	$48.75–$65.00	—	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN-BARR VCA-IgG	$142.50	$190.00	$142.50–$190.00	119% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN BARR VCA IgM	$142.50	$190.00	$142.50–$190.00	119% above	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN-BARR VCA-IgG	$142.50	$190.00	$142.50–$190.00	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN BARR VCA IgM	$142.50	$190.00	$142.50–$190.00	—	25%
Estradiol blood test CPT 82670 ESTRADIOL	$202.50	$270.00	$202.50–$270.00	81% above	25%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$202.50	$270.00	$202.50–$270.00	—	25%
FSH (follicle-stimulating hormone) test CPT 83001 FSH (GONADOTROPIN)	$135.00	$180.00	$135.00–$180.00	57% above	25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH (GONADOTROPIN)	$135.00	$180.00	$135.00–$180.00	—	25%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, FECES	$142.50	$190.00	$142.50–$190.00	5% below	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, FECES	$142.50	$190.00	$142.50–$190.00	—	25%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$97.50	$130.00	$97.50–$130.00	28% above	25%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$97.50	$130.00	$97.50–$130.00	—	25%
Fibrinogen blood test CPT 85384 FIBRINOGEN ACTIVITY	$63.75	$85.00	$63.75–$85.00	44% above	25%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN ACTIVITY	$63.75	$85.00	$63.75–$85.00	—	25%
Folate (folic acid) blood test CPT 82746 FOLIC ACID - SERUM	$105.00	$140.00	$105.00–$140.00	56% above	25%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID - SERUM	$105.00	$140.00	$105.00–$140.00	—	25%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$120.00	$160.00	$120.00–$160.00	61% above	25%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE	$120.00	$160.00	$120.00–$160.00	—	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE	$63.75	$85.00	$63.75–$85.00	52% above	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE	$63.75	$85.00	$63.75–$85.00	—	25%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$183.75	$245.00	$183.75–$245.00	86% above	25%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$183.75	$245.00	$183.75–$245.00	—	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT-P	$52.50	$70.00	$52.50–$70.00	23% above	25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT-P	$52.50	$70.00	$52.50–$70.00	—	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GEST GLUCOSE WITH 50G	$33.75	$45.00	$33.75–$45.00	8% below	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 2HR POST+BEV	$33.75	$45.00	$33.75–$45.00	8% below	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GEST GLUCOSE WITH 50G	$33.75	$45.00	$33.75–$45.00	—	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 2HR POST+BEV	$33.75	$45.00	$33.75–$45.00	—	25%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE 3HR GTT	$93.75	$125.00	$93.75–$125.00	40% above	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE 3HR GTT	$93.75	$125.00	$93.75–$125.00	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONORRHEA DNA URINE	$165.00	$220.00	$165.00–$220.00	78% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONORRHEA SWAB	$165.00	$220.00	$165.00–$220.00	78% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONNORRHEA THIN PREP	$165.00	$220.00	$165.00–$220.00	78% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GONORRHEA DNA URINE	$165.00	$220.00	$165.00–$220.00	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GONNORRHEA THIN PREP	$165.00	$220.00	$165.00–$220.00	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GONORRHEA SWAB	$165.00	$220.00	$165.00–$220.00	—	25%
H. pylori antibody blood test CPT 86677 H PYLORI IgA	$135.00	$180.00	$135.00–$180.00	85% above	25%
H. pylori antibody blood test inpatient CPT 86677 H PYLORI IgA	$135.00	$180.00	$135.00–$180.00	—	25%
H. pylori stool antigen test CPT 87338 H PYLORI AG-STOOL	$67.50	$90.00	$67.50–$90.00	3% below	25%
H. pylori stool antigen test inpatient CPT 87338 H PYLORI AG-STOOL	$67.50	$90.00	$67.50–$90.00	—	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV - VIRAL LOAD	$405.00	$540.00	$405.00–$540.00	12% above	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV - VIRAL LOAD	$405.00	$540.00	$405.00–$540.00	—	25%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1&2 AB C/WST BIT CONF	$108.75	$145.00	$108.75–$145.00	76% above	25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1&2 AB C/WST BIT CONF	$108.75	$145.00	$108.75–$145.00	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1 & 2	$191.25	$255.00	$191.25–$255.00	158% above	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1 & 2	$191.25	$255.00	$191.25–$255.00	—	25%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH RISK	$165.00	$220.00	$165.00–$220.00	39% above	25%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HIGH RISK	$165.00	$220.00	$165.00–$220.00	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HGB GLYCATED	$71.25	$95.00	$71.25–$95.00	56% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HGB GLYCATED	$71.25	$95.00	$71.25–$95.00	—	25%
Hemoglobin blood test CPT 85018 HEMOGLOBIN	$15.00	$20.00	$15.00–$20.00	7% below	25%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN	$15.00	$20.00	$15.00–$20.00	—	25%
Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE ANTIBODY	$97.50	$130.00	$97.50–$130.00	81% above	25%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE ANTIBODY	$97.50	$130.00	$97.50–$130.00	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB (HBSAB)	$86.25	$115.00	$86.25–$115.00	79% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB (HBSAB)	$86.25	$115.00	$86.25–$115.00	—	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG (HBSAG)	$48.75	$65.00	$48.75–$65.00	2% above	25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG (HBSAG)	$48.75	$65.00	$48.75–$65.00	—	25%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C	$112.50	$150.00	$112.50–$150.00	76% above	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C	$112.50	$150.00	$112.50–$150.00	—	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C RNA BY PCR QUANT	$202.50	$270.00	$202.50–$270.00	5% above	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C RNA BY PCR QUANT	$202.50	$270.00	$202.50–$270.00	—	25%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IgG	$105.00	$140.00	$105.00–$140.00	78% above	25%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IgM	$105.00	$140.00	$105.00–$140.00	78% above	25%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1	$105.00	$140.00	$105.00–$140.00	78% above	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IgG	$105.00	$140.00	$105.00–$140.00	—	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE 1	$105.00	$140.00	$105.00–$140.00	—	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IgM	$105.00	$140.00	$105.00–$140.00	—	25%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IgG	$153.75	$205.00	$153.75–$205.00	132% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IgM	$153.75	$205.00	$153.75–$205.00	132% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES TYPE 2	$153.75	$205.00	$153.75–$205.00	132% above	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IgG	$153.75	$205.00	$153.75–$205.00	—	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES TYPE 2	$153.75	$205.00	$153.75–$205.00	—	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IgM	$153.75	$205.00	$153.75–$205.00	—	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 ULTRA-SENS CRP	$101.25	$135.00	$101.25–$135.00	49% above	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 ULTRA-SENS CRP	$101.25	$135.00	$101.25–$135.00	—	25%
Homocysteine blood test CPT 83090 HOMOCYSTEINE	$127.50	$170.00	$127.50–$170.00	58% above	25%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE	$127.50	$170.00	$127.50–$170.00	—	25%
Insulin blood test CPT 83525 INSULIN	$82.50	$110.00	$82.50–$110.00	61% above	25%
Insulin blood test inpatient CPT 83525 INSULIN	$82.50	$110.00	$82.50–$110.00	—	25%
Iron blood test (serum iron) CPT 83540 IRON SERUM	$45.00	$60.00	$45.00–$60.00	15% above	25%
Iron blood test (serum iron) CPT 83540 IRON - URINE	$45.00	$60.00	$45.00–$60.00	15% above	25%
Iron blood test (serum iron) inpatient CPT 83540 IRON SERUM	$45.00	$60.00	$45.00–$60.00	—	25%
Iron blood test (serum iron) inpatient CPT 83540 IRON - URINE	$45.00	$60.00	$45.00–$60.00	—	25%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAP/TIBC	$63.75	$85.00	$63.75–$85.00	63% above	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAP/TIBC	$63.75	$85.00	$63.75–$85.00	—	25%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$63.75	$85.00	$63.75–$85.00	12% below	25%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$63.75	$85.00	$63.75–$85.00	—	25%
LH (luteinizing hormone) test CPT 83002 LH	$135.00	$180.00	$135.00–$180.00	41% above	25%
LH (luteinizing hormone) test inpatient CPT 83002 LH	$135.00	$180.00	$135.00–$180.00	—	25%
Lactate (lactic acid) blood test CPT 83605 LACTATE	$82.50	$110.00	$82.50–$110.00	59% above	25%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE	$82.50	$110.00	$82.50–$110.00	—	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH LD	$45.00	$60.00	$45.00–$60.00	65% above	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH LD	$45.00	$60.00	$45.00–$60.00	—	25%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$48.75	$65.00	$48.75–$65.00	16% below	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$48.75	$65.00	$48.75–$65.00	—	25%
Liver function blood test panel CPT 80076 HEPATIC (LIVER) PANEL	$60.00	$80.00	$60.00–$80.00	2% below	25%
Liver function blood test panel inpatient CPT 80076 HEPATIC (LIVER) PANEL	$60.00	$80.00	$60.00–$80.00	—	25%
Lyme disease antibody test CPT 86618 LYME ANTIBODIES,MOD 2TIER	$135.00	$180.00	$135.00–$180.00	76% above	25%
Lyme disease antibody test CPT 86618 LYME (B-BURGD) IGG	$135.00	$180.00	$135.00–$180.00	76% above	25%
Lyme disease antibody test CPT 86618 LYME (B-BURGD) IgM	$135.00	$180.00	$135.00–$180.00	76% above	25%
Lyme disease antibody test inpatient CPT 86618 LYME (B-BURGD) IgM	$135.00	$180.00	$135.00–$180.00	—	25%
Lyme disease antibody test inpatient CPT 86618 LYME ANTIBODIES,MOD 2TIER	$135.00	$180.00	$135.00–$180.00	—	25%
Lyme disease antibody test inpatient CPT 86618 LYME (B-BURGD) IGG	$135.00	$180.00	$135.00–$180.00	—	25%
Magnesium blood test CPT 83735 MAGNESIUM-STOOL	$48.75	$65.00	$48.75–$65.00	44% above	25%
Magnesium blood test CPT 83735 MAGNESIUM	$48.75	$65.00	$48.75–$65.00	44% above	25%
Magnesium blood test CPT 83735 MAGNESIUM URINE	$48.75	$65.00	$48.75–$65.00	44% above	25%
Magnesium blood test CPT 83735 IONIZED MAGNESIUM	$48.75	$65.00	$48.75–$65.00	44% above	25%
Magnesium blood test CPT 83735 MAGNESIUM-RBC	$48.75	$65.00	$48.75–$65.00	44% above	25%
Magnesium blood test inpatient CPT 83735 MAGNESIUM-STOOL	$48.75	$65.00	$48.75–$65.00	—	25%
Magnesium blood test inpatient CPT 83735 MAGNESIUM URINE	$48.75	$65.00	$48.75–$65.00	—	25%
Magnesium blood test inpatient CPT 83735 MAGNESIUM-RBC	$48.75	$65.00	$48.75–$65.00	—	25%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$48.75	$65.00	$48.75–$65.00	—	25%
Magnesium blood test inpatient CPT 83735 IONIZED MAGNESIUM	$48.75	$65.00	$48.75–$65.00	—	25%
Measles (rubeola) antibody test CPT 86765 MEASLES AB ICC (RUBEOLA)	$101.25	$135.00	$101.25–$135.00	76% above	25%
Measles (rubeola) antibody test CPT 86765 MEASLES AB IGM (RUBEOLA)	$101.25	$135.00	$101.25–$135.00	76% above	25%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES AB ICC (RUBEOLA)	$101.25	$135.00	$101.25–$135.00	—	25%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES AB IGM (RUBEOLA)	$101.25	$135.00	$101.25–$135.00	—	25%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SPOT	$41.25	$55.00	$41.25–$55.00	22% below	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SPOT	$41.25	$55.00	$41.25–$55.00	—	25%
Mumps immunity blood test CPT 86735 MUMPS IgM	$105.00	$140.00	$105.00–$140.00	79% above	25%
Mumps immunity blood test CPT 86735 MUMPS IgG	$105.00	$140.00	$105.00–$140.00	79% above	25%
Mumps immunity blood test inpatient CPT 86735 MUMPS IgG	$105.00	$140.00	$105.00–$140.00	—	25%
Mumps immunity blood test inpatient CPT 86735 MUMPS IgM	$105.00	$140.00	$105.00–$140.00	—	25%
Obstetric blood test panel CPT 80055 OBSTETRIC PANEL	$345.00	$460.00	$345.00–$460.00	61% above	25%
Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL	$345.00	$460.00	$345.00–$460.00	—	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE	$131.25	$175.00	$131.25–$175.00	59% above	25%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, FREE	$131.25	$175.00	$131.25–$175.00	—	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, TOTAL	$131.25	$175.00	$131.25–$175.00	63% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA 3RD GENERATION	$131.25	$175.00	$131.25–$175.00	63% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA SCREENING	$131.25	$175.00	$131.25–$175.00	63% above	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, TOTAL	$131.25	$175.00	$131.25–$175.00	—	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA 3RD GENERATION	$131.25	$175.00	$131.25–$175.00	—	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA SCREENING	$131.25	$175.00	$131.25–$175.00	—	25%
Pap test (liquid-based, automated screening with review) CPT 88175 PAP & REVIEW (HIGH RISK IF)	$187.50	$250.00	$187.50–$250.00	87% above	25%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP & REVIEW (HIGH RISK IF)	$187.50	$250.00	$187.50–$250.00	—	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP/REFLEX HPV-DIANOSTIC	$142.50	$190.00	$142.50–$190.00	57% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP/REFLEX HPV HR -SCREEN	$142.50	$190.00	$142.50–$190.00	57% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP WITH HPV	$142.50	$190.00	$142.50–$190.00	57% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP-THIN PREP-SCREEN	$176.25	$235.00	$176.25–$235.00	94% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP/REFLEX HPV-DIANOSTIC	$142.50	$190.00	$142.50–$190.00	—	25%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP WITH HPV	$142.50	$190.00	$142.50–$190.00	—	25%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP/REFLEX HPV HR -SCREEN	$142.50	$190.00	$142.50–$190.00	—	25%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP-THIN PREP-SCREEN	$176.25	$235.00	$176.25–$235.00	—	25%
Parathyroid hormone (PTH) blood test CPT 83970 PTH	$296.25	$395.00	$296.25–$395.00	110% above	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH	$296.25	$395.00	$296.25–$395.00	—	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT - LA MIXING STUDY	$37.50	$50.00	$37.50–$50.00	at median	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$37.50	$50.00	$37.50–$50.00	at median	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT - LA MIXING STUDY	$37.50	$50.00	$37.50–$50.00	—	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$37.50	$50.00	$37.50–$50.00	—	25%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS	$33.75	$45.00	$33.75–$45.00	5% below	25%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS	$33.75	$45.00	$33.75–$45.00	—	25%
Potassium blood test CPT 84132 POTASSIUM BLOOD	$33.75	$45.00	$33.75–$45.00	43% above	25%
Potassium blood test inpatient CPT 84132 POTASSIUM BLOOD	$33.75	$45.00	$33.75–$45.00	—	25%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 FETAL ANEUPLOIDY	$3,750.00	$5,000.00	$3,750.00–$5,000.00	158% above	25%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 FETAL ANEUPLOIDY	$3,750.00	$5,000.00	$3,750.00–$5,000.00	—	25%
Progesterone blood test CPT 84144 PROGESTERONE	$150.00	$200.00	$150.00–$200.00	85% above	25%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$150.00	$200.00	$150.00–$200.00	—	25%
Prolactin blood test CPT 84146 PROLACTIN	$138.75	$185.00	$138.75–$185.00	59% above	25%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$138.75	$185.00	$138.75–$185.00	—	25%
Prothrombin time (PT/INR) clotting test CPT 85610 PRO TIME	$26.25	$35.00	$26.25–$35.00	9% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 PT - MIXING STUDY	$26.25	$35.00	$26.25–$35.00	9% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 PRO TIME-OFFICE	$26.25	$35.00	$26.25–$35.00	9% above	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PRO TIME	$26.25	$35.00	$26.25–$35.00	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PRO TIME-OFFICE	$26.25	$35.00	$26.25–$35.00	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT - MIXING STUDY	$26.25	$35.00	$26.25–$35.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 COCAINE	$22.50	$30.00	$22.50–$30.00	61% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 PHENYCYCLIDINE	$22.50	$30.00	$22.50–$30.00	61% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 BARBITURATES	$22.50	$30.00	$22.50–$30.00	61% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN, EACH DRUG-OFFICE	$22.50	$30.00	$22.50–$30.00	61% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 THC	$22.50	$30.00	$22.50–$30.00	61% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 BENZODIAZEPINES	$22.50	$30.00	$22.50–$30.00	61% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 OPIATES	$22.50	$30.00	$22.50–$30.00	61% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 AMPHETAMINES	$22.50	$30.00	$22.50–$30.00	61% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 TRICYCLIC	$22.50	$30.00	$22.50–$30.00	61% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN TRIAGE	$90.00	$120.00	$90.00–$120.00	56% above	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 PHENYCYCLIDINE	$22.50	$30.00	$22.50–$30.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 BENZODIAZEPINES	$22.50	$30.00	$22.50–$30.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 AMPHETAMINES	$22.50	$30.00	$22.50–$30.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN, EACH DRUG-OFFICE	$22.50	$30.00	$22.50–$30.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 COCAINE	$22.50	$30.00	$22.50–$30.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 TRICYCLIC	$22.50	$30.00	$22.50–$30.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 THC	$22.50	$30.00	$22.50–$30.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 OPIATES	$22.50	$30.00	$22.50–$30.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 BARBITURATES	$22.50	$30.00	$22.50–$30.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN TRIAGE	$90.00	$120.00	$90.00–$120.00	—	25%
Renin blood test CPT 84244 RENNIN - DIRECT	$157.50	$210.00	$157.50–$210.00	84% above	25%
Renin blood test inpatient CPT 84244 RENNIN - DIRECT	$157.50	$210.00	$157.50–$210.00	—	25%
Rh blood typing CPT 86901 BLOOD TYPING Rh (D)	$22.50	$30.00	$22.50–$30.00	40% below	25%
Rh blood typing CPT 86901 RH TYPE	$22.50	$30.00	$22.50–$30.00	40% below	25%
Rh blood typing inpatient CPT 86901 RH TYPE	$22.50	$30.00	$22.50–$30.00	—	25%
Rh blood typing inpatient CPT 86901 BLOOD TYPING Rh (D)	$22.50	$30.00	$22.50–$30.00	—	25%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTIT	$45.00	$60.00	$45.00–$60.00	36% above	25%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTIT	$45.00	$60.00	$45.00–$60.00	—	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IgM	$112.50	$150.00	$112.50–$150.00	130% above	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IgG	$112.50	$150.00	$112.50–$150.00	130% above	25%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IgG	$112.50	$150.00	$112.50–$150.00	—	25%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IgM	$112.50	$150.00	$112.50–$150.00	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE - AUTOMATED	$18.75	$25.00	$18.75–$25.00	50% below	25%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE - AUTOMATED	$18.75	$25.00	$18.75–$25.00	—	25%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS	$60.00	$80.00	$60.00–$80.00	55% below	25%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANALYSIS	$60.00	$80.00	$60.00–$80.00	—	25%
Sodium blood test CPT 84295 SODIUM-SERUM	$33.75	$45.00	$33.75–$45.00	24% above	25%
Sodium blood test inpatient CPT 84295 SODIUM-SERUM	$33.75	$45.00	$33.75–$45.00	—	25%
Stool ova and parasites exam CPT 87177 OVA & PARASITES	$41.25	$55.00	$41.25–$55.00	4% above	25%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES	$41.25	$55.00	$41.25–$55.00	—	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD-FECAL-3 SAMP	$30.00	$40.00	$30.00–$40.00	8% above	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 FOBT-SCR;3 CARD;QUAL-TOT	$30.00	$40.00	$30.00–$40.00	8% above	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD-FECAL-3 SAMP	$30.00	$40.00	$30.00–$40.00	—	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 FOBT-SCR;3 CARD;QUAL-TOT	$30.00	$40.00	$30.00–$40.00	—	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD-SEND OUT	$116.25	$155.00	$116.25–$155.00	115% above	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD-SEND OUT	$116.25	$155.00	$116.25–$155.00	—	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 T PALLIDUM (FTA-ABS)	$105.00	$140.00	$105.00–$140.00	78% above	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 T PALLIDUM (FTA-ABS)	$105.00	$140.00	$105.00–$140.00	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR VDRL	$33.75	$45.00	$33.75–$45.00	44% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR VDRL	$33.75	$45.00	$33.75–$45.00	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB (HCH EMPLOYEE)	$72.00	$96.00	$72.00–$96.00	41% below	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON - TB	$491.25	$655.00	$491.25–$655.00	306% above	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB (HCH EMPLOYEE)	$72.00	$96.00	$72.00–$96.00	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON - TB	$491.25	$655.00	$491.25–$655.00	—	25%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$187.50	$250.00	$187.50–$250.00	103% above	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL	$187.50	$250.00	$187.50–$250.00	—	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY ANTIBODY	$116.25	$155.00	$116.25–$155.00	79% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE (TPO) AB	$116.25	$155.00	$116.25–$155.00	79% above	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE (TPO) AB	$116.25	$155.00	$116.25–$155.00	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY ANTIBODY	$116.25	$155.00	$116.25–$155.00	—	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH WITH REFLEX TO FREE T4	$120.00	$160.00	$120.00–$160.00	60% above	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH-3RD GENERATION	$120.00	$160.00	$120.00–$160.00	60% above	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$120.00	$160.00	$120.00–$160.00	60% above	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH-3RD GENERATION	$120.00	$160.00	$120.00–$160.00	—	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH WITH REFLEX TO FREE T4	$120.00	$160.00	$120.00–$160.00	—	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$120.00	$160.00	$120.00–$160.00	—	25%
Total IgE blood test CPT 82785 IgE	$120.00	$160.00	$120.00–$160.00	88% above	25%
Total IgE blood test inpatient CPT 82785 IgE	$120.00	$160.00	$120.00–$160.00	—	25%
Total cholesterol blood test CPT 82465 CHOLESTEROL, SERUM	$30.00	$40.00	$30.00–$40.00	18% below	25%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL, SERUM	$30.00	$40.00	$30.00–$40.00	—	25%
Total thyroxine (T4) blood test CPT 84436 THYROXINE TOTAL/T4	$48.75	$65.00	$48.75–$65.00	18% above	25%
Total thyroxine (T4) blood test inpatient CPT 84436 THYROXINE TOTAL/T4	$48.75	$65.00	$48.75–$65.00	—	25%
Total triiodothyronine (T3) blood test CPT 84480 T-3 RIA	$101.25	$135.00	$101.25–$135.00	67% above	25%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T-3 RIA	$101.25	$135.00	$101.25–$135.00	—	25%
Transferrin blood test CPT 84466 TRANSFERRIN	$90.00	$120.00	$90.00–$120.00	21% above	25%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$90.00	$120.00	$90.00–$120.00	—	25%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS	$251.25	$335.00	$251.25–$335.00	191% above	25%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS	$251.25	$335.00	$251.25–$335.00	—	25%
Triglycerides blood test CPT 84478 TRIGLYCERIDES	$41.25	$55.00	$41.25–$55.00	12% above	25%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES	$41.25	$55.00	$41.25–$55.00	—	25%
Troponin test, quantitative CPT 84484 TROPONIN-I	$90.00	$120.00	$90.00–$120.00	8% above	25%
Troponin test, quantitative inpatient CPT 84484 TROPONIN-I	$90.00	$120.00	$90.00–$120.00	—	25%
Uric acid blood test CPT 84550 URIC ACID BLOOD	$33.75	$45.00	$33.75–$45.00	4% below	25%
Uric acid blood test inpatient CPT 84550 URIC ACID BLOOD	$33.75	$45.00	$33.75–$45.00	—	25%
Urinalysis with microscope exam, automated CPT 81001 UA DIPSTICK AUTO W/MICRO	$41.25	$55.00	$41.25–$55.00	53% above	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA DIPSTICK AUTO W/MICRO	$41.25	$55.00	$41.25–$55.00	—	25%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS,DIPSTICK	$22.50	$30.00	$22.50–$30.00	24% above	25%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS,DIPSTICK	$22.50	$30.00	$22.50–$30.00	—	25%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO WO SCOPE-OFFIC	$4.50	$6.00	$4.50–$6.00	81% below	25%
Urinalysis without microscope exam, automated CPT 81003 URINE PROTEIN DIP STICK	$15.00	$20.00	$15.00–$20.00	37% below	25%
Urinalysis without microscope exam, automated CPT 81003 URINE BLOOD	$26.25	$35.00	$26.25–$35.00	11% above	25%
Urinalysis without microscope exam, automated CPT 81003 URINE KETONE	$26.25	$35.00	$26.25–$35.00	11% above	25%
Urinalysis without microscope exam, automated CPT 81003 URINE GLUCOSE	$26.25	$35.00	$26.25–$35.00	11% above	25%
Urinalysis without microscope exam, automated CPT 81003 PH URINE/AUTO NO MICRO	$26.25	$35.00	$26.25–$35.00	11% above	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO WO SCOPE-OFFIC	$4.50	$6.00	$4.50–$6.00	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE PROTEIN DIP STICK	$15.00	$20.00	$15.00–$20.00	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE GLUCOSE	$26.25	$35.00	$26.25–$35.00	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE BLOOD	$26.25	$35.00	$26.25–$35.00	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 PH URINE/AUTO NO MICRO	$26.25	$35.00	$26.25–$35.00	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE KETONE	$26.25	$35.00	$26.25–$35.00	—	25%
Urinalysis without microscope exam, manual CPT 81002 REDUCING SUBSTANCE	$26.25	$35.00	$26.25–$35.00	61% above	25%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS, DIP-OFFICE	$45.00	$60.00	$45.00–$60.00	175% above	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 REDUCING SUBSTANCE	$26.25	$35.00	$26.25–$35.00	—	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS, DIP-OFFICE	$45.00	$60.00	$45.00–$60.00	—	25%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE CCMS	$37.50	$50.00	$37.50–$50.00	34% below	25%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE CCMS	$37.50	$50.00	$37.50–$50.00	—	25%
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN URINE QUANTATITVE	$41.25	$55.00	$41.25–$55.00	18% below	25%
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN URINE QUANTATITVE	$41.25	$55.00	$41.25–$55.00	—	25%
Urine pregnancy test, read by color change CPT 81025 URINE PREG TEST VIS COLOR	$108.75	$145.00	$108.75–$145.00	124% above	25%
Urine pregnancy test, read by color change CPT 81025 PREG TEST,URINE VIS COLOR-TOT	$108.75	$145.00	$108.75–$145.00	124% above	25%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREG TEST VIS COLOR	$108.75	$145.00	$108.75–$145.00	—	25%
Urine pregnancy test, read by color change inpatient CPT 81025 PREG TEST,URINE VIS COLOR-TOT	$108.75	$145.00	$108.75–$145.00	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B 12 (CYANOCOBALAMIN)	$108.75	$145.00	$108.75–$145.00	47% above	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B 12 (CYANOCOBALAMIN)	$108.75	$145.00	$108.75–$145.00	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VIT D2&D3,25 HYDROXY	$213.75	$285.00	$213.75–$285.00	133% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VIT D 25-OH	$213.75	$285.00	$213.75–$285.00	133% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VIT D2&D3,25 HYDROXY	$213.75	$285.00	$213.75–$285.00	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VIT D 25-OH	$213.75	$285.00	$213.75–$285.00	—	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D DIHYDROXY 1,25-	$277.50	$370.00	$277.50–$370.00	80% above	25%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D DIHYDROXY 1,25-	$277.50	$370.00	$277.50–$370.00	—	25%
Zinc blood test CPT 84630 ZINC	$82.50	$110.00	$82.50–$110.00	61% above	25%
Zinc blood test inpatient CPT 84630 ZINC	$82.50	$110.00	$82.50–$110.00	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 B-HCG SEND OUT	$108.75	$145.00	$108.75–$145.00	61% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 B-HCG	$108.75	$145.00	$108.75–$145.00	61% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 B-HCG SEND OUT	$108.75	$145.00	$108.75–$145.00	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 B-HCG	$108.75	$145.00	$108.75–$145.00	—	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 APPY;RUPT APPEND W PERITON-PRO	$1,569.00	$2,092.00	$1,569.00–$2,092.00	—	25%
Appendectomy, open surgery CPT 44950 APPENDECTOMY:-PRO	$1,149.00	$1,532.00	$1,149.00–$1,532.00	12% below	25%
Appendectomy, open surgery inpatient CPT 44950 APPENDECTOMY:-PRO	$1,149.00	$1,532.00	$1,149.00–$1,532.00	—	25%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 ARTHROSC ACL REPAIR/AUGM-PRO	$1,732.50	$2,310.00	$1,732.50–$2,310.00	95% below	25%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 ARTHROSC ACL REPAIR/AUGM-PRO	$1,732.50	$2,310.00	$1,732.50–$2,310.00	—	25%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHRO W ROTAT CUFF REP-PRO	$1,900.50	$2,534.00	$1,900.50–$2,534.00	93% below	25%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 ARTHRO W ROTAT CUFF REP-PRO	$1,900.50	$2,534.00	$1,900.50–$2,534.00	—	25%
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE-FAC	$268.50	$358.00	$268.50–$358.00	51% below	25%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERV MUSC MIGRAINE-FAC	$268.50	$358.00	$268.50–$358.00	—	25%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 STEROTACTIC BRSTBX 1ST LES-PRO	$286.50	$382.00	$286.50–$382.00	93% below	25%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 STEROTACTIC BRSTBX 1ST LES-PRO	$286.50	$382.00	$286.50–$382.00	—	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLTX DST FIB FX WO MAN-PRO	$103.50	$138.00	$103.50–$138.00	73% below	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CL TX DST FIB FX WO MANIP-FAC	$415.50	$554.00	$415.50–$554.00	10% above	25%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLTX DST FIB FX WO MAN-PRO	$103.50	$138.00	$103.50–$138.00	—	25%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CL TX DST FIB FX WO MANIP-FAC	$415.50	$554.00	$415.50–$554.00	—	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLTX METATARSAL FX, WO MAN-PRO	$73.50	$98.00	$73.50–$98.00	80% below	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLTX METATARSAL FX WO MAN-FAC	$294.75	$393.00	$294.75–$393.00	19% below	25%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLTX METATARSAL FX, WO MAN-PRO	$73.50	$98.00	$73.50–$98.00	—	25%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLTX METATARSAL FX WO MAN-FAC	$294.75	$393.00	$294.75–$393.00	—	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION/DEFIB	$1,271.25	$1,695.00	$1,271.25–$1,695.00	38% below	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION/DEFIB	$1,271.25	$1,695.00	$1,271.25–$1,695.00	—	25%
Carpal tunnel release, open surgery CPT 64721 NEUROP, MED NRV CRPL TUN-PRO	$792.00	$1,056.00	$792.00–$1,056.00	91% below	25%
Carpal tunnel release, open surgery inpatient CPT 64721 NEUROP, MED NRV CRPL TUN-PRO	$792.00	$1,056.00	$792.00–$1,056.00	—	25%
Cervical biopsy CPT 57500 BX OF CERVIX - FAC	$206.25	$275.00	$206.25–$275.00	88% below	25%
Cervical biopsy CPT 57500 BX OF CERVIX - TOT	$258.00	$344.00	$258.00–$344.00	84% below	25%
Cervical biopsy inpatient CPT 57500 BX OF CERVIX - FAC	$206.25	$275.00	$206.25–$275.00	—	25%
Cervical biopsy inpatient CPT 57500 BX OF CERVIX - TOT	$258.00	$344.00	$258.00–$344.00	—	25%
Cesarean delivery, including prenatal and postpartum care CPT 59510 ROUTINE OB CARE CS&PP CARE-PRO	$4,782.00	$6,376.00	$4,782.00–$6,376.00	at median	25%
Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 ROUTINE OB CARE CS&PP CARE-PRO	$4,782.00	$6,376.00	$4,782.00–$6,376.00	—	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUM W/REGIONAL BLOCK - PRO	$258.00	$344.00	$258.00–$344.00	85% below	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 PROC-CIRCUMCISION+ANESTH	$8,973.75	$11,965.00	$8,973.75–$11,965.00	406% above	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUM W/REGIONAL BLOCK - PRO	$258.00	$344.00	$258.00–$344.00	—	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 PROC-CIRCUMCISION+ANESTH	$8,973.75	$11,965.00	$8,973.75–$11,965.00	—	25%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUM NEONATE <=28 DAYS - PRO	$382.50	$510.00	$382.50–$510.00	81% below	25%
Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUM NEONATE <=28 DAYS - PRO	$382.50	$510.00	$382.50–$510.00	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLTX DSTL RAD FX WO MANIP-PRO	$589.50	$786.00	$589.50–$786.00	44% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLTX DSTL RAD FX WO MAN-FAC	$600.00	$800.00	$600.00–$800.00	47% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLTX DSTL RAD FX WO MANIP-PRO	$589.50	$786.00	$589.50–$786.00	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLTX DSTL RAD FX WO MAN-FAC	$600.00	$800.00	$600.00–$800.00	—	25%
Colonoscopy with polyp removal CPT 45385 COLNOSCPY,FX W REM LES SN-PRO	$444.00	$592.00	$444.00–$592.00	87% below	25%
Colonoscopy with polyp removal inpatient CPT 45385 COLNOSCPY,FX W REM LES SN-PRO	$444.00	$592.00	$444.00–$592.00	—	25%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY,FLX W BX;S/ML-PRO	$351.75	$469.00	$351.75–$469.00	89% below	25%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY,FLX W BX;S/ML-PRO	$351.75	$469.00	$351.75–$469.00	—	25%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY,FLEX;DX-PRO	$323.25	$431.00	$323.25–$431.00	88% below	25%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY,FLEX;DX-PRO	$323.25	$431.00	$323.25–$431.00	—	25%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX CERVIX W/SCOPE LEEP-FAC	$423.75	$565.00	$423.75–$565.00	89% below	25%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX CERVIX W/ SCOPE LEEP-TOT	$529.50	$706.00	$529.50–$706.00	86% below	25%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 BX CERVIX W/SCOPE LEEP-FAC	$423.75	$565.00	$423.75–$565.00	—	25%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 BX CERVIX W/ SCOPE LEEP-TOT	$529.50	$706.00	$529.50–$706.00	—	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 COLPOSCOPY CX W/BX &CUR- PRO	$59.25	$79.00	$59.25–$79.00	93% below	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Colp cx w bx & curettage-FAC	$236.25	$315.00	$236.25–$315.00	74% below	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 COLP CERVIX W BX&CUR-TOT	$295.50	$394.00	$295.50–$394.00	68% below	25%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 COLPOSCOPY CX W/BX &CUR- PRO	$59.25	$79.00	$59.25–$79.00	—	25%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 Colp cx w bx & curettage-FAC	$236.25	$315.00	$236.25–$315.00	—	25%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 COLP CERVIX W BX&CUR-TOT	$295.50	$394.00	$295.50–$394.00	—	25%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY-PRO	$141.75	$189.00	$141.75–$189.00	93% below	25%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY(USE WITH URODYN)	$1,672.50	$2,230.00	$1,672.50–$2,230.00	16% below	25%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY-PRO	$141.75	$189.00	$141.75–$189.00	—	25%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY(USE WITH URODYN)	$1,672.50	$2,230.00	$1,672.50–$2,230.00	—	25%
D&C (dilation and curettage), not related to pregnancy CPT 58120 D&C NONOBSTETRICAL - PRO	$517.50	$690.00	$517.50–$690.00	93% below	25%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 D&C NONOBSTETRICAL - PRO	$517.50	$690.00	$517.50–$690.00	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 1ST PERML LES DESTRUCTION -PRO	$18.75	$25.00	$18.75–$25.00	91% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 1ST PERML LES DESTRUCTION -FAC	$76.50	$102.00	$76.50–$102.00	62% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 1ST PERML LES DESTRUCTION-TOT	$95.25	$127.00	$95.25–$127.00	53% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 1ST PERML LES DESTRUCTION -PRO	$18.75	$25.00	$18.75–$25.00	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 1ST PERML LES DESTRUCTION -FAC	$76.50	$102.00	$76.50–$102.00	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 1ST PERML LES DESTRUCTION-TOT	$95.25	$127.00	$95.25–$127.00	—	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMP CERUM IRRIG/LAV UN-FAC	$21.00	$28.00	$21.00–$28.00	86% below	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMP CERUM IRRIG/LAV UN-TOT	$26.25	$35.00	$26.25–$35.00	83% below	25%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REM IMP CERUM IRRIG/LAV UN-FAC	$21.00	$28.00	$21.00–$28.00	—	25%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REM IMP CERUM IRRIG/LAV UN-TOT	$26.25	$35.00	$26.25–$35.00	—	25%
Earwax removal with instruments, one ear CPT 69210 REM IMP CERUMEN INSTR UNI-PRO	$16.50	$22.00	$16.50–$22.00	89% below	25%
Earwax removal with instruments, one ear CPT 69210 REM IMP CERUMEN INSTR UNI-FAC	$66.75	$89.00	$66.75–$89.00	57% below	25%
Earwax removal with instruments, one ear CPT 69210 REM IMP CERUMEN INSTR UNI-TOT	$83.25	$111.00	$83.25–$111.00	46% below	25%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMP CERUMEN INSTR UNI-PRO	$16.50	$22.00	$16.50–$22.00	—	25%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMP CERUMEN INSTR UNI-FAC	$66.75	$89.00	$66.75–$89.00	—	25%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMP CERUMEN INSTR UNI-TOT	$83.25	$111.00	$83.25–$111.00	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOM,BX WO DIL;W/WO ECC - PRO	$34.50	$46.00	$34.50–$46.00	91% below	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDO BX WO CERV DIL-FAC	$139.50	$186.00	$139.50–$186.00	64% below	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDO BX WO CERV DIL-TOT	$174.00	$232.00	$174.00–$232.00	55% below	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOM,BX WO DIL;W/WO ECC - PRO	$34.50	$46.00	$34.50–$46.00	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDO BX WO CERV DIL-FAC	$139.50	$186.00	$139.50–$186.00	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDO BX WO CERV DIL-TOT	$174.00	$232.00	$174.00–$232.00	—	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 PM-INJ SPINE/CER/THOR (EPID)	$3,033.75	$4,045.00	$3,033.75–$4,045.00	36% above	25%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 PM-INJ SPINE/CER/THOR (EPID)	$3,033.75	$4,045.00	$3,033.75–$4,045.00	—	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 PM-PARAVERT L/S 1ST LEVEL	$3,900.00	$5,200.00	$3,900.00–$5,200.00	78% above	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 PM-BIL PARAVERT L/S 1ST LEV	$4,875.00	$6,500.00	$4,875.00–$6,500.00	123% above	25%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 PM-PARAVERT L/S 1ST LEVEL	$3,900.00	$5,200.00	$3,900.00–$5,200.00	—	25%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 PM-BIL PARAVERT L/S 1ST LEV	$4,875.00	$6,500.00	$4,875.00–$6,500.00	—	25%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 RPR AA HRN INT 3-10 CM RED-PRO	$1,027.50	$1,370.00	$1,027.50–$1,370.00	96% below	25%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 RPR AA HRN INT 3-10 CM RED-PRO	$1,027.50	$1,370.00	$1,027.50–$1,370.00	—	25%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST < 3 CM RDC-PRO	$612.75	$817.00	$612.75–$817.00	96% below	25%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 RPR AA HRN 1ST < 3 CM RDC-PRO	$612.75	$817.00	$612.75–$817.00	—	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 FLEXIBLE SIGMOIDOSCOPY-PRO	$99.75	$133.00	$99.75–$133.00	96% below	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 FLEXIBLE SIGMOIDOSCOPY-PRO	$99.75	$133.00	$99.75–$133.00	—	25%
Gallbladder removal, laparoscopic CPT 47562 LAP;CHOLECYSTECTOMY	$1,184.25	$1,579.00	$1,184.25–$1,579.00	93% below	25%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAP;CHOLECYSTECTOMY	$1,184.25	$1,579.00	$1,184.25–$1,579.00	—	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAP;CHOLECYSTECTMY W CHOL-PRO	$1,288.50	$1,718.00	$1,288.50–$1,718.00	93% below	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAP;CHOLECYSTECTMY W CHOL-PRO	$1,288.50	$1,718.00	$1,288.50–$1,718.00	—	25%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 CHOLECYSTECTOMY;-PRO	$1,916.25	$2,555.00	$1,916.25–$2,555.00	—	25%
Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOIDS -FAC	$273.00	$364.00	$273.00–$364.00	86% below	25%
Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOIDS-TOTAL	$341.25	$455.00	$341.25–$455.00	82% below	25%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 LIGATION OF HEMORRHOIDS -FAC	$273.00	$364.00	$273.00–$364.00	—	25%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 LIGATION OF HEMORRHOIDS-TOTAL	$341.25	$455.00	$341.25–$455.00	—	25%
Hemorrhoidectomy (internal and external), one area CPT 46255 REM INT/EXT HEM 1 GRP-PRO	$629.25	$839.00	$629.25–$839.00	94% below	25%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 REM INT/EXT HEM 1 GRP-PRO	$629.25	$839.00	$629.25–$839.00	—	25%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 CONV PREVIOUS HIP SURGERY-PRO	$2,970.75	$3,961.00	$2,970.75–$3,961.00	—	25%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TAH W/WO REM TUBE-OVARY-PRO	$1,811.25	$2,415.00	$1,811.25–$2,415.00	—	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HYSTEROGR/SIS CTR/SAL INJ-PRO	$391.50	$522.00	$391.50–$522.00	3% above	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 INJ PROC-HYSTEROSALPINOGR	$637.50	$850.00	$637.50–$850.00	67% above	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HYSTEROGR/SIS CTR/SAL INJ-PRO	$391.50	$522.00	$391.50–$522.00	—	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 INJ PROC-HYSTEROSALPINOGR	$637.50	$850.00	$637.50–$850.00	—	25%
Hysteroscopy with endometrial ablation CPT 58563 LAP ENDOMET ABLATION - PRO	$3,291.00	$4,388.00	$3,291.00–$4,388.00	74% below	25%
Hysteroscopy with endometrial ablation inpatient CPT 58563 LAP ENDOMET ABLATION - PRO	$3,291.00	$4,388.00	$3,291.00–$4,388.00	—	25%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTERO ;W/BX&POLYPECT - PRO	$2,089.50	$2,786.00	$2,089.50–$2,786.00	78% below	25%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HYSTERO ;W/BX&POLYPECT - PRO	$2,089.50	$2,786.00	$2,089.50–$2,786.00	—	25%
IUD insertion (the device itself billed separately) CPT 58300 IUD INSERTION - PRO	$53.25	$71.00	$53.25–$71.00	89% below	25%
IUD insertion (the device itself billed separately) CPT 58300 INSERTION IUD-FAC	$213.00	$284.00	$213.00–$284.00	56% below	25%
IUD insertion (the device itself billed separately) CPT 58300 INSERTION IUD - TOT	$266.25	$355.00	$266.25–$355.00	45% below	25%
IUD insertion (the device itself billed separately) inpatient CPT 58300 IUD INSERTION - PRO	$53.25	$71.00	$53.25–$71.00	—	25%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERTION IUD-FAC	$213.00	$284.00	$213.00–$284.00	—	25%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERTION IUD - TOT	$266.25	$355.00	$266.25–$355.00	—	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE-PRO	$37.50	$50.00	$37.50–$50.00	90% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE -FAC	$149.25	$199.00	$149.25–$199.00	61% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMP/SINGLE-TOTAL	$186.75	$249.00	$186.75–$249.00	52% below	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE/SINGLE-PRO	$37.50	$50.00	$37.50–$50.00	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE/SINGLE -FAC	$149.25	$199.00	$149.25–$199.00	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMP/SINGLE-TOTAL	$186.75	$249.00	$186.75–$249.00	—	25%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR I/HERNIA INIT RED >5YR	$938.25	$1,251.00	$938.25–$1,251.00	91% below	25%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 REPAIR I/HERNIA INIT RED >5YR	$938.25	$1,251.00	$938.25–$1,251.00	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ;SGL TENDON SHEATH/LIG -FAC	$55.50	$74.00	$55.50–$74.00	84% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ;SGL TEND SHE/LIGAMENT-TOT	$69.75	$93.00	$69.75–$93.00	79% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) one side CPT 20550 Right Inj Sgl Shth/Liga-FAC	$1,293.75	$1,725.00	$1,293.75–$1,725.00	281% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) one side CPT 20550 Left Inj Sgl Shth/Liga -FAC	$1,293.75	$1,725.00	$1,293.75–$1,725.00	281% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ;SGL TENDON SHEATH/LIG -FAC	$55.50	$74.00	$55.50–$74.00	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ;SGL TEND SHE/LIGAMENT-TOT	$69.75	$93.00	$69.75–$93.00	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient one side CPT 20550 Left Inj Sgl Shth/Liga -FAC	$1,293.75	$1,725.00	$1,293.75–$1,725.00	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient one side CPT 20550 Right Inj Sgl Shth/Liga-FAC	$1,293.75	$1,725.00	$1,293.75–$1,725.00	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRN/INJ,JNT/BURS LRG WO US-FAC	$64.50	$86.00	$64.50–$86.00	91% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRN/INJ, JNT LRG-BIL WO US-FAC	$80.25	$107.00	$80.25–$107.00	88% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRN/INJ,JNT LRG BIL WO US -TOT	$80.25	$107.00	$80.25–$107.00	88% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRN/INJ,JNT/BURS LRG WO US-FAC	$64.50	$86.00	$64.50–$86.00	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRN/INJ, JNT LRG-BIL WO US-FAC	$80.25	$107.00	$80.25–$107.00	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRN/INJ,JNT LRG BIL WO US -TOT	$80.25	$107.00	$80.25–$107.00	—	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG IMPLANT - FAC	$90.00	$120.00	$90.00–$120.00	76% below	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG IMPLANT - TOTAL	$112.50	$150.00	$112.50–$150.00	70% below	25%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG IMPLANT - FAC	$90.00	$120.00	$90.00–$120.00	—	25%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG IMPLANT - TOTAL	$112.50	$150.00	$112.50–$150.00	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRN/INJ,JNT/BURS MED WO US-FAC	$51.75	$69.00	$51.75–$69.00	92% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRN/INJ JNT/BUR M-BL WO US-FAC	$64.50	$86.00	$64.50–$86.00	90% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRN/INJ,JNT/BUR MED WO US-TOT	$64.50	$86.00	$64.50–$86.00	90% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRN/INJ,JNT/BURS MED WO US-FAC	$51.75	$69.00	$51.75–$69.00	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRN/INJ JNT/BUR M-BL WO US-FAC	$64.50	$86.00	$64.50–$86.00	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRN/INJ,JNT/BUR MED WO US-TOT	$64.50	$86.00	$64.50–$86.00	—	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRN/INJ,JNT/BURSA SM WO US-FAC	$51.00	$68.00	$51.00–$68.00	90% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRN/INJ,JNT/B SM BL WO US -FAC	$63.00	$84.00	$63.00–$84.00	87% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRN/INJ,JNT/BUR SM WO US-TOT	$63.75	$85.00	$63.75–$85.00	87% below	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRN/INJ,JNT/BURSA SM WO US-FAC	$51.00	$68.00	$51.00–$68.00	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRN/INJ,JNT/B SM BL WO US -FAC	$63.00	$84.00	$63.00–$84.00	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRN/INJ,JNT/BUR SM WO US-TOT	$63.75	$85.00	$63.75–$85.00	—	25%
Knee arthroscopy with meniscus trim CPT 29881 ARTHRO KNEE;W MEN M/L W SH-PRO	$967.50	$1,290.00	$967.50–$1,290.00	92% below	25%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHRO KNEE;W MEN M/L W SH-PRO	$967.50	$1,290.00	$967.50–$1,290.00	—	25%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 ARTHRO KNEE;W MEN DEB/SH -PRO	$1,004.25	$1,339.00	$1,004.25–$1,339.00	92% below	25%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 ARTHRO KNEE;W MEN DEB/SH -PRO	$1,004.25	$1,339.00	$1,004.25–$1,339.00	—	25%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 ARTHRO, KNEE; DEB/SH AC-PRO	$1,110.00	$1,480.00	$1,110.00–$1,480.00	92% below	25%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 ARTHRO, KNEE; DEB/SH AC-PRO	$1,110.00	$1,480.00	$1,110.00–$1,480.00	—	25%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY;APPENDECTOMY-PRO	$1,078.50	$1,438.00	$1,078.50–$1,438.00	94% below	25%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAPAROSCOPY;APPENDECTOMY-PRO	$1,078.50	$1,438.00	$1,078.50–$1,438.00	—	25%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 LAPAROSCOPY FUNDOPLASTY-PRO	$1,926.00	$2,568.00	$1,926.00–$2,568.00	92% below	25%
Laparoscopic fundoplication (anti-reflux surgery) inpatient CPT 43280 LAPAROSCOPY FUNDOPLASTY-PRO	$1,926.00	$2,568.00	$1,926.00–$2,568.00	—	25%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 TLH UTERUS 250 G OR LESS-PRO	$1,434.75	$1,913.00	$1,434.75–$1,913.00	96% below	25%
Laparoscopic hysterectomy (uterus 250 g or less) inpatient CPT 58570 TLH UTERUS 250 G OR LESS-PRO	$1,434.75	$1,913.00	$1,434.75–$1,913.00	—	25%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP ING HERNIA REP INIT-PRO	$776.25	$1,035.00	$776.25–$1,035.00	97% below	25%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 LAP ING HERNIA REP INIT-PRO	$776.25	$1,035.00	$776.25–$1,035.00	—	25%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP ING HERNIA REP RECUR-PRO	$1,013.25	$1,351.00	$1,013.25–$1,351.00	97% below	25%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 LAP ING HERNIA REP RECUR-PRO	$1,013.25	$1,351.00	$1,013.25–$1,351.00	—	25%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAP; W REML ADNEXAL STRUCTURES	$1,161.00	$1,548.00	$1,161.00–$1,548.00	93% below	25%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAP; W REML ADNEXAL STRUCTURES	$1,161.00	$1,548.00	$1,161.00–$1,548.00	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD WND RPR S/TR/EXT =< -PRO	$53.25	$71.00	$53.25–$71.00	90% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD WND RPR S/TR/EXT =< -FAC	$212.25	$283.00	$212.25–$283.00	61% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INT WND S/TR/EXT =<2.5CM-TOT	$265.50	$354.00	$265.50–$354.00	51% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTMD WND RPR S/TR/EXT =< -PRO	$53.25	$71.00	$53.25–$71.00	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTMD WND RPR S/TR/EXT =< -FAC	$212.25	$283.00	$212.25–$283.00	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INT WND S/TR/EXT =<2.5CM-TOT	$265.50	$354.00	$265.50–$354.00	—	25%
Lower-back epidural injection, with imaging guidance CPT 62323 PM-INJ SPINE L/S(CD) (EPID)	$3,033.75	$4,045.00	$3,033.75–$4,045.00	49% above	25%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PM-INJ SPINE L/S(CD) (EPID)	$3,033.75	$4,045.00	$3,033.75–$4,045.00	—	25%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC-FAC	$182.25	$243.00	$182.25–$243.00	89% below	25%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC-FAC	$182.25	$243.00	$182.25–$243.00	—	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PM-FORAMEN EPIDURAL INJ L/S	$3,900.00	$5,200.00	$3,900.00–$5,200.00	87% above	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PM-BIL FORAMEN EPI INJ,L/S	$4,875.00	$6,500.00	$4,875.00–$6,500.00	134% above	25%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 PM-FORAMEN EPIDURAL INJ L/S	$3,900.00	$5,200.00	$3,900.00–$5,200.00	—	25%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 PM-BIL FORAMEN EPI INJ,L/S	$4,875.00	$6,500.00	$4,875.00–$6,500.00	—	25%
Lumpectomy (partial mastectomy) CPT 19301 PARTIAL MASTECTOMY-PRO	$1,179.00	$1,572.00	$1,179.00–$1,572.00	93% below	25%
Lumpectomy (partial mastectomy) inpatient CPT 19301 PARTIAL MASTECTOMY-PRO	$1,179.00	$1,572.00	$1,179.00–$1,572.00	—	25%
Mastectomy (total removal of the breast) CPT 19303 MASTECTOMY SIMPLE COMPLETE-PRO	$1,714.50	$2,286.00	$1,714.50–$2,286.00	94% below	25%
Mastectomy (total removal of the breast) inpatient CPT 19303 MASTECTOMY SIMPLE COMPLETE-PRO	$1,714.50	$2,286.00	$1,714.50–$2,286.00	—	25%
Miscarriage treatment with D&C, first trimester CPT 59820 SURG TX MS AB;1ST TRIM-PRO	$768.75	$1,025.00	$768.75–$1,025.00	89% below	25%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 SURG TX MS AB;1ST TRIM-PRO	$768.75	$1,025.00	$768.75–$1,025.00	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BEN LES T/A/L;0.5/<-FAC	$118.50	$158.00	$118.50–$158.00	91% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BEN LES T/A/L;0.5/<-TOTAL	$147.75	$197.00	$147.75–$197.00	89% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BEN LES T/A/L;0.5/<-FAC	$118.50	$158.00	$118.50–$158.00	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BEN LES T/A/L;0.5/<-TOTAL	$147.75	$197.00	$147.75–$197.00	—	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC BEN LES FCE ERS EYLD -FAC	$149.25	$199.00	$149.25–$199.00	89% below	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC BEN LES FCE ERS EYELD-TOTL	$186.75	$249.00	$186.75–$249.00	86% below	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC BEN LES FCE ERS EYLD -FAC	$149.25	$199.00	$149.25–$199.00	—	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC BEN LES FCE ERS EYELD-TOTL	$186.75	$249.00	$186.75–$249.00	—	25%
Nail removal (partial or complete), one nail CPT 11730 1 AVUL PLAT PART/CMPL SMP -FAC	$76.50	$102.00	$76.50–$102.00	76% below	25%
Nail removal (partial or complete), one nail CPT 11730 1 AVUL PLAT PART/CMPL SMP-TOT	$95.25	$127.00	$95.25–$127.00	70% below	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 1 AVUL PLAT PART/CMPL SMP -FAC	$76.50	$102.00	$76.50–$102.00	—	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 1 AVUL PLAT PART/CMPL SMP-TOT	$95.25	$127.00	$95.25–$127.00	—	25%
Occipital nerve block (injection for headaches) CPT 64405 NERVE BLOCK OCCIPITAL-FAC	$132.00	$176.00	$132.00–$176.00	84% below	25%
Occipital nerve block (injection for headaches) inpatient CPT 64405 NERVE BLOCK OCCIPITAL-FAC	$132.00	$176.00	$132.00–$176.00	—	25%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS W IMAGING	$1,822.50	$2,430.00	$1,822.50–$2,430.00	5% above	25%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS INCGD W IMAGE	$1,822.50	$2,430.00	$1,822.50–$2,430.00	5% above	25%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS INCGD W IMAGE	$1,822.50	$2,430.00	$1,822.50–$2,430.00	—	25%
Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS W IMAGING	$1,822.50	$2,430.00	$1,822.50–$2,430.00	—	25%
Partial knee replacement (one compartment) CPT 27446 ARTHROPL C&P; MEDIAL/LAT-PRO	$2,044.50	$2,726.00	$2,044.50–$2,726.00	94% below	25%
Partial knee replacement (one compartment) inpatient CPT 27446 ARTHROPL C&P; MEDIAL/LAT-PRO	$2,044.50	$2,726.00	$2,044.50–$2,726.00	—	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL&MATRIX PART/CMPL -FAC	$143.25	$191.00	$143.25–$191.00	82% below	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL & MATRIX PART/CM-TOT	$179.25	$239.00	$179.25–$239.00	77% below	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL&MATRIX PART/CMPL -FAC	$143.25	$191.00	$143.25–$191.00	—	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL & MATRIX PART/CM-TOT	$179.25	$239.00	$179.25–$239.00	—	25%
Prostate biopsy CPT 55700 PROSTATE NEEDLE BIOPSY-PRO	$414.00	$552.00	$414.00–$552.00	78% below	25%
Prostate biopsy CPT 55700 US PROSTATE BX	$4,462.50	$5,950.00	$4,462.50–$5,950.00	136% above	25%
Prostate biopsy inpatient CPT 55700 PROSTATE NEEDLE BIOPSY-PRO	$414.00	$552.00	$414.00–$552.00	—	25%
Prostate biopsy inpatient CPT 55700 US PROSTATE BX	$4,462.50	$5,950.00	$4,462.50–$5,950.00	—	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 PM-DESTROY L/S FACET JNT	$8,553.75	$11,405.00	$8,553.75–$11,405.00	157% above	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 PM-BIL DESTROY L/S FACET JNT	$10,691.25	$14,255.00	$10,691.25–$14,255.00	221% above	25%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 PM-DESTROY L/S FACET JNT	$8,553.75	$11,405.00	$8,553.75–$11,405.00	—	25%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 PM-BIL DESTROY L/S FACET JNT	$10,691.25	$14,255.00	$10,691.25–$14,255.00	—	25%
Removal of a breast lump, open surgery CPT 19120 REVMOVAL OF BREAST LESION-PRO	$747.75	$997.00	$747.75–$997.00	83% below	25%
Removal of a breast lump, open surgery inpatient CPT 19120 REVMOVAL OF BREAST LESION-PRO	$747.75	$997.00	$747.75–$997.00	—	25%
Removal of a foreign object under the skin, simple CPT 10120 I&R FB SUBQ TISS;SIMPLE -FAC	$147.75	$197.00	$147.75–$197.00	78% below	25%
Removal of a foreign object under the skin, simple CPT 10120 I&R FB SUBQ TISS; SIMPLE-TOTAL	$184.50	$246.00	$184.50–$246.00	72% below	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 I&R FB SUBQ TISS;SIMPLE -FAC	$147.75	$197.00	$147.75–$197.00	—	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 I&R FB SUBQ TISS; SIMPLE-TOTAL	$184.50	$246.00	$184.50–$246.00	—	25%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 TOTAL THYRD LOBECTOMY UNIL-PRO	$1,258.50	$1,678.00	$1,258.50–$1,678.00	94% below	25%
Removal of one lobe of the thyroid (lobectomy) inpatient CPT 60220 TOTAL THYRD LOBECTOMY UNIL-PRO	$1,258.50	$1,678.00	$1,258.50–$1,678.00	—	25%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 MCRSCR COLNSCPY NOT HI RSK-PRO	$581.25	$775.00	$581.25–$775.00	78% below	25%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 MCRSCR COLNSCPY NOT HI RSK-PRO	$581.25	$775.00	$581.25–$775.00	—	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 MEDICARE SCRN COLONOSCOPY-PRO	$580.50	$774.00	$580.50–$774.00	78% below	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 MEDICARE SCRN COLONOSCOPY-PRO	$580.50	$774.00	$580.50–$774.00	—	25%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 LITHOTRIPSY, ESWL-PRO	$1,014.75	$1,353.00	$1,014.75–$1,353.00	90% below	25%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 LITHOTRIPSY, ESWL-PRO	$1,014.75	$1,353.00	$1,014.75–$1,353.00	—	25%
Short arm cast (elbow to hand) CPT 29075 APPL OF FOREARM CAST-FAC	$89.25	$119.00	$89.25–$119.00	70% below	25%
Short arm cast (elbow to hand) inpatient CPT 29075 APPL OF FOREARM CAST-FAC	$89.25	$119.00	$89.25–$119.00	—	25%
Short arm splint (forearm and hand) CPT 29125 APPLY SHORT ARM,SUGAR TONG-TOT	$71.25	$95.00	$71.25–$95.00	75% below	25%
Short arm splint (forearm and hand) CPT 29125 SHORT ARM SPLINT:STATIC	$123.75	$165.00	$123.75–$165.00	57% below	25%
Short arm splint (forearm and hand) CPT 29125 APPLY SHORT ARM,SUGAR TONG-FAC	$322.50	$430.00	$322.50–$430.00	12% above	25%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY SHORT ARM,SUGAR TONG-TOT	$71.25	$95.00	$71.25–$95.00	—	25%
Short arm splint (forearm and hand) inpatient CPT 29125 SHORT ARM SPLINT:STATIC	$123.75	$165.00	$123.75–$165.00	—	25%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY SHORT ARM,SUGAR TONG-FAC	$322.50	$430.00	$322.50–$430.00	—	25%
Short leg cast (below the knee) CPT 29405 APPLIC SHORT LEG CAST-TOT	$104.25	$139.00	$104.25–$139.00	72% below	25%
Short leg cast (below the knee) CPT 29405 APPLIC OF SHRT LEG CAST-FAC	$663.75	$885.00	$663.75–$885.00	75% above	25%
Short leg cast (below the knee) inpatient CPT 29405 APPLIC SHORT LEG CAST-TOT	$104.25	$139.00	$104.25–$139.00	—	25%
Short leg cast (below the knee) inpatient CPT 29405 APPLIC OF SHRT LEG CAST-FAC	$663.75	$885.00	$663.75–$885.00	—	25%
Short leg splint (calf to foot) CPT 29515 APPL SHORT LEG SPLINT-TOT	$88.50	$118.00	$88.50–$118.00	70% below	25%
Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT	$393.75	$525.00	$393.75–$525.00	34% above	25%
Short leg splint (calf to foot) inpatient CPT 29515 APPL SHORT LEG SPLINT-TOT	$88.50	$118.00	$88.50–$118.00	—	25%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION SHORT LEG SPLINT	$393.75	$525.00	$393.75–$525.00	—	25%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 ARTHRS SHLDR DSTL CLAVICLC-PRO	$1,209.00	$1,612.00	$1,209.00–$1,612.00	96% below	25%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 ARTHRS SHLDR DSTL CLAVICLC-PRO	$1,209.00	$1,612.00	$1,209.00–$1,612.00	—	25%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHOULDER ARTHROSCPY/SURG-PRO	$305.25	$407.00	$305.25–$407.00	99% below	25%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 SHOULDER ARTHROSCPY/SURG-PRO	$305.25	$407.00	$305.25–$407.00	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPL REP SCLP&TRNK;<2.5C -FAC	$63.75	$85.00	$63.75–$85.00	81% below	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPL REPR SCLP & TRUNK;-TOTAL	$79.50	$106.00	$79.50–$106.00	76% below	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPL REP SCLP&TRNK;<2.5C -FAC	$63.75	$85.00	$63.75–$85.00	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPL REPR SCLP & TRUNK;-TOTAL	$79.50	$106.00	$79.50–$106.00	—	25%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN, SGL LESION FAC	$66.00	$88.00	$66.00–$88.00	85% below	25%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN, SGL LESION TOTL	$82.50	$110.00	$82.50–$110.00	81% below	25%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN, SGL LESION FAC	$66.00	$88.00	$66.00–$88.00	—	25%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN, SGL LESION TOTL	$82.50	$110.00	$82.50–$110.00	—	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC MAL LES TRNK ARM LEG; -FAC	$171.75	$229.00	$171.75–$229.00	87% below	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC MAL LES TRNK ARM LEG;-TOT	$214.50	$286.00	$214.50–$286.00	84% below	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC MAL LES TRNK ARM LEG; -FAC	$171.75	$229.00	$171.75–$229.00	—	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC MAL LES TRNK ARM LEG;-TOT	$214.50	$286.00	$214.50–$286.00	—	25%
Skin tag removal, up to 15 tags CPT 11200 SKIN TAG1-15 LESIONS REMO-PRO	$27.00	$36.00	$27.00–$36.00	91% below	25%
Skin tag removal, up to 15 tags CPT 11200 SKIN TAG1-15 LESIONS REMO-FAC	$107.25	$143.00	$107.25–$143.00	63% below	25%
Skin tag removal, up to 15 tags CPT 11200 SKIN TAG1-15 LESIONS REM-TOTL	$134.25	$179.00	$134.25–$179.00	54% below	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 SKIN TAG1-15 LESIONS REMO-PRO	$27.00	$36.00	$27.00–$36.00	—	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 SKIN TAG1-15 LESIONS REMO-FAC	$107.25	$143.00	$107.25–$143.00	—	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 SKIN TAG1-15 LESIONS REM-TOTL	$134.25	$179.00	$134.25–$179.00	—	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL TAP/LUMBAR PUNCT-PRO	$250.50	$334.00	$250.50–$334.00	77% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL TAP/LUMBAR PUNCT	$1,346.25	$1,795.00	$1,346.25–$1,795.00	25% above	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL TAP/LUMBAR PUNCT-PRO	$250.50	$334.00	$250.50–$334.00	—	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL TAP/LUMBAR PUNCT	$1,346.25	$1,795.00	$1,346.25–$1,795.00	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPL REP SCLP&TRNK;2.6-7 -FAC	$84.00	$112.00	$84.00–$112.00	76% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPL REPR SCLP & TRUNK;-TOTAL	$105.00	$140.00	$105.00–$140.00	70% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPL REP SCLP&TRNK;2.6-7 -FAC	$84.00	$112.00	$84.00–$112.00	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPL REPR SCLP & TRUNK;-TOTAL	$105.00	$140.00	$105.00–$140.00	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPL REP FACE&MUCOUS;<2. -FAC	$79.50	$106.00	$79.50–$106.00	75% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPL REPR FACE & MUCOUS:-TOT	$99.75	$133.00	$99.75–$133.00	69% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPL REP FACE&MUCOUS;<2. -FAC	$79.50	$106.00	$79.50–$106.00	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPL REPR FACE & MUCOUS:-TOT	$99.75	$133.00	$99.75–$133.00	—	25%
TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP)-PRO	$1,290.75	$1,721.00	$1,290.75–$1,721.00	93% below	25%
TURP (transurethral resection of the prostate) inpatient CPT 52601 PROSTATECTOMY (TURP)-PRO	$1,290.75	$1,721.00	$1,290.75–$1,721.00	—	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANG BX SKIN, SGL LESION-FAC	$52.50	$70.00	$52.50–$70.00	82% below	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANG BX SKIN, SGL LESION-TOTAL	$66.00	$88.00	$66.00–$88.00	78% below	25%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANG BX SKIN, SGL LESION-FAC	$52.50	$70.00	$52.50–$70.00	—	25%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANG BX SKIN, SGL LESION-TOTAL	$66.00	$88.00	$66.00–$88.00	—	25%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/TB INSERT-PRO	$191.25	$255.00	$191.25–$255.00	89% below	25%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS INCL GUIDANCE	$1,200.00	$1,600.00	$1,200.00–$1,600.00	32% below	25%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/TB INSERT-PRO	$191.25	$255.00	$191.25–$255.00	—	25%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS INCL GUIDANCE	$1,200.00	$1,600.00	$1,200.00–$1,600.00	—	25%
Total hip replacement CPT 27130 ARTHROPLASTY ACE/FEM TOTAL-PRO	$2,286.00	$3,048.00	$2,286.00–$3,048.00	95% below	25%
Total hip replacement inpatient CPT 27130 ARTHROPLASTY ACE/FEM TOTAL-PRO	$2,286.00	$3,048.00	$2,286.00–$3,048.00	—	25%
Total knee replacement CPT 27447 ARTHROPL TOT KNEE REPLACE-PRO	$2,283.75	$3,045.00	$2,283.75–$3,045.00	95% below	25%
Total knee replacement inpatient CPT 27447 ARTHROPL TOT KNEE REPLACE-PRO	$2,283.75	$3,045.00	$2,283.75–$3,045.00	—	25%
Total shoulder replacement CPT 23472 TOT SHLDR;GHJ JOINT REPAIR-PRO	$2,568.00	$3,424.00	$2,568.00–$3,424.00	95% below	25%
Total shoulder replacement inpatient CPT 23472 TOT SHLDR;GHJ JOINT REPAIR-PRO	$2,568.00	$3,424.00	$2,568.00–$3,424.00	—	25%
Trigger finger release surgery CPT 26055 INC(REL)TEND SHTH,TR FING-PRO	$524.25	$699.00	$524.25–$699.00	83% below	25%
Trigger finger release surgery inpatient CPT 26055 INC(REL)TEND SHTH,TR FING-PRO	$524.25	$699.00	$524.25–$699.00	—	25%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ SGL/MX TRIG PNT 1-2 M -FAC	$51.75	$69.00	$51.75–$69.00	93% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ SING/MX TRIG PNT 1-2-TOT	$64.50	$86.00	$64.50–$86.00	91% below	25%
Trigger point injections, 1 or 2 muscles one side CPT 20552 Right Inj Trig Point 1/2 M-FAC	$1,293.75	$1,725.00	$1,293.75–$1,725.00	85% above	25%
Trigger point injections, 1 or 2 muscles one side CPT 20552 Left Inj Trig Point 1/2 M-FAC	$1,293.75	$1,725.00	$1,293.75–$1,725.00	85% above	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ SGL/MX TRIG PNT 1-2 M -FAC	$51.75	$69.00	$51.75–$69.00	—	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ SING/MX TRIG PNT 1-2-TOT	$64.50	$86.00	$64.50–$86.00	—	25%
Trigger point injections, 1 or 2 muscles inpatient one side CPT 20552 Right Inj Trig Point 1/2 M-FAC	$1,293.75	$1,725.00	$1,293.75–$1,725.00	—	25%
Trigger point injections, 1 or 2 muscles inpatient one side CPT 20552 Left Inj Trig Point 1/2 M-FAC	$1,293.75	$1,725.00	$1,293.75–$1,725.00	—	25%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 TUBAL LIG/FULGURATION - PRO	$659.25	$879.00	$659.25–$879.00	90% below	25%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 TUBAL LIG/FULGURATION - PRO	$659.25	$879.00	$659.25–$879.00	—	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LES US GD-PRO	$5,748.75	$7,665.00	$5,748.75–$7,665.00	73% above	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US INCGD BRST BX NDL/CR INT LT	$3,225.00	$4,300.00	$3,225.00–$4,300.00	3% below	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US INCGD BRST BX NDL/CR INT RT	$3,225.00	$4,300.00	$3,225.00–$4,300.00	3% below	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST 1ST LES US GD-PRO	$5,748.75	$7,665.00	$5,748.75–$7,665.00	—	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US INCGD BRST BX NDL/CR INT LT	$3,225.00	$4,300.00	$3,225.00–$4,300.00	—	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US INCGD BRST BX NDL/CR INT RT	$3,225.00	$4,300.00	$3,225.00–$4,300.00	—	25%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30 MIN-PRO	$268.50	$358.00	$268.50–$358.00	92% below	25%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 ESOPH EGD DILATION <30 MIN-PRO	$268.50	$358.00	$268.50–$358.00	—	25%
Upper endoscopy (EGD) with biopsy CPT 43239 UGI W BX SGL/MULTIPLE-PRO	$241.50	$322.00	$241.50–$322.00	91% below	25%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UGI W BX SGL/MULTIPLE-PRO	$241.50	$322.00	$241.50–$322.00	—	25%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 UGI W/REM T/P/LES SNARE-PRO	$342.75	$457.00	$342.75–$457.00	89% below	25%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 UGI W/REM T/P/LES SNARE-PRO	$342.75	$457.00	$342.75–$457.00	—	25%
Upper endoscopy (EGD), diagnostic CPT 43235 UGI, DIAGNOSTIC-PRO	$215.25	$287.00	$215.25–$287.00	92% below	25%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UGI, DIAGNOSTIC-PRO	$215.25	$287.00	$215.25–$287.00	—	25%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URETER W/LITHOTRIPSY-PRO	$731.25	$975.00	$731.25–$975.00	95% below	25%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 CYSTO/URETER W/LITHOTRIPSY-PRO	$731.25	$975.00	$731.25–$975.00	—	25%
Vaginal delivery, including prenatal and postpartum care CPT 59400 OB CARE W/VAG DEL&PP/GLBAL-PRO	$4,297.50	$5,730.00	$4,297.50–$5,730.00	2% above	25%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OB CARE W/VAG DEL&PP/GLBAL-PRO	$4,297.50	$5,730.00	$4,297.50–$5,730.00	—	25%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY LOCAL,NO IV SEDATE	$325.50	$434.00	$325.50–$434.00	91% below	25%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY-TOT	$407.25	$543.00	$407.25–$543.00	88% below	25%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 SUR-VASECTOMY, UNIL/BIL-PRO	$407.25	$543.00	$407.25–$543.00	88% below	25%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY LOCAL,NO IV SEDATE	$325.50	$434.00	$325.50–$434.00	—	25%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY-TOT	$407.25	$543.00	$407.25–$543.00	—	25%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 SUR-VASECTOMY, UNIL/BIL-PRO	$407.25	$543.00	$407.25–$543.00	—	25%
Vein ablation, radiofrequency, first vein CPT 36475 Venous ablation-PRO	$488.25	$651.00	$488.25–$651.00	93% below	25%
Vein ablation, radiofrequency, first vein CPT 36475 Venous ablation-FAC	$13,785.00	$18,380.00	$13,785.00–$18,380.00	111% above	25%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 Venous ablation-PRO	$488.25	$651.00	$488.25–$651.00	—	25%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 Venous ablation-FAC	$13,785.00	$18,380.00	$13,785.00–$18,380.00	—	25%
Wart removal, up to 14 warts CPT 17110 1-14 BEN LES DESTRUCTION -PRO	$24.00	$32.00	$24.00–$32.00	92% below	25%
Wart removal, up to 14 warts CPT 17110 1-14 BEN LES DESTRUCTION -FAC	$96.00	$128.00	$96.00–$128.00	69% below	25%
Wart removal, up to 14 warts CPT 17110 1-14BEN LES DESTRUCTION-TOT	$120.00	$160.00	$120.00–$160.00	61% below	25%
Wart removal, up to 14 warts inpatient CPT 17110 1-14 BEN LES DESTRUCTION -PRO	$24.00	$32.00	$24.00–$32.00	—	25%
Wart removal, up to 14 warts inpatient CPT 17110 1-14 BEN LES DESTRUCTION -FAC	$96.00	$128.00	$96.00–$128.00	—	25%
Wart removal, up to 14 warts inpatient CPT 17110 1-14BEN LES DESTRUCTION-TOT	$120.00	$160.00	$120.00–$160.00	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISS 20SQCM/< -FAC	$85.50	$114.00	$85.50–$114.00	89% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISS 20SQCM/<-TOTAL	$107.25	$143.00	$107.25–$143.00	86% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEB SUBQ TISS 20SQCM/< -FAC	$85.50	$114.00	$85.50–$114.00	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEB SUBQ TISS 20SQCM/<-TOTAL	$107.25	$143.00	$107.25–$143.00	—	25%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 ORIF, DSTL RAD EXT-ART FX-PRO	$1,329.00	$1,772.00	$1,329.00–$1,772.00	93% below	25%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 ORIF, DSTL RAD EXT-ART FX-PRO	$1,329.00	$1,772.00	$1,329.00–$1,772.00	—	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD INFUSION	$573.00	$764.00	$573.00–$764.00	48% below	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD INFUSION	$573.00	$764.00	$573.00–$764.00	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL/MDI	$243.75	$325.00	$243.75–$325.00	38% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL/MDI	$243.75	$325.00	$243.75–$325.00	—	25%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION, INIT HR	$892.50	$1,190.00	$892.50–$1,190.00	17% above	25%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION, INIT HR	$892.50	$1,190.00	$892.50–$1,190.00	—	25%
Critical care, first 30 to 74 minutes CPT 99291 ER LEV CRIT CARE INIT 30-74MIN	$1,635.00	$2,180.00	$1,635.00–$2,180.00	44% below	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ER LEV CRIT CARE INIT 30-74MIN	$1,635.00	$2,180.00	$1,635.00–$2,180.00	—	25%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG W/INT&RPT,12LEAD-PRO	$24.75	$33.00	$24.75–$33.00	90% below	25%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG W/INT&RPT,12LEAD-PRO	$24.75	$33.00	$24.75–$33.00	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG-TRACING ONLY	$127.50	$170.00	$127.50–$170.00	31% below	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG-TRACING ONLY	$127.50	$170.00	$127.50–$170.00	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL 1	$172.50	$230.00	$172.50–$230.00	45% below	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL 1	$172.50	$230.00	$172.50–$230.00	—	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL 2	$307.50	$410.00	$307.50–$410.00	40% below	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL 2	$307.50	$410.00	$307.50–$410.00	—	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL 3	$536.25	$715.00	$536.25–$715.00	37% below	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL 3	$536.25	$715.00	$536.25–$715.00	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL 4	$828.75	$1,105.00	$828.75–$1,105.00	38% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL 4	$828.75	$1,105.00	$828.75–$1,105.00	—	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL 5	$1,192.50	$1,590.00	$1,192.50–$1,590.00	31% below	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL 5	$1,192.50	$1,590.00	$1,192.50–$1,590.00	—	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 EKG STRESS, TRACING ONLY	$701.25	$935.00	$701.25–$935.00	22% below	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 EKG STRESS, TRACING ONLY	$701.25	$935.00	$701.25–$935.00	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSE,HYDR,INIT,1H	$371.25	$495.00	$371.25–$495.00	11% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSE,HYDR,INIT,1H	$371.25	$495.00	$371.25–$495.00	—	25%
IV infusion of a medicine, first hour CPT 96365 IV INFUSE,DX,INIT,1 HR	$371.25	$495.00	$371.25–$495.00	14% below	25%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSE,DX,INIT,1 HR	$371.25	$495.00	$371.25–$495.00	—	25%
IV push of a medicine, first drug CPT 96374 INJ, IV PUSH, INIT, THER	$371.25	$495.00	$371.25–$495.00	46% above	25%
IV push of a medicine, first drug inpatient CPT 96374 INJ, IV PUSH, INIT, THER	$371.25	$495.00	$371.25–$495.00	—	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ THER/PROPH/DX;SUBQ/IM	$24.75	$33.00	$24.75–$33.00	82% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ, IM/SQ, each, THERAPEUTIC	$86.25	$115.00	$86.25–$115.00	39% below	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ THER/PROPH/DX;SUBQ/IM	$24.75	$33.00	$24.75–$33.00	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ, IM/SQ, each, THERAPEUTIC	$86.25	$115.00	$86.25–$115.00	—	25%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-ED 15MIN	$101.25	$135.00	$101.25–$135.00	6% below	25%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-ED 15MN	$112.50	$150.00	$112.50–$150.00	5% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 BIO PELV NEURO RE-ED EA 15 MIN	$112.50	$150.00	$112.50–$150.00	5% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 BIOFEED NEURO RE-ED EA 15 MIN	$112.50	$150.00	$112.50–$150.00	5% above	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-ED 15MIN	$101.25	$135.00	$101.25–$135.00	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 BIO PELV NEURO RE-ED EA 15 MIN	$112.50	$150.00	$112.50–$150.00	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-ED 15MN	$112.50	$150.00	$112.50–$150.00	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 BIOFEED NEURO RE-ED EA 15 MIN	$112.50	$150.00	$112.50–$150.00	—	25%
New patient office visit, about 30 minutes CPT 99203 NEW LOW OFFICE VISIT,-PRO	$21.00	$28.00	$21.00–$28.00	81% below	25%
New patient office visit, about 30 minutes CPT 99203 NEW LOW OFFICE VISIT,-UFAC	$84.00	$112.00	$84.00–$112.00	22% below	25%
New patient office visit, about 30 minutes CPT 99203 NEW LOW OFFICE VISIT,-FAC	$84.00	$112.00	$84.00–$112.00	22% below	25%
New patient office visit, about 30 minutes CPT 99203 NEW LOW OFFICE VISIT,-TOT	$105.00	$140.00	$105.00–$140.00	3% below	25%
New patient office visit, about 30 minutes CPT 99203 NEW LOW OFFICE VISIT, -UTOT	$105.00	$140.00	$105.00–$140.00	3% below	25%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW LOW OFFICE VISIT,-PRO	$21.00	$28.00	$21.00–$28.00	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW LOW OFFICE VISIT,-UFAC	$84.00	$112.00	$84.00–$112.00	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW LOW OFFICE VISIT,-FAC	$84.00	$112.00	$84.00–$112.00	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW LOW OFFICE VISIT, -UTOT	$105.00	$140.00	$105.00–$140.00	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW LOW OFFICE VISIT,-TOT	$105.00	$140.00	$105.00–$140.00	—	25%
New patient office visit, about 45 minutes CPT 99204 NEW MOD OFFICE VISIT,-PRO	$24.75	$33.00	$24.75–$33.00	79% below	25%
New patient office visit, about 45 minutes CPT 99204 NEW MOD OFFICE VISIT, -FAC	$99.00	$132.00	$99.00–$132.00	18% below	25%
New patient office visit, about 45 minutes CPT 99204 NEW MOD OFFICE VISIT, -UFAC	$99.00	$132.00	$99.00–$132.00	18% below	25%
New patient office visit, about 45 minutes CPT 99204 NEW MOD OFFICE VISIT,-TOT	$123.75	$165.00	$123.75–$165.00	3% above	25%
New patient office visit, about 45 minutes CPT 99204 NEW MOD OFFICE VISIT,-UTOT	$123.75	$165.00	$123.75–$165.00	3% above	25%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW MOD OFFICE VISIT,-PRO	$24.75	$33.00	$24.75–$33.00	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW MOD OFFICE VISIT, -FAC	$99.00	$132.00	$99.00–$132.00	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW MOD OFFICE VISIT, -UFAC	$99.00	$132.00	$99.00–$132.00	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW MOD OFFICE VISIT,-UTOT	$123.75	$165.00	$123.75–$165.00	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW MOD OFFICE VISIT,-TOT	$123.75	$165.00	$123.75–$165.00	—	25%
New patient office visit, about 60 minutes CPT 99205 NEW HIGH OFFICE VISIT,-PRO	$32.25	$43.00	$32.25–$43.00	80% below	25%
New patient office visit, about 60 minutes CPT 99205 NEW HIGH OFFICE VISIT,-FAC	$129.00	$172.00	$129.00–$172.00	21% below	25%
New patient office visit, about 60 minutes CPT 99205 NEW HIGH OFFICE VISIT, -UFAC	$129.00	$172.00	$129.00–$172.00	21% below	25%
New patient office visit, about 60 minutes CPT 99205 NEW HIGH OFFICE VISIT, -UTOT	$161.25	$215.00	$161.25–$215.00	1% below	25%
New patient office visit, about 60 minutes CPT 99205 NEW HIGH OFFICE VISIT,-TOT	$161.25	$215.00	$161.25–$215.00	1% below	25%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW HIGH OFFICE VISIT,-PRO	$32.25	$43.00	$32.25–$43.00	—	25%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW HIGH OFFICE VISIT,-FAC	$129.00	$172.00	$129.00–$172.00	—	25%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW HIGH OFFICE VISIT, -UFAC	$129.00	$172.00	$129.00–$172.00	—	25%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW HIGH OFFICE VISIT, -UTOT	$161.25	$215.00	$161.25–$215.00	—	25%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW HIGH OFFICE VISIT,-TOT	$161.25	$215.00	$161.25–$215.00	—	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW MIN OFFICE VISIT, -FAC	$54.00	$72.00	$54.00–$72.00	45% below	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW MIN OFFICE VISIT,-UFAC	$54.00	$72.00	$54.00–$72.00	45% below	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW MIN OFFICE VISIT, -UTOT	$67.50	$90.00	$67.50–$90.00	31% below	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW MIN OFFICE VISIT, -TOT	$67.50	$90.00	$67.50–$90.00	31% below	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW MIN OFFICE VISIT,-UFAC	$54.00	$72.00	$54.00–$72.00	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW MIN OFFICE VISIT, -FAC	$54.00	$72.00	$54.00–$72.00	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW MIN OFFICE VISIT, -UTOT	$67.50	$90.00	$67.50–$90.00	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW MIN OFFICE VISIT, -TOT	$67.50	$90.00	$67.50–$90.00	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 INITIAL CONSULT EA 15 MIN	$63.75	$85.00	$63.75–$85.00	2% below	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 INITIAL CONSULT EA 15 MIN	$63.75	$85.00	$63.75–$85.00	—	25%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEX 30	$127.50	$170.00	$127.50–$170.00	51% below	25%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEX 30	$127.50	$170.00	$127.50–$170.00	—	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEX 45	$262.50	$350.00	$262.50–$350.00	13% below	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEX 45	$262.50	$350.00	$262.50–$350.00	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEX 20	$131.25	$175.00	$131.25–$175.00	50% below	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEX 20	$131.25	$175.00	$131.25–$175.00	—	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD COMPLEX 30	$198.75	$265.00	$198.75–$265.00	29% below	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MOD COMPLEX 30	$198.75	$265.00	$198.75–$265.00	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 UE LYMPH MANUAL 15 MIN	$86.25	$115.00	$86.25–$115.00	22% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY WITH IDN 15 MIN	$93.75	$125.00	$93.75–$125.00	15% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 UE LYMPH MANUAL 15MIN	$93.75	$125.00	$93.75–$125.00	15% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 LE LYMPH MANUAL 15 MIN	$93.75	$125.00	$93.75–$125.00	15% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 15 MIN	$93.75	$125.00	$93.75–$125.00	15% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 UE LYMPH MANUAL 15 MIN	$86.25	$115.00	$86.25–$115.00	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY WITH IDN 15 MIN	$93.75	$125.00	$93.75–$125.00	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY 15 MIN	$93.75	$125.00	$93.75–$125.00	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 UE LYMPH MANUAL 15MIN	$93.75	$125.00	$93.75–$125.00	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 LE LYMPH MANUAL 15 MIN	$93.75	$125.00	$93.75–$125.00	—	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXER 15 MIN	$101.25	$135.00	$101.25–$135.00	13% below	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXER 15 MIN	$101.25	$135.00	$101.25–$135.00	—	25%
Preventive checkup, new patient aged 18–39 CPT 99385 18-39YR INIT PREV COMP EX-PRO	$81.00	$108.00	$81.00–$108.00	32% below	25%
Preventive checkup, new patient aged 18–39 CPT 99385 INIT PREVT NEW PT 18-39YRS-FAC	$324.00	$432.00	$324.00–$432.00	171% above	25%
Preventive checkup, new patient aged 18–39 CPT 99385 INIT PREVT NEW PT 18-39YRS-TOT	$405.00	$540.00	$405.00–$540.00	239% above	25%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 18-39YR INIT PREV COMP EX-PRO	$81.00	$108.00	$81.00–$108.00	—	25%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 INIT PREVT NEW PT 18-39YRS-FAC	$324.00	$432.00	$324.00–$432.00	—	25%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 INIT PREVT NEW PT 18-39YRS-TOT	$405.00	$540.00	$405.00–$540.00	—	25%
Preventive checkup, new patient aged 40–64 CPT 99386 40-64YR INIT PREV COMP EX-PRO	$85.50	$114.00	$85.50–$114.00	42% below	25%
Preventive checkup, new patient aged 40–64 CPT 99386 40-64YR INIT PREV COMP EX-FAC	$342.00	$456.00	$342.00–$456.00	130% above	25%
Preventive checkup, new patient aged 40–64 CPT 99386 PREV VISIT NEW AGE 40-64-TOT	$427.50	$570.00	$427.50–$570.00	188% above	25%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 40-64YR INIT PREV COMP EX-PRO	$85.50	$114.00	$85.50–$114.00	—	25%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 40-64YR INIT PREV COMP EX-FAC	$342.00	$456.00	$342.00–$456.00	—	25%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREV VISIT NEW AGE 40-64-TOT	$427.50	$570.00	$427.50–$570.00	—	25%
Preventive checkup, new patient aged 65 or older CPT 99387 65YR> INIT PREV COMP EXAM -PRO	$64.50	$86.00	$64.50–$86.00	59% below	25%
Preventive checkup, new patient aged 65 or older CPT 99387 65YR> INIT PREV COMP EXAM -FAC	$258.00	$344.00	$258.00–$344.00	64% above	25%
Preventive checkup, new patient aged 65 or older CPT 99387 65YR> INIT PREV COMP EXAM -TOT	$322.50	$430.00	$322.50–$430.00	105% above	25%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 65YR> INIT PREV COMP EXAM -PRO	$64.50	$86.00	$64.50–$86.00	—	25%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 65YR> INIT PREV COMP EXAM -FAC	$258.00	$344.00	$258.00–$344.00	—	25%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 65YR> INIT PREV COMP EXAM -TOT	$322.50	$430.00	$322.50–$430.00	—	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 18-39YR PER PREV COMP EXA -PRO	$45.75	$61.00	$45.75–$61.00	63% below	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 18-39YR PER PREV COMP EXA -FAC	$183.00	$244.00	$183.00–$244.00	46% above	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 18-39YR PER PREV COMP EXAM-TOT	$228.75	$305.00	$228.75–$305.00	83% above	25%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 18-39YR PER PREV COMP EXA -PRO	$45.75	$61.00	$45.75–$61.00	—	25%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 18-39YR PER PREV COMP EXA -FAC	$183.00	$244.00	$183.00–$244.00	—	25%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 18-39YR PER PREV COMP EXAM-TOT	$228.75	$305.00	$228.75–$305.00	—	25%
Preventive checkup, returning patient aged 40–64 CPT 99396 40-64 YR PER PREV COMP EX -PRO	$50.25	$67.00	$50.25–$67.00	60% below	25%
Preventive checkup, returning patient aged 40–64 CPT 99396 40-64 YR PER PREV COMP EX -FAC	$201.00	$268.00	$201.00–$268.00	60% above	25%
Preventive checkup, returning patient aged 40–64 CPT 99396 40-64YR PER PREV COMP EXA-TOT	$251.25	$335.00	$251.25–$335.00	99% above	25%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 40-64 YR PER PREV COMP EX -PRO	$50.25	$67.00	$50.25–$67.00	—	25%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 40-64 YR PER PREV COMP EX -FAC	$201.00	$268.00	$201.00–$268.00	—	25%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 40-64YR PER PREV COMP EXA-TOT	$251.25	$335.00	$251.25–$335.00	—	25%
Preventive checkup, returning patient aged 65 or older CPT 99397 65YR> PER PREV COMP EXAM -PRO	$30.75	$41.00	$30.75–$41.00	76% below	25%
Preventive checkup, returning patient aged 65 or older CPT 99397 65YR> PER PREV COMP EXAM -FAC	$123.00	$164.00	$123.00–$164.00	5% below	25%
Preventive checkup, returning patient aged 65 or older CPT 99397 65YR> PER PREV COMP EXAM-TOTAL	$153.75	$205.00	$153.75–$205.00	19% above	25%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 65YR> PER PREV COMP EXAM -PRO	$30.75	$41.00	$30.75–$41.00	—	25%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 65YR> PER PREV COMP EXAM -FAC	$123.00	$164.00	$123.00–$164.00	—	25%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 65YR> PER PREV COMP EXAM-TOTAL	$153.75	$205.00	$153.75–$205.00	—	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOK/TOB CESS CNSL 3-10M-PRO	$5.25	$7.00	$5.25–$7.00	88% below	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOK/TOB CESS CNSL 3-10M - FAC	$20.25	$27.00	$20.25–$27.00	53% below	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOK/TOB CESS CNSL 3-10M - TOT	$25.50	$34.00	$25.50–$34.00	41% below	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOK/TOB CESS CNSL 3-10M-PRO	$5.25	$7.00	$5.25–$7.00	—	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOK/TOB CESS CNSL 3-10M - FAC	$20.25	$27.00	$20.25–$27.00	—	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOK/TOB CESS CNSL 3-10M - TOT	$25.50	$34.00	$25.50–$34.00	—	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST HIGH OFFICE VISIT,-PRO	$32.25	$43.00	$32.25–$43.00	81% below	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST HIGH OFFICE VISIT,-FAC	$129.00	$172.00	$129.00–$172.00	23% below	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST HIGH OFFICE VISIT,-UFAC	$129.00	$172.00	$129.00–$172.00	23% below	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST HIGH OFFICE VISIT,-UTOT	$161.25	$215.00	$161.25–$215.00	4% below	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST HIGH OFFICE VISIT,-TOT	$161.25	$215.00	$161.25–$215.00	4% below	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST HIGH OFFICE VISIT,-PRO	$32.25	$43.00	$32.25–$43.00	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST HIGH OFFICE VISIT,-FAC	$129.00	$172.00	$129.00–$172.00	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST HIGH OFFICE VISIT,-UFAC	$129.00	$172.00	$129.00–$172.00	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST HIGH OFFICE VISIT,-UTOT	$161.25	$215.00	$161.25–$215.00	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST HIGH OFFICE VISIT,-TOT	$161.25	$215.00	$161.25–$215.00	—	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST LOW OFFICE VISIT,-PRO	$21.00	$28.00	$21.00–$28.00	82% below	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST LOW OFFICE VISIT,-UFAC	$84.00	$112.00	$84.00–$112.00	27% below	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST LOW OFFICE VISIT,-FAC	$84.00	$112.00	$84.00–$112.00	27% below	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST LOW OFFICE VISIT,-TOT	$105.00	$140.00	$105.00–$140.00	9% below	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST LOW OFFICE VISIT,-UTOT	$105.00	$140.00	$105.00–$140.00	9% below	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST LOW OFFICE VISIT,-PRO	$21.00	$28.00	$21.00–$28.00	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST LOW OFFICE VISIT,-FAC	$84.00	$112.00	$84.00–$112.00	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST LOW OFFICE VISIT,-UFAC	$84.00	$112.00	$84.00–$112.00	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST LOW OFFICE VISIT,-UTOT	$105.00	$140.00	$105.00–$140.00	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST LOW OFFICE VISIT,-TOT	$105.00	$140.00	$105.00–$140.00	—	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST MOD OFFICE VISIT,-PRO	$24.75	$33.00	$24.75–$33.00	82% below	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST MOD OFFICE VISIT,-FAC	$99.00	$132.00	$99.00–$132.00	27% below	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST MOD OFFICE VISIT,-UFAC	$99.00	$132.00	$99.00–$132.00	27% below	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST MOD OFFICE VISIT,-UTOT	$123.75	$165.00	$123.75–$165.00	8% below	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST MOD OFFICE VISIT,-TOT	$123.75	$165.00	$123.75–$165.00	8% below	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST MOD OFFICE VISIT,-PRO	$24.75	$33.00	$24.75–$33.00	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST MOD OFFICE VISIT,-UFAC	$99.00	$132.00	$99.00–$132.00	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST MOD OFFICE VISIT,-FAC	$99.00	$132.00	$99.00–$132.00	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST MOD OFFICE VISIT,-TOT	$123.75	$165.00	$123.75–$165.00	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST MOD OFFICE VISIT,-UTOT	$123.75	$165.00	$123.75–$165.00	—	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST MIN OFFICE VISIT,-PRO	$13.50	$18.00	$13.50–$18.00	86% below	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST MIN OFFICE VISIT,-FAC	$54.00	$72.00	$54.00–$72.00	45% below	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST MIN OFFICE VISIT, -UFAC	$54.00	$72.00	$54.00–$72.00	45% below	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST MIN OFFICE VISIT,-TOT	$67.50	$90.00	$67.50–$90.00	31% below	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST MIN OFFICE VISIT, -UTOT	$67.50	$90.00	$67.50–$90.00	31% below	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST MIN OFFICE VISIT,-PRO	$13.50	$18.00	$13.50–$18.00	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST MIN OFFICE VISIT,-FAC	$54.00	$72.00	$54.00–$72.00	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST MIN OFFICE VISIT, -UFAC	$54.00	$72.00	$54.00–$72.00	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST MIN OFFICE VISIT, -UTOT	$67.50	$90.00	$67.50–$90.00	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST MIN OFFICE VISIT,-TOT	$67.50	$90.00	$67.50–$90.00	—	25%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFC CNSLT 40 MIN, MOD,NEW -FAC	$176.25	$235.00	$176.25–$235.00	61% above	25%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFC CNSLT 40 MIN, MOD,NEW -PRO	$352.50	$470.00	$352.50–$470.00	221% above	25%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFC CNSLT 40MIN, MOD,NEW -TOTL	$352.50	$470.00	$352.50–$470.00	221% above	25%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFC CNSLT 40 MIN, MOD,NEW -FAC	$176.25	$235.00	$176.25–$235.00	—	25%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFC CNSLT 40 MIN, MOD,NEW -PRO	$352.50	$470.00	$352.50–$470.00	—	25%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFC CNSLT 40MIN, MOD,NEW -TOTL	$352.50	$470.00	$352.50–$470.00	—	25%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFC CNSLT 60 MIN,MOD-HI,N -FAC	$86.25	$115.00	$86.25–$115.00	35% below	25%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFC CNSLT 60 MIN,MOD-HI,N-TOTL	$326.25	$435.00	$326.25–$435.00	146% above	25%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFC CNSLT 60 MIN,MOD-HI,N -PRO	$330.00	$440.00	$330.00–$440.00	149% above	25%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFC CNSLT 60 MIN,MOD-HI,N -FAC	$86.25	$115.00	$86.25–$115.00	—	25%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFC CNSLT 60 MIN,MOD-HI,N-TOTL	$326.25	$435.00	$326.25–$435.00	—	25%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFC CNSLT 60 MIN,MOD-HI,N -PRO	$330.00	$440.00	$330.00–$440.00	—	25%
Speech and language evaluation CPT 92523 SPEECH EVAL-SPEECH/LANG	$540.00	$720.00	$540.00–$720.00	59% above	25%
Speech and language evaluation inpatient CPT 92523 SPEECH EVAL-SPEECH/LANG	$540.00	$720.00	$540.00–$720.00	—	25%
Speech therapy session, individual CPT 92507 SPEECH THERAPY	$206.25	$275.00	$206.25–$275.00	6% below	25%
Speech therapy session, individual inpatient CPT 92507 SPEECH THERAPY	$206.25	$275.00	$206.25–$275.00	—	25%
Spirometry (breathing test) CPT 94010 SPIROMETRY(PF SCREEN)-PRO	$46.50	$62.00	$46.50–$62.00	85% below	25%
Spirometry (breathing test) CPT 94010 SPIROMETRY/PFT	$273.75	$365.00	$273.75–$365.00	13% below	25%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY(PF SCREEN)-PRO	$46.50	$62.00	$46.50–$62.00	—	25%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY/PFT	$273.75	$365.00	$273.75–$365.00	—	25%
Spirometry before and after a bronchodilator CPT 94060 B&A SPIRO(BRONCHSPSM EVAL)-PRO	$66.00	$88.00	$66.00–$88.00	88% below	25%
Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY W/BRONCHODILAT	$547.50	$730.00	$547.50–$730.00	4% below	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 B&A SPIRO(BRONCHSPSM EVAL)-PRO	$66.00	$88.00	$66.00–$88.00	—	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY W/BRONCHODILAT	$547.50	$730.00	$547.50–$730.00	—	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPUTIC ACT 15MIN	$108.75	$145.00	$108.75–$145.00	11% below	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACT 15 MIN	$120.00	$160.00	$120.00–$160.00	2% below	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPUTIC ACT 15MIN	$108.75	$145.00	$108.75–$145.00	—	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACT 15 MIN	$120.00	$160.00	$120.00–$160.00	—	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY/THERAPUTIC	$153.75	$205.00	$153.75–$205.00	35% below	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$153.75	$205.00	$153.75–$205.00	35% below	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY	$153.75	$205.00	$153.75–$205.00	—	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY/THERAPUTIC	$153.75	$205.00	$153.75–$205.00	—	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 FLU vac TriV 65YR>.5ML IM	$294.19	$392.25	$294.19–$392.25	287% above	25%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 FLU vac TriV 65YR>.5ML IM	$294.19	$392.25	$294.19–$392.25	—	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COVID VAC 30MCG/0.3ML COMIRNAT	$346.50	$462.00	$346.50–$462.00	5% above	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COVID VAC 30MCG/0.3ML COMIRNAT	$346.50	$462.00	$346.50–$462.00	—	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VACCINE	$683.44	$911.25	$683.44–$911.25	84% above	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VACCINE	$683.44	$911.25	$683.44–$911.25	—	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV	$280.46	$373.95	$280.46–$373.95	117% above	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP-IPV	$280.46	$373.95	$280.46–$373.95	—	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 TDAP VACCINE < 7YRS IM	$135.08	$180.10	$135.08–$180.10	106% above	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 TDAP VACCINE < 7YRS IM	$135.08	$180.10	$135.08–$180.10	—	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP HEP B IPV VACCINE IM	$463.46	$617.95	$463.46–$617.95	137% above	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP HEP B IPV VACCINE IM	$463.46	$617.95	$463.46–$617.95	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU Vac TriV, 4YR-Adult	$78.19	$104.25	$78.19–$104.25	71% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU Vac TriV, 4YR-Adult	$78.19	$104.25	$78.19–$104.25	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 PED/ADOL HEP A VACCINE	$175.50	$234.00	$175.50–$234.00	96% above	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 PED/ADOL HEP A VACCINE	$175.50	$234.00	$175.50–$234.00	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VAC 20microgram/ml	$257.81	$343.75	$257.81–$343.75	65% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VAC 20microgram/ml	$257.81	$343.75	$257.81–$343.75	—	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIB VACCINE IM	$58.69	$78.25	$58.69–$78.25	92% above	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HIB VACCINE IM	$58.69	$78.25	$58.69–$78.25	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HI DS 180MCG .5 ML	$172.56	$230.08	$172.56–$230.08	67% above	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HI DS 180MCG .5 ML	$172.56	$230.08	$172.56–$230.08	—	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 PROQUAD (MMRV)	$1,249.46	$1,665.95	$1,249.46–$1,665.95	144% above	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 PROQUAD (MMRV)	$1,249.46	$1,665.95	$1,249.46–$1,665.95	—	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL VACCINE	$1,066.50	$1,422.00	$1,066.50–$1,422.00	236% above	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL VACCINE	$1,066.50	$1,422.00	$1,066.50–$1,422.00	—	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20	$1,235.14	$1,646.85	$1,235.14–$1,646.85	87% above	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20	$1,235.14	$1,646.85	$1,235.14–$1,646.85	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUM VAC SUBQ/IM;ADLT/IM-TOT	$526.88	$702.50	$526.88–$702.50	92% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUM VAC SUBQ/IM;ADLT/IM-TOT	$526.88	$702.50	$526.88–$702.50	—	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VACCINE ORAL	$444.11	$592.15	$444.11–$592.15	228% above	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS VACCINE ORAL	$444.11	$592.15	$444.11–$592.15	—	25%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 SHINGLES VACCINE	$822.94	$1,097.25	$822.94–$1,097.25	63% above	25%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 SHINGLES VACCINE	$822.94	$1,097.25	$822.94–$1,097.25	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD 7YR>ADULT (TENIVAC)-TOT	$108.75	$145.00	$108.75–$145.00	21% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD 7YR>ADULT (TENIVAC)-TOT	$108.75	$145.00	$108.75–$145.00	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP 7 YRS-ADULT	$169.31	$225.75	$169.31–$225.75	53% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET TOX-DIPH-ACELL	$169.31	$225.75	$169.31–$225.75	53% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET TOX-DIPH-ACELL	$169.31	$225.75	$169.31–$225.75	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP 7 YRS-ADULT	$169.31	$225.75	$169.31–$225.75	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pneumonia Vaccine Admin	$99.75	$133.00	$99.75–$133.00	149% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 FLU VACCINE ADMINISTRATION	$99.75	$133.00	$99.75–$133.00	149% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMM 1st , ADMINISTRATION	$99.75	$133.00	$99.75–$133.00	149% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMM 1st , ADMINISTRATION	$99.75	$133.00	$99.75–$133.00	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pneumonia Vaccine Admin	$99.75	$133.00	$99.75–$133.00	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 FLU VACCINE ADMINISTRATION	$99.75	$133.00	$99.75–$133.00	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMM EA ADDL, ADMINISTRATION	$71.25	$95.00	$71.25–$95.00	105% above	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMM EA ADDL, ADMINISTRATION	$71.25	$95.00	$71.25–$95.00	—	25%

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://www.henrycountyhospital.org/documents/344477047_henry-county-hospital_standardcharges.csv