Hospital Anchorage, AK

Mat-Su Valley Medical Center

Mat-Su Valley Medical Center in Palmer, AK publishes cash prices for 428 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Alaska median for 293 of 400 procedures and above it for 96. By typical cash price it ranks #2 of 16 Alaska hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

2500 South Woodworth Loop Palmer, AK 99645 Collected Sep 22, 2026 Source price file Check a bill from this hospital (907) 861-6000

Acute care hospital Nonprofit hospital Emergency department CMS star rating 3 of 5 CCN 020006 · CMS hospital register NPI 1417975061

Financial assistance

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

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

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

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Alaska	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen WWO Liver Protocol 3Phase	$1,897.20	$6,324.00	$192.00–$6,071.04	44% below	70%
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen WWO	$1,897.20	$6,324.00	$192.00–$6,071.04	44% below	70%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen WWO Liver Protocol 3Phase	$3,162.00	$6,324.00	$3,162.00–$6,071.04	—	50%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen WWO	$3,162.00	$6,324.00	$3,162.00–$6,071.04	—	50%
Abdominal X-ray, 2 views CPT 74019 XR ABDOMEN 2V CR - XR Abdomen 2V CR	$173.70	$579.00	$62.07–$555.84	70% below	70%
Abdominal X-ray, 2 views CPT 74019 XR Abdomen Complete DR	$182.40	$608.00	$65.18–$583.68	68% below	70%
Abdominal X-ray, 2 views CPT 74019 XR Abd w Decub or Upright DR	$182.40	$608.00	$65.18–$583.68	68% below	70%
Abdominal X-ray, 2 views CPT 74019 XR Abd Flat Upright DR	$182.40	$608.00	$65.18–$583.68	68% below	70%
Abdominal X-ray, 2 views CPT 74019 XR ABDOMEN 2V DR - XR Abdomen 2V DR	$182.40	$608.00	$65.18–$583.68	68% below	70%
Abdominal X-ray, 2 views inpatient CPT 74019 XR ABDOMEN 2V CR - XR Abdomen 2V CR	$289.50	$579.00	$289.50–$555.84	—	50%
Abdominal X-ray, 2 views inpatient CPT 74019 XR Abd Flat Upright DR	$304.00	$608.00	$304.00–$583.68	—	50%
Abdominal X-ray, 2 views inpatient CPT 74019 XR Abd w Decub or Upright DR	$304.00	$608.00	$304.00–$583.68	—	50%
Abdominal X-ray, 2 views inpatient CPT 74019 XR ABDOMEN 2V DR - XR Abdomen 2V DR	$304.00	$608.00	$304.00–$583.68	—	50%
Abdominal X-ray, 2 views inpatient CPT 74019 XR Abdomen Complete DR	$304.00	$608.00	$304.00–$583.68	—	50%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete Min 3 V Left DR	$328.20	$1,094.00	$94.63–$1,050.24	29% below	70%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete Min 3 V Right DR	$328.20	$1,094.00	$94.63–$1,050.24	29% below	70%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete Min 3 V Left DR	$547.00	$1,094.00	$547.00–$1,050.24	—	50%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete Min 3 V Right DR	$547.00	$1,094.00	$547.00–$1,050.24	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 US UE Arterial Doppler Single Lvl Bilat	$184.20	$614.00	$65.82–$589.44	—	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US LE Arterial Duplex W ABIP	$184.20	$614.00	$65.82–$589.44	68% below	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 NI Seg Pres w Dopp UE LE Single	$189.30	$631.00	$67.64–$605.76	68% below	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US-EXT ARTERIAL LTD - Net Health - 207	$200.70	$669.00	$71.72–$642.24	66% below	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US- EXT ARTERIAL LTD - Net Health - 208	$200.70	$669.00	$71.72–$642.24	66% below	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 US UE Arterial Doppler Single Lvl Bilat	$307.00	$614.00	$307.00–$589.44	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US LE Arterial Duplex W ABIP	$307.00	$614.00	$307.00–$589.44	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 NI Seg Pres w Dopp UE LE Single	$315.50	$631.00	$315.50–$605.76	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US-EXT ARTERIAL LTD - Net Health - 207	$334.50	$669.00	$334.50–$642.24	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US- EXT ARTERIAL LTD - Net Health - 208	$334.50	$669.00	$334.50–$642.24	—	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist Left WO	$1,086.90	$3,623.00	$114.72–$3,478.08	49% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist Right WO	$1,086.90	$3,623.00	$114.72–$3,478.08	49% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder Right WO	$1,086.90	$3,623.00	$114.72–$3,478.08	49% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder Left WO	$1,086.90	$3,623.00	$114.72–$3,478.08	49% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus Right WO	$1,086.90	$3,623.00	$114.72–$3,478.08	49% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus Left WO	$1,086.90	$3,623.00	$114.72–$3,478.08	49% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand Right WO	$1,086.90	$3,623.00	$114.72–$3,478.08	49% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand Left WO	$1,086.90	$3,623.00	$114.72–$3,478.08	49% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm Right WO	$1,086.90	$3,623.00	$114.72–$3,478.08	49% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm Left WO	$1,086.90	$3,623.00	$114.72–$3,478.08	49% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow Right WO	$1,086.90	$3,623.00	$114.72–$3,478.08	49% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow Left WO	$1,086.90	$3,623.00	$114.72–$3,478.08	49% below	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist Right WO	$1,811.50	$3,623.00	$1,811.50–$3,478.08	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow Right WO	$1,811.50	$3,623.00	$1,811.50–$3,478.08	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand Right WO	$1,811.50	$3,623.00	$1,811.50–$3,478.08	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand Left WO	$1,811.50	$3,623.00	$1,811.50–$3,478.08	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow Left WO	$1,811.50	$3,623.00	$1,811.50–$3,478.08	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Forearm Left WO	$1,811.50	$3,623.00	$1,811.50–$3,478.08	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Humerus Left WO	$1,811.50	$3,623.00	$1,811.50–$3,478.08	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Humerus Right WO	$1,811.50	$3,623.00	$1,811.50–$3,478.08	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder Left WO	$1,811.50	$3,623.00	$1,811.50–$3,478.08	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder Right WO	$1,811.50	$3,623.00	$1,811.50–$3,478.08	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist Left WO	$1,811.50	$3,623.00	$1,811.50–$3,478.08	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Forearm Right WO	$1,811.50	$3,623.00	$1,811.50–$3,478.08	—	50%
Barium swallow (esophagus X-ray with contrast) CPT 74220 RF Esophagus Gastrografin	$418.50	$1,395.00	$149.54–$1,339.20	49% below	70%
Barium swallow (esophagus X-ray with contrast) CPT 74220 RF Esophagus Barium	$418.50	$1,395.00	$149.54–$1,339.20	49% below	70%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 RF Esophagus Gastrografin	$697.50	$1,395.00	$697.50–$1,339.20	—	50%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 RF Esophagus Barium	$697.50	$1,395.00	$697.50–$1,339.20	—	50%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone and or Joint Whole Body Scan 1 - NM Bone	$1,110.90	$3,703.00	$396.96–$3,554.88	44% below	70%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone and or Joint Whole Body Scan 1 - NM Bone	$1,851.50	$3,703.00	$1,851.50–$3,554.88	—	50%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Left	$239.70	$799.00	$73.60–$767.04	57% below	70%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Right	$239.70	$799.00	$73.60–$767.04	57% below	70%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Left	$399.50	$799.00	$399.50–$767.04	—	50%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Right	$399.50	$799.00	$399.50–$767.04	—	50%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Right	$239.70	$799.00	$57.05–$767.04	49% below	70%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Left	$239.70	$799.00	$57.05–$767.04	49% below	70%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Right	$399.50	$799.00	$399.50–$767.04	—	50%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Left	$399.50	$799.00	$399.50–$767.04	—	50%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA Abdomen Pelvis	$5,040.00	$16,800.00	$385.24–$16,128.00	5% above	70%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA Abdomen Pelvis	$8,400.00	$16,800.00	$8,400.00–$16,128.00	—	50%
CT angiography (CTA) of the head CPT 70496 CTA Head Stroke	$2,578.80	$8,596.00	$192.19–$8,252.16	25% below	70%
CT angiography (CTA) of the head CPT 70496 CTA Head	$2,578.80	$8,596.00	$192.19–$8,252.16	25% below	70%
CT angiography (CTA) of the head inpatient CPT 70496 CTA Head Stroke	$4,298.00	$8,596.00	$4,298.00–$8,252.16	—	50%
CT angiography (CTA) of the head inpatient CPT 70496 CTA Head	$4,298.00	$8,596.00	$4,298.00–$8,252.16	—	50%
CT angiography (CTA) of the neck CPT 70498 CTA Neck	$2,613.90	$8,713.00	$192.19–$8,364.48	24% below	70%
CT angiography (CTA) of the neck CPT 70498 CTA Neck Stroke	$2,613.90	$8,713.00	$192.19–$8,364.48	24% below	70%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA Neck	$4,356.50	$8,713.00	$4,356.50–$8,364.48	—	50%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA Neck Stroke	$4,356.50	$8,713.00	$4,356.50–$8,364.48	—	50%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest for PE	$2,513.40	$8,378.00	$192.19–$8,042.88	19% below	70%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest	$2,513.40	$8,378.00	$192.19–$8,042.88	19% below	70%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA Chest for PE	$4,189.00	$8,378.00	$4,189.00–$8,042.88	—	50%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA Chest	$4,189.00	$8,378.00	$4,189.00–$8,042.88	—	50%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA Coronary Function	$418.50	$1,395.00	$149.54–$1,395.00	76% below	70%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT Angio Heart Function W	$418.50	$1,395.00	$149.54–$1,395.00	76% below	70%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT Angio Heart Function W	$697.50	$1,395.00	$697.50–$1,339.20	—	50%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA Coronary Function	$697.50	$1,395.00	$697.50–$1,339.20	—	50%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Cardiac Score WO	$103.20	$344.00	$36.88–$344.00	52% below	70%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Cardiac Score WO	$172.00	$344.00	$172.00–$330.24	—	50%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen Pelvis WO	$1,182.00	$3,940.00	$260.76–$3,782.40	69% below	70%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen Pelvis Stone Protocol	$1,182.00	$3,940.00	$260.76–$3,782.40	69% below	70%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Trauma Abdomen Pelvis WO	$1,182.00	$3,940.00	$260.76–$3,782.40	69% below	70%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd Pelvis with Rectal WO	$1,182.00	$3,940.00	$260.76–$3,782.40	69% below	70%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Trauma Abdomen Pelvis WO	$1,970.00	$3,940.00	$1,970.00–$3,782.40	—	50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abd Pelvis with Rectal WO	$1,970.00	$3,940.00	$1,970.00–$3,782.40	—	50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen Pelvis Stone Protocol	$1,970.00	$3,940.00	$1,970.00–$3,782.40	—	50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen Pelvis WO	$1,970.00	$3,940.00	$1,970.00–$3,782.40	—	50%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abd Pelvis with Rectal W	$1,554.90	$5,183.00	$385.56–$4,975.68	64% below	70%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Trauma Abdomen Pelvis W	$1,554.90	$5,183.00	$385.56–$4,975.68	64% below	70%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abd Pelvis W Pancreatic Protocol	$1,554.90	$5,183.00	$385.56–$4,975.68	64% below	70%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen Pelvis W	$1,554.90	$5,183.00	$385.56–$4,975.68	64% below	70%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen Pelvis W	$2,591.50	$5,183.00	$2,591.50–$4,975.68	—	50%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abd Pelvis W Pancreatic Protocol	$2,591.50	$5,183.00	$2,591.50–$4,975.68	—	50%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abd Pelvis with Rectal W	$2,591.50	$5,183.00	$2,591.50–$4,975.68	—	50%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Trauma Abdomen Pelvis W	$2,591.50	$5,183.00	$2,591.50–$4,975.68	—	50%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abd Pelvis WWO Liver Protocol 3Phase	$1,912.80	$6,376.00	$385.40–$6,120.96	61% below	70%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen Pelvis WWO	$1,912.80	$6,376.00	$385.40–$6,120.96	61% below	70%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abd Pelvis WWO Urology Protocol	$1,912.80	$6,376.00	$385.40–$6,120.96	61% below	70%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abd Pelvis WWO Liver Protocol 3Phase	$3,188.00	$6,376.00	$3,188.00–$6,120.96	—	50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen Pelvis WWO	$3,188.00	$6,376.00	$3,188.00–$6,120.96	—	50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abd Pelvis WWO Urology Protocol	$3,188.00	$6,376.00	$3,188.00–$6,120.96	—	50%
CT scan of the abdomen with contrast CPT 74160 CT Trauma Abdomen W	$1,369.50	$4,565.00	$192.00–$4,382.40	47% below	70%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen W Pancreatic Protocol	$1,369.50	$4,565.00	$192.00–$4,382.40	47% below	70%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen W	$1,369.50	$4,565.00	$192.00–$4,382.40	47% below	70%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen W Pancreatic Protocol	$2,282.50	$4,565.00	$2,282.50–$4,382.40	—	50%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen W	$2,282.50	$4,565.00	$2,282.50–$4,382.40	—	50%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Trauma Abdomen W	$2,282.50	$4,565.00	$2,282.50–$4,382.40	—	50%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen WO	$1,141.50	$3,805.00	$114.53–$3,652.80	52% below	70%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen WO	$1,902.50	$3,805.00	$1,902.50–$3,652.80	—	50%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus WO	$1,153.50	$3,845.00	$114.88–$3,691.20	38% below	70%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Trauma Maxillofacial WO	$1,153.50	$3,845.00	$114.88–$3,691.20	38% below	70%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Trauma Maxillofacial WO	$1,922.50	$3,845.00	$1,922.50–$3,691.20	—	50%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus WO	$1,922.50	$3,845.00	$1,922.50–$3,691.20	—	50%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain WO	$1,246.20	$4,154.00	$114.72–$3,987.84	43% below	70%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head Stroke Alert	$1,246.20	$4,154.00	$114.72–$3,987.84	43% below	70%
CT scan of the head or brain, no contrast dye CPT 70450 CT Trauma Head WO	$1,246.20	$4,154.00	$114.72–$3,987.84	43% below	70%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head Stroke Alert	$2,077.00	$4,154.00	$2,077.00–$3,987.84	—	50%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Trauma Head WO	$2,077.00	$4,154.00	$2,077.00–$3,987.84	—	50%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain WO	$2,077.00	$4,154.00	$2,077.00–$3,987.84	—	50%
CT scan of the head with contrast CPT 70460 CT Head or Brain W	$1,572.00	$5,240.00	$192.03–$5,030.40	34% below	70%
CT scan of the head with contrast inpatient CPT 70460 CT Head or Brain W	$2,620.00	$5,240.00	$2,620.00–$5,030.40	—	50%
CT scan of the head without and with contrast CPT 70470 CT Head or Brain WWO	$1,862.10	$6,207.00	$191.84–$5,958.72	30% below	70%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head or Brain WWO	$3,103.50	$6,207.00	$3,103.50–$5,958.72	—	50%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar WO	$1,153.50	$3,845.00	$114.53–$3,691.20	45% below	70%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Trauma Lumbar Spine WO	$1,153.50	$3,845.00	$114.53–$3,691.20	45% below	70%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Trauma Lumbar Spine WO	$1,922.50	$3,845.00	$1,922.50–$3,691.20	—	50%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar WO	$1,922.50	$3,845.00	$1,922.50–$3,691.20	—	50%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Trauma Cervical Spine WO	$1,297.50	$4,325.00	$114.53–$4,152.00	37% below	70%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical WO	$1,297.50	$4,325.00	$114.53–$4,152.00	37% below	70%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Trauma Cervical Spine WO	$2,162.50	$4,325.00	$2,162.50–$4,152.00	—	50%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical WO	$2,162.50	$4,325.00	$2,162.50–$4,152.00	—	50%
CT scan of the pelvis, with contrast dye CPT 72193 CT Trauma Pelvis W	$1,526.10	$5,087.00	$192.00–$4,883.52	37% below	70%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis W	$1,526.10	$5,087.00	$192.00–$4,883.52	37% below	70%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis with Rectal W	$1,526.10	$5,087.00	$192.00–$4,883.52	37% below	70%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis with Rectal W	$2,543.50	$5,087.00	$2,543.50–$4,883.52	—	50%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Trauma Pelvis W	$2,543.50	$5,087.00	$2,543.50–$4,883.52	—	50%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis W	$2,543.50	$5,087.00	$2,543.50–$4,883.52	—	50%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Bilateral	$616.20	$2,054.00	$220.19–$1,971.84	—	70%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 NI Duplex Scan Extracran Art Comp Bilat	$713.10	$2,377.00	$254.81–$2,281.92	—	70%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Duplex Bilateral	$1,027.00	$2,054.00	$1,027.00–$1,971.84	—	50%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 NI Duplex Scan Extracran Art Comp Bilat	$1,188.50	$2,377.00	$1,188.50–$2,281.92	—	50%
Chest CT scan without and with contrast CPT 71270 CT Chest Diagnostic WWO	$1,795.50	$5,985.00	$192.19–$5,745.60	38% below	70%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest Diagnostic WWO	$2,992.50	$5,985.00	$2,992.50–$5,745.60	—	50%
Chest X-ray, 2 views both sides CPT 71046 XR Chest Decubitus Bilat DR	$296.40	$988.00	$94.48–$948.48	—	70%
Chest X-ray, 2 views CPT 71046 XR Chest 2 V DR	$296.40	$988.00	$94.48–$948.48	32% below	70%
Chest X-ray, 2 views one side CPT 71046 XR Chest 1V w Decubitus Rt DR	$296.40	$988.00	$94.48–$948.48	32% below	70%
Chest X-ray, 2 views one side CPT 71046 XR Chest 1V w Decubitus Lt DR	$296.40	$988.00	$94.48–$948.48	32% below	70%
Chest X-ray, 2 views inpatient both sides CPT 71046 XR Chest Decubitus Bilat DR	$494.00	$988.00	$494.00–$948.48	—	50%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 V DR	$494.00	$988.00	$494.00–$948.48	—	50%
Chest X-ray, 2 views inpatient one side CPT 71046 XR Chest 1V w Decubitus Lt DR	$494.00	$988.00	$494.00–$948.48	—	50%
Chest X-ray, 2 views inpatient one side CPT 71046 XR Chest 1V w Decubitus Rt DR	$494.00	$988.00	$494.00–$948.48	—	50%
Chest X-ray, single view CPT 71045 XR Stroke Chest 1V Portable DR	$242.70	$809.00	$86.72–$776.64	39% below	70%
Chest X-ray, single view CPT 71045 XR Chest Stereo Frontal DR	$242.70	$809.00	$86.72–$776.64	39% below	70%
Chest X-ray, single view CPT 71045 XR Chest 1 V Frontal DR	$242.70	$809.00	$86.72–$776.64	39% below	70%
Chest X-ray, single view CPT 71045 XR Chest 1 V Portable DR	$254.70	$849.00	$91.01–$815.04	35% below	70%
Chest X-ray, single view CPT 71045 XR Chest 1V DR	$254.70	$849.00	$91.01–$815.04	35% below	70%
Chest X-ray, single view one side CPT 71045 XR Chest Decubitus Lat Lt DR	$254.70	$849.00	$91.01–$815.04	35% below	70%
Chest X-ray, single view one side CPT 71045 XR Chest Decubitus Lat Rt DR	$254.70	$849.00	$91.01–$815.04	35% below	70%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 V Frontal DR	$404.50	$809.00	$404.50–$776.64	—	50%
Chest X-ray, single view inpatient CPT 71045 XR Stroke Chest 1V Portable DR	$404.50	$809.00	$404.50–$776.64	—	50%
Chest X-ray, single view inpatient CPT 71045 XR Chest Stereo Frontal DR	$404.50	$809.00	$404.50–$776.64	—	50%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 V Portable DR	$424.50	$849.00	$424.50–$815.04	—	50%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1V DR	$424.50	$849.00	$424.50–$815.04	—	50%
Chest X-ray, single view inpatient one side CPT 71045 XR Chest Decubitus Lat Lt DR	$424.50	$849.00	$424.50–$815.04	—	50%
Chest X-ray, single view inpatient one side CPT 71045 XR Chest Decubitus Lat Rt DR	$424.50	$849.00	$424.50–$815.04	—	50%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Left DR	$439.50	$1,465.00	$94.83–$1,406.40	6% above	70%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Right DR	$439.50	$1,465.00	$94.83–$1,406.40	6% above	70%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Left DR	$732.50	$1,465.00	$732.50–$1,406.40	—	50%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Right DR	$732.50	$1,465.00	$732.50–$1,406.40	—	50%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$396.60	$1,322.00	$114.57–$1,269.12	59% below	70%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete	$661.00	$1,322.00	$661.00–$1,269.12	—	50%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton	$302.10	$1,007.00	$107.95–$966.72	24% below	70%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Density DEXA Axial Skeleton	$503.50	$1,007.00	$503.50–$966.72	—	50%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD Bone Density DEXA App Skeleton	$129.30	$431.00	$46.20–$413.76	51% below	70%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD Bone Density DEXA App Skeleton	$215.50	$431.00	$215.50–$413.76	—	50%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest Diagnostic WO	$865.50	$2,885.00	$114.53–$2,769.60	60% below	70%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT High Resolution Chest	$865.50	$2,885.00	$114.53–$2,769.60	60% below	70%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Trauma Chest WO	$865.50	$2,885.00	$114.53–$2,769.60	60% below	70%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest Diagnostic WO	$1,442.50	$2,885.00	$1,442.50–$2,769.60	—	50%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Trauma Chest WO	$1,442.50	$2,885.00	$1,442.50–$2,769.60	—	50%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT High Resolution Chest	$1,442.50	$2,885.00	$1,442.50–$2,769.60	—	50%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest Diagnostic W	$1,354.20	$4,514.00	$191.84–$4,333.44	55% below	70%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest Diagnostic W For PE	$1,354.20	$4,514.00	$191.84–$4,333.44	55% below	70%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Trauma Chest W	$1,354.20	$4,514.00	$191.84–$4,333.44	55% below	70%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest Diagnostic W For PE	$2,257.00	$4,514.00	$2,257.00–$4,333.44	—	50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Trauma Chest W	$2,257.00	$4,514.00	$2,257.00–$4,333.44	—	50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest Diagnostic W	$2,257.00	$4,514.00	$2,257.00–$4,333.44	—	50%
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Diagnostic Bilateral WWO CAD	$93.00	$310.00	$33.23–$310.11	—	70%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Diagnostic Bilateral WWO CAD	$155.00	$310.00	$155.00–$297.60	—	50%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Diagnostic Right WWO CAD	$74.70	$249.00	$26.69–$249.00	84% below	70%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Diagnostic Left WWO CAD	$74.70	$249.00	$26.69–$249.00	84% below	70%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Diagnostic Right WWO CAD	$124.50	$249.00	$124.50–$239.04	—	50%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Diagnostic Left WWO CAD	$124.50	$249.00	$124.50–$239.04	—	50%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US LE Arterial Bypass Grafts Comp Bilat	$600.30	$2,001.00	$214.51–$1,920.96	—	70%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US LE Arterial Duplex Bilateral	$600.30	$2,001.00	$214.51–$1,920.96	—	70%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 NI Duplex Scan Leg Arteries Comp Bilat	$656.10	$2,187.00	$234.45–$2,099.52	—	70%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US LE Arterial Duplex Bilateral	$1,000.50	$2,001.00	$1,000.50–$1,920.96	—	50%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US LE Arterial Bypass Grafts Comp Bilat	$1,000.50	$2,001.00	$1,000.50–$1,920.96	—	50%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 NI Duplex Scan Leg Arteries Comp Bilat	$1,093.50	$2,187.00	$1,093.50–$2,099.52	—	50%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LE Venous Mapping Duplex Bilateral	$915.00	$3,050.00	$260.41–$2,928.00	—	70%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US UE Venous Duplex Bilateral	$915.00	$3,050.00	$260.41–$2,928.00	—	70%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LE Venous Duplex Bilateral	$915.00	$3,050.00	$260.41–$2,928.00	—	70%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US UE Venous Mapping Duplex Bilateral	$915.00	$3,050.00	$260.41–$2,928.00	—	70%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LE Venous Insufficiency Duplex Bilat	$915.00	$3,050.00	$260.41–$2,928.00	—	70%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 NI Duplex Venous Leg Comp Bilat	$929.10	$3,097.00	$260.41–$2,973.12	—	70%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 NI Duplex Venous Arm Comp Bilat	$929.10	$3,097.00	$260.41–$2,973.12	—	70%
Duplex ultrasound of the leg veins, both legs CPT 93970 US Lower Extremity Veins Limited Bilater - US Lowe	$915.00	$3,050.00	$260.41–$2,928.00	34% below	70%
Duplex ultrasound of the leg veins, both legs CPT 93970 US Upper Extremity Veins Limited Bilater - US Uppe	$915.00	$3,050.00	$260.41–$2,928.00	34% below	70%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US LE Venous Mapping Duplex Bilateral	$1,525.00	$3,050.00	$1,525.00–$2,928.00	—	50%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US LE Venous Duplex Bilateral	$1,525.00	$3,050.00	$1,525.00–$2,928.00	—	50%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US UE Venous Mapping Duplex Bilateral	$1,525.00	$3,050.00	$1,525.00–$2,928.00	—	50%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US UE Venous Duplex Bilateral	$1,525.00	$3,050.00	$1,525.00–$2,928.00	—	50%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US LE Venous Insufficiency Duplex Bilat	$1,525.00	$3,050.00	$1,525.00–$2,928.00	—	50%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 NI Duplex Venous Leg Comp Bilat	$1,548.50	$3,097.00	$1,548.50–$2,973.12	—	50%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 NI Duplex Venous Arm Comp Bilat	$1,548.50	$3,097.00	$1,548.50–$2,973.12	—	50%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US Lower Extremity Veins Limited Bilater - US Lowe	$1,525.00	$3,050.00	$1,525.00–$2,928.00	—	50%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US Upper Extremity Veins Limited Bilater - US Uppe	$1,525.00	$3,050.00	$1,525.00–$2,928.00	—	50%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 NI Echo TTE 2D Complete w Color Doppler	$3,531.90	$11,773.00	$590.63–$11,302.08	78% above	70%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 NI Echo TTE 2D Complete w Color Doppler	$5,886.50	$11,773.00	$5,886.50–$11,302.08	—	50%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 V Left DR	$251.40	$838.00	$89.83–$804.48	36% below	70%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 V Right DR	$251.40	$838.00	$89.83–$804.48	36% below	70%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 V Right DR	$419.00	$838.00	$419.00–$804.48	—	50%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 V Left DR	$419.00	$838.00	$419.00–$804.48	—	50%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete Min 3 V Left DR	$266.70	$889.00	$94.48–$853.44	40% below	70%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete Min 3 V Right DR	$266.70	$889.00	$94.48–$853.44	40% below	70%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Complete Min 3 V Right DR	$444.50	$889.00	$444.50–$853.44	—	50%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Complete Min 3 V Left DR	$444.50	$889.00	$444.50–$853.44	—	50%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Sella WO	$1,153.50	$3,845.00	$114.72–$3,691.20	41% below	70%
Eye socket (orbit) CT scan without contrast CPT 70480 CT IAC Temporal WO	$1,153.50	$3,845.00	$114.72–$3,691.20	41% below	70%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Mastoids WO	$1,153.50	$3,845.00	$114.72–$3,691.20	41% below	70%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Sella WO	$1,922.50	$3,845.00	$1,922.50–$3,691.20	—	50%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT IAC Temporal WO	$1,922.50	$3,845.00	$1,922.50–$3,691.20	—	50%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Mastoids WO	$1,922.50	$3,845.00	$1,922.50–$3,691.20	—	50%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR Facial Bones Comp Minimum 3 V DR	$332.10	$1,107.00	$114.57–$1,062.72	40% below	70%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR Facial Bones Comp Minimum 3 V DR	$553.50	$1,107.00	$553.50–$1,062.72	—	50%
Forearm X-ray (radius and ulna), 2 views both sides CPT 73090 XR Forearm 2 V Bilateral DR	$507.90	$1,693.00	$94.48–$1,625.28	—	70%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 V Left DR	$282.60	$942.00	$94.48–$904.32	45% below	70%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 V Right DR	$282.60	$942.00	$94.48–$904.32	45% below	70%
Forearm X-ray (radius and ulna), 2 views inpatient both sides CPT 73090 XR Forearm 2 V Bilateral DR	$846.50	$1,693.00	$846.50–$1,625.28	—	50%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 V Left DR	$471.00	$942.00	$471.00–$904.32	—	50%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 V Right DR	$471.00	$942.00	$471.00–$904.32	—	50%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary System Scan 1	$1,214.40	$4,048.00	$433.34–$3,886.08	41% below	70%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary System Scan 1	$2,024.00	$4,048.00	$2,024.00–$3,886.08	—	50%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 V Left DR	$102.60	$342.00	$36.66–$328.32	74% below	70%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 V Right DR	$266.70	$889.00	$95.30–$853.44	34% below	70%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 V Left DR	$171.00	$342.00	$171.00–$328.32	—	50%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 V Right DR	$444.50	$889.00	$444.50–$853.44	—	50%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneus 2 V Left DR	$343.50	$1,145.00	$94.48–$1,099.20	12% below	70%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneus 2 V Right DR	$343.50	$1,145.00	$94.48–$1,099.20	12% below	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneus 2 V Left DR	$572.50	$1,145.00	$572.50–$1,099.20	—	50%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneus 2 V Right DR	$572.50	$1,145.00	$572.50–$1,099.20	—	50%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 CHRG - SLEEP TITRATE UNATT	$1,437.00	$4,790.00	$55.28–$4,598.40	166% above	70%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 CHRG - SLEEP TITRATE UNATT	$2,395.00	$4,790.00	$2,395.00–$4,598.40	—	50%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 CHRG - POLYS-CPAP GT4 GE6YO	$3,710.40	$12,368.00	$559.73–$11,873.28	34% below	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 CHRG - POLYS-CPAP GT4 GE6YO	$6,184.00	$12,368.00	$6,184.00–$11,873.28	—	50%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 V Right DR	$188.40	$628.00	$67.32–$602.88	63% below	70%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 V Left DR	$188.40	$628.00	$67.32–$602.88	63% below	70%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 V Left DR	$314.00	$628.00	$314.00–$602.88	—	50%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 V Right DR	$314.00	$628.00	$314.00–$602.88	—	50%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Complete 4 V Left DR	$314.70	$1,049.00	$112.45–$1,007.04	52% below	70%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee 4 V w Patella Left DR	$314.70	$1,049.00	$112.45–$1,007.04	52% below	70%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Complete 4 V Right DR	$314.70	$1,049.00	$112.45–$1,007.04	52% below	70%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee 4 V w Patella Right DR	$314.70	$1,049.00	$112.45–$1,007.04	52% below	70%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee 4 V w Patella Right DR	$524.50	$1,049.00	$524.50–$1,007.04	—	50%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee 4 V w Patella Left DR	$524.50	$1,049.00	$524.50–$1,007.04	—	50%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Complete 4 V Left DR	$524.50	$1,049.00	$524.50–$1,007.04	—	50%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Complete 4 V Right DR	$524.50	$1,049.00	$524.50–$1,007.04	—	50%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Ankle Bilateral WO	$2,115.00	$7,050.00	$114.53–$6,768.00	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Tibia Fibula Bilateral WO	$2,115.00	$7,050.00	$114.53–$6,768.00	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Femur Bilateral WO	$2,115.00	$7,050.00	$114.53–$6,768.00	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Knee Bilateral WO	$2,115.00	$7,050.00	$114.53–$6,768.00	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Foot Bilateral WO	$2,115.00	$7,050.00	$114.53–$6,768.00	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Hip Bilateral WO	$2,115.00	$7,050.00	$114.53–$6,768.00	—	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot Left WO	$1,057.20	$3,524.00	$114.53–$3,383.04	50% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee Left WO	$1,057.20	$3,524.00	$114.53–$3,383.04	50% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle Left WO	$1,057.20	$3,524.00	$114.53–$3,383.04	50% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Hip Right WO	$1,057.20	$3,524.00	$114.53–$3,383.04	50% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle Right WO	$1,057.20	$3,524.00	$114.53–$3,383.04	50% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur Left WO	$1,057.20	$3,524.00	$114.53–$3,383.04	50% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia Fibula Left WO	$1,057.20	$3,524.00	$114.53–$3,383.04	50% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur Right WO	$1,057.20	$3,524.00	$114.53–$3,383.04	50% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Hip Left WO	$1,057.20	$3,524.00	$114.53–$3,383.04	50% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia Fibula Right WO	$1,057.20	$3,524.00	$114.53–$3,383.04	50% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot Right WO	$1,057.20	$3,524.00	$114.53–$3,383.04	50% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee Right WO	$1,057.20	$3,524.00	$114.53–$3,383.04	50% below	70%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Tibia Fibula Bilateral WO	$3,525.00	$7,050.00	$3,525.00–$6,768.00	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Ankle Bilateral WO	$3,525.00	$7,050.00	$3,525.00–$6,768.00	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Femur Bilateral WO	$3,525.00	$7,050.00	$3,525.00–$6,768.00	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Foot Bilateral WO	$3,525.00	$7,050.00	$3,525.00–$6,768.00	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Hip Bilateral WO	$3,525.00	$7,050.00	$3,525.00–$6,768.00	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Knee Bilateral WO	$3,525.00	$7,050.00	$3,525.00–$6,768.00	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Hip Right WO	$1,762.00	$3,524.00	$1,762.00–$3,383.04	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Femur Left WO	$1,762.00	$3,524.00	$1,762.00–$3,383.04	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle Left WO	$1,762.00	$3,524.00	$1,762.00–$3,383.04	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot Left WO	$1,762.00	$3,524.00	$1,762.00–$3,383.04	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee Right WO	$1,762.00	$3,524.00	$1,762.00–$3,383.04	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot Right WO	$1,762.00	$3,524.00	$1,762.00–$3,383.04	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee Left WO	$1,762.00	$3,524.00	$1,762.00–$3,383.04	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Hip Left WO	$1,762.00	$3,524.00	$1,762.00–$3,383.04	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Femur Right WO	$1,762.00	$3,524.00	$1,762.00–$3,383.04	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Tibia Fibula Right WO	$1,762.00	$3,524.00	$1,762.00–$3,383.04	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Tibia Fibula Left WO	$1,762.00	$3,524.00	$1,762.00–$3,383.04	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle Right WO	$1,762.00	$3,524.00	$1,762.00–$3,383.04	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Ascites	$317.10	$1,057.00	$113.31–$1,014.72	49% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Common Bile Duct	$317.10	$1,057.00	$113.31–$1,014.72	49% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Wall	$317.10	$1,057.00	$113.31–$1,014.72	49% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Liver	$317.10	$1,057.00	$113.31–$1,014.72	49% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Pancreas	$317.10	$1,057.00	$113.31–$1,014.72	49% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Pylorus	$317.10	$1,057.00	$113.31–$1,014.72	49% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Gallbladder	$317.10	$1,057.00	$113.31–$1,014.72	49% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited	$317.10	$1,057.00	$113.31–$1,014.72	49% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Pylorus	$528.50	$1,057.00	$528.50–$1,014.72	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Wall	$528.50	$1,057.00	$528.50–$1,014.72	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Gallbladder	$528.50	$1,057.00	$528.50–$1,014.72	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Liver	$528.50	$1,057.00	$528.50–$1,014.72	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Pancreas	$528.50	$1,057.00	$528.50–$1,014.72	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Ascites	$528.50	$1,057.00	$528.50–$1,014.72	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Limited	$528.50	$1,057.00	$528.50–$1,014.72	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Common Bile Duct	$528.50	$1,057.00	$528.50–$1,014.72	—	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Non Vascular Limited Rt	$152.40	$508.00	$54.46–$487.68	68% below	70%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Axilla Right	$152.40	$508.00	$54.46–$487.68	68% below	70%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Non Vascular Limited Lt	$152.40	$508.00	$54.46–$487.68	68% below	70%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Axilla Left	$152.40	$508.00	$54.46–$487.68	68% below	70%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Axilla Left	$254.00	$508.00	$254.00–$487.68	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Axilla Right	$254.00	$508.00	$254.00–$487.68	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Non Vascular Limited Rt	$254.00	$508.00	$254.00–$487.68	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Non Vascular Limited Lt	$254.00	$508.00	$254.00–$487.68	—	50%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Low Dose Cancer Screening WO	$207.60	$692.00	$74.18–$692.00	29% below	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Low Dose Cncr Scrn Rtn Annual WO	$207.60	$692.00	$74.18–$692.00	29% below	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Low Dose Cancer Screening WO	$346.00	$692.00	$346.00–$664.32	—	50%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Low Dose Cncr Scrn Rtn Annual WO	$346.00	$692.00	$346.00–$664.32	—	50%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia Fibula Right DR	$322.50	$1,075.00	$94.48–$1,032.00	29% below	70%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia Fibula Left DR	$322.50	$1,075.00	$94.48–$1,032.00	29% below	70%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia Fibula Left DR	$537.50	$1,075.00	$537.50–$1,032.00	—	50%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia Fibula Right DR	$537.50	$1,075.00	$537.50–$1,032.00	—	50%
MR angiography (MRA) of the head without contrast CPT 70544 MRA Head WO	$1,985.10	$6,617.00	$260.76–$6,352.32	30% below	70%
MR angiography (MRA) of the head without contrast CPT 70544 MRV Head WO	$1,985.10	$6,617.00	$260.76–$6,352.32	30% below	70%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA Head WO	$3,308.50	$6,617.00	$3,308.50–$6,352.32	—	50%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV Head WO	$3,308.50	$6,617.00	$3,308.50–$6,352.32	—	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee Left WO	$1,893.90	$6,313.00	$260.41–$6,060.48	41% below	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle Left WO	$1,893.90	$6,313.00	$260.41–$6,060.48	41% below	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle Right WO	$1,893.90	$6,313.00	$260.41–$6,060.48	41% below	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip Left WO	$1,893.90	$6,313.00	$260.41–$6,060.48	41% below	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip Right WO	$1,893.90	$6,313.00	$260.41–$6,060.48	41% below	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee Right WO	$1,893.90	$6,313.00	$260.41–$6,060.48	41% below	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle Left WO	$3,156.50	$6,313.00	$3,156.50–$6,060.48	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle Right WO	$3,156.50	$6,313.00	$3,156.50–$6,060.48	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip Left WO	$3,156.50	$6,313.00	$3,156.50–$6,060.48	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip Right WO	$3,156.50	$6,313.00	$3,156.50–$6,060.48	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee Left WO	$3,156.50	$6,313.00	$3,156.50–$6,060.48	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee Right WO	$3,156.50	$6,313.00	$3,156.50–$6,060.48	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee Left WWO	$2,074.80	$6,916.00	$385.40–$6,639.36	45% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee Right WWO	$2,074.80	$6,916.00	$385.40–$6,639.36	45% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle Left WWO	$2,074.80	$6,916.00	$385.40–$6,639.36	45% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip Right WWO	$2,074.80	$6,916.00	$385.40–$6,639.36	45% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle Right WWO	$2,074.80	$6,916.00	$385.40–$6,639.36	45% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip Left WWO	$2,074.80	$6,916.00	$385.40–$6,639.36	45% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle Right WWO	$3,458.00	$6,916.00	$3,458.00–$6,639.36	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee Right WWO	$3,458.00	$6,916.00	$3,458.00–$6,639.36	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle Left WWO	$3,458.00	$6,916.00	$3,458.00–$6,639.36	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee Left WWO	$3,458.00	$6,916.00	$3,458.00–$6,639.36	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip Right WWO	$3,458.00	$6,916.00	$3,458.00–$6,639.36	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip Left WWO	$3,458.00	$6,916.00	$3,458.00–$6,639.36	—	50%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen WO	$1,662.00	$5,540.00	$260.57–$5,318.40	53% below	70%
MRI of the abdomen without contrast CPT 74181 MRI MRCP WO	$1,662.00	$5,540.00	$260.57–$5,318.40	53% below	70%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen WO	$2,770.00	$5,540.00	$2,770.00–$5,318.40	—	50%
MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP WO	$2,770.00	$5,540.00	$2,770.00–$5,318.40	—	50%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI MRCP WWO	$2,010.60	$6,702.00	$385.24–$6,433.92	57% below	70%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen WWO	$2,010.60	$6,702.00	$385.24–$6,433.92	57% below	70%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen WWO	$3,351.00	$6,702.00	$3,351.00–$6,433.92	—	50%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI MRCP WWO	$3,351.00	$6,702.00	$3,351.00–$6,433.92	—	50%
MRI of the brain, no contrast dye CPT 70551 MRI Brain WO	$1,540.50	$5,135.00	$260.57–$4,929.60	53% below	70%
MRI of the brain, no contrast dye CPT 70551 MRV Brain WO	$1,540.50	$5,135.00	$260.57–$4,929.60	53% below	70%
MRI of the brain, no contrast dye CPT 70551 MRI Brain WO Stroke Alert	$1,540.50	$5,135.00	$260.57–$4,929.60	53% below	70%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain WO Stroke Alert	$2,567.50	$5,135.00	$2,567.50–$4,929.60	—	50%
MRI of the brain, no contrast dye inpatient CPT 70551 MRV Brain WO	$2,567.50	$5,135.00	$2,567.50–$4,929.60	—	50%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain WO	$2,567.50	$5,135.00	$2,567.50–$4,929.60	—	50%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain WWO	$2,398.80	$7,996.00	$385.24–$7,676.16	45% below	70%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain WWO	$3,998.00	$7,996.00	$3,998.00–$7,676.16	—	50%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar WO	$2,009.70	$6,699.00	$260.57–$6,431.04	42% below	70%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar WO	$3,349.50	$6,699.00	$3,349.50–$6,431.04	—	50%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar WWO	$2,643.00	$8,810.00	$385.24–$8,457.60	37% below	70%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar WWO	$4,405.00	$8,810.00	$4,405.00–$8,457.60	—	50%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic WO	$1,750.50	$5,835.00	$260.57–$5,601.60	44% below	70%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic WO	$2,917.50	$5,835.00	$2,917.50–$5,601.60	—	50%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical WWO	$2,683.80	$8,946.00	$385.24–$8,588.16	36% below	70%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical WWO	$4,473.00	$8,946.00	$4,473.00–$8,588.16	—	50%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical WO	$1,863.60	$6,212.00	$260.57–$5,963.52	47% below	70%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical WO	$3,106.00	$6,212.00	$3,106.00–$5,963.52	—	50%
MRI of the pelvis without and with contrast CPT 72197 MRI Prostate WWO	$2,576.10	$8,587.00	$385.24–$8,243.52	45% below	70%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis WWO	$2,576.10	$8,587.00	$385.24–$8,243.52	45% below	70%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis WWO	$4,293.50	$8,587.00	$4,293.50–$8,243.52	—	50%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Prostate WWO	$4,293.50	$8,587.00	$4,293.50–$8,243.52	—	50%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis WO	$2,216.10	$7,387.00	$260.73–$7,091.52	30% below	70%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis WO	$3,693.50	$7,387.00	$3,693.50–$7,091.52	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder Left WO	$1,932.00	$6,440.00	$260.41–$6,182.40	39% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder Right WO	$1,932.00	$6,440.00	$260.41–$6,182.40	39% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow Right WO	$1,932.00	$6,440.00	$260.41–$6,182.40	39% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist Left WO	$1,932.00	$6,440.00	$260.41–$6,182.40	39% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow Left WO	$1,932.00	$6,440.00	$260.41–$6,182.40	39% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist Right WO	$1,932.00	$6,440.00	$260.41–$6,182.40	39% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow Right WO	$3,220.00	$6,440.00	$3,220.00–$6,182.40	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist Right WO	$3,220.00	$6,440.00	$3,220.00–$6,182.40	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist Left WO	$3,220.00	$6,440.00	$3,220.00–$6,182.40	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder Right WO	$3,220.00	$6,440.00	$3,220.00–$6,182.40	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder Left WO	$3,220.00	$6,440.00	$3,220.00–$6,182.40	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow Left WO	$3,220.00	$6,440.00	$3,220.00–$6,182.40	—	50%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR Spine Cervical Minimum 4 V DR	$329.40	$1,098.00	$114.57–$1,054.08	56% below	70%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR Spine Cervical Minimum 4 V DR	$549.00	$1,098.00	$549.00–$1,054.08	—	50%
Neck soft tissue CT scan with contrast CPT 70491 CT Soft Tissue Neck W	$1,415.10	$4,717.00	$191.84–$4,528.32	39% below	70%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Soft Tissue Neck W	$2,358.50	$4,717.00	$2,358.50–$4,528.32	—	50%
Neck soft tissue CT scan without contrast CPT 70490 CT Soft Tissue Neck WO	$1,171.80	$3,906.00	$114.88–$3,749.76	40% below	70%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Soft Tissue Neck WO	$1,953.00	$3,906.00	$1,953.00–$3,749.76	—	50%
Neck soft tissue X-ray CPT 70360 XR Neck Soft Tissue DR	$266.70	$889.00	$94.48–$853.44	21% below	70%
Neck soft tissue X-ray inpatient CPT 70360 XR Neck Soft Tissue DR	$444.50	$889.00	$444.50–$853.44	—	50%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Perfusion Rest Multi 1	$2,823.90	$9,413.00	$1,009.07–$9,036.48	32% below	70%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial Perfusion Rest Multi 1	$4,706.50	$9,413.00	$4,706.50–$9,036.48	—	50%
Pelvic CT scan without contrast CPT 72192 CT Pelvis Stone Protocol	$1,172.40	$3,908.00	$114.53–$3,751.68	47% below	70%
Pelvic CT scan without contrast CPT 72192 CT Pelvis WO	$1,172.40	$3,908.00	$114.53–$3,751.68	47% below	70%
Pelvic CT scan without contrast CPT 72192 CT Pelvis with Rectal WO	$1,172.40	$3,908.00	$114.53–$3,751.68	47% below	70%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis WO	$1,954.00	$3,908.00	$1,954.00–$3,751.68	—	50%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis with Rectal WO	$1,954.00	$3,908.00	$1,954.00–$3,751.68	—	50%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis Stone Protocol	$1,954.00	$3,908.00	$1,954.00–$3,751.68	—	50%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvis Non OB FU	$237.60	$792.00	$84.90–$760.32	56% below	70%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvis Non OB Limited	$237.60	$792.00	$84.90–$760.32	56% below	70%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvis Non OB FU	$396.00	$792.00	$396.00–$760.32	—	50%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvis Non OB Limited	$396.00	$792.00	$396.00–$760.32	—	50%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Non OB Complete	$316.50	$1,055.00	$113.10–$1,012.80	66% below	70%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis Non OB Complete	$527.50	$1,055.00	$527.50–$1,012.80	—	50%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pregnancy After 1st Trimester Transabdominal	$580.80	$1,936.00	$114.57–$1,858.56	45% below	70%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pregnancy After 1st Trimester Transabdominal	$968.00	$1,936.00	$968.00–$1,858.56	—	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Pregnancy 1st Trimester Transabdominal	$294.30	$981.00	$105.16–$941.76	62% below	70%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Pregnancy 1st Trimester Transabdominal	$490.50	$981.00	$490.50–$941.76	—	50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pregnancy Limited	$245.10	$817.00	$87.58–$784.32	57% below	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pregnancy Limited Placenta Location	$245.10	$817.00	$87.58–$784.32	57% below	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Pregnancy Limited	$408.50	$817.00	$408.50–$784.32	—	50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Pregnancy Limited Placenta Location	$408.50	$817.00	$408.50–$784.32	—	50%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w PA Chest Right Min 3 V DR	$341.10	$1,137.00	$114.41–$1,091.52	38% below	70%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w PA Chest Left Min 3 V DR	$341.10	$1,137.00	$114.41–$1,091.52	38% below	70%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs w PA Chest Left Min 3 V DR	$568.50	$1,137.00	$568.50–$1,091.52	—	50%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs w PA Chest Right Min 3 V DR	$568.50	$1,137.00	$568.50–$1,091.52	—	50%
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Screen Bilateral WWO CAD	$81.00	$270.00	$28.94–$270.00	—	70%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Screen Left WWO CAD	$81.00	$270.00	$28.94–$270.00	85% below	70%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Screen Right WWO CAD	$81.00	$270.00	$28.94–$270.00	85% below	70%
Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Screen Bilateral WWO CAD	$135.00	$270.00	$135.00–$259.20	—	50%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Screen Left WWO CAD	$135.00	$270.00	$135.00–$259.20	—	50%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Screen Right WWO CAD	$135.00	$270.00	$135.00–$259.20	—	50%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete Min 2 V Left DR	$471.00	$1,570.00	$94.83–$1,507.20	24% below	70%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete Min 2 V Right DR	$471.00	$1,570.00	$94.83–$1,507.20	24% below	70%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete Min 2 V Left DR	$785.00	$1,570.00	$785.00–$1,507.20	—	50%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete Min 2 V Right DR	$785.00	$1,570.00	$785.00–$1,507.20	—	50%
Sinus X-ray, complete, 3 or more views CPT 70220 XR Sinuses Paranasal Complete DR	$394.20	$1,314.00	$94.63–$1,261.44	27% below	70%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR Sinuses Paranasal Complete DR	$657.00	$1,314.00	$657.00–$1,261.44	—	50%
Skull X-ray, fewer than 4 views CPT 70250 XR Skull Less Than 4 V DR	$345.60	$1,152.00	$114.41–$1,105.92	34% below	70%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR Skull Less Than 4 V DR	$576.00	$1,152.00	$576.00–$1,105.92	—	50%
Sleep study in a lab (polysomnography) CPT 95810 CHRG - POLYSOMNO GT4 GE6YO	$3,384.60	$11,282.00	$533.86–$10,830.72	29% below	70%
Sleep study in a lab (polysomnography) inpatient CPT 95810 CHRG - POLYSOMNO GT4 GE6YO	$5,641.00	$11,282.00	$5,641.00–$10,830.72	—	50%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 NI Echo TTE 2D Rest Stress w Cont Monito	$773.40	$2,578.00	$276.36–$2,474.88	55% below	70%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 NI Echo TTE 2D Rest Stress w Cont Monito	$1,289.00	$2,578.00	$1,289.00–$2,474.88	—	50%
Swallow study (modified barium swallow, video X-ray) CPT 74230 RF Modified Barium Swallow	$490.50	$1,635.00	$175.27–$1,569.60	49% below	70%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 RF Modified Barium Swallow	$817.50	$1,635.00	$817.50–$1,569.60	—	50%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur Minimum 2 Views Right DR	$311.40	$1,038.00	$94.63–$996.48	46% below	70%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur Minimum 2 Views Left DR	$311.40	$1,038.00	$94.63–$996.48	46% below	70%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur Minimum 2 Views Left DR	$519.00	$1,038.00	$519.00–$996.48	—	50%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur Minimum 2 Views Right DR	$519.00	$1,038.00	$519.00–$996.48	—	50%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Trauma Thoracic Spine WO	$1,222.20	$4,074.00	$114.53–$3,911.04	52% below	70%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Spine Thoracic WO	$1,222.20	$4,074.00	$114.53–$3,911.04	52% below	70%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Spine Thoracic WO	$2,037.00	$4,074.00	$2,037.00–$3,911.04	—	50%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Trauma Thoracic Spine WO	$2,037.00	$4,074.00	$2,037.00–$3,911.04	—	50%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 2nd Digit Min 2 V Left DR	$399.60	$1,332.00	$94.48–$1,278.72	10% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes Great Min 2 V Right DR	$399.60	$1,332.00	$94.48–$1,278.72	10% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes Great Min 2 V Left DR	$399.60	$1,332.00	$94.48–$1,278.72	10% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 5th Digit Min 2 V Right DR	$399.60	$1,332.00	$94.48–$1,278.72	10% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 5th Digit Min 2 V Left DR	$399.60	$1,332.00	$94.48–$1,278.72	10% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 4th Digit Min 2 V Right DR	$399.60	$1,332.00	$94.48–$1,278.72	10% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 4th Digit Min 2 V Left DR	$399.60	$1,332.00	$94.48–$1,278.72	10% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 3rd Digit Min 2 V Right DR	$399.60	$1,332.00	$94.48–$1,278.72	10% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 3rd Digit Min 2 V Left DR	$399.60	$1,332.00	$94.48–$1,278.72	10% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 2nd Digit Min 2 V Right DR	$399.60	$1,332.00	$94.48–$1,278.72	10% below	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 3rd Digit Min 2 V Right DR	$666.00	$1,332.00	$666.00–$1,278.72	—	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes Great Min 2 V Right DR	$666.00	$1,332.00	$666.00–$1,278.72	—	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes Great Min 2 V Left DR	$666.00	$1,332.00	$666.00–$1,278.72	—	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 5th Digit Min 2 V Right DR	$666.00	$1,332.00	$666.00–$1,278.72	—	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 5th Digit Min 2 V Left DR	$666.00	$1,332.00	$666.00–$1,278.72	—	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 2nd Digit Min 2 V Left DR	$666.00	$1,332.00	$666.00–$1,278.72	—	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 4th Digit Min 2 V Right DR	$666.00	$1,332.00	$666.00–$1,278.72	—	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 4th Digit Min 2 V Left DR	$666.00	$1,332.00	$666.00–$1,278.72	—	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 2nd Digit Min 2 V Right DR	$666.00	$1,332.00	$666.00–$1,278.72	—	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 3rd Digit Min 2 V Left DR	$666.00	$1,332.00	$666.00–$1,278.72	—	50%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non OB	$311.40	$1,038.00	$111.27–$996.48	46% below	70%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non OB	$519.00	$1,038.00	$519.00–$996.48	—	50%
Transvaginal ultrasound during pregnancy CPT 76817 US Pregnancy Transvaginal	$319.50	$1,065.00	$114.17–$1,022.40	55% below	70%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Pregnancy Transvaginal	$532.50	$1,065.00	$532.50–$1,022.40	—	50%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$482.70	$1,609.00	$114.57–$1,544.64	55% below	70%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$804.50	$1,609.00	$804.50–$1,544.64	—	50%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum Contents	$510.00	$1,700.00	$114.57–$1,632.00	45% below	70%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum Contents	$850.00	$1,700.00	$850.00–$1,632.00	—	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Parathyroid	$397.20	$1,324.00	$114.57–$1,271.04	55% below	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid	$397.20	$1,324.00	$114.57–$1,271.04	55% below	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Parotid	$397.20	$1,324.00	$114.57–$1,271.04	55% below	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head Neck Soft Tissue	$397.20	$1,324.00	$114.57–$1,271.04	55% below	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Parotid	$662.00	$1,324.00	$662.00–$1,271.04	—	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head Neck Soft Tissue	$662.00	$1,324.00	$662.00–$1,271.04	—	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid	$662.00	$1,324.00	$662.00–$1,271.04	—	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Parathyroid	$662.00	$1,324.00	$662.00–$1,271.04	—	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 RF Upper GI w or wo KUB Gastrografin	$523.80	$1,746.00	$187.17–$1,676.16	48% below	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 RF Esophagus w Upper GI Barium	$523.80	$1,746.00	$187.17–$1,676.16	48% below	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 RF Upper GI w or wo KUB Barium	$523.80	$1,746.00	$187.17–$1,676.16	48% below	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 RF Upper GI w or wo KUB Barium	$873.00	$1,746.00	$873.00–$1,676.16	—	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 RF Upper GI w or wo KUB Gastrografin	$873.00	$1,746.00	$873.00–$1,676.16	—	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 RF Esophagus w Upper GI Barium	$873.00	$1,746.00	$873.00–$1,676.16	—	50%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Min 2 V Right DR	$235.20	$784.00	$84.04–$752.64	48% below	70%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Min 2 V Left DR	$235.20	$784.00	$84.04–$752.64	48% below	70%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Min 2 V Right DR	$392.00	$784.00	$392.00–$752.64	—	50%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Min 2 V Left DR	$392.00	$784.00	$392.00–$752.64	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 NI Duplex Venous Arm Limited	$605.70	$2,019.00	$114.72–$1,938.24	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 NI Duplex Venous Leg Limited	$605.70	$2,019.00	$114.72–$1,938.24	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY	$1,437.11	$4,790.37	$114.72–$4,598.76	22% above	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Extremity Veins Limited Left	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Venous Mapping Duplex Left	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Venous Mapping Duplex Right	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Venous Mapping Duplex Left	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Venous Duplex Right	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Venous Duplex Left	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Extremity Veins Limited Left	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Venous Duplex Right	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Venous Duplex Left	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Extremity Veins Limited Right	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Venous Mapping Duplex Right	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Venous Insufficiency Duplex Right	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Extremity Veins Limited Right	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Venous Insufficiency Duplex Left	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Extremity Veins Limited Left.	$596.70	$1,989.00	$114.72–$1,909.44	49% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 NI Duplex Venous Arm Limited	$1,009.50	$2,019.00	$1,009.50–$1,938.24	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 NI Duplex Venous Leg Limited	$1,009.50	$2,019.00	$1,009.50–$1,938.24	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Venous Mapping Duplex Right	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Extremity Veins Limited Right	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Extremity Veins Limited Left	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Venous Insufficiency Duplex Right	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Venous Duplex Left	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Extremity Veins Limited Left.	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Venous Duplex Right	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Venous Mapping Duplex Right	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Venous Mapping Duplex Left	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Extremity Veins Limited Left	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Venous Duplex Left	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Venous Mapping Duplex Left	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Venous Duplex Right	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Extremity Veins Limited Right	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Venous Insufficiency Duplex Left	$994.50	$1,989.00	$994.50–$1,909.44	—	50%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 V Right DR	$188.40	$628.00	$67.32–$602.88	41% below	70%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 V Left DR	$188.40	$628.00	$67.32–$602.88	41% below	70%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 V Right DR	$314.00	$628.00	$314.00–$602.88	—	50%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 V Left DR	$314.00	$628.00	$314.00–$602.88	—	50%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete Min 3 V Left DR	$219.60	$732.00	$78.47–$702.72	53% below	70%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete Min 3 V Right DR	$219.60	$732.00	$78.47–$702.72	53% below	70%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete Min 3 V Left DR	$366.00	$732.00	$366.00–$702.72	—	50%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete Min 3 V Right DR	$366.00	$732.00	$366.00–$702.72	—	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Right 2 or 3 Views DR	$242.10	$807.00	$86.51–$774.72	45% below	70%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Left 2 or 3 Views DR	$242.10	$807.00	$86.51–$774.72	45% below	70%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Left w Pelvis 2 or 3 Views DR	$254.10	$847.00	$90.80–$813.12	42% below	70%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Right w Pelvis 2 or 3 Views DR	$254.10	$847.00	$90.80–$813.12	42% below	70%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Left 2 or 3 Views DR	$403.50	$807.00	$403.50–$774.72	—	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Right 2 or 3 Views DR	$403.50	$807.00	$403.50–$774.72	—	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Right w Pelvis 2 or 3 Views DR	$423.50	$847.00	$423.50–$813.12	—	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Left w Pelvis 2 or 3 Views DR	$423.50	$847.00	$423.50–$813.12	—	50%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen AP KUB DR	$237.30	$791.00	$84.80–$759.36	43% below	70%
X-ray of the abdomen, 1 view one side CPT 74018 XR Abdomen 1V Decub Rt DR	$237.30	$791.00	$84.80–$759.36	43% below	70%
X-ray of the abdomen, 1 view one side CPT 74018 XR Abdomen 1V Decub Lt DR	$237.30	$791.00	$84.80–$759.36	43% below	70%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen AP KUB DR	$395.50	$791.00	$395.50–$759.36	—	50%
X-ray of the abdomen, 1 view inpatient one side CPT 74018 XR Abdomen 1V Decub Rt DR	$395.50	$791.00	$395.50–$759.36	—	50%
X-ray of the abdomen, 1 view inpatient one side CPT 74018 XR Abdomen 1V Decub Lt DR	$395.50	$791.00	$395.50–$759.36	—	50%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 V Right DR	$263.40	$878.00	$94.12–$842.88	26% below	70%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 V Left DR	$263.40	$878.00	$94.12–$842.88	26% below	70%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 V Right DR	$439.00	$878.00	$439.00–$842.88	—	50%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 V Left DR	$439.00	$878.00	$439.00–$842.88	—	50%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 5th Digit Right DR	$171.00	$570.00	$61.10–$547.20	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 2nd Digit Right DR	$171.00	$570.00	$61.10–$547.20	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 2nd Digit Left DR	$171.00	$570.00	$61.10–$547.20	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 3rd Digit Left DR	$171.00	$570.00	$61.10–$547.20	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 3rd Digit Right DR	$171.00	$570.00	$61.10–$547.20	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 4th Digit Left DR	$171.00	$570.00	$61.10–$547.20	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 4th Digit Right DR	$171.00	$570.00	$61.10–$547.20	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 5th Digit Left DR	$171.00	$570.00	$61.10–$547.20	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V Thumb Left DR	$171.00	$570.00	$61.10–$547.20	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V Thumb Right DR	$171.00	$570.00	$61.10–$547.20	54% below	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 3rd Digit Right DR	$285.00	$570.00	$285.00–$547.20	—	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 2nd Digit Right DR	$285.00	$570.00	$285.00–$547.20	—	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 2nd Digit Left DR	$285.00	$570.00	$285.00–$547.20	—	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 4th Digit Left DR	$285.00	$570.00	$285.00–$547.20	—	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V Thumb Left DR	$285.00	$570.00	$285.00–$547.20	—	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 4th Digit Right DR	$285.00	$570.00	$285.00–$547.20	—	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 3rd Digit Left DR	$285.00	$570.00	$285.00–$547.20	—	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 5th Digit Left DR	$285.00	$570.00	$285.00–$547.20	—	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V Thumb Right DR	$285.00	$570.00	$285.00–$547.20	—	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 5th Digit Right DR	$285.00	$570.00	$285.00–$547.20	—	50%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 V Left DR	$263.40	$878.00	$94.12–$842.88	28% below	70%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 V Right DR	$263.40	$878.00	$94.12–$842.88	28% below	70%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 V Left DR	$439.00	$878.00	$439.00–$842.88	—	50%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 V Right DR	$439.00	$878.00	$439.00–$842.88	—	50%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete Min 3 V Right DR	$243.30	$811.00	$86.94–$778.56	47% below	70%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete Min 3 V Left DR	$243.30	$811.00	$86.94–$778.56	47% below	70%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete Min 3 V Right DR	$405.50	$811.00	$405.50–$778.56	—	50%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete Min 3 V Left DR	$405.50	$811.00	$405.50–$778.56	—	50%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete Min 3 V Right DR	$407.40	$1,358.00	$94.63–$1,303.68	13% below	70%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete Min 3 V Left DR	$407.40	$1,358.00	$94.63–$1,303.68	13% below	70%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete Min 3 V Left DR	$679.00	$1,358.00	$679.00–$1,303.68	—	50%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete Min 3 V Right DR	$679.00	$1,358.00	$679.00–$1,303.68	—	50%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 V Left DR	$110.70	$369.00	$39.56–$354.24	73% below	70%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 V Right DR	$110.70	$369.00	$39.56–$354.24	73% below	70%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 V Right DR	$184.50	$369.00	$184.50–$354.24	—	50%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 V Left DR	$184.50	$369.00	$184.50–$354.24	—	50%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 V DR	$310.50	$1,035.00	$110.95–$993.60	39% below	70%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 V DR	$517.50	$1,035.00	$517.50–$993.60	—	50%
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Minimum 4 V DR	$365.40	$1,218.00	$114.57–$1,169.28	42% below	70%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Minimum 4 V DR	$609.00	$1,218.00	$609.00–$1,169.28	—	50%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 V DR	$148.50	$495.00	$53.06–$475.20	65% below	70%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 V DR	$247.50	$495.00	$247.50–$475.20	—	50%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Comp Minimum 3 V DR	$323.40	$1,078.00	$94.63–$1,034.88	27% below	70%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones Comp Minimum 3 V DR	$539.00	$1,078.00	$539.00–$1,034.88	—	50%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 V DR	$282.60	$942.00	$94.63–$904.32	42% below	70%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical 2 or 3 V DR	$471.00	$942.00	$471.00–$904.32	—	50%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 V DR	$275.70	$919.00	$98.52–$882.24	34% below	70%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 V DR	$459.50	$919.00	$459.50–$882.24	—	50%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum Coccyx Minimum 2 V DR	$252.30	$841.00	$90.16–$807.36	34% below	70%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum Coccyx Minimum 2 V DR	$420.50	$841.00	$420.50–$807.36	—	50%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Alaska	Off list
ACTH blood test CPT 82024 Adrenocorticotropic Hormone Plasma (LC)	$124.20	$414.00	$37.85–$414.00	41% below	70%
ACTH blood test inpatient CPT 82024 Adrenocorticotropic Hormone Plasma (LC)	$207.00	$414.00	$207.00–$397.44	—	50%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase	$49.80	$166.00	$5.19–$159.36	15% below	70%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine Aminotransferase	$83.00	$166.00	$83.00–$159.36	—	50%
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate Aminotransferase	$24.60	$82.00	$5.08–$78.72	54% below	70%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Aspartate Aminotransferase	$41.00	$82.00	$41.00–$78.72	—	50%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute Viral Hepatitis (HAV,HBV,HCV) LC	$114.00	$380.00	$46.68–$380.00	67% below	70%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute Viral Hepatitis (HAV,HBV,HCV) LC	$190.00	$380.00	$190.00–$364.80	—	50%
Albumin blood test CPT 82040 Albumin Level	$25.20	$84.00	$4.85–$80.64	44% below	70%
Albumin blood test CPT 82040 82040 L203836 ALBUMIN SERUM	$25.20	$84.00	$4.85–$80.64	44% below	70%
Albumin blood test CPT 82040 82040 ALBUMIN SERUM	$25.20	$84.00	$4.85–$80.64	44% below	70%
Albumin blood test CPT 82040 82040 L123075 ALB SER	$25.20	$84.00	$4.85–$80.64	44% below	70%
Albumin blood test inpatient CPT 82040 82040 ALBUMIN SERUM	$42.00	$84.00	$42.00–$80.64	—	50%
Albumin blood test inpatient CPT 82040 82040 L123075 ALB SER	$42.00	$84.00	$42.00–$80.64	—	50%
Albumin blood test inpatient CPT 82040 Albumin Level	$42.00	$84.00	$42.00–$80.64	—	50%
Albumin blood test inpatient CPT 82040 82040 L203836 ALBUMIN SERUM	$42.00	$84.00	$42.00–$80.64	—	50%
Aldosterone blood test CPT 82088 Aldosterone Urine LC	$104.40	$348.00	$39.93–$348.00	22% below	70%
Aldosterone blood test CPT 82088 82088 L4354 ALDOSTERONE	$104.40	$348.00	$39.93–$348.00	22% below	70%
Aldosterone blood test CPT 82088 Aldosterone LCMS Level LC	$104.40	$348.00	$39.93–$348.00	22% below	70%
Aldosterone blood test inpatient CPT 82088 Aldosterone LCMS Level LC	$174.00	$348.00	$174.00–$334.08	—	50%
Aldosterone blood test inpatient CPT 82088 82088 L4354 ALDOSTERONE	$174.00	$348.00	$174.00–$334.08	—	50%
Aldosterone blood test inpatient CPT 82088 Aldosterone Urine LC	$174.00	$348.00	$174.00–$334.08	—	50%
Alkaline phosphatase (ALP) blood test CPT 84075 84075 L1612 PHOSPHATASE,ALKALINE	$27.60	$92.00	$5.08–$88.32	30% below	70%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$27.60	$92.00	$5.08–$88.32	30% below	70%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 84075 L1612 PHOSPHATASE,ALKALINE	$46.00	$92.00	$46.00–$88.32	—	50%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase	$46.00	$92.00	$46.00–$88.32	—	50%
Allergy blood test, specific IgE, per allergen CPT 86003 F004-IgE Wheat LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 I004-IgE Wasp Paper LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F075-IgE Egg (Yolk) LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 M016-IgE Curvularia lunata LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 E005-IgE Dog Hair/Dander LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 W018-IgE Sheep Sorrel(Dock) LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 E001-IgE Cat Hair/Dander LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 T008-IgE Elm American (White LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen D pteronyssinus D001 IgE (LC)	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F284-IgE Turkey LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 I005-IgE Hornet Yellow LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 G004-IgE Fescue Meadow LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 I001-IgE Honeybee LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F013-IgE Peanut LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 M002-IgE Cladosporium herbaru LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 M003-IgE Aspergillus fumigatu LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 I100-IgE Cockroach American Sendout to LabCorp	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen D farinae Mite D002 IgE (LC)	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 86003 L600919 ALG IGE QT	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 T001-IgE Maple/Box Elder LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F048-IgE Onions LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen M001 IgE Penicillium chrysogen (LC)	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 86003 L62448 ALG IGE QT	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 86003 L62695 ALG IGE QT	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 86003 - L601872 ALG FRUIT PN	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen M006 IgE Alternaria alternata (LC)	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F080-IgE Lobster LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 T015-IgE Ash White LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F002-IgE Milk (Cow) LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 G010-IgE Johnson Grass LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F023-IgE Crab LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F290-IgE Oyster LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F024-IgE Shrimp LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 M014-IgE Epicoccum purpurasce LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F202-IgE Cashew Nut LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 T007-IgE Oak White LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F001-IgE Egg White LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F210-IgE Pineapple LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F047-IgE Garlic LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F053-IgE Scallop LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 ALG PROFILE FOOD CITRS L600981	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 ALG PROFILE FOOD GRAIN L601633	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 ALG VEG PNL L601831	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 T016-IgE Pine White LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F207-IgE Clam LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 86003 L600973 ALLERGEN IGE	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 86003 L601823 ALG IGE QT	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 W010-IgE Lamb's Quarter LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 W014-IgE Pigweed Rough LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 W001-IgE Ragweed Short/Commo LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 F079-IgE Gluten LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 G006-IgE Timothy LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 I002-IgE Hornet White Face LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 W009-IgE Plantain English LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 W016-IgE Marsh Elder Rough LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 G002-IgE Bermuda Grass LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 I003-IgE Yellow Jacket LC	$11.40	$38.00	$5.12–$38.00	14% below	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 W009-IgE Plantain English LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 G006-IgE Timothy LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 G010-IgE Johnson Grass LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 G004-IgE Fescue Meadow LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 G002-IgE Bermuda Grass LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 T016-IgE Pine White LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 T007-IgE Oak White LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 T008-IgE Elm American (White LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 T001-IgE Maple/Box Elder LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 T015-IgE Ash White LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 I100-IgE Cockroach American Sendout to LabCorp	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F290-IgE Oyster LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F004-IgE Wheat LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F284-IgE Turkey LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F013-IgE Peanut LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F048-IgE Onions LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F080-IgE Lobster LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F002-IgE Milk (Cow) LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F023-IgE Crab LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F024-IgE Shrimp LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F202-IgE Cashew Nut LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F001-IgE Egg White LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F210-IgE Pineapple LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F047-IgE Garlic LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F053-IgE Scallop LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F207-IgE Clam LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F079-IgE Gluten LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 I002-IgE Hornet White Face LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 W016-IgE Marsh Elder Rough LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 I003-IgE Yellow Jacket LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 I004-IgE Wasp Paper LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen D pteronyssinus D001 IgE (LC)	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 I005-IgE Hornet Yellow LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 I001-IgE Honeybee LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 M002-IgE Cladosporium herbaru LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 M003-IgE Aspergillus fumigatu LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen D farinae Mite D002 IgE (LC)	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 E001-IgE Cat Hair/Dander LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 W018-IgE Sheep Sorrel(Dock) LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 E005-IgE Dog Hair/Dander LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 M016-IgE Curvularia lunata LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F075-IgE Egg (Yolk) LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 W001-IgE Ragweed Short/Commo LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 W014-IgE Pigweed Rough LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 W010-IgE Lamb's Quarter LC	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003 L601823 ALG IGE QT	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003 L62448 ALG IGE QT	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen M006 IgE Alternaria alternata (LC)	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003 L600973 ALLERGEN IGE	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALG VEG PNL L601831	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALG PROFILE FOOD GRAIN L601633	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALG PROFILE FOOD CITRS L600981	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003 - L601872 ALG FRUIT PN	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003 L62695 ALG IGE QT	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen M001 IgE Penicillium chrysogen (LC)	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003 L600919 ALG IGE QT	$19.00	$38.00	$19.00–$36.48	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 M014-IgE Epicoccum purpurasce LC	$19.00	$38.00	$19.00–$36.48	—	50%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein Open Spina Bifida (LC)	$73.20	$244.00	$16.43–$234.24	5% above	70%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein Tumor Marker (LC)	$73.20	$244.00	$16.43–$234.24	5% above	70%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha Fetoprotein Open Spina Bifida (LC)	$122.00	$244.00	$122.00–$234.24	—	50%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha Fetoprotein Tumor Marker (LC)	$122.00	$244.00	$122.00–$234.24	—	50%
Ammonia blood test CPT 82140 Ammonia Level	$147.30	$491.00	$14.28–$471.36	5% below	70%
Ammonia blood test inpatient CPT 82140 Ammonia Level	$245.50	$491.00	$245.50–$471.36	—	50%
Amylase blood test CPT 82150 Amylase Blood	$55.80	$186.00	$6.35–$178.56	4% below	70%
Amylase blood test CPT 82150 Amylase Body Fluid	$55.80	$186.00	$6.35–$178.56	4% below	70%
Amylase blood test inpatient CPT 82150 Amylase Body Fluid	$93.00	$186.00	$93.00–$178.56	—	50%
Amylase blood test inpatient CPT 82150 Amylase Blood	$93.00	$186.00	$93.00–$178.56	—	50%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide Ab IgG IgA (LC)	$137.70	$459.00	$12.69–$440.64	47% above	70%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrullinated Peptide Ab IgG IgA (LC)	$229.50	$459.00	$229.50–$440.64	—	50%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA w/Reflex if Positive (LC)	$65.40	$218.00	$11.85–$209.28	14% below	70%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Anti Nuclear Antibodies Direct (LC)	$65.40	$218.00	$11.85–$209.28	14% below	70%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Anti Nuclear Antibody IFA (LC)	$65.40	$218.00	$11.85–$209.28	14% below	70%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA w/Reflex if Positive (LC)	$109.00	$218.00	$109.00–$209.28	—	50%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Anti Nuclear Antibody IFA (LC)	$109.00	$218.00	$109.00–$209.28	—	50%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Anti Nuclear Antibodies Direct (LC)	$109.00	$218.00	$109.00–$209.28	—	50%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B Type Natriuretic Peptide Prohormone	$285.60	$952.00	$38.47–$913.92	3% below	70%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B Type Natriuretic Peptide Prohormone	$476.00	$952.00	$476.00–$913.92	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Nasopharyngeal Culture without Gram Stain	$99.30	$331.00	$8.45–$317.76	31% below	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Transfusion Reaction Culture	$99.30	$331.00	$8.45–$317.76	31% below	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Catheter Tip Culture	$99.30	$331.00	$8.45–$317.76	31% below	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Throat Culture	$99.30	$331.00	$8.45–$317.76	31% below	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 CULTURE BACTERIA OTH	$99.30	$331.00	$8.45–$317.76	31% below	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Transfusion Reaction Culture	$165.50	$331.00	$165.50–$317.76	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 87070 CULTURE BACTERIA OTH	$165.50	$331.00	$165.50–$317.76	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Throat Culture	$165.50	$331.00	$165.50–$317.76	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Catheter Tip Culture	$165.50	$331.00	$165.50–$317.76	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Nasopharyngeal Culture without Gram Stain	$165.50	$331.00	$165.50–$317.76	—	50%
Basic metabolic panel (blood test) CPT 80048 BMPWTCA	$86.10	$287.00	$8.29–$275.52	35% below	70%
Basic metabolic panel (blood test) inpatient CPT 80048 BMPWTCA	$143.50	$287.00	$143.50–$275.52	—	50%
Bilirubin blood test, total CPT 82247 82247 BILIRUBIN TOTAL	$25.20	$84.00	$4.92–$80.64	55% below	70%
Bilirubin blood test, total CPT 82247 Bilirubin Total Neo	$25.20	$84.00	$4.92–$80.64	55% below	70%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$25.20	$84.00	$4.92–$80.64	55% below	70%
Bilirubin blood test, total inpatient CPT 82247 82247 BILIRUBIN TOTAL	$42.00	$84.00	$42.00–$80.64	—	50%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total Neo	$42.00	$84.00	$42.00–$80.64	—	50%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total	$42.00	$84.00	$42.00–$80.64	—	50%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 $APRL 88305 Bill Surg Path Gross Lvl4	$116.40	$388.00	$37.26–$388.00	60% below	70%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 $APRL 88305 Bill Surg Path Gross Lvl4	$194.00	$388.00	$194.00–$372.48	—	50%
Blood culture for bacteria CPT 87040 Blood Culture	$157.20	$524.00	$10.11–$503.04	25% below	70%
Blood culture for bacteria inpatient CPT 87040 Blood Culture	$262.00	$524.00	$262.00–$503.04	—	50%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw Chg	$19.80	$66.00	$9.09–$63.36	48% below	70%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$19.80	$66.00	$9.09–$63.36	48% below	70%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$33.00	$66.00	$33.00–$63.36	—	50%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw Chg	$33.00	$66.00	$33.00–$63.36	—	50%
Blood glucose (sugar) test CPT 82947 Glucose Level	$21.60	$72.00	$3.85–$69.12	49% below	70%
Blood glucose (sugar) test CPT 82947 .Glucose Fasting	$21.60	$72.00	$3.85–$69.12	49% below	70%
Blood glucose (sugar) test CPT 82947 .GTT 2nd Hr OB	$21.60	$72.00	$3.85–$69.12	49% below	70%
Blood glucose (sugar) test CPT 82947 .GTT 3rd Hr OB	$21.60	$72.00	$3.85–$69.12	49% below	70%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level	$36.00	$72.00	$36.00–$69.12	—	50%
Blood glucose (sugar) test inpatient CPT 82947 .GTT 3rd Hr OB	$36.00	$72.00	$36.00–$69.12	—	50%
Blood glucose (sugar) test inpatient CPT 82947 .GTT 2nd Hr OB	$36.00	$72.00	$36.00–$69.12	—	50%
Blood glucose (sugar) test inpatient CPT 82947 .Glucose Fasting	$36.00	$72.00	$36.00–$69.12	—	50%
Blood lead test CPT 83655 Lead, Blood (Pediatric), Capillary (LC)	$37.50	$125.00	$11.87–$125.00	51% below	70%
Blood lead test CPT 83655 83655 L42580 LEAD	$37.50	$125.00	$11.87–$125.00	51% below	70%
Blood lead test CPT 83655 83655 L250281 LEAD	$37.50	$125.00	$11.87–$125.00	51% below	70%
Blood lead test CPT 83655 Lead Blood Adult (LC)	$37.50	$125.00	$11.87–$125.00	51% below	70%
Blood lead test CPT 83655 Lead Blood Pediatric (LC)	$37.50	$125.00	$11.87–$125.00	51% below	70%
Blood lead test CPT 83655 83655 L7046 LEAD	$37.50	$125.00	$11.87–$125.00	51% below	70%
Blood lead test inpatient CPT 83655 83655 L7046 LEAD	$62.50	$125.00	$62.50–$120.00	—	50%
Blood lead test inpatient CPT 83655 Lead Blood Adult (LC)	$62.50	$125.00	$62.50–$120.00	—	50%
Blood lead test inpatient CPT 83655 Lead Blood Pediatric (LC)	$62.50	$125.00	$62.50–$120.00	—	50%
Blood lead test inpatient CPT 83655 83655 L42580 LEAD	$62.50	$125.00	$62.50–$120.00	—	50%
Blood lead test inpatient CPT 83655 83655 L250281 LEAD	$62.50	$125.00	$62.50–$120.00	—	50%
Blood lead test inpatient CPT 83655 Lead, Blood (Pediatric), Capillary (LC)	$62.50	$125.00	$62.50–$120.00	—	50%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCGQLS	$65.10	$217.00	$7.37–$208.32	36% below	70%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCGQLS	$108.50	$217.00	$108.50–$208.32	—	50%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 86900 BLOOD TYPING ABO	$35.40	$118.00	$2.99–$155.75	37% below	70%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 86900 BLOOD TYPING ABO	$59.00	$118.00	$59.00–$113.28	—	50%
Blood urea nitrogen (BUN) test CPT 84520 Blood Urea Nitrogen	$33.00	$110.00	$3.87–$105.60	32% below	70%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Blood Urea Nitrogen	$55.00	$110.00	$55.00–$105.60	—	50%
C-peptide blood test CPT 84681 C-Peptide Level LC	$114.00	$380.00	$20.39–$364.80	32% below	70%
C-peptide blood test inpatient CPT 84681 C-Peptide Level LC	$190.00	$380.00	$190.00–$364.80	—	50%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C Reactive Protein	$9.30	$31.00	$5.08–$31.00	85% below	70%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C Reactive Protein Quant (LC)	$9.30	$31.00	$5.08–$31.00	85% below	70%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C Reactive Protein Quant (LC)	$15.50	$31.00	$15.50–$29.76	—	50%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C Reactive Protein	$15.50	$31.00	$15.50–$29.76	—	50%
C. difficile toxin gene test (stool PCR) CPT 87493 C difficile DNA Amp w/reflex Toxin Confirmation	$63.90	$213.00	$36.52–$213.00	73% below	70%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C difficile DNA Amp w/reflex Toxin Confirmation	$106.50	$213.00	$106.50–$204.48	—	50%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 LC	$155.10	$517.00	$20.39–$496.32	33% below	70%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 LC	$258.50	$517.00	$258.50–$496.32	—	50%
CA-125 blood test (ovarian cancer marker) CPT 86304 Cancer Antigen (CA) 125 LC	$100.20	$334.00	$20.39–$320.64	43% below	70%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Cancer Antigen (CA) 125 LC	$167.00	$334.00	$167.00–$320.64	—	50%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 NAA (LC)	$54.60	$182.00	$50.28–$179.59	47% below	70%
COVID-19 PCR test (SARS-CoV-2 lab test) one side CPT 87635 COVID-19 RT-PCR LIAT	$48.90	$163.00	$48.90–$163.00	53% below	70%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 NAA (LC)	$91.00	$182.00	$91.00–$174.72	—	50%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient one side CPT 87635 COVID-19 RT-PCR LIAT	$81.50	$163.00	$81.50–$156.48	—	50%
Calcium blood test, total CPT 82310 Calcium Level	$30.90	$103.00	$5.06–$98.88	56% below	70%
Calcium blood test, total inpatient CPT 82310 Calcium Level	$51.50	$103.00	$51.50–$98.88	—	50%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen (LC)	$114.30	$381.00	$18.58–$365.76	39% below	70%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen (LC)	$190.50	$381.00	$190.50–$365.76	—	50%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Virus Ab IgG (LC)	$74.40	$248.00	$12.62–$238.08	10% below	70%
Chickenpox (varicella) immunity blood test CPT 86787 zzVaricella Zoster Virus Ab IgM (LC)	$74.40	$248.00	$12.62–$238.08	10% below	70%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Virus Ab IgG (LC)	$124.00	$248.00	$124.00–$238.08	—	50%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 zzVaricella Zoster Virus Ab IgM (LC)	$124.00	$248.00	$124.00–$238.08	—	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 87491 CHLMYD TRACH DNA AMP	$93.83	$312.77	$34.39–$312.77	38% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 L188698 87491 CTRACH AMPPR	$112.20	$374.00	$34.39–$374.00	26% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 87491 L183194CHLMYD TRACH	$112.20	$374.00	$34.39–$374.00	26% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia trachomatis NAA LC	$112.20	$374.00	$34.39–$374.00	26% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 87491 L183160 C TRACH AMP	$112.20	$374.00	$34.39–$374.00	26% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 L188672 87491 CTRACH AMPPR	$112.20	$374.00	$34.39–$374.00	26% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 87491 CHLMYD TRACH DNA AMP	$156.39	$312.77	$156.38–$300.26	—	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 87491 L183160 C TRACH AMP	$187.00	$374.00	$187.00–$359.04	—	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 L188698 87491 CTRACH AMPPR	$187.00	$374.00	$187.00–$359.04	—	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 L188672 87491 CTRACH AMPPR	$187.00	$374.00	$187.00–$359.04	—	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia trachomatis NAA LC	$187.00	$374.00	$187.00–$359.04	—	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 87491 L183194CHLMYD TRACH	$187.00	$374.00	$187.00–$359.04	—	50%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LipidRfxLDLDM	$102.00	$340.00	$13.12–$326.40	4% above	70%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 80061 L884247 LIPID PANEL	$102.00	$340.00	$13.12–$326.40	4% above	70%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LipidRfxLDLDM	$170.00	$340.00	$170.00–$326.40	—	50%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 80061 L884247 LIPID PANEL	$170.00	$340.00	$170.00–$326.40	—	50%
Complete blood count (CBC) with differential CPT 85025 Complete Blood Count w/Diff Auto	$101.40	$338.00	$7.61–$324.48	7% below	70%
Complete blood count (CBC) with differential CPT 85025 Complete Blood Count w/ 3 Part Diff Auto LNI (UC)	$101.40	$338.00	$7.61–$324.48	7% below	70%
Complete blood count (CBC) with differential CPT 85025 CBCADIFF	$101.40	$338.00	$7.61–$324.48	7% below	70%
Complete blood count (CBC) with differential inpatient CPT 85025 Complete Blood Count w/Diff Auto	$169.00	$338.00	$169.00–$324.48	—	50%
Complete blood count (CBC) with differential inpatient CPT 85025 CBCADIFF	$169.00	$338.00	$169.00–$324.48	—	50%
Complete blood count (CBC) with differential inpatient CPT 85025 Complete Blood Count w/ 3 Part Diff Auto LNI (UC)	$169.00	$338.00	$169.00–$324.48	—	50%
Complete blood count (CBC), no differential CPT 85027 Complete Blood Count w/o Diff	$80.70	$269.00	$6.34–$258.24	1% below	70%
Complete blood count (CBC), no differential CPT 85027 CBC	$80.70	$269.00	$6.34–$258.24	1% below	70%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC	$134.50	$269.00	$134.50–$258.24	—	50%
Complete blood count (CBC), no differential inpatient CPT 85027 Complete Blood Count w/o Diff	$134.50	$269.00	$134.50–$258.24	—	50%
Comprehensive metabolic panel (blood test) CPT 80053 CMP	$104.10	$347.00	$10.35–$333.12	39% below	70%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP	$173.50	$347.00	$173.50–$333.12	—	50%
Cortisol blood test, total CPT 82533 Salivary Cortisol MS Sendout to LabCorp	$34.80	$116.00	$15.97–$116.00	63% below	70%
Cortisol blood test, total CPT 82533 L500175 82533 CORTISOL TOT	$34.80	$116.00	$15.97–$116.00	63% below	70%
Cortisol blood test, total CPT 82533 Cortisol Sendout to LabCorp	$34.80	$116.00	$15.97–$116.00	63% below	70%
Cortisol blood test, total CPT 82533 82533 L500440 CORTISOL TOT	$34.80	$116.00	$15.97–$116.00	63% below	70%
Cortisol blood test, total CPT 82533 82533 L502120 CORTISOL TOT	$34.80	$116.00	$15.97–$116.00	63% below	70%
Cortisol blood test, total inpatient CPT 82533 Salivary Cortisol MS Sendout to LabCorp	$58.00	$116.00	$58.00–$111.36	—	50%
Cortisol blood test, total inpatient CPT 82533 Cortisol Sendout to LabCorp	$58.00	$116.00	$58.00–$111.36	—	50%
Cortisol blood test, total inpatient CPT 82533 L500175 82533 CORTISOL TOT	$58.00	$116.00	$58.00–$111.36	—	50%
Cortisol blood test, total inpatient CPT 82533 82533 L502120 CORTISOL TOT	$58.00	$116.00	$58.00–$111.36	—	50%
Cortisol blood test, total inpatient CPT 82533 82533 L500440 CORTISOL TOT	$58.00	$116.00	$58.00–$111.36	—	50%
Creatine kinase (CK) blood test, total CPT 82550 82550 L2154 CREATINE KINASE TOTAL	$68.40	$228.00	$6.38–$218.88	33% below	70%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase	$68.40	$228.00	$6.38–$218.88	33% below	70%
Creatine kinase (CK) blood test, total inpatient CPT 82550 82550 L2154 CREATINE KINASE TOTAL	$114.00	$228.00	$114.00–$218.88	—	50%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase	$114.00	$228.00	$114.00–$218.88	—	50%
Creatinine blood test CPT 82565 ISCREA	$36.90	$123.00	$5.02–$118.08	38% below	70%
Creatinine blood test CPT 82565 CREA	$36.90	$123.00	$5.02–$118.08	38% below	70%
Creatinine blood test CPT 82565 Creatinine Blood	$36.90	$123.00	$5.02–$118.08	38% below	70%
Creatinine blood test inpatient CPT 82565 Creatinine Blood	$61.50	$123.00	$61.50–$118.08	—	50%
Creatinine blood test inpatient CPT 82565 ISCREA	$61.50	$123.00	$61.50–$118.08	—	50%
Creatinine blood test inpatient CPT 82565 CREA	$61.50	$123.00	$61.50–$118.08	—	50%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus Antibody IgG (LC)	$47.70	$159.00	$14.10–$159.00	19% below	70%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus Antibody IgG (LC)	$79.50	$159.00	$79.50–$152.64	—	50%
D-dimer blood test (blood clot marker) CPT 85379 D Dimer Quant	$160.20	$534.00	$9.98–$512.64	22% below	70%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D Dimer Quant	$267.00	$534.00	$267.00–$512.64	—	50%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone Sulfate (LC)	$60.60	$202.00	$21.79–$202.00	59% below	70%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone Sulfate (LC)	$101.00	$202.00	$101.00–$193.92	—	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Umbil. Cord Tissue LC	$315.90	$1,053.00	$60.90–$1,010.88	79% above	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Acetyl Fentanyl, Urine (LC)	$315.90	$1,053.00	$60.90–$1,010.88	79% above	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 UDS12QualAuto	$315.90	$1,053.00	$60.90–$1,010.88	79% above	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 L791350 80307 FENT UR	$315.90	$1,053.00	$60.90–$1,010.88	79% above	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 UDS12QualAuto	$526.50	$1,053.00	$526.50–$1,010.88	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen Umbil. Cord Tissue LC	$526.50	$1,053.00	$526.50–$1,010.88	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 L791350 80307 FENT UR	$526.50	$1,053.00	$526.50–$1,010.88	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Acetyl Fentanyl, Urine (LC)	$526.50	$1,053.00	$526.50–$1,010.88	—	50%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 LYTES	$62.70	$209.00	$6.87–$200.64	36% below	70%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 LYTES	$104.50	$209.00	$104.50–$200.64	—	50%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein Barr Virus VCA IgM (LC)	$50.70	$169.00	$17.78–$169.00	32% below	70%
Epstein-Barr virus (EBV) antibody test CPT 86665 86665 L240610 EBV VCA	$50.70	$169.00	$17.78–$169.00	32% below	70%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein Barr Virus VCA IgG (LC)	$50.70	$169.00	$17.78–$169.00	32% below	70%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 86665 L240610 EBV VCA	$84.50	$169.00	$84.50–$162.24	—	50%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein Barr Virus VCA IgG (LC)	$84.50	$169.00	$84.50–$162.24	—	50%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein Barr Virus VCA IgM (LC)	$84.50	$169.00	$84.50–$162.24	—	50%
Estradiol blood test CPT 82670 L500649 82670 ESTRADIOL	$75.00	$250.00	$27.38–$250.00	57% below	70%
Estradiol blood test CPT 82670 Estradiol Sensitive (LC)	$75.00	$250.00	$27.38–$250.00	57% below	70%
Estradiol blood test CPT 82670 82670-L4606 Estradiol	$75.00	$250.00	$27.38–$250.00	57% below	70%
Estradiol blood test CPT 82670 Estradiol Sendout to LabCorp	$75.00	$250.00	$27.38–$250.00	57% below	70%
Estradiol blood test CPT 82670 82670 L4606 ESTRADIOL	$75.00	$250.00	$27.38–$250.00	57% below	70%
Estradiol blood test inpatient CPT 82670 Estradiol Sensitive (LC)	$125.00	$250.00	$125.00–$240.00	—	50%
Estradiol blood test inpatient CPT 82670 82670-L4606 Estradiol	$125.00	$250.00	$125.00–$240.00	—	50%
Estradiol blood test inpatient CPT 82670 L500649 82670 ESTRADIOL	$125.00	$250.00	$125.00–$240.00	—	50%
Estradiol blood test inpatient CPT 82670 82670 L4606 ESTRADIOL	$125.00	$250.00	$125.00–$240.00	—	50%
Estradiol blood test inpatient CPT 82670 Estradiol Sendout to LabCorp	$125.00	$250.00	$125.00–$240.00	—	50%
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone (LC)	$74.40	$248.00	$18.21–$238.08	62% below	70%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stimulating Hormone (LC)	$124.00	$248.00	$124.00–$238.08	—	50%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin Feces (LC)	$46.80	$156.00	$19.24–$156.00	90% below	70%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin Feces (LC)	$78.00	$156.00	$78.00–$149.76	—	50%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$105.30	$351.00	$13.36–$336.96	10% below	70%
Ferritin blood test (iron stores) CPT 82728 Ferritin, Serum (LC)	$105.30	$351.00	$13.36–$336.96	10% below	70%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$175.50	$351.00	$175.50–$336.96	—	50%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin, Serum (LC)	$175.50	$351.00	$175.50–$336.96	—	50%
Fibrinogen blood test CPT 85384 Fibrinogen Level	$91.20	$304.00	$9.53–$291.84	37% below	70%
Fibrinogen blood test inpatient CPT 85384 Fibrinogen Level	$152.00	$304.00	$152.00–$291.84	—	50%
Folate (folic acid) blood test CPT 82746 Folate (Folic Acid) Serum Sendout to LabCorp	$98.10	$327.00	$14.41–$313.92	29% below	70%
Folate (folic acid) blood test inpatient CPT 82746 Folate (Folic Acid) Serum Sendout to LabCorp	$163.50	$327.00	$163.50–$313.92	—	50%
Free T3 thyroid hormone test CPT 84481 Triiodothyronine 3 Free Serum (LC)	$117.30	$391.00	$16.60–$375.36	26% below	70%
Free T3 thyroid hormone test inpatient CPT 84481 Triiodothyronine 3 Free Serum (LC)	$195.50	$391.00	$195.50–$375.36	—	50%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine 4 Free	$68.40	$228.00	$8.84–$218.88	50% below	70%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine (T4) Free, Direct, S (LC)	$68.40	$228.00	$8.84–$218.88	50% below	70%
Free T4 (free thyroxine) thyroid blood test CPT 84439 .Thyroxine (T4) Free, Direct, S 2 LC	$68.40	$228.00	$8.84–$218.88	50% below	70%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Thyroxine (T4) Free, Direct, S (LC)	$114.00	$228.00	$114.00–$218.88	—	50%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Thyroxine 4 Free	$114.00	$228.00	$114.00–$218.88	—	50%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 .Thyroxine (T4) Free, Direct, S 2 LC	$114.00	$228.00	$114.00–$218.88	—	50%
Free testosterone test CPT 84402 84402 L140103 TESTOST FREE	$115.80	$386.00	$24.96–$370.56	7% below	70%
Free testosterone test CPT 84402 Testosterone Free Direct LC	$115.80	$386.00	$24.96–$370.56	7% below	70%
Free testosterone test inpatient CPT 84402 Testosterone Free Direct LC	$193.00	$386.00	$193.00–$370.56	—	50%
Free testosterone test inpatient CPT 84402 84402 L140103 TESTOST FREE	$193.00	$386.00	$193.00–$370.56	—	50%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase (LC)	$38.40	$128.00	$7.06–$122.88	46% below	70%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Gamma Glutamyl Transferase (LC)	$64.00	$128.00	$64.00–$122.88	—	50%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 .GTT 1st Hr OB	$21.60	$72.00	$4.65–$69.12	66% below	70%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 1 Hr Postprandial	$21.60	$72.00	$4.65–$69.12	66% below	70%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 2 Hour Postprandial	$21.60	$72.00	$4.65–$69.12	66% below	70%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 1 Hr Postprandial	$36.00	$72.00	$36.00–$69.12	—	50%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 .GTT 1st Hr OB	$36.00	$72.00	$36.00–$69.12	—	50%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 2 Hour Postprandial	$36.00	$72.00	$36.00–$69.12	—	50%
Glucose tolerance test, 3 samples CPT 82951 L46300 82951 GTT 3 SPEC	$64.50	$215.00	$12.61–$206.40	41% below	70%
Glucose tolerance test, 3 samples CPT 82951 .GTT Fasting	$64.50	$215.00	$12.61–$206.40	41% below	70%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT Fasting	$107.50	$215.00	$107.50–$206.40	—	50%
Glucose tolerance test, 3 samples inpatient CPT 82951 L46300 82951 GTT 3 SPEC	$107.50	$215.00	$107.50–$206.40	—	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591 N GONORRHO,DNA,AMPPR	$93.83	$312.77	$34.39–$312.77	19% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 L188698 87591 NG AMP PRB	$112.20	$374.00	$34.39–$374.00	3% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591 L183194N.GONORRHO,DN	$112.20	$374.00	$34.39–$374.00	3% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 L188672 87591 NG AMP PRB	$112.20	$374.00	$34.39–$374.00	3% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591 L183160 N GONO AMP	$112.20	$374.00	$34.39–$374.00	3% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhoeae NAA Sendout to LabCorp	$112.20	$374.00	$34.39–$374.00	3% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591 N GONORRHO,DNA,AMPPR	$156.39	$312.77	$156.38–$300.26	—	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591 L183160 N GONO AMP	$187.00	$374.00	$187.00–$359.04	—	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591 L183194N.GONORRHO,DN	$187.00	$374.00	$187.00–$359.04	—	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 L188698 87591 NG AMP PRB	$187.00	$374.00	$187.00–$359.04	—	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 L188672 87591 NG AMP PRB	$187.00	$374.00	$187.00–$359.04	—	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria gonorrhoeae NAA Sendout to LabCorp	$187.00	$374.00	$187.00–$359.04	—	50%
H. pylori antibody blood test CPT 86677 Heliobacter pylori Ab IgG (LC)	$87.30	$291.00	$16.51–$279.36	7% below	70%
H. pylori antibody blood test CPT 86677 Heliobacter pylori Ab IgM (LC)	$87.30	$291.00	$16.51–$279.36	7% below	70%
H. pylori antibody blood test inpatient CPT 86677 Heliobacter pylori Ab IgG (LC)	$145.50	$291.00	$145.50–$279.36	—	50%
H. pylori antibody blood test inpatient CPT 86677 Heliobacter pylori Ab IgM (LC)	$145.50	$291.00	$145.50–$279.36	—	50%
H. pylori stool antigen test CPT 87338 Heliobacter pylori Stool Ag EIA (LC)	$218.40	$728.00	$14.09–$698.88	19% above	70%
H. pylori stool antigen test CPT 87338 Heliobacter pylori Fecal IA	$218.40	$728.00	$14.09–$698.88	19% above	70%
H. pylori stool antigen test inpatient CPT 87338 Heliobacter pylori Fecal IA	$364.00	$728.00	$364.00–$698.88	—	50%
H. pylori stool antigen test inpatient CPT 87338 Heliobacter pylori Stool Ag EIA (LC)	$364.00	$728.00	$364.00–$698.88	—	50%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1, Quant RNA LC	$312.00	$1,040.00	$83.40–$998.40	15% below	70%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 RNA Real Time PCR (Non-Graph) Sendout to LabCorp	$321.30	$1,071.00	$83.40–$1,028.16	12% below	70%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1, Quant RNA LC	$520.00	$1,040.00	$520.00–$998.40	—	50%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 RNA Real Time PCR (Non-Graph) Sendout to LabCorp	$535.50	$1,071.00	$535.50–$1,028.16	—	50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c (LC)	$83.10	$277.00	$9.52–$265.92	32% below	70%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HgbA1c w/Est Avg Gluc	$83.10	$277.00	$9.52–$265.92	32% below	70%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HgbA1c w/Est Avg Gluc	$138.50	$277.00	$138.50–$265.92	—	50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c (LC)	$138.50	$277.00	$138.50–$265.92	—	50%
Hemoglobin blood test CPT 85018 Hemoglobin	$24.30	$81.00	$2.32–$77.76	48% below	70%
Hemoglobin blood test CPT 85018 85018 HEMOGLOBIN 131	$24.30	$81.00	$2.32–$77.76	48% below	70%
Hemoglobin blood test inpatient CPT 85018 85018 HEMOGLOBIN 131	$40.50	$81.00	$40.50–$77.76	—	50%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin	$40.50	$81.00	$40.50–$77.76	—	50%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Ab Total (LC)	$63.30	$211.00	$11.81–$202.56	14% below	70%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Ab Total (LC)	$105.50	$211.00	$105.50–$202.56	—	50%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab (LC)	$65.10	$217.00	$10.53–$208.32	28% below	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Ab (LC)	$108.50	$217.00	$108.50–$208.32	—	50%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag Screen (LC)	$64.50	$215.00	$10.12–$206.40	9% below	70%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Ag Screen (LC)	$107.50	$215.00	$107.50–$206.40	—	50%
Hepatitis C antibody blood test (screening) CPT 86803 HCV Antibody RFX to Quant PCR (LC)	$75.30	$251.00	$13.98–$240.96	21% below	70%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Virus Antibody (LC)	$75.30	$251.00	$13.98–$240.96	21% below	70%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Virus Antibody (LC)	$125.50	$251.00	$125.50–$240.96	—	50%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV Antibody RFX to Quant PCR (LC)	$125.50	$251.00	$125.50–$240.96	—	50%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Virus RNA Diagnosis LC	$106.80	$356.00	$41.98–$356.00	67% below	70%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Virus RNA PCR Quant Reflex Geno. (LC)	$106.80	$356.00	$41.98–$356.00	67% below	70%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Virus RNA PCR Quant Reflex Geno (LC)	$106.80	$356.00	$41.98–$356.00	67% below	70%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 Hepatitis C Virus RT PCR Quant Non-Graph (LC)	$106.80	$356.00	$41.98–$356.00	67% below	70%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 .HCV RT-PCR, Quant (Non-Graph) LC	$106.80	$356.00	$41.98–$356.00	67% below	70%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Virus RNA Diagnosis LC	$178.00	$356.00	$178.00–$341.76	—	50%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Virus RNA PCR Quant Reflex Geno (LC)	$178.00	$356.00	$178.00–$341.76	—	50%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Virus RNA PCR Quant Reflex Geno. (LC)	$178.00	$356.00	$178.00–$341.76	—	50%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 .HCV RT-PCR, Quant (Non-Graph) LC	$178.00	$356.00	$178.00–$341.76	—	50%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 Hepatitis C Virus RT PCR Quant Non-Graph (LC)	$178.00	$356.00	$178.00–$341.76	—	50%
Herpes blood test, HSV-1 antibody CPT 86695 86695 L164099 HSV1	$37.80	$126.00	$12.93–$126.00	32% below	70%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Virus 1 Specific Antibody IgG (LC)	$37.80	$126.00	$12.93–$126.00	32% below	70%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 86695 L164099 HSV1	$63.00	$126.00	$63.00–$120.96	—	50%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex Virus 1 Specific Antibody IgG (LC)	$63.00	$126.00	$63.00–$120.96	—	50%
Herpes blood test, HSV-2 antibody CPT 86696 .HSV2 IgG Supplemental (LC)	$53.40	$178.00	$18.96–$178.00	34% below	70%
Herpes blood test, HSV-2 antibody CPT 86696 HSV Type 2, Type-specific Antibodies, IgG LC	$53.40	$178.00	$18.96–$178.00	34% below	70%
Herpes blood test, HSV-2 antibody CPT 86696 86696 L164099 HSV2	$53.40	$178.00	$18.96–$178.00	34% below	70%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 86696 L164099 HSV2	$89.00	$178.00	$89.00–$170.88	—	50%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV Type 2, Type-specific Antibodies, IgG LC	$89.00	$178.00	$89.00–$170.88	—	50%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 .HSV2 IgG Supplemental (LC)	$89.00	$178.00	$89.00–$170.88	—	50%
High-sensitivity CRP (hs-CRP) test CPT 86141 C Reactive Protein Cardiac (LC)	$93.60	$312.00	$12.69–$299.52	43% below	70%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C Reactive Protein Cardiac (LC)	$156.00	$312.00	$156.00–$299.52	—	50%
Homocysteine blood test CPT 83090 Homocyst(e)ine Plasma LC	$173.40	$578.00	$17.56–$554.88	17% below	70%
Homocysteine blood test inpatient CPT 83090 Homocyst(e)ine Plasma LC	$289.00	$578.00	$289.00–$554.88	—	50%
Insulin blood test CPT 83525 Insulin LC	$36.30	$121.00	$11.20–$121.00	15% below	70%
Insulin blood test inpatient CPT 83525 Insulin LC	$60.50	$121.00	$60.50–$116.16	—	50%
Iron blood test (serum iron) CPT 83540 83540 IRON	$54.60	$182.00	$6.34–$174.72	31% below	70%
Iron blood test (serum iron) CPT 83540 83540 L1321 IRON	$54.60	$182.00	$6.34–$174.72	31% below	70%
Iron blood test (serum iron) CPT 83540 IRON	$54.60	$182.00	$6.34–$174.72	31% below	70%
Iron blood test (serum iron) inpatient CPT 83540 83540 IRON	$91.00	$182.00	$91.00–$174.72	—	50%
Iron blood test (serum iron) inpatient CPT 83540 83540 L1321 IRON	$91.00	$182.00	$91.00–$174.72	—	50%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$91.00	$182.00	$91.00–$174.72	—	50%
Iron-binding capacity (TIBC) test CPT 83550 83550 L1321 IRON BIND CAP	$61.20	$204.00	$8.57–$195.84	20% below	70%
Iron-binding capacity (TIBC) test CPT 83550 83550 IRON BINDING CAPACIT	$61.20	$204.00	$8.57–$195.84	20% below	70%
Iron-binding capacity (TIBC) test inpatient CPT 83550 83550 L1321 IRON BIND CAP	$102.00	$204.00	$102.00–$195.84	—	50%
Iron-binding capacity (TIBC) test inpatient CPT 83550 83550 IRON BINDING CAPACIT	$102.00	$204.00	$102.00–$195.84	—	50%
Kidney function blood test panel CPT 80069 RFP	$81.00	$270.00	$8.51–$259.20	46% below	70%
Kidney function blood test panel CPT 80069 Renal Function Panel	$81.00	$270.00	$8.51–$259.20	46% below	70%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$135.00	$270.00	$135.00–$259.20	—	50%
Kidney function blood test panel inpatient CPT 80069 RFP	$135.00	$270.00	$135.00–$259.20	—	50%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone, Pediatric (LC)	$51.60	$172.00	$18.15–$172.00	75% below	70%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone S (LC)	$51.60	$172.00	$18.15–$172.00	75% below	70%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone, Pediatric (LC)	$86.00	$172.00	$86.00–$165.12	—	50%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone S (LC)	$86.00	$172.00	$86.00–$165.12	—	50%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid	$102.90	$343.00	$11.34–$329.28	35% below	70%
Lactate (lactic acid) blood test CPT 83605 .Lactic Acid Reflex 2	$102.90	$343.00	$11.34–$329.28	35% below	70%
Lactate (lactic acid) blood test CPT 83605 .Lactic Acid Reflex	$102.90	$343.00	$11.34–$329.28	35% below	70%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid w/ Reflex LA	$102.90	$343.00	$11.34–$329.28	35% below	70%
Lactate (lactic acid) blood test CPT 83605 .ISTAT Creatinine POC	$102.90	$343.00	$11.34–$329.28	35% below	70%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid w/ Reflex LA	$171.50	$343.00	$171.50–$329.28	—	50%
Lactate (lactic acid) blood test inpatient CPT 83605 .Lactic Acid Reflex	$171.50	$343.00	$171.50–$329.28	—	50%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid	$171.50	$343.00	$171.50–$329.28	—	50%
Lactate (lactic acid) blood test inpatient CPT 83605 .Lactic Acid Reflex 2	$171.50	$343.00	$171.50–$329.28	—	50%
Lactate (lactic acid) blood test inpatient CPT 83605 .ISTAT Creatinine POC	$171.50	$343.00	$171.50–$329.28	—	50%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase (LC)	$32.70	$109.00	$5.92–$104.64	57% below	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 83615 L1842 LACTATE DEHYDR	$32.70	$109.00	$5.92–$104.64	57% below	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase	$32.70	$109.00	$5.92–$104.64	57% below	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase Body Fluid (LC)	$32.70	$109.00	$5.92–$104.64	57% below	70%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase (LC)	$54.50	$109.00	$54.50–$104.64	—	50%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase	$54.50	$109.00	$54.50–$104.64	—	50%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase Body Fluid (LC)	$54.50	$109.00	$54.50–$104.64	—	50%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 83615 L1842 LACTATE DEHYDR	$54.50	$109.00	$54.50–$104.64	—	50%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$75.90	$253.00	$6.75–$242.88	37% below	70%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase, Body Fluid Sendout to LabCorp	$75.90	$253.00	$6.75–$242.88	37% below	70%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$126.50	$253.00	$126.50–$242.88	—	50%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase, Body Fluid Sendout to LabCorp	$126.50	$253.00	$126.50–$242.88	—	50%
Liver function blood test panel CPT 80076 HFP	$59.10	$197.00	$8.01–$189.12	41% below	70%
Liver function blood test panel inpatient CPT 80076 HFP	$98.50	$197.00	$98.50–$189.12	—	50%
Lyme disease antibody test CPT 86618 86618 L139825 LYME DIS AB	$199.20	$664.00	$16.69–$637.44	70% above	70%
Lyme disease antibody test CPT 86618 Lyme Disease Total Ab Rfx Immunoassay LC	$199.20	$664.00	$16.69–$637.44	70% above	70%
Lyme disease antibody test inpatient CPT 86618 86618 L139825 LYME DIS AB	$332.00	$664.00	$332.00–$637.44	—	50%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Total Ab Rfx Immunoassay LC	$332.00	$664.00	$332.00–$637.44	—	50%
Magnesium blood test CPT 83735 Magnesium Serum	$54.30	$181.00	$6.57–$173.76	27% below	70%
Magnesium blood test CPT 83735 Magnesium RBC LC	$54.30	$181.00	$6.57–$173.76	27% below	70%
Magnesium blood test CPT 83735 L1537 83735 MAGNESIUM	$54.30	$181.00	$6.57–$173.76	27% below	70%
Magnesium blood test inpatient CPT 83735 Magnesium RBC LC	$90.50	$181.00	$90.50–$173.76	—	50%
Magnesium blood test inpatient CPT 83735 Magnesium Serum	$90.50	$181.00	$90.50–$173.76	—	50%
Magnesium blood test inpatient CPT 83735 L1537 83735 MAGNESIUM	$90.50	$181.00	$90.50–$173.76	—	50%
Measles (rubeola) antibody test CPT 86765 86765 L58495 RUBEOLA AB	$24.90	$83.00	$12.62–$83.00	56% below	70%
Measles (rubeola) antibody test CPT 86765 Measles (Rubeola) Antibodies, IgG (LC)	$24.90	$83.00	$12.62–$83.00	56% below	70%
Measles (rubeola) antibody test inpatient CPT 86765 86765 L58495 RUBEOLA AB	$41.50	$83.00	$41.50–$79.68	—	50%
Measles (rubeola) antibody test inpatient CPT 86765 Measles (Rubeola) Antibodies, IgG (LC)	$41.50	$83.00	$41.50–$79.68	—	50%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$86.40	$288.00	$5.08–$276.48	12% above	70%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen	$144.00	$288.00	$144.00–$276.48	—	50%
Mumps immunity blood test CPT 86735 Mumps Antibodies IgG LC	$37.50	$125.00	$12.79–$125.00	55% below	70%
Mumps immunity blood test CPT 86735 Mumps Antibodies IgM Sendout to LabCorp	$37.50	$125.00	$12.79–$125.00	55% below	70%
Mumps immunity blood test CPT 86735 86735 L58495 MUMPS AB	$37.50	$125.00	$12.79–$125.00	55% below	70%
Mumps immunity blood test inpatient CPT 86735 86735 L58495 MUMPS AB	$62.50	$125.00	$62.50–$120.00	—	50%
Mumps immunity blood test inpatient CPT 86735 Mumps Antibodies IgM Sendout to LabCorp	$62.50	$125.00	$62.50–$120.00	—	50%
Mumps immunity blood test inpatient CPT 86735 Mumps Antibodies IgG LC	$62.50	$125.00	$62.50–$120.00	—	50%
PSA (prostate-specific antigen) blood test, free CPT 84154 84154 L480947 PSA, FREE	$79.50	$265.00	$18.02–$254.40	at median	70%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 84154 L480947 PSA, FREE	$132.50	$265.00	$132.50–$254.40	—	50%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Ultrasensitive W/O Serial LC	$95.40	$318.00	$18.02–$305.28	43% below	70%
PSA (prostate-specific antigen) blood test, total CPT 84153 84153 L480947 PSA, TOTAL	$95.40	$318.00	$18.02–$305.28	43% below	70%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Ag Total	$95.40	$318.00	$18.02–$305.28	43% below	70%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Ag Total	$159.00	$318.00	$159.00–$305.28	—	50%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 84153 L480947 PSA, TOTAL	$159.00	$318.00	$159.00–$305.28	—	50%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Ultrasensitive W/O Serial LC	$159.00	$318.00	$159.00–$305.28	—	50%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Intact	$144.30	$481.00	$40.45–$481.00	56% below	70%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Intact (LC)	$144.30	$481.00	$40.45–$481.00	56% below	70%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Intact Surgical	$144.30	$481.00	$40.45–$481.00	56% below	70%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone Intact	$240.50	$481.00	$240.50–$461.76	—	50%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone Intact Surgical	$240.50	$481.00	$240.50–$461.76	—	50%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone Intact (LC)	$240.50	$481.00	$240.50–$461.76	—	50%
Partial thromboplastin time (PTT) clotting test CPT 85730 85730 L117199 THROMBO TIME	$95.40	$318.00	$5.89–$305.28	at median	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$95.40	$318.00	$5.89–$305.28	at median	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 85730 L117199 THROMBO TIME	$159.00	$318.00	$159.00–$305.28	—	50%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time	$159.00	$318.00	$159.00–$305.28	—	50%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Serum	$49.20	$164.00	$4.65–$157.44	26% below	70%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Serum	$82.00	$164.00	$82.00–$157.44	—	50%
Potassium blood test CPT 84132 Potassium Serum	$29.10	$97.00	$4.66–$93.12	53% below	70%
Potassium blood test inpatient CPT 84132 Potassium Serum	$48.50	$97.00	$48.50–$93.12	—	50%
Progesterone blood test CPT 84144 Progesterone Sendout to LabCorp	$56.40	$188.00	$20.44–$188.00	75% below	70%
Progesterone blood test CPT 84144 Progesterone - Send Out CQ	$56.40	$188.00	$20.44–$188.00	75% below	70%
Progesterone blood test CPT 84144 L500175 84144 PROGESTERONE	$56.40	$188.00	$20.44–$188.00	75% below	70%
Progesterone blood test inpatient CPT 84144 Progesterone Sendout to LabCorp	$94.00	$188.00	$94.00–$180.48	—	50%
Progesterone blood test inpatient CPT 84144 L500175 84144 PROGESTERONE	$94.00	$188.00	$94.00–$180.48	—	50%
Progesterone blood test inpatient CPT 84144 Progesterone - Send Out CQ	$94.00	$188.00	$94.00–$180.48	—	50%
Prolactin blood test CPT 84146 Prolactin (LC)	$96.90	$323.00	$18.99–$310.08	50% below	70%
Prolactin blood test inpatient CPT 84146 Prolactin (LC)	$161.50	$323.00	$161.50–$310.08	—	50%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time w/INR	$23.70	$79.00	$4.20–$75.84	40% below	70%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time w/INR	$39.50	$79.00	$39.50–$75.84	—	50%
Rapid flu test (influenza antigen) CPT 87804 87804 INFLUENZA ASSAY W-OP	$29.10	$97.00	$16.22–$97.00	64% below	70%
Rapid flu test (influenza antigen) inpatient CPT 87804 87804 INFLUENZA ASSAY W-OP	$48.50	$97.00	$48.50–$93.12	—	50%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Streptococcus A Antigen IA1	$27.60	$92.00	$16.20–$92.00	69% below	70%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Streptococcus A Antigen IA1	$46.00	$92.00	$46.00–$88.32	—	50%
Renin blood test CPT 84244 84244 L4354 RENIN	$115.80	$386.00	$21.55–$370.56	41% above	70%
Renin blood test CPT 84244 Renin Activity Plasma LC	$115.80	$386.00	$21.55–$370.56	41% above	70%
Renin blood test inpatient CPT 84244 84244 L4354 RENIN	$193.00	$386.00	$193.00–$370.56	—	50%
Renin blood test inpatient CPT 84244 Renin Activity Plasma LC	$193.00	$386.00	$193.00–$370.56	—	50%
Rh blood typing CPT 86901 86901 BLOOD TYPING RH D	$31.80	$106.00	$2.99–$101.76	36% below	70%
Rh blood typing inpatient CPT 86901 86901 BLOOD TYPING RH D	$53.00	$106.00	$53.00–$101.76	—	50%
Rheumatoid factor (RF) test CPT 86431 86431 L56499 RA FACT QT	$77.70	$259.00	$5.56–$248.64	15% above	70%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Arthritis Factor (LC)	$77.70	$259.00	$5.56–$248.64	15% above	70%
Rheumatoid factor (RF) test inpatient CPT 86431 86431 L56499 RA FACT QT	$129.50	$259.00	$129.50–$248.64	—	50%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Arthritis Factor (LC)	$129.50	$259.00	$129.50–$248.64	—	50%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibodies IgG LC	$47.70	$159.00	$14.10–$159.00	24% below	70%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibodies IgM Sendout to LabCorp	$47.70	$159.00	$14.10–$159.00	24% below	70%
Rubella antibody test (immunity check) CPT 86762 86762 L58495 RUBELLA AB	$47.70	$159.00	$14.10–$159.00	24% below	70%
Rubella antibody test (immunity check) inpatient CPT 86762 86762 L58495 RUBELLA AB	$79.50	$159.00	$79.50–$152.64	—	50%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibodies IgM Sendout to LabCorp	$79.50	$159.00	$79.50–$152.64	—	50%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibodies IgG LC	$79.50	$159.00	$79.50–$152.64	—	50%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESRA	$48.00	$160.00	$2.65–$153.60	25% below	70%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESRA	$80.00	$160.00	$80.00–$153.60	—	50%
Sodium blood test CPT 84295 Sodium Serum	$29.10	$97.00	$4.71–$93.12	44% below	70%
Sodium blood test inpatient CPT 84295 Sodium Serum	$48.50	$97.00	$48.50–$93.12	—	50%
Stool ova and parasites exam CPT 87177 87177 L8623 OVA-PARASITES SMEARS	$52.80	$176.00	$8.72–$168.96	50% below	70%
Stool ova and parasites exam inpatient CPT 87177 87177 L8623 OVA-PARASITES SMEARS	$88.00	$176.00	$88.00–$168.96	—	50%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Occult Blood Feces Diagnostic 1-3 D	$25.20	$84.00	$15.60–$84.00	55% below	70%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Occult Blood Feces Diagnostic 1-3 D	$42.00	$84.00	$42.00–$80.64	—	50%
Syphilis antibody test (Treponema pallidum) CPT 86780 zzTreponema pallidum Ab FTA (LC)	$37.80	$126.00	$12.98–$126.00	13% below	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 T pallidum Screening cascade LC	$37.80	$126.00	$12.98–$126.00	13% below	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 86780 L12021 TPALLID CONF	$37.80	$126.00	$12.98–$126.00	13% below	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 LRX82348 86780 T PALLID AB	$37.80	$126.00	$12.98–$126.00	13% below	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 LRX82348 86780 T PALLID AB	$63.00	$126.00	$63.00–$120.96	—	50%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 T pallidum Screening cascade LC	$63.00	$126.00	$63.00–$120.96	—	50%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 zzTreponema pallidum Ab FTA (LC)	$63.00	$126.00	$63.00–$120.96	—	50%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 86780 L12021 TPALLID CONF	$63.00	$126.00	$63.00–$120.96	—	50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL CSF LC	$20.10	$67.00	$4.18–$64.32	67% below	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin Reflex Titer + TP-PA (LC)	$20.10	$67.00	$4.18–$64.32	67% below	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 .RPR LC	$20.10	$67.00	$4.18–$64.32	67% below	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagin Reflex Titer + TP-PA (LC)	$33.50	$67.00	$33.50–$64.32	—	50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 .RPR LC	$33.50	$67.00	$33.50–$64.32	—	50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL CSF LC	$33.50	$67.00	$33.50–$64.32	—	50%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON-TB Gold Plus (Client Incubated) LC	$148.50	$495.00	$60.74–$495.00	46% above	70%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QuantiFERON-TB Gold Plus (Client Incubated) LC	$247.50	$495.00	$247.50–$475.20	—	50%
Testosterone blood test, total (not free testosterone) CPT 84403 84403 L140103 TESTOST TOTA	$112.20	$374.00	$25.29–$359.04	24% above	70%
Testosterone blood test, total (not free testosterone) CPT 84403 L500175 84403 TOT	$112.20	$374.00	$25.29–$359.04	24% above	70%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Level (LC)	$112.20	$374.00	$25.29–$359.04	24% above	70%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 L500175 84403 TOT	$187.00	$374.00	$187.00–$359.04	—	50%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 84403 L140103 TESTOST TOTA	$187.00	$374.00	$187.00–$359.04	—	50%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Level (LC)	$187.00	$374.00	$187.00–$359.04	—	50%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibody (LC)	$100.20	$334.00	$14.26–$320.64	at median	70%
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver-Kidney Microsomal Ab LC	$100.20	$334.00	$14.26–$320.64	at median	70%
Thyroid peroxidase (TPO) antibody test CPT 86376 86376 L6684 MICROSOMAL AB	$100.20	$334.00	$14.26–$320.64	at median	70%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Liver-Kidney Microsomal Ab LC	$167.00	$334.00	$167.00–$320.64	—	50%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 86376 L6684 MICROSOMAL AB	$167.00	$334.00	$167.00–$320.64	—	50%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Antibody (LC)	$167.00	$334.00	$167.00–$320.64	—	50%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$88.50	$295.00	$16.46–$283.20	42% below	70%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone w/Reflex to Free T4	$88.50	$295.00	$16.46–$283.20	42% below	70%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 L620 84443 TSH	$88.50	$295.00	$16.46–$283.20	42% below	70%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH LC	$88.50	$295.00	$16.46–$283.20	42% below	70%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$88.50	$295.00	$16.46–$283.20	42% below	70%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 84443 L620 TSH	$88.50	$295.00	$16.46–$283.20	42% below	70%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$147.50	$295.00	$147.50–$283.20	—	50%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 L620 84443 TSH	$147.50	$295.00	$147.50–$283.20	—	50%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone w/Reflex to Free T4	$147.50	$295.00	$147.50–$283.20	—	50%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$147.50	$295.00	$147.50–$283.20	—	50%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH LC	$147.50	$295.00	$147.50–$283.20	—	50%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 84443 L620 TSH	$147.50	$295.00	$147.50–$283.20	—	50%
Total IgE blood test CPT 82785 82785 L2295 GAMMAGLOBULIN IGE	$73.20	$244.00	$16.13–$234.24	at median	70%
Total IgE blood test CPT 82785 Immunoglobulin E Total (LC)	$73.20	$244.00	$16.13–$234.24	at median	70%
Total IgE blood test inpatient CPT 82785 Immunoglobulin E Total (LC)	$122.00	$244.00	$122.00–$234.24	—	50%
Total IgE blood test inpatient CPT 82785 82785 L2295 GAMMAGLOBULIN IGE	$122.00	$244.00	$122.00–$234.24	—	50%
Total cholesterol blood test CPT 82465 Cholesterol	$33.60	$112.00	$4.26–$107.52	50% below	70%
Total cholesterol blood test inpatient CPT 82465 Cholesterol	$56.00	$112.00	$56.00–$107.52	—	50%
Total thyroxine (T4) blood test CPT 84436 84436 L620 T4 TOTAL	$70.20	$234.00	$6.73–$224.64	17% below	70%
Total thyroxine (T4) blood test CPT 84436 84436 L455 THYROXINE T4,TOTAL	$70.20	$234.00	$6.73–$224.64	17% below	70%
Total thyroxine (T4) blood test CPT 84436 L620 84436 T4 TOTAL	$70.20	$234.00	$6.73–$224.64	17% below	70%
Total thyroxine (T4) blood test CPT 84436 Thyroxine 4 (LC)	$70.20	$234.00	$6.73–$224.64	17% below	70%
Total thyroxine (T4) blood test inpatient CPT 84436 L620 84436 T4 TOTAL	$117.00	$234.00	$117.00–$224.64	—	50%
Total thyroxine (T4) blood test inpatient CPT 84436 84436 L620 T4 TOTAL	$117.00	$234.00	$117.00–$224.64	—	50%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine 4 (LC)	$117.00	$234.00	$117.00–$224.64	—	50%
Total thyroxine (T4) blood test inpatient CPT 84436 84436 L455 THYROXINE T4,TOTAL	$117.00	$234.00	$117.00–$224.64	—	50%
Total triiodothyronine (T3) blood test CPT 84480 Triiodothyronine (LC)	$54.60	$182.00	$13.90–$174.72	69% below	70%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Triiodothyronine (LC)	$91.00	$182.00	$91.00–$174.72	—	50%
Transferrin blood test CPT 84466 Transferrin LC	$53.40	$178.00	$12.50–$170.88	56% below	70%
Transferrin blood test inpatient CPT 84466 Transferrin LC	$89.00	$178.00	$89.00–$170.88	—	50%
Trichomonas test (NAAT) CPT 87661 87661 L183160 T VAG AMP	$63.60	$212.00	$34.39–$212.00	35% below	70%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis, NAA (LC)	$63.60	$212.00	$34.39–$212.00	35% below	70%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis, NAA (LC)	$106.00	$212.00	$106.00–$203.52	—	50%
Trichomonas test (NAAT) inpatient CPT 87661 87661 L183160 T VAG AMP	$106.00	$212.00	$106.00–$203.52	—	50%
Triglycerides blood test CPT 84478 Triglycerides	$37.80	$126.00	$5.63–$120.96	31% below	70%
Triglycerides blood test CPT 84478 Triglycerides Fluid (LC)	$37.80	$126.00	$5.63–$120.96	31% below	70%
Triglycerides blood test inpatient CPT 84478 Triglycerides	$63.00	$126.00	$63.00–$120.96	—	50%
Triglycerides blood test inpatient CPT 84478 Triglycerides Fluid (LC)	$63.00	$126.00	$63.00–$120.96	—	50%
Troponin test, quantitative CPT 84484 Troponin I HS x 3 Series	$209.70	$699.00	$12.22–$671.04	1% above	70%
Troponin test, quantitative CPT 84484 Troponin I HS	$209.70	$699.00	$12.22–$671.04	1% above	70%
Troponin test, quantitative CPT 84484 .Troponin I HS 1 Hour	$209.70	$699.00	$12.22–$671.04	1% above	70%
Troponin test, quantitative CPT 84484 .Troponin I HS 3 Hour	$209.70	$699.00	$12.22–$671.04	1% above	70%
Troponin test, quantitative inpatient CPT 84484 .Troponin I HS 3 Hour	$349.50	$699.00	$349.50–$671.04	—	50%
Troponin test, quantitative inpatient CPT 84484 Troponin I HS x 3 Series	$349.50	$699.00	$349.50–$671.04	—	50%
Troponin test, quantitative inpatient CPT 84484 .Troponin I HS 1 Hour	$349.50	$699.00	$349.50–$671.04	—	50%
Troponin test, quantitative inpatient CPT 84484 Troponin I HS	$349.50	$699.00	$349.50–$671.04	—	50%
Uric acid blood test CPT 84550 Uric Acid Level	$35.40	$118.00	$4.43–$113.28	41% below	70%
Uric acid blood test inpatient CPT 84550 Uric Acid Level	$59.00	$118.00	$59.00–$113.28	—	50%
Urinalysis with microscope exam, automated CPT 81001 .Bill Only DS Auto/MSc Reqd	$63.30	$211.00	$3.11–$202.56	43% below	70%
Urinalysis with microscope exam, automated inpatient CPT 81001 .Bill Only DS Auto/MSc Reqd	$105.50	$211.00	$105.50–$202.56	—	50%
Urinalysis with microscope exam, manual CPT 81000 Urinalysis w/Microscopic Manual	$93.30	$311.00	$3.94–$298.56	12% above	70%
Urinalysis with microscope exam, manual CPT 81000 .Bill Only DS Man/MSc Reqd	$93.30	$311.00	$3.94–$298.56	12% above	70%
Urinalysis with microscope exam, manual inpatient CPT 81000 .Bill Only DS Man/MSc Reqd	$155.50	$311.00	$155.50–$298.56	—	50%
Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis w/Microscopic Manual	$155.50	$311.00	$155.50–$298.56	—	50%
Urinalysis without microscope exam, automated CPT 81003 .Bill Only DS Auto/No MSc	$43.80	$146.00	$2.20–$140.16	11% below	70%
Urinalysis without microscope exam, automated CPT 81003 Urine Color Urine Dipstick	$43.80	$146.00	$2.20–$140.16	11% below	70%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis w/o Microscopic Automated	$43.80	$146.00	$2.20–$140.16	11% below	70%
Urinalysis without microscope exam, automated inpatient CPT 81003 .Bill Only DS Auto/No MSc	$73.00	$146.00	$73.00–$140.16	—	50%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Color Urine Dipstick	$73.00	$146.00	$73.00–$140.16	—	50%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis w/o Microscopic Automated	$73.00	$146.00	$73.00–$140.16	—	50%
Urinalysis without microscope exam, manual CPT 81002 .Bill Only DS Man/No MSc	$18.00	$60.00	$3.41–$57.60	54% below	70%
Urinalysis without microscope exam, manual inpatient CPT 81002 .Bill Only DS Man/No MSc	$30.00	$60.00	$30.00–$57.60	—	50%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture Qn	$89.40	$298.00	$7.91–$286.08	15% below	70%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture Qn	$149.00	$298.00	$149.00–$286.08	—	50%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Urine Quant	$58.20	$194.00	$5.66–$186.24	35% below	70%
Urine microalbumin (albumin) test CPT 82043 82043 L140285 MICROALB QT	$58.20	$194.00	$5.66–$186.24	35% below	70%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Urine 24 Hour	$58.20	$194.00	$5.66–$186.24	35% below	70%
Urine microalbumin (albumin) test CPT 82043 82043 MICROALB QNT	$58.20	$194.00	$5.66–$186.24	35% below	70%
Urine microalbumin (albumin) test CPT 82043 Microalbumin 24 hr Urine Sendout to LabCorp	$58.20	$194.00	$5.66–$186.24	35% below	70%
Urine microalbumin (albumin) test inpatient CPT 82043 82043 L140285 MICROALB QT	$97.00	$194.00	$97.00–$186.24	—	50%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin 24 hr Urine Sendout to LabCorp	$97.00	$194.00	$97.00–$186.24	—	50%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Urine 24 Hour	$97.00	$194.00	$97.00–$186.24	—	50%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Urine Quant	$97.00	$194.00	$97.00–$186.24	—	50%
Urine microalbumin (albumin) test inpatient CPT 82043 82043 MICROALB QNT	$97.00	$194.00	$97.00–$186.24	—	50%
Urine pregnancy test, read by color change CPT 81025 .HCG Urine Ql POC	$65.10	$217.00	$8.44–$208.32	27% below	70%
Urine pregnancy test, read by color change CPT 81025 POC HCG Patient Test Result - Positive	$65.10	$217.00	$8.44–$208.32	27% below	70%
Urine pregnancy test, read by color change CPT 81025 POC HCG Patient Test Result - Negative	$65.10	$217.00	$8.44–$208.32	27% below	70%
Urine pregnancy test, read by color change CPT 81025 POC HCG Patient Test Result	$65.10	$217.00	$8.44–$208.32	27% below	70%
Urine pregnancy test, read by color change CPT 81025 Human Chorionic Gonadotropin Urine Qual Manual	$65.10	$217.00	$8.44–$208.32	27% below	70%
Urine pregnancy test, read by color change inpatient CPT 81025 POC HCG Patient Test Result - Negative	$108.50	$217.00	$108.50–$208.32	—	50%
Urine pregnancy test, read by color change inpatient CPT 81025 POC HCG Patient Test Result	$108.50	$217.00	$108.50–$208.32	—	50%
Urine pregnancy test, read by color change inpatient CPT 81025 POC HCG Patient Test Result - Positive	$108.50	$217.00	$108.50–$208.32	—	50%
Urine pregnancy test, read by color change inpatient CPT 81025 Human Chorionic Gonadotropin Urine Qual Manual	$108.50	$217.00	$108.50–$208.32	—	50%
Urine pregnancy test, read by color change inpatient CPT 81025 .HCG Urine Ql POC	$108.50	$217.00	$108.50–$208.32	—	50%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 (LC)	$102.30	$341.00	$14.78–$327.36	12% below	70%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 (LC)	$170.50	$341.00	$170.50–$327.36	—	50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 hydroxy	$114.30	$381.00	$29.01–$365.76	23% below	70%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25-Hydroxy LC	$114.30	$381.00	$29.01–$365.76	23% below	70%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25-Hydroxy D2 + D3 LC	$114.30	$381.00	$29.01–$365.76	23% below	70%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 hydroxy	$190.50	$381.00	$190.50–$365.76	—	50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25-Hydroxy D2 + D3 LC	$190.50	$381.00	$190.50–$365.76	—	50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25-Hydroxy LC	$190.50	$381.00	$190.50–$365.76	—	50%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Calcitriol Level (LC)	$142.80	$476.00	$37.73–$456.96	50% below	70%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Calcitriol Level (LC)	$238.00	$476.00	$238.00–$456.96	—	50%
Zinc blood test CPT 84630 Zinc, Whole Blood (LC)	$79.50	$265.00	$11.16–$254.40	35% above	70%
Zinc blood test CPT 84630 Zinc Plasma or Serum (LC)	$79.50	$265.00	$11.16–$254.40	35% above	70%
Zinc blood test inpatient CPT 84630 Zinc Plasma or Serum (LC)	$132.50	$265.00	$132.50–$254.40	—	50%
Zinc blood test inpatient CPT 84630 Zinc, Whole Blood (LC)	$132.50	$265.00	$132.50–$254.40	—	50%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Human Chorionic Gonadotropin Beta Sub unit Quant (	$108.60	$362.00	$14.75–$347.52	18% below	70%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Human Chorionic Gonadotropin Quant	$108.60	$362.00	$14.75–$347.52	18% below	70%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Human Chorionic Gonadotropin Beta Sub unit Quant (	$181.00	$362.00	$181.00–$347.52	—	50%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Human Chorionic Gonadotropin Quant	$181.00	$362.00	$181.00–$347.52	—	50%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Alaska	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 REMOVAL OF ADENOIDS	$9,875.75	$32,919.15	$258.08–$31,602.38	—	70%
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 ARTHRD ANT NTRBDY CERVICAL	$33,960.29	$113,200.96	$2,018.45–$108,672.92	—	70%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 KNEE ARTHROSCOPY/SURGERY	$36,861.89	$122,872.97	$1,185.64–$117,958.05	226% above	70%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 SHO ARTHRS SRG RT8TR CUF RPR	$31,292.96	$104,309.88	$1,298.73–$100,137.48	231% above	70%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MG Breast Biopsy w Loc w Stereo 1 Lsn Rt	$2,356.80	$7,856.00	$212.88–$7,541.76	27% below	70%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MG Breast Biopsy w Loc w Stereo 1 Lsn Lt	$2,474.70	$8,249.00	$212.88–$7,919.04	23% below	70%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MG Breast Biopsy w Loc w Stereo 1 Lsn Rt	$3,928.00	$7,856.00	$3,928.00–$7,541.76	—	50%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MG Breast Biopsy w Loc w Stereo 1 Lsn Lt	$4,124.50	$8,249.00	$4,124.50–$7,919.04	—	50%
Cardiac catheterization with coronary angiogram CPT 93458 CC-L HRT ARTERY-VENT - GL 106	$20,881.80	$69,606.00	$740.15–$66,821.76	30% below	70%
Cardiac catheterization with coronary angiogram CPT 93458 CC-L HRT ARTERY-VENT[AKMS]	$20,881.80	$69,606.00	$740.15–$66,821.76	30% below	70%
Cardiac catheterization with coronary angiogram CPT 93458 L HRT ARTERY/VENTRICLE ANGIO	$38,952.65	$129,842.16	$740.15–$124,648.47	31% above	70%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 CC-L HRT ARTERY-VENT[AKMS]	$34,803.00	$69,606.00	$34,803.00–$66,821.76	—	50%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 CC-L HRT ARTERY-VENT - GL 106	$34,803.00	$69,606.00	$34,803.00–$66,821.76	—	50%
Cardioversion, elective (restoring heart rhythm) CPT 92960 NI- CARDIOVERSION	$855.00	$2,850.00	$184.72–$2,736.00	41% below	70%
Cardioversion, elective (restoring heart rhythm) CPT 92960 NI-CARDIOVERSION - GL 106	$1,122.60	$3,742.00	$184.72–$3,592.32	22% below	70%
Cardioversion, elective (restoring heart rhythm) CPT 92960 NI-CARDIOVERSION[AKMS]	$1,122.60	$3,742.00	$184.72–$3,592.32	22% below	70%
Cardioversion, elective (restoring heart rhythm) CPT 92960 $ED Cardioversion/Defibrillation	$1,158.30	$3,861.00	$184.72–$3,706.56	19% below	70%
Cardioversion, elective (restoring heart rhythm) CPT 92960 ED Cardioversion Set up for procedure - Cardiovers	$1,158.30	$3,861.00	$184.72–$3,706.56	19% below	70%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC, EXT	$5,337.28	$17,790.92	$184.72–$17,079.28	271% above	70%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 NI- CARDIOVERSION	$1,425.00	$2,850.00	$1,425.00–$2,736.00	—	50%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 NI-CARDIOVERSION[AKMS]	$1,871.00	$3,742.00	$1,871.00–$3,592.32	—	50%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 NI-CARDIOVERSION - GL 106	$1,871.00	$3,742.00	$1,871.00–$3,592.32	—	50%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 $ED Cardioversion/Defibrillation	$1,930.50	$3,861.00	$1,930.50–$3,706.56	—	50%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ED Cardioversion Set up for procedure - Cardiovers	$1,930.50	$3,861.00	$1,930.50–$3,706.56	—	50%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURGERY	$8,697.18	$28,990.59	$531.44–$27,830.97	148% above	70%
Colonoscopy with polyp removal CPT 45385 LESION REMOVAL COLONOSCOPY	$4,243.77	$14,145.89	$523.73–$13,580.05	76% above	70%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY	$3,925.70	$13,085.65	$489.09–$12,562.22	118% above	70%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY	$2,913.57	$9,711.90	$391.59–$9,323.42	80% above	70%
Coronary stent placement, one artery CPT 92928 IC-PRQ CRD STN W-ANG - GL 106	$23,266.20	$77,554.00	$711.56–$74,451.84	23% below	70%
Coronary stent placement, one artery CPT 92928 IC-PRQ CRD STN W-ANG[AKMS]	$23,266.20	$77,554.00	$711.56–$74,451.84	23% below	70%
Coronary stent placement, one artery inpatient CPT 92928 IC-PRQ CRD STN W-ANG - GL 106	$38,777.00	$77,554.00	$38,777.00–$74,451.84	—	50%
Coronary stent placement, one artery inpatient CPT 92928 IC-PRQ CRD STN W-ANG[AKMS]	$38,777.00	$77,554.00	$38,777.00–$74,451.84	—	50%
Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY AND TREATMENT	$11,955.20	$39,850.66	$424.66–$38,256.63	299% above	70%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY	$15,241.64	$50,805.45	$248.32–$48,773.23	1095% above	70%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTAGE	$11,562.48	$38,541.61	$351.77–$36,999.95	427% above	70%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM OPENING	$10,654.07	$35,513.55	$192.24–$34,093.01	511% above	70%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$200.04	$666.80	$16.28–$640.13	119% above	70%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX	$1,037.65	$3,458.83	$57.51–$3,320.48	418% above	70%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 RPR AA HRN 1ST 3-10 RDC	$14,931.34	$49,771.14	$701.89–$47,780.29	128% above	70%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 RPR AA HRN 1ST > 10 RDC	$20,433.82	$68,112.73	$948.16–$65,388.22	—	70%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST < 3 CM RDC	$14,260.41	$47,534.69	$418.03–$45,633.30	173% above	70%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$3,259.98	$10,866.59	$204.09–$10,431.93	101% above	70%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$16,503.10	$55,010.34	$801.89–$52,809.93	91% above	70%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPARO CHOLECYSTECTOMY/GRAPH	$21,719.56	$72,398.53	$872.36–$69,502.59	85% above	70%
Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY	$9,469.40	$31,564.67	$601.23–$30,302.08	89% above	70%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 S-INJ CATH HYSTERSO	$343.50	$1,145.00	$122.74–$1,099.20	66% below	70%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 S-INJ CATH HYSTERSO	$572.50	$1,145.00	$572.50–$1,099.20	—	50%
Hysteroscopy with endometrial ablation CPT 58563 HYSTEROSCOPY, ABLATION	$11,567.65	$38,558.84	$2,112.95–$37,016.49	23% above	70%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY, BIOPSY	$10,030.81	$33,436.04	$1,350.24–$32,098.60	37% above	70%
IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE	$8,279.56	$27,598.53	$90.86–$26,494.59	2071% above	70%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS	$1,563.62	$5,212.08	$148.75–$5,003.60	298% above	70%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR INGUINAL HERNIA	$13,783.83	$45,946.11	$633.77–$44,108.27	100% above	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 S-JNT ASP INJ MAJ UN	$335.40	$1,118.00	$77.19–$1,073.28	20% below	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT, JOINT/BURSA	$4,433.16	$14,777.20	$77.19–$14,186.11	961% above	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 RF Joint Aspiration-Injection Major Rt	$335.40	$1,118.00	$77.19–$1,073.28	20% below	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 RF Joint Aspiration-Injection Major Lt	$335.40	$1,118.00	$77.19–$1,073.28	20% below	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 CT Joint Aspiration-Injection Major Rt	$335.40	$1,118.00	$77.19–$1,073.28	20% below	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 CT Joint Aspiration-Injection Major Lt	$335.40	$1,118.00	$77.19–$1,073.28	20% below	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 S-JNT ASP INJ MAJ UN	$559.00	$1,118.00	$559.00–$1,073.28	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 RF Joint Aspiration-Injection Major Rt	$559.00	$1,118.00	$559.00–$1,073.28	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 CT Joint Aspiration-Injection Major Rt	$559.00	$1,118.00	$559.00–$1,073.28	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 CT Joint Aspiration-Injection Major Lt	$559.00	$1,118.00	$559.00–$1,073.28	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 RF Joint Aspiration-Injection Major Lt	$559.00	$1,118.00	$559.00–$1,073.28	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 S-JOINT ASP-INJ IM	$368.70	$1,229.00	$65.65–$1,179.84	1% above	70%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJECT, JOINT/BURSA	$2,112.98	$7,043.25	$65.65–$6,761.52	480% above	70%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 CT Joint Aspiration-Injection Intermed Lt	$368.70	$1,229.00	$65.65–$1,179.84	1% above	70%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 RF Joint Aspiration-Injection Intermed Lt	$368.70	$1,229.00	$65.65–$1,179.84	1% above	70%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 CT Joint Aspiration-Injection Intermed Rt	$368.70	$1,229.00	$65.65–$1,179.84	1% above	70%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 RF Joint Aspiration-Injection Intermed Rt	$368.70	$1,229.00	$65.65–$1,179.84	1% above	70%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 S-JOINT ASP-INJ IM	$614.50	$1,229.00	$614.50–$1,179.84	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 RF Joint Aspiration-Injection Intermed Rt	$614.50	$1,229.00	$614.50–$1,179.84	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 CT Joint Aspiration-Injection Intermed Rt	$614.50	$1,229.00	$614.50–$1,179.84	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 CT Joint Aspiration-Injection Intermed Lt	$614.50	$1,229.00	$614.50–$1,179.84	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 RF Joint Aspiration-Injection Intermed Lt	$614.50	$1,229.00	$614.50–$1,179.84	—	50%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 S-JOINT ASP-INJ SM	$355.20	$1,184.00	$64.33–$1,136.64	1% above	70%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 S-JOINT ASP-INJ SM	$592.00	$1,184.00	$592.00–$1,136.64	—	50%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 KNEE ARTHROSCOPY/SURGERY	$24,374.39	$81,247.95	$837.63–$77,998.03	223% above	70%
Knee arthroscopy with meniscus trim CPT 29881 KNEE ARTHROSCOPY/SURGERY	$14,264.11	$47,547.03	$655.14–$45,645.15	106% above	70%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 KNEE ARTHROSCOPY/SURGERY	$12,162.29	$40,540.98	$680.43–$38,919.34	50% above	70%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 KNEE ARTHROSCOPY/SURGERY	$18,120.15	$60,400.50	$753.01–$57,984.48	—	70%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY, APPENDECTOMY	$19,035.93	$63,453.11	$731.08–$60,914.99	210% above	70%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 LAPAROSCOPY, FUNDOPLASTY	$26,291.13	$87,637.09	$1,310.20–$84,131.61	—	70%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 TLH UTERUS 250 G OR LESS	$17,957.12	$59,857.05	$997.93–$57,462.77	—	70%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 TLH W/T/O 250 G OR LESS	$18,528.55	$61,761.82	$1,121.30–$59,291.35	—	70%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAPARO HERNIA REPAIR INITIAL	$16,508.46	$55,028.21	$523.31–$52,827.08	28% above	70%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAPARO HERNIA REPAIR RECUR	$17,991.49	$59,971.62	$682.87–$57,572.76	—	70%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY, REMOVE ADNEXA	$12,864.11	$42,880.36	$810.71–$41,165.15	—	70%
Left heart catheterization, diagnostic one side CPT 93452 LEFT HRT CATH W/VENTRCLGRPHY	$43,044.45	$143,481.50	$655.69–$137,742.24	100% above	70%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC	$15,592.91	$51,976.35	$288.50–$49,897.30	515% above	70%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC	$16,945.88	$56,486.28	$156.59–$54,226.83	869% above	70%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 LOW BACK DISK SURGERY	$15,570.86	$51,902.88	$1,082.90–$49,826.76	—	70%
Lumbar fusion with interbody cage and posterolateral graft (TLIF), one level CPT 22633 ARTHRD CMBN 1NTRSPC LUMBAR	$62,350.34	$207,834.45	$2,155.93–$199,521.07	—	70%
Lumbar laminectomy (spinal decompression), one level CPT 63047 REMOVAL OF SPINAL LAMINA	$16,690.00	$55,633.34	$1,314.90–$53,408.01	—	70%
Lumpectomy (partial mastectomy) CPT 19301 PARTIAL MASTECTOMY	$13,059.38	$43,531.26	$797.27–$41,790.01	—	70%
Mastectomy (total removal of the breast) CPT 19303 MAST SIMPLE COMPLETE	$13,573.20	$45,244.00	$1,160.62–$43,434.24	—	70%
Miscarriage treatment with D&C, first trimester CPT 59820 CARE OF MISCARRIAGE	$8,668.08	$28,893.59	$505.65–$27,737.85	57% above	70%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$1,424.61	$4,748.70	$132.55–$4,558.75	301% above	70%
Occipital nerve block (injection for headaches) CPT 64405 INJECTION FOR NERVE BLOCK	$6,675.00	$22,250.00	$88.63–$21,360.00	714% above	70%
Pacemaker implant (dual chamber) CPT 33208 INSERTION OF HEART PACEMAKER	$24,212.51	$80,708.36	$620.25–$77,480.03	32% above	70%
Paracentesis with imaging guidance CPT 49083 CT Abdominal Paracentesis w Imaging	$1,292.40	$4,308.00	$323.61–$4,135.68	at median	70%
Paracentesis with imaging guidance CPT 49083 US Paracentesis Abd w Image	$1,292.40	$4,308.00	$323.61–$4,135.68	at median	70%
Paracentesis with imaging guidance CPT 49083 IR Abdominal Paracentesis w Imaging - GL 106	$1,312.20	$4,374.00	$323.61–$4,199.04	2% above	70%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$4,498.20	$14,994.00	$323.61–$14,394.24	248% above	70%
Paracentesis with imaging guidance inpatient CPT 49083 CT Abdominal Paracentesis w Imaging	$2,154.00	$4,308.00	$2,154.00–$4,135.68	—	50%
Paracentesis with imaging guidance inpatient CPT 49083 US Paracentesis Abd w Image	$2,154.00	$4,308.00	$2,154.00–$4,135.68	—	50%
Paracentesis with imaging guidance inpatient CPT 49083 IR Abdominal Paracentesis w Imaging - GL 106	$2,187.00	$4,374.00	$2,187.00–$4,199.04	—	50%
Partial knee replacement (one compartment) CPT 27446 REVISION OF KNEE JOINT	$35,956.12	$119,853.74	$1,396.56–$115,059.59	174% above	70%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$1,042.39	$3,474.63	$187.20–$3,335.64	21% above	70%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE	$5,982.99	$19,943.30	$281.40–$19,145.57	130% above	70%
Prostate removal (prostatectomy), laparoscopic CPT 55866 LAPS SURG PRST8ECT RPBIC RAD	$25,535.47	$85,118.23	$1,511.47–$81,713.50	—	70%
Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION	$12,221.62	$40,738.72	$514.20–$39,109.17	114% above	70%
Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY	$1,397.93	$4,659.76	$173.26–$4,473.37	137% above	70%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 PARTIAL REMOVAL OF THYROID	$20,708.30	$69,027.66	$866.25–$66,266.55	—	70%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CA SCRN NOT HI RSK IND	$2,324.49	$7,748.29	$391.78–$7,438.36	44% above	70%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL SCRN; HI RISK IND	$2,391.87	$7,972.89	$391.59–$7,653.97	35% above	70%
Septoplasty to straighten the nasal septum CPT 30520 REPAIR OF NASAL SEPTUM	$16,358.18	$54,527.27	$785.55–$52,346.18	195% above	70%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 Extracorporeal Shockwave Lithotripsy	$9,679.50	$32,265.00	$888.77–$30,974.40	at median	70%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 FRAGMENTING OF KIDNEY STONE	$11,809.79	$39,365.95	$888.77–$37,791.31	22% above	70%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 Extracorporeal Shockwave Lithotripsy	$16,132.50	$32,265.00	$16,132.50–$30,974.40	—	50%
Short arm splint (forearm and hand) CPT 29125 OT Static Short Arm Splint Charge	$265.80	$886.00	$78.24–$850.56	at median	70%
Short arm splint (forearm and hand) CPT 29125 OT Static Short Arm Splint Assist Units	$265.80	$886.00	$78.24–$850.56	at median	70%
Short arm splint (forearm and hand) CPT 29125 OT Static Short Arm Splint Units	$265.80	$886.00	$78.24–$850.56	at median	70%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT	$2,110.22	$7,034.07	$78.24–$6,752.71	694% above	70%
Short arm splint (forearm and hand) inpatient CPT 29125 OT Static Short Arm Splint Units	$443.00	$886.00	$443.00–$850.56	—	50%
Short arm splint (forearm and hand) inpatient CPT 29125 OT Static Short Arm Splint Charge	$443.00	$886.00	$443.00–$850.56	—	50%
Short arm splint (forearm and hand) inpatient CPT 29125 OT Static Short Arm Splint Assist Units	$443.00	$886.00	$443.00–$850.56	—	50%
Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLINT	$1,900.41	$6,334.69	$87.02–$6,081.30	592% above	70%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 SHO ARTHRS SRG DSTL CLAVICLC	$26,618.78	$88,729.27	$819.97–$85,180.10	355% above	70%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHOULDER ARTHROSCOPY/SURGERY	$28,040.79	$93,469.30	$211.41–$89,730.53	411% above	70%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR SUPERFICIAL WOUND(S)	$1,578.42	$5,261.40	$107.46–$5,050.94	267% above	70%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$3,044.70	$10,149.00	$138.69–$9,743.04	580% above	70%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS	$17,056.95	$56,856.50	$107.40–$54,582.24	4252% above	70%
Spinal tap (lumbar puncture), diagnostic CPT 62270 S-Spinal Tab Diagnostic - GL 106	$571.20	$1,904.00	$165.26–$1,827.84	36% below	70%
Spinal tap (lumbar puncture), diagnostic CPT 62270 S-SPINAL TAP DIAGNST	$1,082.70	$3,609.00	$165.26–$3,464.64	21% above	70%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP, DIAGNOSTIC	$6,646.63	$22,155.44	$165.26–$21,269.22	644% above	70%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 S-Spinal Tab Diagnostic - GL 106	$952.00	$1,904.00	$952.00–$1,827.84	—	50%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 S-SPINAL TAP DIAGNST	$1,804.50	$3,609.00	$1,804.50–$3,464.64	—	50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR SUPERFICIAL WOUND(S)	$2,143.25	$7,144.15	$131.91–$6,858.38	223% above	70%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR SUPERFICIAL WOUND(S)	$1,797.95	$5,993.18	$129.02–$5,753.45	285% above	70%
TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP)	$13,770.83	$45,902.77	$917.58–$44,066.66	28% above	70%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$18,737.97	$62,459.90	$111.50–$59,961.50	5078% above	70%
Thoracentesis with imaging guidance CPT 32555 CT Thoracentesis w Imaging Guidance	$1,840.80	$6,136.00	$348.79–$5,890.56	17% below	70%
Thoracentesis with imaging guidance CPT 32555 US Thoracentesis w Imaging Guidance	$1,840.80	$6,136.00	$348.79–$5,890.56	17% below	70%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING	$6,454.78	$21,515.93	$348.79–$20,655.29	192% above	70%
Thoracentesis with imaging guidance inpatient CPT 32555 US Thoracentesis w Imaging Guidance	$3,068.00	$6,136.00	$3,068.00–$5,890.56	—	50%
Thoracentesis with imaging guidance inpatient CPT 32555 CT Thoracentesis w Imaging Guidance	$3,068.00	$6,136.00	$3,068.00–$5,890.56	—	50%
Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS AND ADENOIDS	$10,345.67	$34,485.58	$358.40–$33,106.16	—	70%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS	$9,676.32	$32,254.41	$312.29–$30,964.23	—	70%
Total hip replacement CPT 27130 TOTAL HIP REPLACEMENT	$43,373.94	$144,579.80	$1,563.78–$138,796.61	—	70%
Total knee replacement CPT 27447 TOTAL KNEE REPLACEMENT	$40,454.10	$134,847.01	$1,562.19–$129,453.13	—	70%
Total shoulder replacement CPT 23472 RECONSTRUCT SHOULDER JOINT	$115,251.65	$384,172.18	$1,760.72–$368,805.29	—	70%
Total thyroid removal (thyroidectomy) CPT 60240 REMOVAL OF THYROID	$29,588.75	$98,629.18	$1,124.80–$94,684.01	—	70%
Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH	$5,037.61	$16,792.04	$648.42–$16,120.36	8% above	70%
Trigger point injections, 1 or 2 muscles CPT 20552 NJX 1/MLT TRIGGER POINT 1/2	$724.78	$2,415.93	$62.74–$2,319.29	106% above	70%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy w Loc 1 Lesion Left	$1,911.00	$6,370.00	$200.87–$6,115.20	38% below	70%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy w Loc 1 Lesion Right	$1,911.00	$6,370.00	$200.87–$6,115.20	38% below	70%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy w Loc 1 Lesion Left	$3,185.00	$6,370.00	$3,185.00–$6,115.20	—	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy w Loc 1 Lesion Right	$3,185.00	$6,370.00	$3,185.00–$6,115.20	—	50%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH ENDOSCOPY, DILATION	$8,326.76	$27,755.87	$1,102.18–$26,645.64	145% above	70%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDOSCOPY, BIOPSY	$4,173.59	$13,911.97	$413.84–$13,355.49	174% above	70%
Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPR GI SCOPE W/SUBMUC INJ	$5,404.35	$18,014.50	$438.31–$17,293.92	—	70%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 OPERATIVE UPPER GI ENDOSCOPY	$8,582.06	$28,606.87	$546.19–$27,462.60	230% above	70%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 UPPR GI ENDOSCOPY/GUIDE WIRE	$4,191.69	$13,972.31	$458.59–$13,413.42	22% above	70%
Upper endoscopy (EGD), diagnostic CPT 43235 UPPR GI ENDOSCOPY, DIAGNOSIS	$3,560.33	$11,867.78	$322.67–$11,393.07	161% above	70%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOURETERO W/LITHOTRIPSY	$10,372.53	$34,575.10	$493.18–$33,192.10	28% above	70%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URETERO W/LITHOTRIPSY	$13,446.86	$44,822.88	$523.87–$43,029.96	20% above	70%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN/TISSUE	$2,953.08	$9,843.59	$146.95–$9,449.85	489% above	70%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 OPTX DST RD XARTC FX/EPI SEP	$22,991.71	$76,639.03	$899.36–$73,573.47	78% above	70%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Alaska	Off list
Blood transfusion (giving blood or blood components) CPT 36430 CHRG - BLOOD TRANSFUSION - Blood Transfusion Perfo	$1,328.70	$4,429.00	$44.63–$4,251.84	12% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Whole blood	$1,419.60	$4,732.00	$44.63–$4,542.72	20% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood transfusions	$1,419.60	$4,732.00	$44.63–$4,542.72	20% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Red blood cells (preoperativ	$1,419.60	$4,732.00	$44.63–$4,542.72	20% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Red blood cells (postoperati	$1,419.60	$4,732.00	$44.63–$4,542.72	20% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Platelets (single donor)	$1,419.60	$4,732.00	$44.63–$4,542.72	20% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration Fee	$1,419.60	$4,732.00	$44.63–$4,542.72	20% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Packed red blood cells	$1,419.60	$4,732.00	$44.63–$4,542.72	20% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Platelets (random donor)	$1,419.60	$4,732.00	$44.63–$4,542.72	20% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Cryoprecipitate	$1,419.60	$4,732.00	$44.63–$4,542.72	20% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Fresh frozen plasma	$1,419.60	$4,732.00	$44.63–$4,542.72	20% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 $ED Transfusion >2 yrs	$1,527.00	$5,090.00	$44.63–$4,886.40	29% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Verified with Pt Information: - Transfu	$1,527.00	$5,090.00	$44.63–$4,886.40	29% above	70%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION SERVICE	$13,421.94	$44,739.80	$44.63–$42,950.21	1036% above	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 CHRG - BLOOD TRANSFUSION - Blood Transfusion Perfo	$2,214.50	$4,429.00	$2,214.50–$4,251.84	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Platelets (random donor)	$2,366.00	$4,732.00	$2,366.00–$4,542.72	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Platelets (single donor)	$2,366.00	$4,732.00	$2,366.00–$4,542.72	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Red blood cells (postoperati	$2,366.00	$4,732.00	$2,366.00–$4,542.72	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Red blood cells (preoperativ	$2,366.00	$4,732.00	$2,366.00–$4,542.72	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood transfusions	$2,366.00	$4,732.00	$2,366.00–$4,542.72	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Fresh frozen plasma	$2,366.00	$4,732.00	$2,366.00–$4,542.72	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Whole blood	$2,366.00	$4,732.00	$2,366.00–$4,542.72	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Cryoprecipitate	$2,366.00	$4,732.00	$2,366.00–$4,542.72	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Packed red blood cells	$2,366.00	$4,732.00	$2,366.00–$4,542.72	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Administration Fee	$2,366.00	$4,732.00	$2,366.00–$4,542.72	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Verified with Pt Information: - Transfu	$2,545.00	$5,090.00	$2,545.00–$4,886.40	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 $ED Transfusion >2 yrs	$2,545.00	$5,090.00	$2,545.00–$4,886.40	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Charge - IPPB Subsequent	$369.30	$1,231.00	$8.23–$1,181.76	13% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler Charge - Initial	$369.30	$1,231.00	$8.23–$1,181.76	13% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler Charge - Subsequent	$369.30	$1,231.00	$8.23–$1,181.76	13% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Charge - Initial	$369.30	$1,231.00	$8.23–$1,181.76	13% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Charge - Subsequent	$369.30	$1,231.00	$8.23–$1,181.76	13% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Charge - IPV Subsequent	$369.30	$1,231.00	$8.23–$1,181.76	13% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Charge - IPV Initial	$369.30	$1,231.00	$8.23–$1,181.76	13% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Charge - IPPB Initial	$369.30	$1,231.00	$8.23–$1,181.76	13% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$1,533.33	$5,111.10	$8.23–$4,906.66	261% above	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Meter Dose Inhaler Charge - Subsequent	$615.50	$1,231.00	$615.50–$1,181.76	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment Charge - IPV Initial	$615.50	$1,231.00	$615.50–$1,181.76	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment Charge - IPV Subsequent	$615.50	$1,231.00	$615.50–$1,181.76	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Meter Dose Inhaler Charge - Initial	$615.50	$1,231.00	$615.50–$1,181.76	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment Charge - Subsequent	$615.50	$1,231.00	$615.50–$1,181.76	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment Charge - IPPB Subsequent	$615.50	$1,231.00	$615.50–$1,181.76	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment Charge - IPPB Initial	$615.50	$1,231.00	$615.50–$1,181.76	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment Charge - Initial	$615.50	$1,231.00	$615.50–$1,181.76	—	50%
Chemotherapy IV infusion, first hour CPT 96413 CHRG - CHEMO IV INFU 1ST HR	$617.70	$2,059.00	$131.87–$1,976.64	32% below	70%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHRG - CHEMO IV INFU 1ST HR	$1,029.50	$2,059.00	$1,029.50–$1,976.64	—	50%
Critical care, first 30 to 74 minutes CPT 99291 99291 - Critical Care	$3,850.50	$12,835.00	$341.11–$12,321.60	12% above	70%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 - Critical Care	$6,417.50	$12,835.00	$6,417.50–$12,321.60	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG BCE	$258.90	$863.00	$44.73–$828.48	27% below	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ED EKG Start Time	$258.90	$863.00	$44.73–$828.48	27% below	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Is the patient scheduled for a Cath Lab procedure	$258.90	$863.00	$44.73–$828.48	27% below	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG Series 1 Hour	$258.90	$863.00	$44.73–$828.48	27% below	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG Series 3 Hours	$258.90	$863.00	$44.73–$828.48	27% below	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ED EKG Series 3 Hours	$258.90	$863.00	$44.73–$828.48	27% below	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 Lead Series Now	$258.90	$863.00	$44.73–$828.48	27% below	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ED EKG Series 1 Hour	$258.90	$863.00	$44.73–$828.48	27% below	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ED EKG 12 Lead Series Now	$258.90	$863.00	$44.73–$828.48	27% below	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG BCE	$431.50	$863.00	$431.50–$828.48	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ED EKG 12 Lead Series Now	$431.50	$863.00	$431.50–$828.48	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ED EKG Series 1 Hour	$431.50	$863.00	$431.50–$828.48	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG Series 1 Hour	$431.50	$863.00	$431.50–$828.48	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 Lead Series Now	$431.50	$863.00	$431.50–$828.48	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ED EKG Series 3 Hours	$431.50	$863.00	$431.50–$828.48	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Is the patient scheduled for a Cath Lab procedure	$431.50	$863.00	$431.50–$828.48	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ED EKG Start Time	$431.50	$863.00	$431.50–$828.48	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG Series 3 Hours	$431.50	$863.00	$431.50–$828.48	—	50%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 - Level 1	$185.40	$618.00	$14.80–$593.28	50% below	70%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 - Level 1	$309.00	$618.00	$309.00–$593.28	—	50%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 - Level 2	$371.40	$1,238.00	$54.73–$1,188.48	30% below	70%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 - Level 2	$619.00	$1,238.00	$619.00–$1,188.48	—	50%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 - Level 3	$556.20	$1,854.00	$92.93–$1,779.84	30% below	70%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 - Level 3	$927.00	$1,854.00	$927.00–$1,779.84	—	50%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 - Level 4	$1,203.30	$4,011.00	$158.43–$3,850.56	11% below	70%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 - Level 4	$2,005.50	$4,011.00	$2,005.50–$3,850.56	—	50%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 - Level 5	$2,222.40	$7,408.00	$229.94–$7,111.68	3% below	70%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Trauma Notification Level - No Prior Notification	$4,187.40	$13,958.00	$229.94–$13,399.68	82% above	70%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 - Level 5	$3,704.00	$7,408.00	$3,704.00–$7,111.68	—	50%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Trauma Notification Level - No Prior Notification	$6,979.00	$13,958.00	$6,979.00–$13,399.68	—	50%
Exercise stress test, tracing only, the hospital charge CPT 93017 NI Stress Test	$929.70	$3,099.00	$39.90–$2,975.04	20% below	70%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 NI Stress Test	$1,549.50	$3,099.00	$1,549.50–$2,975.04	—	50%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OB CHRG - Inf/Inj/Hydration Once - IV HYDRATION 1	$341.10	$1,137.00	$34.66–$1,091.52	47% below	70%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 - Hydration, first hour	$392.40	$1,308.00	$34.66–$1,255.68	39% below	70%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 CHRG - Inf/Inj/Hydration - IV HYDRATION 1 HR	$392.40	$1,308.00	$34.66–$1,255.68	39% below	70%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 OB CHRG - Inf/Inj/Hydration Once - IV HYDRATION 1	$568.50	$1,137.00	$568.50–$1,091.52	—	50%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 CHRG - Inf/Inj/Hydration - IV HYDRATION 1 HR	$654.00	$1,308.00	$654.00–$1,255.68	—	50%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 - Hydration, first hour	$654.00	$1,308.00	$654.00–$1,255.68	—	50%
IV infusion of a medicine, first hour CPT 96365 OB CHRG - Inf/Inj/Hydration Once - IV THERAPY DX 1	$341.10	$1,137.00	$64.80–$1,091.52	41% below	70%
IV infusion of a medicine, first hour CPT 96365 CHRG - Inf/Inj/Hydration - IV THERAPY DX 1 HR	$364.50	$1,215.00	$64.80–$1,166.40	37% below	70%
IV infusion of a medicine, first hour CPT 96365 96365 - IV tx, first hour	$392.40	$1,308.00	$64.80–$1,255.68	32% below	70%
IV infusion of a medicine, first hour inpatient CPT 96365 OB CHRG - Inf/Inj/Hydration Once - IV THERAPY DX 1	$568.50	$1,137.00	$568.50–$1,091.52	—	50%
IV infusion of a medicine, first hour inpatient CPT 96365 CHRG - Inf/Inj/Hydration - IV THERAPY DX 1 HR	$607.50	$1,215.00	$607.50–$1,166.40	—	50%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 - IV tx, first hour	$654.00	$1,308.00	$654.00–$1,255.68	—	50%
IV push of a medicine, first drug CPT 96374 OB CHRG - Inf/Inj/Hydration Once - THERAPEUTIC IV	$341.10	$1,137.00	$38.84–$1,091.52	2% below	70%
IV push of a medicine, first drug CPT 96374 CHRG - Inf/Inj/Hydration - THERAPEUTIC IV PUSH	$364.50	$1,215.00	$38.84–$1,166.40	4% above	70%
IV push of a medicine, first drug CPT 96374 96374 - IV Injection, single/initial	$392.40	$1,308.00	$38.84–$1,255.68	12% above	70%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IV PUSH	$7,273.80	$24,246.00	$38.84–$23,276.16	1984% above	70%
IV push of a medicine, first drug inpatient CPT 96374 OB CHRG - Inf/Inj/Hydration Once - THERAPEUTIC IV	$568.50	$1,137.00	$568.50–$1,091.52	—	50%
IV push of a medicine, first drug inpatient CPT 96374 CHRG - Inf/Inj/Hydration - THERAPEUTIC IV PUSH	$607.50	$1,215.00	$607.50–$1,166.40	—	50%
IV push of a medicine, first drug inpatient CPT 96374 96374 - IV Injection, single/initial	$654.00	$1,308.00	$654.00–$1,255.68	—	50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 OB CHRG - THERAPEUTIC DX SQ IM	$101.40	$338.00	$17.18–$324.48	22% below	70%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 CHRG - THERAPEUTIC DX SQ IM	$108.00	$360.00	$17.18–$345.60	17% below	70%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 - Subq/IM Injection	$117.00	$390.00	$17.18–$374.40	10% below	70%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 OB CHRG - THERAPEUTIC DX SQ IM	$169.00	$338.00	$169.00–$324.48	—	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 CHRG - THERAPEUTIC DX SQ IM	$180.00	$360.00	$180.00–$345.60	—	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 - Subq/IM Injection	$195.00	$390.00	$195.00–$374.40	—	50%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation Charges	$138.60	$462.00	$41.24–$443.52	19% below	70%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Charges	$138.60	$462.00	$41.24–$443.52	19% below	70%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducatn Assist Charge	$138.60	$462.00	$41.24–$443.52	19% below	70%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromusclr Reeducation Assist Charge	$138.60	$462.00	$41.24–$443.52	19% below	70%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT Neuromusclr Reeducation Assist Charge	$231.00	$462.00	$231.00–$443.52	—	50%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducation Charges	$231.00	$462.00	$231.00–$443.52	—	50%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducatn Assist Charge	$231.00	$462.00	$231.00–$443.52	—	50%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT Neuromuscular Reeducation Charges	$231.00	$462.00	$231.00–$443.52	—	50%
New patient office visit, about 60 minutes CPT 99205 99205 - Clinic New Level 5	$118.50	$395.00	$118.50–$379.20	84% below	70%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 - Clinic New Level 5	$197.50	$395.00	$197.50–$379.20	—	50%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW Unit - Yes	$355.80	$1,186.00	$127.14–$1,138.56	14% below	70%
Occupational therapy evaluation, low complexity CPT 97165 IRF OT EVAL LOW	$355.80	$1,186.00	$127.14–$1,138.56	14% below	70%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW Unit - Yes	$593.00	$1,186.00	$593.00–$1,138.56	—	50%
Occupational therapy evaluation, low complexity inpatient CPT 97165 IRF OT EVAL LOW	$593.00	$1,186.00	$593.00–$1,138.56	—	50%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH Unit - Yes	$226.20	$754.00	$80.83–$723.84	57% below	70%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH Unit - Yes	$377.00	$754.00	$377.00–$723.84	—	50%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW Unit - Yes	$226.20	$754.00	$80.83–$723.84	46% below	70%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW Unit - Yes	$377.00	$754.00	$377.00–$723.84	—	50%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD Unit - Yes	$226.20	$754.00	$80.83–$723.84	52% below	70%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MOD Unit - Yes	$377.00	$754.00	$377.00–$723.84	—	50%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Assistant Charges	$100.50	$335.00	$35.03–$321.60	43% below	70%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Assistant Charges	$100.50	$335.00	$35.03–$321.60	43% below	70%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Charges	$100.50	$335.00	$35.03–$321.60	43% below	70%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Charges	$100.50	$335.00	$35.03–$321.60	43% below	70%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Assistant Charges	$167.50	$335.00	$167.50–$321.60	—	50%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Assistant Charges	$167.50	$335.00	$167.50–$321.60	—	50%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Charges	$167.50	$335.00	$167.50–$321.60	—	50%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Charges	$167.50	$335.00	$167.50–$321.60	—	50%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Assistant Charge	$108.30	$361.00	$36.71–$346.56	36% below	70%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Charges	$108.30	$361.00	$36.71–$346.56	36% below	70%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Assistant Charge	$108.30	$361.00	$36.71–$346.56	36% below	70%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Charges	$108.30	$361.00	$36.71–$346.56	36% below	70%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Charges	$180.50	$361.00	$180.50–$346.56	—	50%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise Charges	$180.50	$361.00	$180.50–$346.56	—	50%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Assistant Charge	$180.50	$361.00	$180.50–$346.56	—	50%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise Assistant Charge	$180.50	$361.00	$180.50–$346.56	—	50%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Behavior change Smoke Charge - 1-10 minutes	$43.50	$145.00	$17.97–$139.20	29% below	70%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco counseling Charge - 3-10 minutes	$43.50	$145.00	$17.97–$139.20	29% below	70%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHG SMOKE U 10 - Net Health	$84.90	$283.00	$17.97–$271.68	39% above	70%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Behavior change Smoke Charge - 1-10 minutes	$72.50	$145.00	$72.50–$139.20	—	50%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco counseling Charge - 3-10 minutes	$72.50	$145.00	$72.50–$139.20	—	50%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHG SMOKE U 10 - Net Health	$141.50	$283.00	$141.50–$271.68	—	50%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OUTPATIENT VISIT, EST	$1,286.70	$4,289.00	$112.20–$4,117.44	504% above	70%
Speech and language evaluation CPT 92523 Speech Evaluation with Language Charge	$368.70	$1,229.00	$131.75–$1,179.84	43% below	70%
Speech and language evaluation CPT 92523 SLP Eval Lang Comprehension,Express Unit	$368.70	$1,229.00	$131.75–$1,179.84	43% below	70%
Speech and language evaluation CPT 92523 Speech Evaluation with Language Units	$368.70	$1,229.00	$131.75–$1,179.84	43% below	70%
Speech and language evaluation inpatient CPT 92523 Speech Evaluation with Language Charge	$614.50	$1,229.00	$614.50–$1,179.84	—	50%
Speech and language evaluation inpatient CPT 92523 SLP Eval Lang Comprehension,Express Unit	$614.50	$1,229.00	$614.50–$1,179.84	—	50%
Speech and language evaluation inpatient CPT 92523 Speech Evaluation with Language Units	$614.50	$1,229.00	$614.50–$1,179.84	—	50%
Speech therapy session, individual CPT 92507 Speech Treatment Charge - Yes	$297.60	$992.00	$98.22–$952.32	35% below	70%
Speech therapy session, individual CPT 92507 SLP Auditory Processing Tx Units	$297.60	$992.00	$98.22–$952.32	35% below	70%
Speech therapy session, individual CPT 92507 Speech Treatment Charge	$297.60	$992.00	$98.22–$952.32	35% below	70%
Speech therapy session, individual inpatient CPT 92507 SLP Auditory Processing Tx Units	$496.00	$992.00	$496.00–$952.32	—	50%
Speech therapy session, individual inpatient CPT 92507 Speech Treatment Charge - Yes	$496.00	$992.00	$496.00–$952.32	—	50%
Speech therapy session, individual inpatient CPT 92507 Speech Treatment Charge	$496.00	$992.00	$496.00–$952.32	—	50%
Spirometry (breathing test) CPT 94010 Pulmonary Function Test Charge - spirometry	$350.40	$1,168.00	$125.21–$1,121.28	18% below	70%
Spirometry (breathing test) inpatient CPT 94010 Pulmonary Function Test Charge - spirometry	$584.00	$1,168.00	$584.00–$1,121.28	—	50%
Spirometry before and after a bronchodilator CPT 94060 Pulmonary Function Test Charge - Pre and post bron	$687.60	$2,292.00	$245.70–$2,200.32	11% below	70%
Spirometry before and after a bronchodilator inpatient CPT 94060 Pulmonary Function Test Charge - Pre and post bron	$1,146.00	$2,292.00	$1,146.00–$2,200.32	—	50%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Charges	$115.50	$385.00	$41.27–$369.60	30% below	70%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activities Assist Charge	$115.50	$385.00	$41.27–$369.60	30% below	70%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activities Charge	$115.50	$385.00	$41.27–$369.60	30% below	70%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Assist Charges	$115.50	$385.00	$41.27–$369.60	30% below	70%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activities Assist Charge	$192.50	$385.00	$192.50–$369.60	—	50%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activities Charge	$192.50	$385.00	$192.50–$369.60	—	50%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activities Charges	$192.50	$385.00	$192.50–$369.60	—	50%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activities Assist Charges	$192.50	$385.00	$192.50–$369.60	—	50%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Alaska	Off list
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 00069-2432-10 - SARS-CoV-2 (COVID-19) mRNA-LNP vac	$179.49	$598.31	$64.14–$574.38	12% below	70%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 00069-2528-10 - SARS-CoV-2 (COVID-19) mRNA-LNP vac	$179.49	$598.31	$64.14–$574.38	12% below	70%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 00069-2377-10 - SARS-CoV-2 (COVID-19) mRNA-LNP vac	$179.49	$598.31	$64.14–$574.38	12% below	70%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 00069-2528-10 - SARS-CoV-2 (COVID-19) mRNA-LNP vac	$299.16	$598.31	$299.15–$574.38	—	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 00069-2432-10 - SARS-CoV-2 (COVID-19) mRNA-LNP vac	$299.16	$598.31	$299.15–$574.38	—	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 00069-2377-10 - SARS-CoV-2 (COVID-19) mRNA-LNP vac	$299.16	$598.31	$299.15–$574.38	—	50%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 00006-4827-00 - varicella virus vaccine REC Inject	$232.45	$774.83	$83.06–$743.84	7% below	70%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 54569-4055-00 - varicella virus vaccine - Powder	$232.45	$774.83	$83.06–$743.84	7% below	70%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 54569-4056-00 - varicella virus vaccine - Powder	$232.45	$774.83	$83.06–$743.84	7% below	70%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 00006-4826-00 - varicella virus vaccine REC Inject	$232.45	$774.83	$83.06–$743.84	7% below	70%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 54569-4055-00 - varicella virus vaccine - Powder	$387.42	$774.83	$387.42–$743.84	—	50%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 00006-4826-00 - varicella virus vaccine REC Inject	$387.42	$774.83	$387.42–$743.84	—	50%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 54569-4056-00 - varicella virus vaccine - Powder	$387.42	$774.83	$387.42–$743.84	—	50%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 00006-4827-00 - varicella virus vaccine REC Inject	$387.42	$774.83	$387.42–$743.84	—	50%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 49281-0564-10 - diphtheria/pertussis, acellular/te	$126.60	$422.00	$45.24–$405.12	at median	70%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 49281-0562-10 - diphtheria/pertussis,acel/tetanus/	$126.60	$422.00	$45.24–$405.12	at median	70%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 58160-0812-52 - diphtheria/pertussis, acellular/te	$126.60	$422.00	$45.24–$405.12	at median	70%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 58160-0812-52 - diphtheria/pertussis,acel/tetanus/	$126.60	$422.00	$45.24–$405.12	at median	70%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 58160-0812-11 - diphtheria/pertussis,acel/tetanus/	$126.60	$422.00	$45.24–$405.12	at median	70%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 49281-0564-15 - diphtheria/pertussis,acel/tetanus/	$126.60	$422.00	$45.24–$405.12	at median	70%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 49281-0564-15 - diphtheria/pertussis,acel/tetanus/	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 49281-0564-10 - diphtheria/pertussis, acellular/te	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 58160-0812-11 - diphtheria/pertussis,acel/tetanus/	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 58160-0812-52 - diphtheria/pertussis, acellular/te	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 49281-0562-10 - diphtheria/pertussis,acel/tetanus/	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 58160-0812-52 - diphtheria/pertussis,acel/tetanus/	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 58160-0810-11 - diphtheria/tetanus/pertussis, acel	$126.60	$422.00	$45.24–$405.12	46% above	70%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 49281-0286-10 - diphtheria/tetanus/pertussis, acel	$126.60	$422.00	$45.24–$405.12	46% above	70%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 diphtheria-tetanus-pertussis (DTaP) 15 units-5 uni	$126.60	$422.00	$45.24–$405.12	46% above	70%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 49281-0298-10 - diphtheria/tetanus/pertussis, acel	$126.60	$422.00	$45.24–$405.12	46% above	70%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 58160-0810-52 - diphtheria/tetanus/pertussis, acel	$126.60	$422.00	$45.24–$405.12	46% above	70%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 diphtheria-tetanus-pertussis (DTaP) 15 units-5 uni	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 49281-0286-10 - diphtheria/tetanus/pertussis, acel	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 58160-0810-11 - diphtheria/tetanus/pertussis, acel	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 58160-0810-52 - diphtheria/tetanus/pertussis, acel	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 49281-0298-10 - diphtheria/tetanus/pertussis, acel	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 58160-0811-52 - diphtheria/hepB/pertussis,acel/pol	$126.60	$422.00	$45.24–$405.12	35% below	70%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 58160-0811-52 - diphtheria/hepB/pertussis,acel/pol	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 49281-0511-05 - diphth/haemophilus/pertussis/tetan	$126.60	$422.00	$45.24–$405.12	81% above	70%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 49281-0510-05 - diphth/haemophilus/pertussis/tetan	$126.60	$422.00	$45.24–$405.12	81% above	70%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 49281-0511-05 - diphth/haemophilus/pertussis/tetan	$211.00	$422.00	$211.00–$405.12	—	50%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 49281-0510-05 - diphth/haemophilus/pertussis/tetan	$211.00	$422.00	$211.00–$405.12	—	50%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 49281-0724-10 - 2024-2025 influenza virus vaccine,	$126.60	$422.00	$45.24–$405.12	34% below	70%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 49281-0725-10 - influenza virus vaccine, inactivat	$126.60	$422.00	$45.24–$405.12	34% below	70%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 49281-0724-10 - 2024-2025 influenza virus vaccine,	$211.00	$422.00	$211.00–$405.12	—	50%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 49281-0725-10 - influenza virus vaccine, inactivat	$211.00	$422.00	$211.00–$405.12	—	50%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 58160-0912-52 - influenza virus vaccine, inactivat	$126.60	$422.00	$23.22–$405.12	105% above	70%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 49281-0425-50 - influenza virus vaccine, inactivat	$126.60	$422.00	$23.22–$405.12	105% above	70%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 19515-0810-52 - influenza virus vaccine, inactivat	$126.60	$422.00	$23.22–$405.12	105% above	70%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 49281-0424-50 - 2024-2025 influenza virus vaccine,	$126.60	$422.00	$23.22–$405.12	105% above	70%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 19515-0810-52 - influenza virus vaccine, inactivat	$211.00	$422.00	$211.00–$405.12	—	50%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 58160-0912-52 - influenza virus vaccine, inactivat	$211.00	$422.00	$211.00–$405.12	—	50%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 49281-0424-50 - 2024-2025 influenza virus vaccine,	$211.00	$422.00	$211.00–$405.12	—	50%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 49281-0425-50 - influenza virus vaccine, inactivat	$211.00	$422.00	$211.00–$405.12	—	50%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 00006-4121-02 - human papillomavirus vaccine 9-val	$369.17	$1,230.58	$131.92–$1,181.36	24% below	70%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 00006-4121-02 - human papillomavirus vaccine 9-val	$615.29	$1,230.58	$615.29–$1,181.36	—	50%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 58160-0815-46 - hepatitis A-hepatitis B vaccine 72	$147.40	$491.34	$52.67–$471.69	at median	70%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 58160-0815-46 - hepatitis A-hepatitis B vaccine 72	$245.67	$491.34	$245.67–$471.69	—	50%
Hepatitis A vaccine, adult dose CPT 90632 00006-4096-02 - hepatitis A adult vaccine 50 units	$126.60	$422.00	$45.24–$405.12	2% below	70%
Hepatitis A vaccine, adult dose CPT 90632 58160-0826-48 - hepatitis A adult vaccine 1440 uni	$126.60	$422.00	$45.24–$405.12	2% below	70%
Hepatitis A vaccine, adult dose CPT 90632 00006-4841-00 - hepatitis A adult vaccine 50. Sus	$126.60	$422.00	$45.24–$405.12	2% below	70%
Hepatitis A vaccine, adult dose CPT 90632 00006-4096-09 - hepatitis A adult vaccine 50 units	$126.60	$422.00	$45.24–$405.12	2% below	70%
Hepatitis A vaccine, adult dose CPT 90632 00006-4841-41 - hepatitis A adult vaccine 50 units	$126.60	$422.00	$45.24–$405.12	2% below	70%
Hepatitis A vaccine, adult dose inpatient CPT 90632 00006-4096-09 - hepatitis A adult vaccine 50 units	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis A vaccine, adult dose inpatient CPT 90632 00006-4096-02 - hepatitis A adult vaccine 50 units	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis A vaccine, adult dose inpatient CPT 90632 00006-4841-41 - hepatitis A adult vaccine 50 units	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis A vaccine, adult dose inpatient CPT 90632 00006-4841-00 - hepatitis A adult vaccine 50. Sus	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis A vaccine, adult dose inpatient CPT 90632 58160-0826-48 - hepatitis A adult vaccine 1440 uni	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 58160-0825-01 - hepatitis A pediatric vaccine 720	$126.60	$422.00	$45.24–$405.12	at median	70%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 00006-4095-02 - hepatitis A pediatric vaccine 25 u	$126.60	$422.00	$45.24–$405.12	at median	70%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 58160-0825-52 - hepatitis A pediatric vaccine 720.	$126.60	$422.00	$45.24–$405.12	at median	70%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 00006-4095-09 - hepatitis A pediatric vaccine 25 u	$126.60	$422.00	$45.24–$405.12	at median	70%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 58160-0825-11 - hepatitis A pediatric vaccine 720.	$126.60	$422.00	$45.24–$405.12	at median	70%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 00006-4831-41 - hepatitis A pediatric vaccine 25.	$126.60	$422.00	$45.24–$405.12	at median	70%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 58160-0825-52 - hepatitis A pediatric vaccine 720.	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 58160-0825-01 - hepatitis A pediatric vaccine 720	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 00006-4095-09 - hepatitis A pediatric vaccine 25 u	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 00006-4095-02 - hepatitis A pediatric vaccine 25 u	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 00006-4831-41 - hepatitis A pediatric vaccine 25.	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 58160-0825-11 - hepatitis A pediatric vaccine 720.	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 58160-0821-52 - hepatitis B adult vaccine 20 mcg/m	$126.60	$422.00	$45.24–$405.12	10% above	70%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 00006-4094-02 - hepatitis B adult vaccine 10 mcg/m	$126.60	$422.00	$45.24–$405.12	10% above	70%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 58160-0857-01 - hepatitis B adult vaccine Susp	$126.60	$422.00	$45.24–$405.12	10% above	70%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 58160-0821-11 - hepatitis B adult vaccine Susp	$126.60	$422.00	$45.24–$405.12	10% above	70%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 58160-0821-32 - hepatitis B adult vaccine 20 mcg/m	$126.60	$422.00	$45.24–$405.12	10% above	70%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 58160-0821-11 - hepatitis B adult vaccine Susp	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 00006-4094-02 - hepatitis B adult vaccine 10 mcg/m	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 58160-0821-52 - hepatitis B adult vaccine 20 mcg/m	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 58160-0821-32 - hepatitis B adult vaccine 20 mcg/m	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 58160-0857-01 - hepatitis B adult vaccine Susp	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 00006-4093-02 - hepatitis B pediatric vaccine 5 mc	$126.60	$422.00	$31.67–$405.12	30% above	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 58160-0856-01 - hepatitis B pediatric vaccine Susp	$126.60	$422.00	$46.42–$405.12	30% above	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 58160-0820-52 - hepatitis B pediatric vaccine Susp	$126.60	$422.00	$31.67–$405.12	30% above	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 58160-0820-11 - hepatitis B pediatric vaccine Susp	$126.60	$422.00	$31.67–$405.12	30% above	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 00006-4981-00 - hepatitis B pediatric vaccine Susp	$126.60	$422.00	$31.67–$405.12	30% above	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 58160-0820-01 - hepatitis B pediatric vaccine 10 m	$126.60	$422.00	$31.67–$405.12	30% above	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 00006-4093-09 - hepatitis B pediatric vaccine 5 mc	$126.60	$422.00	$31.67–$405.12	30% above	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 58160-0820-52 - hepatitis B pediatric vaccine Susp	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 58160-0856-01 - hepatitis B pediatric vaccine Susp	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 00006-4093-02 - hepatitis B pediatric vaccine 5 mc	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 00006-4981-00 - hepatitis B pediatric vaccine Susp	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 58160-0820-11 - hepatitis B pediatric vaccine Susp	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 58160-0820-01 - hepatitis B pediatric vaccine 10 m	$211.00	$422.00	$211.00–$405.12	—	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 00006-4093-09 - hepatitis B pediatric vaccine 5 mc	$211.00	$422.00	$211.00–$405.12	—	50%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 49281-0545-03 - haemophilus b conjugate (PRP-T) va	$126.60	$422.00	$45.24–$405.12	74% above	70%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 49281-0545-05 - haemophilus b conjugate (PRP-T) va	$126.60	$422.00	$45.24–$405.12	74% above	70%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 49281-0545-03 - haemophilus b conjugate (PRP-T) va	$211.00	$422.00	$211.00–$405.12	—	50%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 49281-0545-05 - haemophilus b conjugate (PRP-T) va	$211.00	$422.00	$211.00–$405.12	—	50%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 49281-0124-65 - 2024-2025 influenza virus vaccine,	$126.60	$422.00	$45.24–$405.12	20% below	70%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 49281-0403-65 - influenza virus vaccine, inactivat	$126.60	$422.00	$45.24–$405.12	20% below	70%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 49281-0125-65 - influenza virus vaccine, inactivat	$126.60	$422.00	$45.24–$405.12	20% below	70%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 49281-0405-65 - 2019-2020 influenza virus vaccine,	$126.60	$422.00	$45.24–$405.12	20% below	70%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 49281-0403-65 - influenza virus vaccine, inactivat	$211.00	$422.00	$211.00–$405.12	—	50%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 49281-0405-65 - 2019-2020 influenza virus vaccine,	$211.00	$422.00	$211.00–$405.12	—	50%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 49281-0124-65 - 2024-2025 influenza virus vaccine,	$211.00	$422.00	$211.00–$405.12	—	50%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 49281-0125-65 - influenza virus vaccine, inactivat	$211.00	$422.00	$211.00–$405.12	—	50%
MMR vaccine (measles, mumps and rubella), live CPT 90707 00006-4681-00 - measles/mumps/rubella virus vaccin	$126.60	$422.00	$45.24–$405.12	36% below	70%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles/mumps/rubella virus vaccine Powder-Inj 0.	$126.60	$422.00	$45.24–$405.12	36% below	70%
MMR vaccine (measles, mumps and rubella), live CPT 90707 49999-0422-01 - measles/mumps/rubella virus vaccin	$126.60	$422.00	$45.24–$405.12	36% below	70%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles/mumps/rubella virus vaccine Powder-Inj 0.	$211.00	$422.00	$211.00–$405.12	—	50%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 00006-4681-00 - measles/mumps/rubella virus vaccin	$211.00	$422.00	$211.00–$405.12	—	50%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 49999-0422-01 - measles/mumps/rubella virus vaccin	$211.00	$422.00	$211.00–$405.12	—	50%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 00006-4171-00 - measles/mumps/rubella/varicella vi	$340.73	$1,135.75	$121.75–$1,090.32	—	70%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 00006-4999-00 - measles/mumps/rubella/varicella vi	$340.73	$1,135.75	$121.75–$1,090.32	—	70%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 00006-4999-00 - measles/mumps/rubella/varicella vi	$567.88	$1,135.75	$567.88–$1,090.32	—	50%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 00006-4171-00 - measles/mumps/rubella/varicella vi	$567.88	$1,135.75	$567.88–$1,090.32	—	50%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 49281-0589-05 - meningococcal conjugate vaccine So	$127.31	$424.38	$45.49–$407.40	46% below	70%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 46028-0208-01 - meningococcal conjugate vaccine RE	$183.68	$612.27	$65.64–$587.78	23% below	70%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 49281-0589-05 - meningococcal conjugate vaccine So	$212.19	$424.38	$212.19–$407.40	—	50%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 46028-0208-01 - meningococcal conjugate vaccine RE	$306.14	$612.27	$306.14–$587.78	—	50%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 49281-0590-05 - meningococcal conjugate vaccine po	$138.69	$462.30	$49.56–$443.81	64% below	70%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 49281-0590-05 - meningococcal conjugate vaccine po	$231.15	$462.30	$231.15–$443.81	—	50%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 46028-0114-01 - meningococcal group B vaccine reco	$250.64	$835.47	$89.56–$802.05	50% below	70%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 46028-0114-01 - meningococcal group B vaccine reco	$417.74	$835.47	$417.74–$802.05	—	50%
Nasal spray flu vaccine, live (FluMist) CPT 90660 66019-0112-51 - influenza virus vaccine, live 0.2	$36.42	$121.39	$13.01–$116.53	48% below	70%
Nasal spray flu vaccine, live (FluMist) CPT 90660 66019-0311-10 - 2024-2025 influenza virus vaccine,	$36.42	$121.39	$13.01–$116.53	48% below	70%
Nasal spray flu vaccine, live (FluMist) CPT 90660 66019-0112-10 - influenza virus vaccine, live triv	$36.42	$121.39	$13.01–$116.53	48% below	70%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 66019-0112-51 - influenza virus vaccine, live 0.2	$60.70	$121.39	$60.70–$116.53	—	50%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 66019-0311-10 - 2024-2025 influenza virus vaccine,	$60.70	$121.39	$60.70–$116.53	—	50%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 66019-0112-10 - influenza virus vaccine, live triv	$60.70	$121.39	$60.70–$116.53	—	50%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 00005-1971-05 - pneumococcal 13-valent conjugate v	$272.70	$908.99	$97.44–$872.63	50% below	70%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 00005-1971-01 - pneumococcal 13-valent conjugate v	$272.70	$908.99	$97.44–$872.63	50% below	70%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 00005-1971-02 - pneumococcal 13-valent conjugate v	$272.70	$908.99	$97.44–$872.63	50% below	70%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 50090-1944-00 - pneumococcal 13-valent conjugate v	$272.70	$908.99	$97.44–$872.63	50% below	70%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 00005-1971-02 - pneumococcal 13-valent conjugate v	$454.50	$908.99	$454.50–$872.63	—	50%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 00005-1971-01 - pneumococcal 13-valent conjugate v	$454.50	$908.99	$454.50–$872.63	—	50%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 50090-1944-00 - pneumococcal 13-valent conjugate v	$454.50	$908.99	$454.50–$872.63	—	50%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 00005-1971-05 - pneumococcal 13-valent conjugate v	$454.50	$908.99	$454.50–$872.63	—	50%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 00006-4329-03 - pneumococcal 15-valent conjugate v	$237.85	$792.84	$84.99–$761.13	77% below	70%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 00006-4329-02 - pneumococcal 15-valent conjugate v	$237.85	$792.84	$84.99–$761.13	77% below	70%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 00006-4329-03 - pneumococcal 15-valent conjugate v	$396.42	$792.84	$396.42–$761.13	—	50%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 00006-4329-02 - pneumococcal 15-valent conjugate v	$396.42	$792.84	$396.42–$761.13	—	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 00005-2000-02 - pneumococcal 20-valent conjugate v	$294.85	$982.84	$105.36–$943.53	54% below	70%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 00005-2000-10 - pneumococcal 20-valent conjugate v	$294.85	$982.84	$105.36–$943.53	54% below	70%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 00005-2000-02 - pneumococcal 20-valent conjugate v	$491.42	$982.84	$491.42–$943.53	—	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 00005-2000-10 - pneumococcal 20-valent conjugate v	$491.42	$982.84	$491.42–$943.53	—	50%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 00006-4347-02 - pneumococcal 21-valent conjugate v	$294.84	$982.79	$105.36–$943.48	—	70%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 00006-4347-02 - pneumococcal 21-valent conjugate v	$491.40	$982.79	$491.40–$943.48	—	50%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 00006-4943-00 - pneumococcal 23-valent vaccine Sol	$130.56	$435.21	$46.65–$417.80	65% below	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 00006-4837-02 - pneumococcal 23-polyvalent vaccine	$130.56	$435.21	$46.65–$417.80	65% below	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 00006-4837-03 - pneumococcal 23-polyvalent vaccine	$130.56	$435.21	$46.65–$417.80	65% below	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 00006-4943-01 - pneumococcal 23-polyvalent vaccine	$130.56	$435.21	$46.65–$417.80	65% below	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 00006-4837-03 - pneumococcal 23-polyvalent vaccine	$217.61	$435.21	$217.60–$417.80	—	50%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 00006-4943-00 - pneumococcal 23-valent vaccine Sol	$217.61	$435.21	$217.60–$417.80	—	50%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 00006-4943-01 - pneumococcal 23-polyvalent vaccine	$217.61	$435.21	$217.60–$417.80	—	50%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 00006-4837-02 - pneumococcal 23-polyvalent vaccine	$217.61	$435.21	$217.60–$417.80	—	50%
Polio vaccine, inactivated (IPV) CPT 90713 49281-0860-55 - poliovirus vaccine, inactivated Su	$126.60	$422.00	$45.24–$405.12	8% below	70%
Polio vaccine, inactivated (IPV) CPT 90713 49281-0860-10 - poliovirus vaccine, inactivated Su	$126.60	$422.00	$45.24–$405.12	8% below	70%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 49281-0860-10 - poliovirus vaccine, inactivated Su	$211.00	$422.00	$211.00–$405.12	—	50%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 49281-0860-55 - poliovirus vaccine, inactivated Su	$211.00	$422.00	$211.00–$405.12	—	50%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 49281-0574-88 - nirsevimab (cvx 307) alip preserva	$562.32	$1,874.41	$200.94–$1,799.43	55% below	70%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 49281-0574-88 - nirsevimab (cvx 307) alip preserva	$937.21	$1,874.41	$937.20–$1,799.43	—	50%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 49281-0575-15 - nirsevimab (cvx 306) alip preserva	$562.32	$1,874.41	$200.94–$1,799.43	78% below	70%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 49281-0575-00 - nirsevimab (cvx 306) alip preserva	$562.32	$1,874.41	$200.94–$1,799.43	78% below	70%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 49281-0575-15 - nirsevimab (cvx 306) alip preserva	$937.21	$1,874.41	$937.20–$1,799.43	—	50%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 49281-0575-00 - nirsevimab (cvx 306) alip preserva	$937.21	$1,874.41	$937.20–$1,799.43	—	50%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 00069-0344-01 - RSV vaccine, preF A-preF B, recomb	$322.39	$1,074.62	$115.20–$1,031.64	45% below	70%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 00069-0344-05 - RSV vaccine, preF A-preF B, recomb	$322.39	$1,074.62	$115.20–$1,031.64	45% below	70%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 00069-0344-05 - RSV vaccine, preF A-preF B, recomb	$537.31	$1,074.62	$537.31–$1,031.64	—	50%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 00069-0344-01 - RSV vaccine, preF A-preF B, recomb	$537.31	$1,074.62	$537.31–$1,031.64	—	50%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 58160-0848-11 - RSV vaccine preF3, recombinant pre	$322.45	$1,074.83	$115.22–$1,031.84	21% below	70%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 58160-0848-11 - RSV vaccine preF3, recombinant pre	$537.42	$1,074.83	$537.42–$1,031.84	—	50%
Rabies vaccine, one dose CPT 90675 49281-0250-51 - rabies vaccine, human diploid cell	$431.93	$1,439.75	$154.34–$1,382.16	28% below	70%
Rabies vaccine, one dose CPT 90675 49999-0414-01 - rabies vaccine, human diploid cell	$431.93	$1,439.75	$154.34–$1,382.16	28% below	70%
Rabies vaccine, one dose CPT 90675 49281-0252-51 - rabies vaccine, human diploid cell	$431.93	$1,439.75	$154.34–$1,382.16	28% below	70%
Rabies vaccine, one dose CPT 90675 63851-0501-01 - rabies vaccine, purified chick emb	$495.44	$1,651.46	$177.04–$1,585.40	17% below	70%
Rabies vaccine, one dose CPT 90675 58160-0964-12 - rabies vaccine, purified chick emb	$495.44	$1,651.46	$177.04–$1,585.40	17% below	70%
Rabies vaccine, one dose CPT 90675 63851-0501-02 - rabies vaccine, purified chick emb	$495.44	$1,651.46	$177.04–$1,585.40	17% below	70%
Rabies vaccine, one dose CPT 90675 50632-0010-01 - rabies vaccine, purified chick emb	$495.44	$1,651.46	$177.04–$1,585.40	17% below	70%
Rabies vaccine, one dose inpatient CPT 90675 49281-0250-51 - rabies vaccine, human diploid cell	$719.88	$1,439.75	$719.88–$1,382.16	—	50%
Rabies vaccine, one dose inpatient CPT 90675 49281-0252-51 - rabies vaccine, human diploid cell	$719.88	$1,439.75	$719.88–$1,382.16	—	50%
Rabies vaccine, one dose inpatient CPT 90675 49999-0414-01 - rabies vaccine, human diploid cell	$719.88	$1,439.75	$719.88–$1,382.16	—	50%
Rabies vaccine, one dose inpatient CPT 90675 58160-0964-12 - rabies vaccine, purified chick emb	$825.73	$1,651.46	$825.73–$1,585.40	—	50%
Rabies vaccine, one dose inpatient CPT 90675 63851-0501-02 - rabies vaccine, purified chick emb	$825.73	$1,651.46	$825.73–$1,585.40	—	50%
Rabies vaccine, one dose inpatient CPT 90675 63851-0501-01 - rabies vaccine, purified chick emb	$825.73	$1,651.46	$825.73–$1,585.40	—	50%
Rabies vaccine, one dose inpatient CPT 90675 50632-0010-01 - rabies vaccine, purified chick emb	$825.73	$1,651.46	$825.73–$1,585.40	—	50%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 00006-4047-20 - rotavirus vaccine pentavalent Susp	$99.44	$331.48	$35.53–$318.22	46% below	70%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 00006-4047-01 - rotavirus vaccine 2 mL Susp	$99.44	$331.48	$35.53–$318.22	46% below	70%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 00006-4047-41 - rotavirus vaccine Susp	$99.44	$331.48	$35.53–$318.22	46% below	70%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 00006-4047-20 - rotavirus vaccine pentavalent Susp	$165.74	$331.48	$165.74–$318.22	—	50%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 00006-4047-41 - rotavirus vaccine Susp	$165.74	$331.48	$165.74–$318.22	—	50%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 00006-4047-01 - rotavirus vaccine 2 mL Susp	$165.74	$331.48	$165.74–$318.22	—	50%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 58160-0823-11 - zoster vaccine, inactivated adjuva	$253.13	$843.76	$90.45–$810.01	at median	70%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 58160-0819-12 - zoster vaccine, inactivated adjuva	$253.13	$843.76	$90.45–$810.01	at median	70%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 58160-0819-12 - zoster vaccine, inactivated adjuva	$421.88	$843.76	$421.88–$810.01	—	50%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 58160-0823-11 - zoster vaccine, inactivated adjuva	$421.88	$843.76	$421.88–$810.01	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 49281-0215-15 - tetanus-diphtheria toxoids 5 units	$126.60	$422.00	$37.37–$405.12	9% below	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 00006-4133-41 - tetanus-diphtheria toxoids 2 units	$126.60	$422.00	$37.37–$405.12	9% below	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 49281-0291-83 - tetanus-diphtheria toxoids 5 units	$126.60	$422.00	$37.37–$405.12	9% below	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 00006-4133-01 - tetanus-diphth toxoids (Td) adult/	$126.60	$422.00	$37.37–$405.12	9% below	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 49281-0291-10 - tetanus-diphtheria toxoids 5 units	$126.60	$422.00	$37.37–$405.12	9% below	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 13533-0131-01 - tetanus-diphth toxoids (Td) adult/	$126.60	$422.00	$37.37–$405.12	9% below	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 49281-0215-10 - tetanus-diphtheria toxoids 5 units	$126.60	$422.00	$37.37–$405.12	9% below	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 17478-0131-01 - tetanus-diphth toxoids (Td) adult/	$126.60	$422.00	$37.37–$405.12	9% below	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 49281-0225-10 - diphtheria-tetanus toxoids (DT) pe	$126.60	$422.00	$37.37–$405.12	9% below	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 49281-0215-10 - tetanus-diphtheria toxoids 5 units	$211.00	$422.00	$211.00–$405.12	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 49281-0215-15 - tetanus-diphtheria toxoids 5 units	$211.00	$422.00	$211.00–$405.12	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 00006-4133-01 - tetanus-diphth toxoids (Td) adult/	$211.00	$422.00	$211.00–$405.12	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 49281-0225-10 - diphtheria-tetanus toxoids (DT) pe	$211.00	$422.00	$211.00–$405.12	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 49281-0291-83 - tetanus-diphtheria toxoids 5 units	$211.00	$422.00	$211.00–$405.12	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 00006-4133-41 - tetanus-diphtheria toxoids 2 units	$211.00	$422.00	$211.00–$405.12	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 49281-0291-10 - tetanus-diphtheria toxoids 5 units	$211.00	$422.00	$211.00–$405.12	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 13533-0131-01 - tetanus-diphth toxoids (Td) adult/	$211.00	$422.00	$211.00–$405.12	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 17478-0131-01 - tetanus-diphth toxoids (Td) adult/	$211.00	$422.00	$211.00–$405.12	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 49281-0400-15 - tetanus/diphtheria/pertussis, acel	$126.60	$422.00	$45.24–$405.12	19% below	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 58160-0842-52 - tetanus/diphtheria/pertussis, acel	$126.60	$422.00	$45.24–$405.12	19% below	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2	$126.60	$422.00	$45.24–$405.12	19% below	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 49281-0400-10 - tetanus/diphtheria/pertussis, acel	$126.60	$422.00	$45.24–$405.12	19% below	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 49281-0400-20 - tetanus/diphth/pertuss (Tdap) adul	$126.60	$422.00	$45.24–$405.12	19% below	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 58160-0842-11 - tetanus/diphtheria/pertussis, acel	$126.60	$422.00	$45.24–$405.12	19% below	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 58160-0842-43 - tetanus/diphth/pertuss (Tdap) adul	$126.60	$422.00	$45.24–$405.12	19% below	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 58160-0842-46 - tetanus/diphth/pertuss (Tdap) adul	$126.60	$422.00	$45.24–$405.12	19% below	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 49281-0400-15 - tetanus/diphtheria/pertussis, acel	$211.00	$422.00	$211.00–$405.12	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 49281-0400-20 - tetanus/diphth/pertuss (Tdap) adul	$211.00	$422.00	$211.00–$405.12	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 58160-0842-46 - tetanus/diphth/pertuss (Tdap) adul	$211.00	$422.00	$211.00–$405.12	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 58160-0842-43 - tetanus/diphth/pertuss (Tdap) adul	$211.00	$422.00	$211.00–$405.12	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2	$211.00	$422.00	$211.00–$405.12	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 49281-0400-10 - tetanus/diphtheria/pertussis, acel	$211.00	$422.00	$211.00–$405.12	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 58160-0842-52 - tetanus/diphtheria/pertussis, acel	$211.00	$422.00	$211.00–$405.12	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 58160-0842-11 - tetanus/diphtheria/pertussis, acel	$211.00	$422.00	$211.00–$405.12	—	50%
Typhoid vaccine, oral capsules (Vivotif) CPT 90690 69401-0000-01 - typhoid vaccine, live - Cap-DR	$119.17	$397.24	$42.58–$381.35	at median	70%
Typhoid vaccine, oral capsules (Vivotif) CPT 90690 58337-0003-01 - typhoid vaccine, live Cap-EC	$119.17	$397.24	$42.58–$381.35	at median	70%
Typhoid vaccine, oral capsules (Vivotif) inpatient CPT 90690 58337-0003-01 - typhoid vaccine, live Cap-EC	$198.62	$397.24	$198.62–$381.35	—	50%
Typhoid vaccine, oral capsules (Vivotif) inpatient CPT 90690 69401-0000-01 - typhoid vaccine, live - Cap-DR	$198.62	$397.24	$198.62–$381.35	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pt. Location - Vaccine Charge - OB/Nursery	$83.70	$279.00	$23.83–$267.84	at median	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pt. Location - Vaccine Charge - In House/Observati	$89.10	$297.00	$23.83–$285.12	6% above	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pt. Location - Vaccine Charge - Infusion Center	$89.10	$297.00	$23.83–$285.12	6% above	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pt. Location - Vaccine Charge - Urgent Care	$90.60	$302.00	$23.83–$289.92	8% above	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 $ED Admin Vaccine	$96.00	$320.00	$23.83–$307.20	15% above	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pt. Location - Vaccine Charge - Emergency Departme	$96.00	$320.00	$23.83–$307.20	15% above	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN	$1,142.70	$3,809.00	$23.83–$3,656.64	1265% above	70%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pt. Location - Vaccine Charge - OB/Nursery	$139.50	$279.00	$139.50–$267.84	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pt. Location - Vaccine Charge - In House/Observati	$148.50	$297.00	$148.50–$285.12	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pt. Location - Vaccine Charge - Infusion Center	$148.50	$297.00	$148.50–$285.12	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pt. Location - Vaccine Charge - Urgent Care	$151.00	$302.00	$151.00–$289.92	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pt. Location - Vaccine Charge - Emergency Departme	$160.00	$320.00	$160.00–$307.20	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 $ED Admin Vaccine	$160.00	$320.00	$160.00–$307.20	—	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 OB CHRG - VACCINE ADM EA AD	$19.50	$65.00	$17.26–$62.40	62% below	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Pt. Location - Vaccine Charge - Obs/OP Additional	$21.30	$71.00	$17.26–$68.16	58% below	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Pt. Location - Vaccine Charge - Urgent Care Additi	$21.60	$72.00	$17.26–$69.12	57% below	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Pt. Location - Vaccine Charge - ED Additional	$36.90	$123.00	$17.26–$118.08	27% below	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 $ED Admin Vaccine Ea Add'l	$36.90	$123.00	$17.26–$118.08	27% below	70%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 OB CHRG - VACCINE ADM EA AD	$32.50	$65.00	$32.50–$62.40	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Pt. Location - Vaccine Charge - Obs/OP Additional	$35.50	$71.00	$35.50–$68.16	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Pt. Location - Vaccine Charge - Urgent Care Additi	$36.00	$72.00	$36.00–$69.12	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Pt. Location - Vaccine Charge - ED Additional	$61.50	$123.00	$61.50–$118.08	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 $ED Admin Vaccine Ea Add'l	$61.50	$123.00	$61.50–$118.08	—	50%
Yellow fever vaccine, live CPT 90717 49281-0915-01 - yellow fever vaccine - Powder	$748.55	$2,495.16	$267.48–$2,495.16	10% above	70%
Yellow fever vaccine, live CPT 90717 49281-0915-05 - yellow fever vaccine - Powder	$748.55	$2,495.16	$267.48–$2,495.16	10% above	70%
Yellow fever vaccine, live inpatient CPT 90717 49281-0915-05 - yellow fever vaccine - Powder	$1,247.58	$2,495.16	$1,247.58–$2,395.35	—	50%
Yellow fever vaccine, live inpatient CPT 90717 49281-0915-01 - yellow fever vaccine - Powder	$1,247.58	$2,495.16	$1,247.58–$2,395.35	—	50%

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.matsuregional.com/Uploads/Public/Documents/charge-masters/charge-masters-2024/721563402_mat-su-regional-medical-center_standardcharges.csv