Norman Regional
Norman Regional in Norman, OK publishes cash prices for 384 common procedures listed here, from its own machine-readable price file updated Jan 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Oklahoma median for 335 of 384 procedures and below it for 48. By typical cash price it ranks #58 of 64 Oklahoma hospitals and #8 of 8 hospitals in the Oklahoma City, OK area, cheapest first. Select a procedure to compare it with other hospitals nearby.
3300 Healthplex Pkwy, Norman, OK 73072 Collected Oct 29, 2026 Source price file Check a bill from this hospital (405) 307-1050
Acute care hospital Government-owned hospital Emergency department CMS star rating 2 of 5 CCN 370008 · CMS hospital register
Financial assistance
Public hospital: ask for its charity care or sliding-scale discount
Norman Regional is government-owned (CMS register). The federal financial assistance rules for nonprofit hospitals do not always apply to public ones, but many public hospitals run charity care or sliding-scale discounts for uninsured and low-income patients. Ask the billing office for its financial assistance or charity care policy and application before you pay. Letters you can copy.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Oklahoma | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 Ct Abd W&Wo-Urology Protocol | $2,964.60 | $4,941.00 | — | 123% above | 40% |
| Abdominal CT scan without and with contrast CPT 74170 Ct Abdomen W&Wo Contrast | $2,964.60 | $4,941.00 | — | 123% above | 40% |
| Abdominal CT scan without and with contrast CPT 74170 Ct Abd W&Wo-Pancreatic Mass | $2,964.60 | $4,941.00 | — | 123% above | 40% |
| Abdominal CT scan without and with contrast CPT 74170 Ct Abd W&Wo-Renal Mass | $2,964.60 | $4,941.00 | — | 123% above | 40% |
| Abdominal CT scan without and with contrast CPT 74170 Ct Abd W&Wo-Liver Mass | $2,964.60 | $4,941.00 | — | 123% above | 40% |
| Abdominal CT scan without and with contrast CPT 74170 Ct Abd W&Wo-Adrenal Mass | $2,964.60 | $4,941.00 | — | 123% above | 40% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 Ct Abd W&Wo-Adrenal Mass | $2,964.60 | $4,941.00 | — | — | 40% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 Ct Abd W&Wo-Urology Protocol | $2,964.60 | $4,941.00 | — | — | 40% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 Ct Abd W&Wo-Liver Mass | $2,964.60 | $4,941.00 | — | — | 40% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 Ct Abd W&Wo-Pancreatic Mass | $2,964.60 | $4,941.00 | — | — | 40% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 Ct Abd W&Wo-Renal Mass | $2,964.60 | $4,941.00 | — | — | 40% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 Ct Abdomen W&Wo Contrast | $2,964.60 | $4,941.00 | — | — | 40% |
| Abdominal X-ray, 2 views CPT 74019 Abdomen Portable (2 Views) | $342.60 | $571.00 | — | 61% above | 40% |
| Abdominal X-ray, 2 views CPT 74019 Abd Pad Upright Decub(2 Views) | $342.60 | $571.00 | — | 61% above | 40% |
| Abdominal X-ray, 2 views inpatient CPT 74019 Abd Pad Upright Decub(2 Views) | $342.60 | $571.00 | — | — | 40% |
| Abdominal X-ray, 2 views inpatient CPT 74019 Abdomen Portable (2 Views) | $342.60 | $571.00 | — | — | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Left Ankle 3 View | $346.20 | $577.00 | — | 94% above | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Right Ankle 3 View | $346.20 | $577.00 | — | 94% above | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Xr Right Ankle 3 View | $346.20 | $577.00 | — | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Xr Left Ankle 3 View | $346.20 | $577.00 | — | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Us Physi Ue Le Art1 Lvl Bi | $367.20 | $612.00 | — | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Upr/L Xtremity Art 2 Levels | $367.20 | $612.00 | — | 44% above | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Abi W/Trans Ox Meas-Limited | $367.20 | $612.00 | — | 44% above | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Us Lower Physiolog Sng Lvl Bil | $367.20 | $612.00 | — | 44% above | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Us Ankle/Brachial Indices | $367.20 | $612.00 | — | 44% above | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 Us Physi Ue Le Art1 Lvl Bi | $367.20 | $612.00 | — | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Abi W/Trans Ox Meas-Limited | $367.20 | $612.00 | — | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Us Ankle/Brachial Indices | $367.20 | $612.00 | — | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Us Lower Physiolog Sng Lvl Bil | $367.20 | $612.00 | — | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Upr/L Xtremity Art 2 Levels | $367.20 | $612.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 Ct Ext Upper Wo/Contrast | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Left Forearm W/O Con | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Left Elbow W/O Con | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Left Humerus W/O Con | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Left Shoulder W/O Con | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Right Hand W/O Con | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Right Wrist W/O Con | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Right Forearm W/O Con | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Right Elbow W/O Con | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Right Shoulder W/O Con | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Right Humerus W/O Cont | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Left Hand W/O Con | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Left Wrist W/O Con | $1,597.80 | $2,663.00 | — | 76% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 Ct Ext Upper Wo/Contrast | $1,597.80 | $2,663.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Left Humerus W/O Con | $1,597.80 | $2,663.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Left Elbow W/O Con | $1,597.80 | $2,663.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Left Wrist W/O Con | $1,597.80 | $2,663.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Left Hand W/O Con | $1,597.80 | $2,663.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Left Forearm W/O Con | $1,597.80 | $2,663.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Right Elbow W/O Con | $1,597.80 | $2,663.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Right Forearm W/O Con | $1,597.80 | $2,663.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Right Wrist W/O Con | $1,597.80 | $2,663.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Right Humerus W/O Cont | $1,597.80 | $2,663.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Right Hand W/O Con | $1,597.80 | $2,663.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Right Shoulder W/O Con | $1,597.80 | $2,663.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Left Shoulder W/O Con | $1,597.80 | $2,663.00 | — | — | 40% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 Esophagus,Sngl Contr,Water Sol | $568.80 | $948.00 | — | 94% above | 40% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 Esophagus, Single Contrast | $568.80 | $948.00 | — | 94% above | 40% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Esophagus, Single Contrast | $568.80 | $948.00 | — | — | 40% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Esophagus,Sngl Contr,Water Sol | $568.80 | $948.00 | — | — | 40% |
| Bone scan, whole body (nuclear medicine) CPT 78306 Nm Bone Scan Complete | $1,797.60 | $2,996.00 | — | 88% above | 40% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Nm Bone Scan Complete | $1,797.60 | $2,996.00 | — | — | 40% |
| Breast ultrasound, complete, one breast CPT 76641 Us Breast Complete | $547.20 | $912.00 | — | 57% above | 40% |
| Breast ultrasound, complete, one breast inpatient CPT 76641 Us Breast Complete | $547.20 | $912.00 | — | — | 40% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 Us Ed Bedside Soft Tiss Breast | $523.80 | $873.00 | — | 57% above | 40% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 Us Breast Limited | $523.80 | $873.00 | — | 57% above | 40% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Us Breast Limited | $523.80 | $873.00 | — | — | 40% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Us Ed Bedside Soft Tiss Breast | $523.80 | $873.00 | — | — | 40% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 Ct Angio Abd&Pelv W/O&W/Dye | $507.75 | $846.25 | — | 77% below | 40% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 Ct Venogram Abdomen/Pelvis | $507.75 | $846.25 | — | 77% below | 40% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 Ct Venogram Abdomen/Pelvis | $507.75 | $846.25 | — | — | 40% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 Ct Angio Abd&Pelv W/O&W/Dye | $507.75 | $846.25 | — | — | 40% |
| CT angiography (CTA) of the head CPT 70496 Cta Head W/ Contrast | $2,314.80 | $3,858.00 | — | 74% above | 40% |
| CT angiography (CTA) of the head inpatient CPT 70496 Cta Head W/ Contrast | $2,314.80 | $3,858.00 | — | — | 40% |
| CT angiography (CTA) of the neck CPT 70498 Cta Neck W/Wo Contrast | $1,578.60 | $2,631.00 | — | 20% above | 40% |
| CT angiography (CTA) of the neck CPT 70498 Ctv Neck W/Wo Contrast | $1,578.60 | $2,631.00 | — | 20% above | 40% |
| CT angiography (CTA) of the neck inpatient CPT 70498 Cta Neck W/Wo Contrast | $1,578.60 | $2,631.00 | — | — | 40% |
| CT angiography (CTA) of the neck inpatient CPT 70498 Ctv Neck W/Wo Contrast | $1,578.60 | $2,631.00 | — | — | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ctv Chest,Diagnostic,W/Contr | $2,340.00 | $3,900.00 | — | 56% above | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Cta Chest W/Wo Contrast | $2,923.80 | $4,873.00 | — | 95% above | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Dissection,Aorta,Chest, W&Wo | $2,923.80 | $4,873.00 | — | 95% above | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Ctv Chest,Diagnostic,W/Contr | $2,340.00 | $3,900.00 | — | — | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Cta Chest W/Wo Contrast | $2,923.80 | $4,873.00 | — | — | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Dissection,Aorta,Chest, W&Wo | $2,923.80 | $4,873.00 | — | — | 40% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Cta Hrt/Cornry Art/Grfts W/3D | $2,923.80 | $4,873.00 | — | 138% above | 40% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 Cta Hrt/Cornry Art/Grfts W/3D | $2,923.80 | $4,873.00 | — | — | 40% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 Ct Card Scorng-Hrt W/O Cn W/Ca | $310.20 | $517.00 | — | 204% above | 40% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 Ct Heart W/O Contr W/Calc Eval | $310.20 | $517.00 | — | 204% above | 40% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 Ct Card Scorng-Hrt W/O Cn W/Ca | $310.20 | $517.00 | — | — | 40% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 Ct Heart W/O Contr W/Calc Eval | $310.20 | $517.00 | — | — | 40% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Enterography W/O Contrast | $3,782.40 | $6,304.00 | — | 183% above | 40% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abd&Pelv W/O Con/Polycystic | $3,782.40 | $6,304.00 | — | 183% above | 40% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abd&Pelv W/O Oral Cont Only | $3,782.40 | $6,304.00 | — | 183% above | 40% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abd & Pelvis W/O Contrast | $3,782.40 | $6,304.00 | — | 183% above | 40% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Ct Abd&Pelv W/O Oral Cont Only | $3,782.40 | $6,304.00 | — | — | 40% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Ct Abd&Pelv W/O Con/Polycystic | $3,782.40 | $6,304.00 | — | — | 40% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Ct Abd & Pelvis W/O Contrast | $3,782.40 | $6,304.00 | — | — | 40% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Ct Enterography W/O Contrast | $3,782.40 | $6,304.00 | — | — | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct Abdomen & Pelvis W/Contrast | $3,998.40 | $6,664.00 | — | 119% above | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Enterography W/Contrast Gi | $3,998.40 | $6,664.00 | — | 119% above | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Trauma Er Ct Abd&Pelv W/Contr | $3,998.40 | $6,664.00 | — | 119% above | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct Enterography W/Contrast | $3,998.40 | $6,664.00 | — | 119% above | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Enterography W/Contrast Gi | $3,998.40 | $6,664.00 | — | — | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct Abdomen & Pelvis W/Contrast | $3,998.40 | $6,664.00 | — | — | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct Enterography W/Contrast | $3,998.40 | $6,664.00 | — | — | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Trauma Er Ct Abd&Pelv W/Contr | $3,998.40 | $6,664.00 | — | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Enterography W&Wo Contrast | $4,966.20 | $8,277.00 | — | 134% above | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd&Pelv W&Wo-Adrenal Mass | $4,966.20 | $8,277.00 | — | 134% above | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd W&Wo & Pelvis W/Contr | $4,966.20 | $8,277.00 | — | 134% above | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd&Pelv 1/> Regns W&Wo | $4,966.20 | $8,277.00 | — | 134% above | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd&Pelv W&Wo-Pancreat Mass | $4,966.20 | $8,277.00 | — | 134% above | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd&Pelv W&Wo-Urology Prtcl | $4,966.20 | $8,277.00 | — | 134% above | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd&Pelv W&Wo-Liver Mass | $4,966.20 | $8,277.00 | — | 134% above | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd&Pelv W&Wo-Renal Mass | $4,966.20 | $8,277.00 | — | 134% above | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct Abd&Pelv W&Wo-Urology Prtcl | $4,966.20 | $8,277.00 | — | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct Abd&Pelv W&Wo-Renal Mass | $4,966.20 | $8,277.00 | — | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct Abd&Pelv W&Wo-Liver Mass | $4,966.20 | $8,277.00 | — | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct Abd&Pelv W&Wo-Pancreat Mass | $4,966.20 | $8,277.00 | — | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct Enterography W&Wo Contrast | $4,966.20 | $8,277.00 | — | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct Abd&Pelv W&Wo-Adrenal Mass | $4,966.20 | $8,277.00 | — | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct Abd W&Wo & Pelvis W/Contr | $4,966.20 | $8,277.00 | — | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct Abd&Pelv 1/> Regns W&Wo | $4,966.20 | $8,277.00 | — | — | 40% |
| CT scan of the abdomen with contrast CPT 74160 Ct Abdomen W/Contrast | $2,433.60 | $4,056.00 | — | 121% above | 40% |
| CT scan of the abdomen with contrast inpatient CPT 74160 Ct Abdomen W/Contrast | $2,433.60 | $4,056.00 | — | — | 40% |
| CT scan of the abdomen without contrast CPT 74150 Ct Abdomen W/O Oral Contr Only | $2,341.80 | $3,903.00 | — | 137% above | 40% |
| CT scan of the abdomen without contrast CPT 74150 Ct Abdomen W/O Contrast | $2,341.80 | $3,903.00 | — | 137% above | 40% |
| CT scan of the abdomen without contrast inpatient CPT 74150 Ct Abdomen W/O Contrast | $2,341.80 | $3,903.00 | — | — | 40% |
| CT scan of the abdomen without contrast inpatient CPT 74150 Ct Abdomen W/O Oral Contr Only | $2,341.80 | $3,903.00 | — | — | 40% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Temporomandibular Joints | $2,049.00 | $3,415.00 | — | 115% above | 40% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Maxilla Facial Area W/O Con | $2,049.00 | $3,415.00 | — | 115% above | 40% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Ct Maxilla Facial Area W/O Con | $2,049.00 | $3,415.00 | — | — | 40% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Ct Temporomandibular Joints | $2,049.00 | $3,415.00 | — | — | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 Ct Head Wo/Contrast | $2,035.80 | $3,393.00 | — | 108% above | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 Trauma Er Ct Head W/O Contr | $2,035.80 | $3,393.00 | — | 108% above | 40% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct Head Wo/Contrast | $2,035.80 | $3,393.00 | — | — | 40% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Trauma Er Ct Head W/O Contr | $2,035.80 | $3,393.00 | — | — | 40% |
| CT scan of the head with contrast CPT 70460 Ct Head W/Contrast | $2,630.40 | $4,384.00 | — | 118% above | 40% |
| CT scan of the head with contrast CPT 70460 Ct & Cta Head W/ Contrast | $2,630.40 | $4,384.00 | — | 118% above | 40% |
| CT scan of the head with contrast inpatient CPT 70460 Ct & Cta Head W/ Contrast | $2,630.40 | $4,384.00 | — | — | 40% |
| CT scan of the head with contrast inpatient CPT 70460 Ct Head W/Contrast | $2,630.40 | $4,384.00 | — | — | 40% |
| CT scan of the head without and with contrast CPT 70470 Ct Head W/Wo Contrast | $2,663.40 | $4,439.00 | — | 108% above | 40% |
| CT scan of the head without and with contrast inpatient CPT 70470 Ct Head W/Wo Contrast | $2,663.40 | $4,439.00 | — | — | 40% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct Mazor Prot Lumbr Spine W/O | $2,134.80 | $3,558.00 | — | 107% above | 40% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct Lumbar Spine W/O Contrast | $2,134.80 | $3,558.00 | — | 107% above | 40% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 Ct Mazor Prot Lumbr Spine W/O | $2,134.80 | $3,558.00 | — | — | 40% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 Ct Lumbar Spine W/O Contrast | $2,134.80 | $3,558.00 | — | — | 40% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct Spine Cervical W/O Contrast | $2,173.20 | $3,622.00 | — | 104% above | 40% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 Trauma Er Ct Cervical Spine Wo | $2,173.20 | $3,622.00 | — | 104% above | 40% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 Ct Spine Cervical W/O Contrast | $2,173.20 | $3,622.00 | — | — | 40% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 Trauma Er Ct Cervical Spine Wo | $2,173.20 | $3,622.00 | — | — | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct Pelvis W/Contrast | $2,446.80 | $4,078.00 | — | 126% above | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct Sacrum, W/, Mazor Protocol | $2,446.80 | $4,078.00 | — | 126% above | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct Sacrum W/Contrast | $2,446.80 | $4,078.00 | — | 126% above | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct Cystogram | $2,446.80 | $4,078.00 | — | 126% above | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct Pelvis, W/, Mazor Protocol | $2,446.80 | $4,078.00 | — | 126% above | 40% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Sacrum, W/, Mazor Protocol | $2,446.80 | $4,078.00 | — | — | 40% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Cystogram | $2,446.80 | $4,078.00 | — | — | 40% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Sacrum W/Contrast | $2,446.80 | $4,078.00 | — | — | 40% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Pelvis, W/, Mazor Protocol | $2,446.80 | $4,078.00 | — | — | 40% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Pelvis W/Contrast | $2,446.80 | $4,078.00 | — | — | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Us Carotid/Vert/Art Comp Bil | $1,342.80 | $2,238.00 | — | 179% above | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 Us Carotid/Vert/Art Comp Bil | $1,342.80 | $2,238.00 | — | — | 40% |
| Chest CT scan without and with contrast CPT 71270 Ct Chest,Diagnostic,W/Wo Contr | $2,605.20 | $4,342.00 | — | 109% above | 40% |
| Chest CT scan without and with contrast inpatient CPT 71270 Ct Chest,Diagnostic,W/Wo Contr | $2,605.20 | $4,342.00 | — | — | 40% |
| Chest X-ray, 2 views CPT 71046 Cchd Chest (2 Views) | $43.20 | $72.00 | — | 76% below | 40% |
| Chest X-ray, 2 views CPT 71046 Chest (2 Views) Alameda | $269.40 | $449.00 | — | 52% above | 40% |
| Chest X-ray, 2 views CPT 71046 Chest (2 Views) | $269.40 | $449.00 | — | 52% above | 40% |
| Chest X-ray, 2 views CPT 71046 Chest Pa & Lat(Routine)2 Views | $269.40 | $449.00 | — | 52% above | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 Cchd Chest (2 Views) | $43.20 | $72.00 | — | — | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 Chest Pa & Lat(Routine)2 Views | $269.40 | $449.00 | — | — | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 Chest (2 Views) Alameda | $269.40 | $449.00 | — | — | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 Chest (2 Views) | $269.40 | $449.00 | — | — | 40% |
| Chest X-ray, single view CPT 71045 Cchd Chest (1 View) | $40.20 | $67.00 | — | 76% below | 40% |
| Chest X-ray, single view CPT 71045 Chest (1 View) | $241.80 | $403.00 | — | 46% above | 40% |
| Chest X-ray, single view CPT 71045 Surg Chest (1 View) | $241.80 | $403.00 | — | 46% above | 40% |
| Chest X-ray, single view CPT 71045 Chest Portable (1 View) | $241.80 | $403.00 | — | 46% above | 40% |
| Chest X-ray, single view CPT 71045 Chest (1 View) Alameda | $241.80 | $403.00 | — | 46% above | 40% |
| Chest X-ray, single view inpatient CPT 71045 Cchd Chest (1 View) | $40.20 | $67.00 | — | — | 40% |
| Chest X-ray, single view inpatient CPT 71045 Chest Portable (1 View) | $241.80 | $403.00 | — | — | 40% |
| Chest X-ray, single view inpatient CPT 71045 Surg Chest (1 View) | $241.80 | $403.00 | — | — | 40% |
| Chest X-ray, single view inpatient CPT 71045 Chest (1 View) Alameda | $241.80 | $403.00 | — | — | 40% |
| Chest X-ray, single view inpatient CPT 71045 Chest (1 View) | $241.80 | $403.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete both sides CPT 73000 Bilateral Clavicle | $425.40 | $709.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete CPT 73000 Surgery Clavicle | $425.40 | $709.00 | — | 138% above | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 Xr Left Clavicle 2 View | $425.40 | $709.00 | — | 138% above | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 Xr Right Clavicle 2 Views | $425.40 | $709.00 | — | 138% above | 40% |
| Collarbone (clavicle) X-ray, complete inpatient both sides CPT 73000 Bilateral Clavicle | $425.40 | $709.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 Surgery Clavicle | $425.40 | $709.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Xr Right Clavicle 2 Views | $425.40 | $709.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Xr Left Clavicle 2 View | $425.40 | $709.00 | — | — | 40% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Us Renal | $856.80 | $1,428.00 | — | 83% above | 40% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Us Renal | $856.80 | $1,428.00 | — | — | 40% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 Dexa Bone Densitometry | $426.00 | $710.00 | — | 65% above | 40% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Dexa Bone Densitometry | $426.00 | $710.00 | — | — | 40% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Dxa Bone Density/Periph 1+Site | $265.80 | $443.00 | — | 145% above | 40% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 Dxa Bone Density/Periph 1+Site | $265.80 | $443.00 | — | — | 40% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest,Diagnostic,W/O Contr | $2,184.60 | $3,641.00 | — | 129% above | 40% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ion Chest Without-Pulm Only | $2,184.60 | $3,641.00 | — | 129% above | 40% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Ct Chest,Diagnostic,W/O Contr | $2,184.60 | $3,641.00 | — | — | 40% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Ion Chest Without-Pulm Only | $2,184.60 | $3,641.00 | — | — | 40% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ion Chest With- Pulm Only | $2,340.00 | $3,900.00 | — | 106% above | 40% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest,Diag,W/Co,Pe Protocol | $2,340.00 | $3,900.00 | — | 106% above | 40% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest,Diagnostic,W/Contrast | $2,340.00 | $3,900.00 | — | 106% above | 40% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Trauma Er Ct Chest,Diag,W/Cont | $2,340.00 | $3,900.00 | — | 106% above | 40% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Trauma Er Ct Chest,Diag,W/Cont | $2,340.00 | $3,900.00 | — | — | 40% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Ion Chest With- Pulm Only | $2,340.00 | $3,900.00 | — | — | 40% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Ct Chest,Diagnostic,W/Contrast | $2,340.00 | $3,900.00 | — | — | 40% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Ct Chest,Diag,W/Co,Pe Protocol | $2,340.00 | $3,900.00 | — | — | 40% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Mammogram Diagnostic,Bilateral | $279.60 | $466.00 | — | — | 40% |
| Diagnostic mammogram, both breasts CPT 77066 Tc-Diagnostic Mammo-Bil | $89.24 | $148.73 | — | 70% below | 40% |
| Diagnostic mammogram, both breasts CPT 77066 Pw-Digital Diag Mammo-Bil | $90.00 | $150.00 | — | 69% below | 40% |
| Diagnostic mammogram, both breasts CPT 77066 Mammo Call Bck Add Digtl Bil | $279.60 | $466.00 | — | 5% below | 40% |
| Diagnostic mammogram, both breasts CPT 77066 Bil Augmented Digital Dx Mammo | $279.60 | $466.00 | — | 5% below | 40% |
| Diagnostic mammogram, both breasts CPT 77066 Male Diagnostic Mammogram | $279.60 | $466.00 | — | 5% below | 40% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Mammogram Diagnostic,Bilateral | $279.60 | $466.00 | — | — | 40% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 Tc-Diagnostic Mammo-Bil | $89.24 | $148.73 | — | — | 40% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 Pw-Digital Diag Mammo-Bil | $90.00 | $150.00 | — | — | 40% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 Male Diagnostic Mammogram | $279.60 | $466.00 | — | — | 40% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 Mammo Call Bck Add Digtl Bil | $279.60 | $466.00 | — | — | 40% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 Bil Augmented Digital Dx Mammo | $279.60 | $466.00 | — | — | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Tc-Diagnostic Mammo, Uni-Lt | $70.68 | $117.80 | — | 65% below | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Tc-Diagnostic Mammo, Uni-Rt | $70.68 | $117.80 | — | 65% below | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Pw-Digital Diag Mammo-Lt | $72.00 | $120.00 | — | 64% below | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Pw-Digital Diag Mammo-Rt | $72.00 | $120.00 | — | 64% below | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Pw-Mammo Digitl Cll Bk-Rt | $72.00 | $120.00 | — | 64% below | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Pw-Mammo Digitl Cll Bk-Lt | $72.00 | $120.00 | — | 64% below | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Rt Augmented Digital Diag Set | $240.00 | $400.00 | — | 19% above | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Mammo Left Digital Call Back | $240.00 | $400.00 | — | 19% above | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Mammo Right Digital Call Back | $240.00 | $400.00 | — | 19% above | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Rt Augmented Digital Dx Mammo | $240.00 | $400.00 | — | 19% above | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Mammo Rt Digital Diag Unilat | $240.00 | $400.00 | — | 19% above | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Lt Augmented Digital Dx Mammo | $240.00 | $400.00 | — | 19% above | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Mammo Lt Digital Diag Unilat | $240.00 | $400.00 | — | 19% above | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Tc-Diagnostic Mammo, Uni-Rt | $70.68 | $117.80 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Tc-Diagnostic Mammo, Uni-Lt | $70.68 | $117.80 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Pw-Mammo Digitl Cll Bk-Lt | $72.00 | $120.00 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Pw-Digital Diag Mammo-Rt | $72.00 | $120.00 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Pw-Digital Diag Mammo-Lt | $72.00 | $120.00 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Pw-Mammo Digitl Cll Bk-Rt | $72.00 | $120.00 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Rt Augmented Digital Diag Set | $240.00 | $400.00 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Mammo Lt Digital Diag Unilat | $240.00 | $400.00 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Lt Augmented Digital Dx Mammo | $240.00 | $400.00 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Mammo Rt Digital Diag Unilat | $240.00 | $400.00 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Rt Augmented Digital Dx Mammo | $240.00 | $400.00 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Mammo Right Digital Call Back | $240.00 | $400.00 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Mammo Left Digital Call Back | $240.00 | $400.00 | — | — | 40% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 Us Dup Le Ext Art Com Bil | $1,039.80 | $1,733.00 | — | 91% above | 40% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 Us Dup Le Ext Art Com Bil | $1,039.80 | $1,733.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Vein Mapping-Compl Bilat Study | $967.80 | $1,613.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 Ext,Lower,Venous,Bil,Complete | $967.80 | $1,613.00 | — | 51% above | 40% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 Lower Extremity Venous Study | $967.80 | $1,613.00 | — | 51% above | 40% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 Ext,Upper,Venous,Bil,Complete | $967.80 | $1,613.00 | — | 51% above | 40% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 Us Dup Ext Venous Bil Comp | $967.80 | $1,613.00 | — | 51% above | 40% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 Upper Extremity Venous Study | $967.80 | $1,613.00 | — | 51% above | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Vein Mapping-Compl Bilat Study | $967.80 | $1,613.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Lower Extremity Venous Study | $967.80 | $1,613.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Upper Extremity Venous Study | $967.80 | $1,613.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Ext,Upper,Venous,Bil,Complete | $967.80 | $1,613.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Ext,Lower,Venous,Bil,Complete | $967.80 | $1,613.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Us Dup Ext Venous Bil Comp | $967.80 | $1,613.00 | — | — | 40% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echo/Dop/Col Flw W/O Contrast | $2,485.80 | $4,143.00 | — | 126% above | 40% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Ped Echo/Dop/Col Flw W/O Contr | $2,485.80 | $4,143.00 | — | 126% above | 40% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Echo/Dop/Col Flw W/O Contrast | $2,485.80 | $4,143.00 | — | — | 40% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Ped Echo/Dop/Col Flw W/O Contr | $2,485.80 | $4,143.00 | — | — | 40% |
| Elbow X-ray, 2 views one side CPT 73070 Surg Left Elbow 2 View | $296.40 | $494.00 | — | 71% above | 40% |
| Elbow X-ray, 2 views one side CPT 73070 Surg Right Elbow 2 View | $296.40 | $494.00 | — | 71% above | 40% |
| Elbow X-ray, 2 views one side CPT 73070 Left Elbow Routine 2 View | $296.40 | $494.00 | — | 71% above | 40% |
| Elbow X-ray, 2 views one side CPT 73070 Right Elbow Routine 2 View | $296.40 | $494.00 | — | 71% above | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 Surg Right Elbow 2 View | $296.40 | $494.00 | — | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 Left Elbow Routine 2 View | $296.40 | $494.00 | — | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 Right Elbow Routine 2 View | $296.40 | $494.00 | — | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 Surg Left Elbow 2 View | $296.40 | $494.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 Left Elbow 3 View | $309.60 | $516.00 | — | 72% above | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 Left Elbow 4 View | $309.60 | $516.00 | — | 72% above | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 Right Elbow 4 View | $309.60 | $516.00 | — | 72% above | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 Right Elbow 3 View | $309.60 | $516.00 | — | 72% above | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Right Elbow 4 View | $309.60 | $516.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Left Elbow 3 View | $309.60 | $516.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Right Elbow 3 View | $309.60 | $516.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Left Elbow 4 View | $309.60 | $516.00 | — | — | 40% |
| Eye socket (orbit) CT scan without contrast CPT 70480 Orbits Without Contrast | $2,041.20 | $3,402.00 | — | 123% above | 40% |
| Eye socket (orbit) CT scan without contrast CPT 70480 Ct Orbits/Iac Wo/Contrast | $2,041.20 | $3,402.00 | — | 123% above | 40% |
| Eye socket (orbit) CT scan without contrast CPT 70480 Ct Temporal Bone W/O Contrast | $2,041.20 | $3,402.00 | — | 123% above | 40% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Orbits Without Contrast | $2,041.20 | $3,402.00 | — | — | 40% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Ct Orbits/Iac Wo/Contrast | $2,041.20 | $3,402.00 | — | — | 40% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Ct Temporal Bone W/O Contrast | $2,041.20 | $3,402.00 | — | — | 40% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 Facial Bones W/ Zyg 3Vw | $466.20 | $777.00 | — | 111% above | 40% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 Facial Bone (3V) | $466.20 | $777.00 | — | 111% above | 40% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 Facial Bones W/ Zyg 3Vw | $466.20 | $777.00 | — | — | 40% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 Facial Bone (3V) | $466.20 | $777.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Surg Left Forearm 2 View | $312.00 | $520.00 | — | 74% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Surg Right Forearm 2 View | $312.00 | $520.00 | — | 74% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Left Forearm 2 View | $312.00 | $520.00 | — | 74% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Right Forearm 2 View | $312.00 | $520.00 | — | 74% above | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Left Forearm 2 View | $312.00 | $520.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Surg Right Forearm 2 View | $312.00 | $520.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Surg Left Forearm 2 View | $312.00 | $520.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Right Forearm 2 View | $312.00 | $520.00 | — | — | 40% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary System Imaging | $1,948.80 | $3,248.00 | — | 69% above | 40% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hepatobiliary System Imaging | $1,948.80 | $3,248.00 | — | — | 40% |
| Hand X-ray, 2 views one side CPT 73120 Left Hand 2 View | $264.60 | $441.00 | — | 42% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 Surg Right Hand 2 View | $264.60 | $441.00 | — | 42% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 Surg Left Hand 2 View | $264.60 | $441.00 | — | 42% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 Right Hand 2 View | $264.60 | $441.00 | — | 42% above | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 Left Hand 2 View | $264.60 | $441.00 | — | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 Surg Right Hand 2 View | $264.60 | $441.00 | — | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 Right Hand 2 View | $264.60 | $441.00 | — | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 Surg Left Hand 2 View | $264.60 | $441.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Os Calcis Heel Right 2Vw | $310.20 | $517.00 | — | 92% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Surg Os Calcis Heel Right 2V | $310.20 | $517.00 | — | 92% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Os Calcis Heel Left 2 Vw | $310.20 | $517.00 | — | 92% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Surg Os Calcis Heel Left 2Vw | $310.20 | $517.00 | — | 92% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Os Calcis Heel Right 2Vw | $310.20 | $517.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Surg Os Calcis Heel Left 2Vw | $310.20 | $517.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Os Calcis Heel Left 2 Vw | $310.20 | $517.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Surg Os Calcis Heel Right 2V | $310.20 | $517.00 | — | — | 40% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep Study Unatt &Resp Effort | $1,260.00 | $2,100.00 | — | 195% above | 40% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Sleep Study Unatt &Resp Effort | $1,260.00 | $2,100.00 | — | — | 40% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnography-Cpap 2Nd Study | $5,139.00 | $8,565.00 | — | 66% above | 40% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysomnography-Cpap 2Nd Study | $5,139.00 | $8,565.00 | — | — | 40% |
| Knee X-ray, 3 views one side CPT 73562 Xr Left Knee 3 View | $435.60 | $726.00 | — | 125% above | 40% |
| Knee X-ray, 3 views one side CPT 73562 Xr Right Knee 3 View | $435.60 | $726.00 | — | 125% above | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 Xr Right Knee 3 View | $435.60 | $726.00 | — | — | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 Xr Left Knee 3 View | $435.60 | $726.00 | — | — | 40% |
| Knee X-ray, complete, 4 or more views CPT 73564 Knee 4 View Includes Sunrise P | $496.20 | $827.00 | — | 73% above | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 Xr Right Knee 4 View/Sunrise | $496.20 | $827.00 | — | 73% above | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 Xr Left Knee 4 View/Sunrise | $496.20 | $827.00 | — | 73% above | 40% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 Knee 4 View Includes Sunrise P | $496.20 | $827.00 | — | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Xr Left Knee 4 View/Sunrise | $496.20 | $827.00 | — | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Xr Right Knee 4 View/Sunrise | $496.20 | $827.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 Ct Lower Extremity Wo Contrast | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Right Foot W/O Con | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Left Foot W/O Con | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Left Ankle W/O Con | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Left Tib/Fib W/O Con | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Left Knee W/O Con | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Left Femur W/O Con | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Left Hip W/O Con | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Trumatch Knee W/O Contr Lt | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Trumatch Knee W/O Contr Rt | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Makolt Knee W/O Contrast Lt | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Makort Knee W/O Contrast Rt | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Makolthip W/O Contrast | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Makorthip W/O Contrast | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Right Hip W/O Con | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Right Femur W/O Con | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Right Knee W/O Con | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Right Tib/Fib W/O Con | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Right Ankle W/O Con | $2,160.60 | $3,601.00 | — | 140% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 Ct Lower Extremity Wo Contrast | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Makort Knee W/O Contrast Rt | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Right Knee W/O Con | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Left Foot W/O Con | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Makolthip W/O Contrast | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Left Ankle W/O Con | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Left Hip W/O Con | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Left Tib/Fib W/O Con | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Makorthip W/O Contrast | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Left Knee W/O Con | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Right Tib/Fib W/O Con | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Left Femur W/O Con | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Right Hip W/O Con | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Trumatch Knee W/O Contr Lt | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Right Foot W/O Con | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Trumatch Knee W/O Contr Rt | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Right Femur W/O Con | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Right Ankle W/O Con | $2,160.60 | $3,601.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Makolt Knee W/O Contrast Lt | $2,160.60 | $3,601.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Ed Bedside Sft Tis Abd Wall | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Abdomen, Limited | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Liver | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Gallbladder | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Pancreas | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Spleen | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Biliary System & Pancreas | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Abdomen, Limited, Rlq | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Ed Bedside Appendix | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Ed Bedside Gallbladder | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Ed Bedside Sft Tis Lowr Bck | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Soft Tissue Abdomen Limited | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Ed Bedside Fast Abdomen | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Soft Tissue Back | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Ed Bedside Echo Exam Of Abd | $752.40 | $1,254.00 | — | 94% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Soft Tissue Back | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Abdomen, Limited | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Liver | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Gallbladder | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Pancreas | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Spleen | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Biliary System & Pancreas | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Abdomen, Limited, Rlq | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Ed Bedside Appendix | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Ed Bedside Gallbladder | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Ed Bedside Sft Tis Lowr Bck | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Soft Tissue Abdomen Limited | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Ed Bedside Sft Tis Abd Wall | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Ed Bedside Fast Abdomen | $752.40 | $1,254.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Ed Bedside Echo Exam Of Abd | $752.40 | $1,254.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Us Ed Bedside Soft Tiss Axilla | $471.60 | $786.00 | — | 82% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Us Non-Vas Sft Tss Lt Upp Xtr | $471.60 | $786.00 | — | 82% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Us Xtr Non-Vasc Lmtd | $471.60 | $786.00 | — | 82% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Us Non-Vas Sft Tss Rt Upp Xtr | $471.60 | $786.00 | — | 82% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Us Xtr Non-Vasc Lmtd | $471.60 | $786.00 | — | 82% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Us Non-Vas Sft Tss Rt Low Xtr | $471.60 | $786.00 | — | 82% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Us Non-Vas Sft Tss Lt Low Xtr | $471.60 | $786.00 | — | 82% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 Us Ed Bedside Soft Tiss Axilla | $471.60 | $786.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Us Non-Vas Sft Tss Rt Low Xtr | $471.60 | $786.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Us Xtr Non-Vasc Lmtd | $471.60 | $786.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Us Non-Vas Sft Tss Lt Low Xtr | $471.60 | $786.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Us Xtr Non-Vasc Lmtd | $471.60 | $786.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Us Non-Vas Sft Tss Lt Upp Xtr | $471.60 | $786.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Us Non-Vas Sft Tss Rt Upp Xtr | $471.60 | $786.00 | — | — | 40% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct Lung Screening Scan W/O Con | $873.00 | $1,455.00 | — | 119% above | 40% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Ct Lung Screening Scan W/O Con | $873.00 | $1,455.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Xr Right Tib/Fib 2 View | $326.40 | $544.00 | — | 93% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Surg Right Tib/Fib | $326.40 | $544.00 | — | 93% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Xr Left Tib/Fib 2 View | $326.40 | $544.00 | — | 93% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Surg Left Tib/Fib | $326.40 | $544.00 | — | 93% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Surg Right Tib/Fib | $326.40 | $544.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Xr Left Tib/Fib 2 View | $326.40 | $544.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Xr Right Tib/Fib 2 View | $326.40 | $544.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Surg Left Tib/Fib | $326.40 | $544.00 | — | — | 40% |
| MR angiography (MRA) of the head without contrast CPT 70544 Mra Brain W/O Contrast | $2,115.60 | $3,526.00 | — | 96% above | 40% |
| MR angiography (MRA) of the head without contrast CPT 70544 Mra Angio Head W/O Contrast | $2,115.60 | $3,526.00 | — | 96% above | 40% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 Mra Angio Head W/O Contrast | $2,115.60 | $3,526.00 | — | — | 40% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 Mra Brain W/O Contrast | $2,115.60 | $3,526.00 | — | — | 40% |
| MRI of both breasts, without and then with contrast dye CPT 77049 Mri Breast Wo&W Contr,W/Cad,Bi | $2,073.00 | $3,455.00 | — | 14% above | 40% |
| MRI of both breasts, without and then with contrast dye inpatient CPT 77049 Mri Breast Wo&W Contr,W/Cad,Bi | $2,073.00 | $3,455.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mri Right Knee W/O Con | $2,344.20 | $3,907.00 | — | 74% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mri Left Ankle W/O Con | $2,344.20 | $3,907.00 | — | 74% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mri Left Hip W/O Con | $2,344.20 | $3,907.00 | — | 74% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mri Left Knee W/O Con | $2,344.20 | $3,907.00 | — | 74% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mr Rt Foot Joint Wo Cont | $2,344.20 | $3,907.00 | — | 74% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mr Rt Toe Joint Wo Cont | $2,344.20 | $3,907.00 | — | 74% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mr Lt Toe Joint Wo Cont | $2,344.20 | $3,907.00 | — | 74% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mr Lt Foot Joint Wo Cont | $2,344.20 | $3,907.00 | — | 74% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mri Heel Rt Wo/Cont | $2,344.20 | $3,907.00 | — | 74% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mri Heel Lt Wo/Cont | $2,344.20 | $3,907.00 | — | 74% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mri Right Hip W/O Con | $2,344.20 | $3,907.00 | — | 74% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mri Right Ankle W/O Con | $2,344.20 | $3,907.00 | — | 74% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mri Right Knee W/O Con | $2,344.20 | $3,907.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mri Right Hip W/O Con | $2,344.20 | $3,907.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mri Right Ankle W/O Con | $2,344.20 | $3,907.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mri Heel Lt Wo/Cont | $2,344.20 | $3,907.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mri Heel Rt Wo/Cont | $2,344.20 | $3,907.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mr Lt Foot Joint Wo Cont | $2,344.20 | $3,907.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mr Lt Toe Joint Wo Cont | $2,344.20 | $3,907.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mr Rt Toe Joint Wo Cont | $2,344.20 | $3,907.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mr Rt Foot Joint Wo Cont | $2,344.20 | $3,907.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mri Left Knee W/O Con | $2,344.20 | $3,907.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mri Left Hip W/O Con | $2,344.20 | $3,907.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mri Left Ankle W/O Con | $2,344.20 | $3,907.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mr Rt Foot Joint W Wo Cont | $2,672.40 | $4,454.00 | — | 49% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Left Knee W/Wo Con | $2,672.40 | $4,454.00 | — | 49% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mr Lt Foot Joint W Wo Cont | $2,672.40 | $4,454.00 | — | 49% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Left Hip W/Wo Con | $2,672.40 | $4,454.00 | — | 49% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mr Lt Toe Joint W Wo Cont | $2,672.40 | $4,454.00 | — | 49% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Left Ankle W/Wo Con | $2,672.40 | $4,454.00 | — | 49% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Heel Rt W/O&W/Cont | $2,672.40 | $4,454.00 | — | 49% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Right Knee W/Wo Con | $2,672.40 | $4,454.00 | — | 49% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mr Rt Toe Joint W Wo Cont | $2,672.40 | $4,454.00 | — | 49% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Right Hip W/Wo Con | $2,672.40 | $4,454.00 | — | 49% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Heel Lt W/O&W/Cont | $2,672.40 | $4,454.00 | — | 49% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Right Ankle W/Wo Con | $2,672.40 | $4,454.00 | — | 49% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mri Left Hip W/Wo Con | $2,672.40 | $4,454.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mr Lt Toe Joint W Wo Cont | $2,672.40 | $4,454.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mr Rt Foot Joint W Wo Cont | $2,672.40 | $4,454.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mr Rt Toe Joint W Wo Cont | $2,672.40 | $4,454.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mr Lt Foot Joint W Wo Cont | $2,672.40 | $4,454.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mri Heel Rt W/O&W/Cont | $2,672.40 | $4,454.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mri Heel Lt W/O&W/Cont | $2,672.40 | $4,454.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mri Left Knee W/Wo Con | $2,672.40 | $4,454.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mri Left Ankle W/Wo Con | $2,672.40 | $4,454.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mri Right Knee W/Wo Con | $2,672.40 | $4,454.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mri Right Hip W/Wo Con | $2,672.40 | $4,454.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mri Right Ankle W/Wo Con | $2,672.40 | $4,454.00 | — | — | 40% |
| MRI of the abdomen without contrast CPT 74181 Mri Liver W/O Contrast Pro | $2,050.80 | $3,418.00 | — | 75% above | 40% |
| MRI of the abdomen without contrast CPT 74181 Mri Abdomen Wo/Contrast Pro | $2,050.80 | $3,418.00 | — | 75% above | 40% |
| MRI of the abdomen without contrast CPT 74181 Mri Adrenals W/O Contrast | $2,050.80 | $3,418.00 | — | 75% above | 40% |
| MRI of the abdomen without contrast CPT 74181 Mri Pancreas Pro | $2,050.80 | $3,418.00 | — | 75% above | 40% |
| MRI of the abdomen without contrast CPT 74181 Mri Liver W/O Contrast | $2,050.80 | $3,418.00 | — | 75% above | 40% |
| MRI of the abdomen without contrast CPT 74181 Mri Renal Pro | $2,050.80 | $3,418.00 | — | 75% above | 40% |
| MRI of the abdomen without contrast CPT 74181 Mri Cholangiopancreatiography | $2,050.80 | $3,418.00 | — | 75% above | 40% |
| MRI of the abdomen without contrast inpatient CPT 74181 Mri Abdomen Wo/Contrast Pro | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the abdomen without contrast inpatient CPT 74181 Mri Liver W/O Contrast Pro | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the abdomen without contrast inpatient CPT 74181 Mri Cholangiopancreatiography | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the abdomen without contrast inpatient CPT 74181 Mri Adrenals W/O Contrast | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the abdomen without contrast inpatient CPT 74181 Mri Liver W/O Contrast | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the abdomen without contrast inpatient CPT 74181 Mri Pancreas Pro | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the abdomen without contrast inpatient CPT 74181 Mri Renal Pro | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Abdomen W/Wo Contrast Pro | $2,955.00 | $4,925.00 | — | 54% above | 40% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Liver W/O & W/ Contrast | $2,955.00 | $4,925.00 | — | 54% above | 40% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Adrenals W&W/O Contrast | $2,955.00 | $4,925.00 | — | 54% above | 40% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Renal W/Wo | $2,955.00 | $4,925.00 | — | 54% above | 40% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Pancreas W/Wo | $2,955.00 | $4,925.00 | — | 54% above | 40% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Mri Pancreas W/Wo | $2,955.00 | $4,925.00 | — | — | 40% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Mri Liver W/O & W/ Contrast | $2,955.00 | $4,925.00 | — | — | 40% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Mri Renal W/Wo | $2,955.00 | $4,925.00 | — | — | 40% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Mri Adrenals W&W/O Contrast | $2,955.00 | $4,925.00 | — | — | 40% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Mri Abdomen W/Wo Contrast Pro | $2,955.00 | $4,925.00 | — | — | 40% |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain W/O Contr W/Addl Seq | $2,379.60 | $3,966.00 | — | 91% above | 40% |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain Wo/Contrast | $2,379.60 | $3,966.00 | — | 91% above | 40% |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain & Iac W/O Cont | $2,379.60 | $3,966.00 | — | 91% above | 40% |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain & Pituitary W/O Cont | $2,379.60 | $3,966.00 | — | 91% above | 40% |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain W/O For Trigeminals | $2,379.60 | $3,966.00 | — | 91% above | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain W/O For Trigeminals | $2,379.60 | $3,966.00 | — | — | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain W/O Contr W/Addl Seq | $2,379.60 | $3,966.00 | — | — | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain & Iac W/O Cont | $2,379.60 | $3,966.00 | — | — | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain & Pituitary W/O Cont | $2,379.60 | $3,966.00 | — | — | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain Wo/Contrast | $2,379.60 | $3,966.00 | — | — | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Brain & Iac W&W/O Cont | $2,855.40 | $4,759.00 | — | 92% above | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Brain W/Wo Cont & Add Seq | $2,855.40 | $4,759.00 | — | 92% above | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Brain W & W/O Contrast Pro | $2,855.40 | $4,759.00 | — | 92% above | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Iac's W/Wo | $2,855.40 | $4,759.00 | — | 92% above | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Pitutary W/Wo | $2,855.40 | $4,759.00 | — | 92% above | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Brain W/Wo For Trigeminals | $2,855.40 | $4,759.00 | — | 92% above | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Brain & Pituitary W/Wo Con | $2,855.40 | $4,759.00 | — | 92% above | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Brain W/Wo-Red Svs-Stealth | $2,855.40 | $4,759.00 | — | 92% above | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Brain & Pituitary W/Wo Con | $2,855.40 | $4,759.00 | — | — | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Brain W/Wo For Trigeminals | $2,855.40 | $4,759.00 | — | — | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Iac's W/Wo | $2,855.40 | $4,759.00 | — | — | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Pitutary W/Wo | $2,855.40 | $4,759.00 | — | — | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Brain W/Wo-Red Svs-Stealth | $2,855.40 | $4,759.00 | — | — | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Brain W & W/O Contrast Pro | $2,855.40 | $4,759.00 | — | — | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Brain W/Wo Cont & Add Seq | $2,855.40 | $4,759.00 | — | — | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Brain & Iac W&W/O Cont | $2,855.40 | $4,759.00 | — | — | 40% |
| MRI of the lower back, no contrast dye CPT 72148 Mri Spine Lumbar W/O Cont | $2,347.20 | $3,912.00 | — | 86% above | 40% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 Mri Spine Lumbar W/O Cont | $2,347.20 | $3,912.00 | — | — | 40% |
| MRI of the lower back, without and then with contrast dye CPT 72158 Mri Spine Lumbar W & W/O Contr | $3,725.40 | $6,209.00 | — | 130% above | 40% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 Mri Spine Lumbar W & W/O Contr | $3,725.40 | $6,209.00 | — | — | 40% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri Spine Thoracic W/O Cont | $2,347.20 | $3,912.00 | — | 109% above | 40% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 Mri Spine Thoracic W/O Cont | $2,347.20 | $3,912.00 | — | — | 40% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri Spine Cervical W & W/O Con | $3,345.60 | $5,576.00 | — | 104% above | 40% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 Mri Spine Cervical W & W/O Con | $3,345.60 | $5,576.00 | — | — | 40% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri Spine Cervical W/O Cont | $2,411.40 | $4,019.00 | — | 103% above | 40% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 Mri Spine Cervical W/O Cont | $2,411.40 | $4,019.00 | — | — | 40% |
| MRI of the pelvis without and with contrast CPT 72197 Mri Si Joints W&Wo Contrast | $2,891.40 | $4,819.00 | — | 79% above | 40% |
| MRI of the pelvis without and with contrast CPT 72197 Mri Sacrum/Coccyx Wo/W &Ad Seq | $2,891.40 | $4,819.00 | — | 79% above | 40% |
| MRI of the pelvis without and with contrast CPT 72197 Mri Pelvis W/Wo Contrast Pro | $2,891.40 | $4,819.00 | — | 79% above | 40% |
| MRI of the pelvis without and with contrast CPT 72197 Mri Lumbosacral Plexus W/O&W | $2,891.40 | $4,819.00 | — | 79% above | 40% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 Mri Pelvis W/Wo Contrast Pro | $2,891.40 | $4,819.00 | — | — | 40% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 Mri Lumbosacral Plexus W/O&W | $2,891.40 | $4,819.00 | — | — | 40% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 Mri Sacrum/Coccyx Wo/W &Ad Seq | $2,891.40 | $4,819.00 | — | — | 40% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 Mri Si Joints W&Wo Contrast | $2,891.40 | $4,819.00 | — | — | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 Mri Si Joints W/O Contrast | $872.48 | $1,454.14 | — | 15% below | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 Mri Pelvis Wo/Contrast Pro | $872.48 | $1,454.14 | — | 15% below | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 Mri Sacrum/Coccyx Wo Contrast | $872.48 | $1,454.14 | — | 15% below | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 Mri Prostate Tx Planning | $872.48 | $1,454.14 | — | 15% below | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 Mri Pelvis Wo Bony (Bone Prot) | $2,356.80 | $3,928.00 | — | 129% above | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 Mri Lumbosacral Plexus Wo/Cont | $2,356.80 | $3,928.00 | — | 129% above | 40% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 Mri Pelvis Wo/Contrast Pro | $872.48 | $1,454.14 | — | — | 40% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 Mri Si Joints W/O Contrast | $872.48 | $1,454.14 | — | — | 40% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 Mri Prostate Tx Planning | $872.48 | $1,454.14 | — | — | 40% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 Mri Sacrum/Coccyx Wo Contrast | $872.48 | $1,454.14 | — | — | 40% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 Mri Lumbosacral Plexus Wo/Cont | $2,356.80 | $3,928.00 | — | — | 40% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 Mri Pelvis Wo Bony (Bone Prot) | $2,356.80 | $3,928.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Left Shoulder W/O Con | $2,050.80 | $3,418.00 | — | 45% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Right Elbow W/O Con | $2,050.80 | $3,418.00 | — | 45% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Left Wrist W/O Con | $2,050.80 | $3,418.00 | — | 45% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Right Shoulder W/O Con | $2,050.80 | $3,418.00 | — | 45% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mr Rt Finger Joint Wo Cont | $2,050.80 | $3,418.00 | — | 45% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mr Lt Finger Joint Wo Cont | $2,050.80 | $3,418.00 | — | 45% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Right Wrist W/O Con | $2,050.80 | $3,418.00 | — | 45% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mr Rt Hand Joint Wo Cont | $2,050.80 | $3,418.00 | — | 45% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mr Lt Hand Joint Wo Cont | $2,050.80 | $3,418.00 | — | 45% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Left Elbow W/O Con | $2,050.80 | $3,418.00 | — | 45% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mri Left Wrist W/O Con | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mr Rt Hand Joint Wo Cont | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mri Left Shoulder W/O Con | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mri Right Wrist W/O Con | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mri Right Elbow W/O Con | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mri Right Shoulder W/O Con | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mr Lt Hand Joint Wo Cont | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mri Left Elbow W/O Con | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mr Rt Finger Joint Wo Cont | $2,050.80 | $3,418.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mr Lt Finger Joint Wo Cont | $2,050.80 | $3,418.00 | — | — | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Spine Cervical (Routine 5 V) | $465.60 | $776.00 | — | 69% above | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Spine Cervical 2V & Flex/Ext | $465.60 | $776.00 | — | 69% above | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 Spine Cervical 2V & Flex/Ext | $465.60 | $776.00 | — | — | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 Spine Cervical (Routine 5 V) | $465.60 | $776.00 | — | — | 40% |
| Neck soft tissue CT scan with contrast CPT 70491 Ct Neck Soft Tissue W/Contrast | $2,430.60 | $4,051.00 | — | 122% above | 40% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 Ct Neck Soft Tissue W/Contrast | $2,430.60 | $4,051.00 | — | — | 40% |
| Neck soft tissue CT scan without contrast CPT 70490 Ct Neck Soft Tissue W/O Contra | $2,192.40 | $3,654.00 | — | 158% above | 40% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 Ct Neck Soft Tissue W/O Contra | $2,192.40 | $3,654.00 | — | — | 40% |
| Neck soft tissue X-ray CPT 70360 Neck Soft Tissue (1V) | $321.00 | $535.00 | — | 99% above | 40% |
| Neck soft tissue X-ray CPT 70360 Neck Soft Tissue (2 Views) | $321.00 | $535.00 | — | 99% above | 40% |
| Neck soft tissue X-ray inpatient CPT 70360 Neck Soft Tissue (2 Views) | $321.00 | $535.00 | — | — | 40% |
| Neck soft tissue X-ray inpatient CPT 70360 Neck Soft Tissue (1V) | $321.00 | $535.00 | — | — | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nm Myocardial Viability Scan | $3,319.20 | $5,532.00 | — | 24% above | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nm Myocard Perf (Spect) Comp-M | $3,319.20 | $5,532.00 | — | 24% above | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Nm Myocardial Viability Scan | $3,319.20 | $5,532.00 | — | — | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Nm Myocard Perf (Spect) Comp-M | $3,319.20 | $5,532.00 | — | — | 40% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet/Ct Skull Base To Mid-Thigh | $4,470.00 | $7,450.00 | — | 12% above | 40% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet Image W/Ct Skull To Thigh | $4,470.00 | $7,450.00 | — | 12% above | 40% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet/Ct Netspot | $4,470.00 | $7,450.00 | — | 12% above | 40% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Pet/Ct Netspot | $4,470.00 | $7,450.00 | — | — | 40% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Pet Image W/Ct Skull To Thigh | $4,470.00 | $7,450.00 | — | — | 40% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Pet/Ct Skull Base To Mid-Thigh | $4,470.00 | $7,450.00 | — | — | 40% |
| Pelvic CT scan without contrast CPT 72192 Ct Pelvis W/O Oral Contr Only | $2,092.20 | $3,487.00 | — | 116% above | 40% |
| Pelvic CT scan without contrast CPT 72192 Ct Pelvis, W/O, Mazor Protocol | $2,092.20 | $3,487.00 | — | 116% above | 40% |
| Pelvic CT scan without contrast CPT 72192 Ct Sacrum W/O Contrast | $2,092.20 | $3,487.00 | — | 116% above | 40% |
| Pelvic CT scan without contrast CPT 72192 Ct Pelvis W/O Contrast | $2,092.20 | $3,487.00 | — | 116% above | 40% |
| Pelvic CT scan without contrast CPT 72192 Ct Sacrum, W/O, Mazor Protocol | $2,092.20 | $3,487.00 | — | 116% above | 40% |
| Pelvic CT scan without contrast inpatient CPT 72192 Ct Pelvis W/O Oral Contr Only | $2,092.20 | $3,487.00 | — | — | 40% |
| Pelvic CT scan without contrast inpatient CPT 72192 Ct Sacrum W/O Contrast | $2,092.20 | $3,487.00 | — | — | 40% |
| Pelvic CT scan without contrast inpatient CPT 72192 Ct Pelvis, W/O, Mazor Protocol | $2,092.20 | $3,487.00 | — | — | 40% |
| Pelvic CT scan without contrast inpatient CPT 72192 Ct Sacrum, W/O, Mazor Protocol | $2,092.20 | $3,487.00 | — | — | 40% |
| Pelvic CT scan without contrast inpatient CPT 72192 Ct Pelvis W/O Contrast | $2,092.20 | $3,487.00 | — | — | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Soft Tissue Pelvis Limited | $436.80 | $728.00 | — | 45% above | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us Pelvic,Non Ob,Ltd,Follow Up | $436.80 | $728.00 | — | 45% above | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us Pelvis, Ltd | $436.80 | $728.00 | — | 45% above | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Soft Tissue Pelvis Limited | $436.80 | $728.00 | — | — | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Us Pelvis, Ltd | $436.80 | $728.00 | — | — | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Us Pelvic,Non Ob,Ltd,Follow Up | $436.80 | $728.00 | — | — | 40% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us Pelvic Complete | $924.00 | $1,540.00 | — | 89% above | 40% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Us Pelvic Complete | $924.00 | $1,540.00 | — | — | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Us Ob >/= 14 Wks Sngl Fetus | $596.40 | $994.00 | — | 29% above | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Us Ob >/= 14 Wks Sngl Fetus | $596.40 | $994.00 | — | — | 40% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Us Ob <14 Wks Single Fetus | $739.20 | $1,232.00 | — | 92% above | 40% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Us Ob <14 Wks Single Fetus | $739.20 | $1,232.00 | — | — | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Preg Ltd Trip | $597.00 | $995.00 | — | 78% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Ultrasound Ltd | $597.00 | $995.00 | — | 78% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Preg Ltd Single | $597.00 | $995.00 | — | 78% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ed Bedside Transabdominl Ob | $597.00 | $995.00 | — | 78% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Preg Ltd Twins | $597.00 | $995.00 | — | 78% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Us Preg Ltd Twins | $597.00 | $995.00 | — | — | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Us Ob Ultrasound Ltd | $597.00 | $995.00 | — | — | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Us Preg Ltd Single | $597.00 | $995.00 | — | — | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Us Ed Bedside Transabdominl Ob | $597.00 | $995.00 | — | — | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Us Preg Ltd Trip | $597.00 | $995.00 | — | — | 40% |
| Rib X-ray, one side, 2 views CPT 71100 Ribs Unil (2V) | $418.80 | $698.00 | — | 110% above | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 Ribs Rt Unilat 2 Views | $418.80 | $698.00 | — | 110% above | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 Ribs Lt Unilateral 2V | $418.80 | $698.00 | — | 110% above | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 Ribs Rt Unilateral 2V | $418.80 | $698.00 | — | 110% above | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 Ribs Lt Unilat 2 Views | $418.80 | $698.00 | — | 110% above | 40% |
| Rib X-ray, one side, 2 views inpatient CPT 71100 Ribs Unil (2V) | $418.80 | $698.00 | — | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 Ribs Rt Unilat 2 Views | $418.80 | $698.00 | — | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 Ribs Lt Unilat 2 Views | $418.80 | $698.00 | — | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 Ribs Rt Unilateral 2V | $418.80 | $698.00 | — | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 Ribs Lt Unilateral 2V | $418.80 | $698.00 | — | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Ribs Unilateral Include Pac Xr | $445.80 | $743.00 | — | 83% above | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Ribs Lt Unilat & Pa Cxr | $445.80 | $743.00 | — | 83% above | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Ribs Rt Unilat & Pa Cxr | $445.80 | $743.00 | — | 83% above | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Ribs Unilateral Include Pac Xr | $445.80 | $743.00 | — | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Ribs Rt Unilat & Pa Cxr | $445.80 | $743.00 | — | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Ribs Lt Unilat & Pa Cxr | $445.80 | $743.00 | — | — | 40% |
| Screening mammogram, both breasts both sides CPT 77067 Pw-Augmnted Screening Mammo-Bi | $75.60 | $126.00 | — | — | 40% |
| Screening mammogram, both breasts CPT 77067 Tc-Screening Mammo-Bil | $71.84 | $119.73 | — | 60% below | 40% |
| Screening mammogram, both breasts CPT 77067 Pw-Digital Screening Mammo | $75.60 | $126.00 | — | 58% below | 40% |
| Screening mammogram, both breasts CPT 77067 Mammo Augmnted Digital Scrning | $250.20 | $417.00 | — | 38% above | 40% |
| Screening mammogram, both breasts CPT 77067 Mammogram Digital Screening | $250.20 | $417.00 | — | 38% above | 40% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 Pw-Augmnted Screening Mammo-Bi | $75.60 | $126.00 | — | — | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 Tc-Screening Mammo-Bil | $71.84 | $119.73 | — | — | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 Pw-Digital Screening Mammo | $75.60 | $126.00 | — | — | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 Mammogram Digital Screening | $250.20 | $417.00 | — | — | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 Mammo Augmnted Digital Scrning | $250.20 | $417.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Right Shoulder 3 View | $381.60 | $636.00 | — | 97% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Left Shoulder 3 View | $427.20 | $712.00 | — | 121% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Surg Left Shoulder 2 View | $427.20 | $712.00 | — | 121% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Left Shoulder 2 View | $427.20 | $712.00 | — | 121% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Right Shoulder 2 View | $427.20 | $712.00 | — | 121% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Surg Right Shoulder 2 View | $427.20 | $712.00 | — | 121% above | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Right Shoulder 3 View | $381.60 | $636.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Left Shoulder 3 View | $427.20 | $712.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Surg Right Shoulder 2 View | $427.20 | $712.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Surg Left Shoulder 2 View | $427.20 | $712.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Right Shoulder 2 View | $427.20 | $712.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Left Shoulder 2 View | $427.20 | $712.00 | — | — | 40% |
| Sinus X-ray, complete, 3 or more views CPT 70220 Sinuses Paranasal Min 3 Vw | $466.20 | $777.00 | — | 126% above | 40% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Sinuses Paranasal Min 3 Vw | $466.20 | $777.00 | — | — | 40% |
| Skull X-ray, fewer than 4 views CPT 70250 Surgery Iv Skull | $319.20 | $532.00 | — | 55% above | 40% |
| Skull X-ray, fewer than 4 views CPT 70250 Skull (Less Than 4 Views) | $319.20 | $532.00 | — | 55% above | 40% |
| Skull X-ray, fewer than 4 views CPT 70250 Skull 1 View Pro | $319.20 | $532.00 | — | 55% above | 40% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 Skull 1 View Pro | $319.20 | $532.00 | — | — | 40% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 Surgery Iv Skull | $319.20 | $532.00 | — | — | 40% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 Skull (Less Than 4 Views) | $319.20 | $532.00 | — | — | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnography Study 4 Or Mor | $4,098.00 | $6,830.00 | — | 48% above | 40% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnography Study 4 Or Mor | $4,098.00 | $6,830.00 | — | — | 40% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Stress Echo Test W/ Contin Ecg | $1,619.40 | $2,699.00 | — | 38% above | 40% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Stress Echo Test W/ Contin Ecg | $1,619.40 | $2,699.00 | — | — | 40% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 Pediatric Dysphagiagram | $639.00 | $1,065.00 | — | 95% above | 40% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 Dysphagiagram,Sngl Cntr-Barium | $639.00 | $1,065.00 | — | 95% above | 40% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Dysphagiagram,Sngl Cntr-Barium | $639.00 | $1,065.00 | — | — | 40% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Pediatric Dysphagiagram | $639.00 | $1,065.00 | — | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 X-Ray Left Femur Min 2 Views | $429.60 | $716.00 | — | 123% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 X-Ray Right Femur Min 2 Views | $429.60 | $716.00 | — | 123% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Surg Left Femur Min 2 Views | $429.60 | $716.00 | — | 123% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Surg Right Femur Min 2 Views | $429.60 | $716.00 | — | 123% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 X-Ray Left Femur Min 2 Views | $429.60 | $716.00 | — | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Surg Left Femur Min 2 Views | $429.60 | $716.00 | — | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 X-Ray Right Femur Min 2 Views | $429.60 | $716.00 | — | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Surg Right Femur Min 2 Views | $429.60 | $716.00 | — | — | 40% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 Ct Mazor Prot Thor Spine W/O | $2,029.20 | $3,382.00 | — | 100% above | 40% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 Ct Thoracic Spine W/O Contrast | $2,029.20 | $3,382.00 | — | 100% above | 40% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 Ct Thoracic Spine W/O Contrast | $2,029.20 | $3,382.00 | — | — | 40% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 Ct Mazor Prot Thor Spine W/O | $2,029.20 | $3,382.00 | — | — | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 X-Ray Toe 2 Views Right | $267.60 | $446.00 | — | 64% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 X-Ray Toe 3 Views Routine Left | $267.60 | $446.00 | — | 64% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 Surg Right Toes 2 View | $267.60 | $446.00 | — | 64% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 X-Ray Toe 2 Views Left | $267.60 | $446.00 | — | 64% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 X-Ray Toe 3Views Routine Right | $267.60 | $446.00 | — | 64% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 Surg Left Toes 2 View | $267.60 | $446.00 | — | 64% above | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 X-Ray Toe 3Views Routine Right | $267.60 | $446.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 X-Ray Toe 3 Views Routine Left | $267.60 | $446.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 Surg Right Toes 2 View | $267.60 | $446.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 Surg Left Toes 2 View | $267.60 | $446.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 X-Ray Toe 2 Views Right | $267.60 | $446.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 X-Ray Toe 2 Views Left | $267.60 | $446.00 | — | — | 40% |
| Transvaginal pelvic ultrasound CPT 76830 Us Transvaginal Exam | $721.80 | $1,203.00 | — | 73% above | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Us Transvaginal Exam | $721.80 | $1,203.00 | — | — | 40% |
| Transvaginal ultrasound during pregnancy CPT 76817 Us Pregnancy Transvaginal | $662.40 | $1,104.00 | — | 107% above | 40% |
| Transvaginal ultrasound during pregnancy CPT 76817 Us Ed Bedside Transvaginal Ob | $662.40 | $1,104.00 | — | 107% above | 40% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 Us Pregnancy Transvaginal | $662.40 | $1,104.00 | — | — | 40% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 Us Ed Bedside Transvaginal Ob | $662.40 | $1,104.00 | — | — | 40% |
| Ultrasound of the abdomen, complete CPT 76700 Us Abdomen Complete | $963.00 | $1,605.00 | — | 83% above | 40% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Us Abdomen Complete | $963.00 | $1,605.00 | — | — | 40% |
| Ultrasound of the scrotum and testicles CPT 76870 Us Scrotum | $880.20 | $1,467.00 | — | 148% above | 40% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 Us Scrotum | $880.20 | $1,467.00 | — | — | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Soft Tissue Head & Neck,Ltd | $657.00 | $1,095.00 | — | 61% above | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Lymph Node Survey | $657.00 | $1,095.00 | — | 61% above | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Thyroid | $657.00 | $1,095.00 | — | 61% above | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Parathyroid Ultrasound | $657.00 | $1,095.00 | — | 61% above | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Ed Bedside Soft Tissue Neck | $657.00 | $1,095.00 | — | 61% above | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Soft Tissue Head & Neck | $657.00 | $1,095.00 | — | 61% above | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Us Ed Bedside Soft Tissue Neck | $657.00 | $1,095.00 | — | — | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Us Thyroid | $657.00 | $1,095.00 | — | — | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Us Soft Tissue Head & Neck | $657.00 | $1,095.00 | — | — | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Us Parathyroid Ultrasound | $657.00 | $1,095.00 | — | — | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Us Soft Tissue Head & Neck,Ltd | $657.00 | $1,095.00 | — | — | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Us Lymph Node Survey | $657.00 | $1,095.00 | — | — | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Ugi, Single Contrast | $792.00 | $1,320.00 | — | 108% above | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Ugi,Single Contr,Water Soluble | $792.00 | $1,320.00 | — | 108% above | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Ugi,Single Contr,Water Soluble | $792.00 | $1,320.00 | — | — | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Ugi, Single Contrast | $792.00 | $1,320.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 Surg Right Humerus 2 View | $307.20 | $512.00 | — | 76% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 Surg Left Humerus 2 View | $307.20 | $512.00 | — | 76% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 Right Humerus 2 View | $307.20 | $512.00 | — | 76% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 Left Humerus 2 View | $307.20 | $512.00 | — | 76% above | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Surg Right Humerus 2 View | $307.20 | $512.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Surg Left Humerus 2 View | $307.20 | $512.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Left Humerus 2 View | $307.20 | $512.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Right Humerus 2 View | $307.20 | $512.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Us Dplx Ext Venous Unil Or Ltd | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Us Ed Bedside Dvt | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Duplex Venous Lower Extr Lt | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Rad Us Dplx Venous Uppr Ext Lt | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Rad Us Dplx Venous Uppr Ext Rt | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Duplx Ext Venous Uni/Ltd Lt | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Vein Mapping-Unilat/Lmtd Study | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Duplex Venous Upper Extr Lt | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Duplx Ext Venous Uni/Ltd Rt | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Duplex Venous Upper Extr Rt | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Duplex Venous Lower Extr Rt | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Rad Us Dplx Venous Lowr Ext Lt | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Rad Us Dplx Venous Lowr Ext Rt | $783.60 | $1,306.00 | — | 70% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Us Ed Bedside Dvt | $783.60 | $1,306.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Us Dplx Ext Venous Unil Or Ltd | $783.60 | $1,306.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Us Duplex Venous Upper Extr Rt | $783.60 | $1,306.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Us Duplx Ext Venous Uni/Ltd Lt | $783.60 | $1,306.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Us Duplx Ext Venous Uni/Ltd Rt | $783.60 | $1,306.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Rad Us Dplx Venous Lowr Ext Lt | $783.60 | $1,306.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Rad Us Dplx Venous Lowr Ext Rt | $783.60 | $1,306.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Rad Us Dplx Venous Uppr Ext Lt | $783.60 | $1,306.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Rad Us Dplx Venous Uppr Ext Rt | $783.60 | $1,306.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Vein Mapping-Unilat/Lmtd Study | $783.60 | $1,306.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Us Duplex Venous Lower Extr Lt | $783.60 | $1,306.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Us Duplex Venous Lower Extr Rt | $783.60 | $1,306.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Us Duplex Venous Upper Extr Lt | $783.60 | $1,306.00 | — | — | 40% |
| Wrist X-ray, 2 views one side CPT 73100 Right Wrist 2 View | $334.20 | $557.00 | — | 104% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 Surg Right Wrist 2 View | $334.20 | $557.00 | — | 104% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 Surg Left Wrist 2 View | $334.20 | $557.00 | — | 104% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 Left Wrist 2 View | $334.20 | $557.00 | — | 104% above | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 Right Wrist 2 View | $334.20 | $557.00 | — | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 Surg Right Wrist 2 View | $334.20 | $557.00 | — | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 Surg Left Wrist 2 View | $334.20 | $557.00 | — | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 Left Wrist 2 View | $334.20 | $557.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Left Wrist W/Navicular 4 View | $366.00 | $610.00 | — | 104% above | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Right Wrist 3 View | $366.00 | $610.00 | — | 104% above | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Right Wrist W/Navicular 4 View | $366.00 | $610.00 | — | 104% above | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Left Wrist 3 View | $366.00 | $610.00 | — | 104% above | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Right Wrist W/Navicular 4 View | $366.00 | $610.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Left Wrist W/Navicular 4 View | $366.00 | $610.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Right Wrist 3 View | $366.00 | $610.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Left Wrist 3 View | $366.00 | $610.00 | — | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-Ray Left Hip 2-3 Views | $332.40 | $554.00 | — | 75% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Surgery Lt Hip 2-3 Views | $332.40 | $554.00 | — | 75% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-Ray Right Hip 2-3 Views | $332.40 | $554.00 | — | 75% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Surgery Rt Hip 2-3 Views | $332.40 | $554.00 | — | 75% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Surgery Rt Hip 2-3 Views | $332.40 | $554.00 | — | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 X-Ray Left Hip 2-3 Views | $332.40 | $554.00 | — | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Surgery Lt Hip 2-3 Views | $332.40 | $554.00 | — | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 X-Ray Right Hip 2-3 Views | $332.40 | $554.00 | — | — | 40% |
| X-ray of the abdomen, 1 view CPT 74018 Chest/Abd Port Tube Plcmnt Pro | $263.40 | $439.00 | — | 51% above | 40% |
| X-ray of the abdomen, 1 view CPT 74018 Abdomen Portable (1 View) | $263.40 | $439.00 | — | 51% above | 40% |
| X-ray of the abdomen, 1 view CPT 74018 Surgery Abdomen (1 View) | $263.40 | $439.00 | — | 51% above | 40% |
| X-ray of the abdomen, 1 view CPT 74018 Fetogram Ap | $263.40 | $439.00 | — | 51% above | 40% |
| X-ray of the abdomen, 1 view CPT 74018 Surgery Stimulator | $263.40 | $439.00 | — | 51% above | 40% |
| X-ray of the abdomen, 1 view CPT 74018 Abdomen (1 View) | $263.40 | $439.00 | — | 51% above | 40% |
| X-ray of the abdomen, 1 view CPT 74018 Kub | $263.40 | $439.00 | — | 51% above | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 Kub | $263.40 | $439.00 | — | — | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 Abdomen (1 View) | $263.40 | $439.00 | — | — | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 Chest/Abd Port Tube Plcmnt Pro | $263.40 | $439.00 | — | — | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 Fetogram Ap | $263.40 | $439.00 | — | — | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 Abdomen Portable (1 View) | $263.40 | $439.00 | — | — | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 Surgery Abdomen (1 View) | $263.40 | $439.00 | — | — | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 Surgery Stimulator | $263.40 | $439.00 | — | — | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 Xr Left Ankle 2 View | $296.40 | $494.00 | — | 66% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 Xr Right Ankle 2 View | $296.40 | $494.00 | — | 66% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 Surg Right Ankle 2 View | $296.40 | $494.00 | — | 66% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 Surg Left Ankle 2 View | $296.40 | $494.00 | — | 66% above | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 Xr Right Ankle 2 View | $296.40 | $494.00 | — | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 Surg Left Ankle 2 View | $296.40 | $494.00 | — | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 Surg Right Ankle 2 View | $296.40 | $494.00 | — | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 Xr Left Ankle 2 View | $296.40 | $494.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Surg Left Finger 2 View | $292.80 | $488.00 | — | 80% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Surg Right Finger 2 View | $292.80 | $488.00 | — | 80% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Left Finger 2 Or More Views | $292.80 | $488.00 | — | 80% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Left Finger 3 View | $292.80 | $488.00 | — | 80% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Right Finger 3 View | $292.80 | $488.00 | — | 80% above | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Surg Right Finger 2 View | $292.80 | $488.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Left Finger 2 Or More Views | $292.80 | $488.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Left Finger 3 View | $292.80 | $488.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Right Finger 3 View | $292.80 | $488.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Surg Left Finger 2 View | $292.80 | $488.00 | — | — | 40% |
| X-ray of the foot, 2 views one side CPT 73620 Xr Left Foot 2 View | $324.00 | $540.00 | — | 85% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 Surg Left Foot 2 View | $324.00 | $540.00 | — | 85% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 Surg Right Foot 2 View | $324.00 | $540.00 | — | 85% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 Xr Right Foot 2 View | $324.00 | $540.00 | — | 85% above | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 Surg Left Foot 2 View | $324.00 | $540.00 | — | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 Surg Right Foot 2 View | $324.00 | $540.00 | — | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 Xr Left Foot 2 View | $324.00 | $540.00 | — | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 Xr Right Foot 2 View | $324.00 | $540.00 | — | — | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Right Foot 3 View | $471.60 | $786.00 | — | 139% above | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Left Foot 3 View | $471.60 | $786.00 | — | 139% above | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Xr Left Foot 3 View | $471.60 | $786.00 | — | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Xr Right Foot 3 View | $471.60 | $786.00 | — | — | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 Right Hand 3 View | $331.80 | $553.00 | — | 68% above | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 Left Hand 3 View | $331.80 | $553.00 | — | 68% above | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 Left Hand 3 View | $331.80 | $553.00 | — | — | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 Right Hand 3 View | $331.80 | $553.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Right Knee 2 View | $328.20 | $547.00 | — | 90% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Surg Right Knee 1-2 View | $328.20 | $547.00 | — | 90% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Surg Left Knee 1-2 View | $328.20 | $547.00 | — | 90% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Left Knee 2 View | $328.20 | $547.00 | — | 90% above | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Xr Left Knee 2 View | $328.20 | $547.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Xr Right Knee 2 View | $328.20 | $547.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Surg Left Knee 1-2 View | $328.20 | $547.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Surg Right Knee 1-2 View | $328.20 | $547.00 | — | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Spine Lumbar (2V) | $375.00 | $625.00 | — | 77% above | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Spine, Lumbar, Standing (2V) | $375.00 | $625.00 | — | 77% above | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Surgery Lumbar Kyphoplasty | $375.00 | $625.00 | — | 77% above | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Surg Lumbar (2V) | $375.00 | $625.00 | — | 77% above | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Selective Nerve Root Inj | $375.00 | $625.00 | — | 77% above | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Spine Lumbar (Routine 3 Views) | $375.00 | $625.00 | — | 77% above | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Surg Lumbar (2V) | $375.00 | $625.00 | — | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Surgery Lumbar Kyphoplasty | $375.00 | $625.00 | — | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Spine, Lumbar, Standing (2V) | $375.00 | $625.00 | — | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Spine Lumbar (2V) | $375.00 | $625.00 | — | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Spine Lumbar (Routine 3 Views) | $375.00 | $625.00 | — | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Selective Nerve Root Inj | $375.00 | $625.00 | — | — | 40% |
| X-ray of the lower back, 4 or more views CPT 72110 Spine Lumbar 2V & Flex/Ext | $535.20 | $892.00 | — | 71% above | 40% |
| X-ray of the lower back, 4 or more views CPT 72110 Spine Lumbar, 4V, Stand&Supine | $535.20 | $892.00 | — | 71% above | 40% |
| X-ray of the lower back, 4 or more views CPT 72110 Spine Lumbar W/Obliques | $535.20 | $892.00 | — | 71% above | 40% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Spine Lumbar, 4V, Stand&Supine | $535.20 | $892.00 | — | — | 40% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Spine Lumbar 2V & Flex/Ext | $535.20 | $892.00 | — | — | 40% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Spine Lumbar W/Obliques | $535.20 | $892.00 | — | — | 40% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 T Spine 2V | $309.60 | $516.00 | — | 47% above | 40% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 Surgery Thoracic Kyphoplasty | $309.60 | $516.00 | — | 47% above | 40% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 Surgery Thoracic Spine 2Fm | $309.60 | $516.00 | — | 47% above | 40% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 T Spine 2V | $309.60 | $516.00 | — | — | 40% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Surgery Thoracic Kyphoplasty | $309.60 | $516.00 | — | — | 40% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Surgery Thoracic Spine 2Fm | $309.60 | $516.00 | — | — | 40% |
| X-ray of the nasal bones, 3 or more views CPT 70160 Nasal Bones Complete Min 3Vw | $340.20 | $567.00 | — | 108% above | 40% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Nasal Bones Complete Min 3Vw | $340.20 | $567.00 | — | — | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Spine Cervical (2-3 Vw) | $372.00 | $620.00 | — | 82% above | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Surgery Cervical Spin (2-3 Fm) | $372.00 | $620.00 | — | 82% above | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Spine Cervical Flex/Ext(2-3Vw) | $372.00 | $620.00 | — | 82% above | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Surgery Cervical Spin (2-3 Fm) | $372.00 | $620.00 | — | — | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Spine Cervical (2-3 Vw) | $372.00 | $620.00 | — | — | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Spine Cervical Flex/Ext(2-3Vw) | $372.00 | $620.00 | — | — | 40% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 X-Ray Pelvis, 2 View | $302.40 | $504.00 | — | 57% above | 40% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 X-Ray Pelvis (1 View) Routine | $302.40 | $504.00 | — | 57% above | 40% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 Surgery Pelvis 1-2 View | $302.40 | $504.00 | — | 57% above | 40% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-Ray Pelvis (1 View) Routine | $302.40 | $504.00 | — | — | 40% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-Ray Pelvis, 2 View | $302.40 | $504.00 | — | — | 40% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Surgery Pelvis 1-2 View | $302.40 | $504.00 | — | — | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Surgery Sacrum | $354.00 | $590.00 | — | 99% above | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Sacrum And Coccyx | $354.00 | $590.00 | — | 99% above | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Surgery Sacrum | $354.00 | $590.00 | — | — | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Sacrum And Coccyx | $354.00 | $590.00 | — | — | 40% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Oklahoma | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 Acth Plasmatst | $124.80 | $208.00 | — | 4% below | 40% |
| ACTH blood test inpatient CPT 82024 Acth Plasmatst | $124.80 | $208.00 | — | — | 40% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase | $30.00 | $50.00 | — | 8% below | 40% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine Aminotransferase | $30.00 | $50.00 | — | — | 40% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate Amino Transferase | $25.20 | $42.00 | — | 33% below | 40% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Aspartate Amino Transferase | $25.20 | $42.00 | — | — | 40% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hep Acute Panel | $297.60 | $496.00 | — | 60% above | 40% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hep Acute Panel | $297.60 | $496.00 | — | — | 40% |
| Albumin blood test CPT 82040 Albumin | $38.40 | $64.00 | — | 23% above | 40% |
| Albumin blood test CPT 82040 Ms Profile Albumin, Serum R | $38.40 | $64.00 | — | 23% above | 40% |
| Albumin blood test inpatient CPT 82040 Ms Profile Albumin, Serum R | $38.40 | $64.00 | — | — | 40% |
| Albumin blood test inpatient CPT 82040 Albumin | $38.40 | $64.00 | — | — | 40% |
| Aldosterone blood test CPT 82088 Aldosterone, S R | $142.20 | $237.00 | — | 2% above | 40% |
| Aldosterone blood test inpatient CPT 82088 Aldosterone, S R | $142.20 | $237.00 | — | — | 40% |
| Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase | $30.00 | $50.00 | — | at median | 40% |
| Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphate R | $30.00 | $50.00 | — | at median | 40% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphate R | $30.00 | $50.00 | — | — | 40% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase | $30.00 | $50.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Peach, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Elm, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Scallop, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cat Epithelium, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Ragweed, Short, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Oak, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Coffee, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Yeast, S. Cerev, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Lemon, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Garlic, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cherry, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Horse Dander, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Brazil Nut Food, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Ragweed, Giant, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Wheat, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Hazelnut Food Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Curvularia, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Greer Lab, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Hollister, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Fescue, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Salmon, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Crab, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Chocolate, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Green Pea, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Potato, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Banana, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Tuna, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Turkey (Food), Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Casein, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Rice, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Pork, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Corn, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Milk, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Kentucky Blue Grass, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium Chryso, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Egg White, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Pecan Tree, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Mountain Juniper/Cedar T6,Iger | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium Mold, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Dog Epithelium, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Lobster, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Box Elder, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Soybean, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Beef, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Barley, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Lamb's Quarters, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 English Plantain, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Grass Rye, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Oyster Ige | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Sardine, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Walnut Food, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Peanut, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda Grass, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Russian Thistle, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Sycamore, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Grass, Johnson, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Pistachio, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Macadamia, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Almond, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Carrot, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophag Pteronyss, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophag Farinae, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria Tenuis, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus Fumigatus, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Codfish, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cashew, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Chicken, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Gluten, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Orange, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cheddar Cheese, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Rye Food, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Onion, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Mushroom, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Melon, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Pineapple, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Sesame, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Clam, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Red Sorrel, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Pig Weed, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium Notatum, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Pecan, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Nettle Weed, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Mulberry, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Maple, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cottonwood, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Birch, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Ash, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Coconut, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Latex, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Blueberry, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Apple, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Strawberry, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Rg Marsh Elder, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Egg Yolk, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Oat, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Tomato, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Walnut Tree, Ige R | $21.00 | $35.00 | — | 3% below | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 English Plantain, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sesame, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Grass Rye, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Strawberry, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oyster Ige | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Clam, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sardine, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Ash, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut Food, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Timothy Grass, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Russian Thistle, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Gluten, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pork, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Kentucky Blue Grass, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peach, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cockroach, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Elm, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Corn, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Orange, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillium Chryso, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Milk, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cheddar Cheese, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg White, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pecan Tree, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rye Food, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mountain Juniper/Cedar T6,Iger | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cladosporium Mold, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Onion, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lobster, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Scallop, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dog Epithelium, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mushroom, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Box Elder, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Beef, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Melon, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Soybean, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tomato, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Barley, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pineapple, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lamb's Quarters, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Birch, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oat, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peanut, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Red Sorrel, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Coconut, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sycamore, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pig Weed, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pistachio, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bermuda Grass, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rg Marsh Elder, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Grass, Johnson, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillium Notatum, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Macadamia, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Latex, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Almond, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pecan, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cat Epithelium, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Carrot, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Ragweed, Short, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut Tree, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Coffee, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Nettle Weed, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Yeast, S. Cerev, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dermatophag Pteronyss, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lemon, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Blueberry, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Garlic, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dermatophag Farinae, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cherry, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cashew, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Horse Dander, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Brazil Nut Food, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oak, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Shrimp, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Ragweed, Giant, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mulberry, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Wheat, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hazelnut Food Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Curvularia, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 House Dust Greer Lab, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 House Dust Hollister, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Alternaria Tenuis, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Fescue, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg Yolk, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Salmon, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus Fumigatus, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Crab, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Chocolate, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Green Pea, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Maple, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Potato, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Banana, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Codfish, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tuna, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Apple, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Turkey (Food), Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Chicken, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Casein, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cottonwood, Ige R | $21.00 | $35.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rice, Ige R | $21.00 | $35.00 | — | — | 40% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Feto Protein | $127.20 | $212.00 | — | 131% above | 40% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha Feto Protein | $127.20 | $212.00 | — | — | 40% |
| Ammonia blood test CPT 82140 Ammonia | $96.00 | $160.00 | — | 38% above | 40% |
| Ammonia blood test CPT 82140 Supersaturation Ammonium R | $96.00 | $160.00 | — | 38% above | 40% |
| Ammonia blood test inpatient CPT 82140 Supersaturation Ammonium R | $96.00 | $160.00 | — | — | 40% |
| Ammonia blood test inpatient CPT 82140 Ammonia | $96.00 | $160.00 | — | — | 40% |
| Amylase blood test CPT 82150 Amylase | $61.20 | $102.00 | — | 32% above | 40% |
| Amylase blood test CPT 82150 Amylase,Body Fluid R | $61.20 | $102.00 | — | 32% above | 40% |
| Amylase blood test CPT 82150 Amylase,Body Fluid | $61.20 | $102.00 | — | 32% above | 40% |
| Amylase blood test inpatient CPT 82150 Amylase | $61.20 | $102.00 | — | — | 40% |
| Amylase blood test inpatient CPT 82150 Amylase,Body Fluid R | $61.20 | $102.00 | — | — | 40% |
| Amylase blood test inpatient CPT 82150 Amylase,Body Fluid | $61.20 | $102.00 | — | — | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptidabr | $126.00 | $210.00 | — | 92% above | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptid Ab | $126.00 | $210.00 | — | 92% above | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrullinated Peptidabr | $126.00 | $210.00 | — | — | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrullinated Peptid Ab | $126.00 | $210.00 | — | — | 40% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Prn Titer | $84.00 | $140.00 | — | 38% above | 40% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Ab, Elisa R | $84.00 | $140.00 | — | 38% above | 40% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Ana Prn Titer | $84.00 | $140.00 | — | — | 40% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Ana Ab, Elisa R | $84.00 | $140.00 | — | — | 40% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Nt-Pro Bnp R | $173.40 | $289.00 | — | 47% above | 40% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-Type Natriuretic Peptide | $173.40 | $289.00 | — | 47% above | 40% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-Type Natriuretic Peptide | $173.40 | $289.00 | — | — | 40% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Nt-Pro Bnp R | $173.40 | $289.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Aerobic Culture | $207.00 | $345.00 | — | 369% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Environmental Culture | $207.00 | $345.00 | — | 369% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Throat Culture | $207.00 | $345.00 | — | 369% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture | $207.00 | $345.00 | — | 369% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Nasopharyngeal Culture | $207.00 | $345.00 | — | 369% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Water Culture | $207.00 | $345.00 | — | 369% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Respiratory Culture | $207.00 | $345.00 | — | 369% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Aerobic Culture | $207.00 | $345.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Environmental Culture | $207.00 | $345.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Genital Culture | $207.00 | $345.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Nasopharyngeal Culture | $207.00 | $345.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Respiratory Culture | $207.00 | $345.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Throat Culture | $207.00 | $345.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Water Culture | $207.00 | $345.00 | — | — | 40% |
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $139.80 | $233.00 | — | 154% above | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel | $139.80 | $233.00 | — | — | 40% |
| Bilirubin blood test, total CPT 82247 Bilirubin Body Fluid | $54.60 | $91.00 | — | 40% above | 40% |
| Bilirubin blood test, total CPT 82247 Bilirubin,Total | $54.60 | $91.00 | — | 40% above | 40% |
| Bilirubin blood test, total inpatient CPT 82247 Bilirubin Body Fluid | $54.60 | $91.00 | — | — | 40% |
| Bilirubin blood test, total inpatient CPT 82247 Bilirubin,Total | $54.60 | $91.00 | — | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Arkana G&M Lvl Iv R | $250.20 | $417.00 | — | 78% above | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Gross & Microscopic-Level 4 Tc | $250.20 | $417.00 | — | 78% above | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Gross And Microscopic-Lvl Iv | $250.20 | $417.00 | — | 78% above | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Washu G&M Lvl Iv R | $344.40 | $574.00 | — | 146% above | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Arkana G&M Lvl Iv R | $250.20 | $417.00 | — | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Gross & Microscopic-Level 4 Tc | $250.20 | $417.00 | — | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Gross And Microscopic-Lvl Iv | $250.20 | $417.00 | — | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Washu G&M Lvl Iv R | $344.40 | $574.00 | — | — | 40% |
| Blood culture for bacteria CPT 87040 Blood Culture | $262.20 | $437.00 | — | 255% above | 40% |
| Blood culture for bacteria inpatient CPT 87040 Blood Culture | $262.20 | $437.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Specimen Collect Bld Only | $22.80 | $38.00 | — | 128% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Ed Venipuncture, Routine | $22.80 | $38.00 | — | 128% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture Charge-Wound Care | $22.80 | $38.00 | — | 128% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture Charge | $24.00 | $40.00 | — | 140% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture Charge-Wound Care | $22.80 | $38.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Specimen Collect Bld Only | $22.80 | $38.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Ed Venipuncture, Routine | $22.80 | $38.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture Charge | $24.00 | $40.00 | — | — | 40% |
| Blood glucose (sugar) test CPT 82947 Glucose,Fasting | $44.40 | $74.00 | — | 59% above | 40% |
| Blood glucose (sugar) test CPT 82947 Poc Istat Glucose | $44.40 | $74.00 | — | 59% above | 40% |
| Blood glucose (sugar) test CPT 82947 Glucose | $44.40 | $74.00 | — | 59% above | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 Glucose,Fasting | $44.40 | $74.00 | — | — | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 Glucose | $44.40 | $74.00 | — | — | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 Poc Istat Glucose | $44.40 | $74.00 | — | — | 40% |
| Blood lead test CPT 83655 Lead Assay Blood R | $81.00 | $135.00 | — | 71% above | 40% |
| Blood lead test CPT 83655 Lead Urine R | $81.00 | $135.00 | — | 71% above | 40% |
| Blood lead test inpatient CPT 83655 Lead Urine R | $81.00 | $135.00 | — | — | 40% |
| Blood lead test inpatient CPT 83655 Lead Assay Blood R | $81.00 | $135.00 | — | — | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Poc Urine Pregnancy Test | $84.00 | $140.00 | — | 84% above | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hcg,Serum Screen Qual | $84.00 | $140.00 | — | 84% above | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Urine Hcg, Qualitative | $84.00 | $140.00 | — | 84% above | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Poc Urine Pregnancy Test | $84.00 | $140.00 | — | — | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Urine Hcg, Qualitative | $84.00 | $140.00 | — | — | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Hcg,Serum Screen Qual | $84.00 | $140.00 | — | — | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo | $69.00 | $115.00 | — | 13% above | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Abo | $69.00 | $115.00 | — | — | 40% |
| Blood urea nitrogen (BUN) test CPT 84520 Blood Urea Nitrogen | $40.20 | $67.00 | — | 61% above | 40% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 Blood Urea Nitrogen | $40.20 | $67.00 | — | — | 40% |
| C-peptide blood test CPT 84681 C Peptidetst R | $100.20 | $167.00 | — | 10% above | 40% |
| C-peptide blood test inpatient CPT 84681 C Peptidetst R | $100.20 | $167.00 | — | — | 40% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Crp Inflammation | $72.00 | $120.00 | — | 89% above | 40% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 Crp Inflammation | $72.00 | $120.00 | — | — | 40% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C Diff Toxin B Pcr | $328.20 | $547.00 | — | 242% above | 40% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C Diff Toxin B Pcr | $328.20 | $547.00 | — | — | 40% |
| CA 19-9 blood test (tumor marker) CPT 86301 Ca 19 - 9 | $67.20 | $112.00 | — | 26% below | 40% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 Ca 19 - 9 | $67.20 | $112.00 | — | — | 40% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Ca125 | $121.20 | $202.00 | — | 31% above | 40% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Ca125 | $121.20 | $202.00 | — | — | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Id Now Sars-Cov-2 Pcr | $120.00 | $200.00 | — | 48% above | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Sars Cov-2 Rna Thermo | $123.60 | $206.00 | — | 53% above | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Sars Cov-2 Rna Cepheid | $123.60 | $206.00 | — | 53% above | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Sars Cov-2 Rna R | $123.60 | $206.00 | — | 53% above | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Id Now Sars-Cov-2 Pcr | $120.00 | $200.00 | — | — | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Sars Cov-2 Rna Thermo | $123.60 | $206.00 | — | — | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Sars Cov-2 Rna Cepheid | $123.60 | $206.00 | — | — | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Sars Cov-2 Rna R | $123.60 | $206.00 | — | — | 40% |
| Calcium blood test, total CPT 82310 Calcium | $70.20 | $117.00 | — | 93% above | 40% |
| Calcium blood test, total inpatient CPT 82310 Calcium | $70.20 | $117.00 | — | — | 40% |
| Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen | $121.20 | $202.00 | — | 17% above | 40% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen | $121.20 | $202.00 | — | — | 40% |
| Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Ab Igg | $76.20 | $127.00 | — | 32% above | 40% |
| Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster Ab, Igm, S | $136.80 | $228.00 | — | 137% above | 40% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Ab Igg | $76.20 | $127.00 | — | — | 40% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella-Zoster Ab, Igm, S | $136.80 | $228.00 | — | — | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia By Dna Probe | $106.20 | $177.00 | — | 33% above | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Dna Probe R | $106.20 | $177.00 | — | 33% above | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Pap | $106.20 | $177.00 | — | 33% above | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Urine | $106.20 | $177.00 | — | 33% above | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Pap | $106.20 | $177.00 | — | — | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia By Dna Probe | $106.20 | $177.00 | — | — | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Urine | $106.20 | $177.00 | — | — | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Dna Probe R | $106.20 | $177.00 | — | — | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Profile | $100.80 | $168.00 | — | 45% above | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Profile | $100.80 | $168.00 | — | — | 40% |
| Complete blood count (CBC) with differential CPT 85025 Complete Blood Count Cbc | $79.20 | $132.00 | — | 75% above | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Complete Blood Count Cbc | $79.20 | $132.00 | — | — | 40% |
| Complete blood count (CBC), no differential CPT 85027 Hemogram | $73.20 | $122.00 | — | 66% above | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram | $73.20 | $122.00 | — | — | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comp Metabolic Panel Cmp | $165.00 | $275.00 | — | 130% above | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comp Metabolic Panel Cmp | $165.00 | $275.00 | — | — | 40% |
| Cortisol blood test, total CPT 82533 Cortisol,Am | $140.40 | $234.00 | — | 83% above | 40% |
| Cortisol blood test, total CPT 82533 Cortisol, Saliva R | $140.40 | $234.00 | — | 83% above | 40% |
| Cortisol blood test, total CPT 82533 Cortisol,Pm | $140.40 | $234.00 | — | 83% above | 40% |
| Cortisol blood test, total CPT 82533 Cortisol,Baseline | $140.40 | $234.00 | — | 83% above | 40% |
| Cortisol blood test, total CPT 82533 Cortisol,Random | $140.40 | $234.00 | — | 83% above | 40% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol, Saliva R | $140.40 | $234.00 | — | — | 40% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol,Random | $140.40 | $234.00 | — | — | 40% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol,Baseline | $140.40 | $234.00 | — | — | 40% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol,Am | $140.40 | $234.00 | — | — | 40% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol,Pm | $140.40 | $234.00 | — | — | 40% |
| Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase | $70.80 | $118.00 | — | 69% above | 40% |
| Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase Ref | $70.80 | $118.00 | — | 69% above | 40% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase Ref | $70.80 | $118.00 | — | — | 40% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase | $70.80 | $118.00 | — | — | 40% |
| Creatinine blood test CPT 82565 Poc Creatinine | $25.20 | $42.00 | — | 15% below | 40% |
| Creatinine blood test CPT 82565 Creatinine | $25.20 | $42.00 | — | 15% below | 40% |
| Creatinine blood test inpatient CPT 82565 Creatinine | $25.20 | $42.00 | — | — | 40% |
| Creatinine blood test inpatient CPT 82565 Poc Creatinine | $25.20 | $42.00 | — | — | 40% |
| Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus Ab Igg R | $39.00 | $65.00 | — | 48% below | 40% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus Ab Igg R | $39.00 | $65.00 | — | — | 40% |
| D-dimer blood test (blood clot marker) CPT 85379 D-Dimer | $113.40 | $189.00 | — | 15% above | 40% |
| D-dimer blood test (blood clot marker) CPT 85379 D-Dimer R | $113.40 | $189.00 | — | 15% above | 40% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer R | $113.40 | $189.00 | — | — | 40% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer | $113.40 | $189.00 | — | — | 40% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 Dhea Sulfate R | $75.00 | $125.00 | — | 1% below | 40% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dhea Sulfate R | $75.00 | $125.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Immunoassay Panel U R | $159.60 | $266.00 | — | 64% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen 5 R | $178.80 | $298.00 | — | 84% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Panel 9 | $196.80 | $328.00 | — | 103% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen 7 R | $200.40 | $334.00 | — | 106% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cocaine Screen, Urine | $240.60 | $401.00 | — | 148% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Tricyclic Screen, Urine | $240.60 | $401.00 | — | 148% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Meconium Drug Screen 12 R | $240.60 | $401.00 | — | 148% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Methadone Screen Urine R | $240.60 | $401.00 | — | 148% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Hypoglycemic Agent Screen S R | $240.60 | $401.00 | — | 148% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Synthetic Cannabinoids Panel R | $240.60 | $401.00 | — | 148% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Amphetamine Screen, Urine | $240.60 | $401.00 | — | 148% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Thc Screen, Urine | $240.60 | $401.00 | — | 148% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Etoh Screen, Urine | $240.60 | $401.00 | — | 148% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Urine Drug Scrn Infant 12Coc R | $240.60 | $401.00 | — | 148% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Benzodiazepine Screen, Urine | $240.60 | $401.00 | — | 148% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen 12 R | $242.40 | $404.00 | — | 150% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen 5 + Etg R | $243.00 | $405.00 | — | 150% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen 9 R | $257.40 | $429.00 | — | 165% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen 13 R | $267.00 | $445.00 | — | 175% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen 14 R | $289.80 | $483.00 | — | 199% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen 15 R | $312.60 | $521.00 | — | 222% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen 13 + Etg R | $331.20 | $552.00 | — | 241% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen 14 + Etg R | $354.00 | $590.00 | — | 265% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Meconium Drug Screen 13 R | $372.00 | $620.00 | — | 283% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen 17 R | $460.20 | $767.00 | — | 374% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen 17 + Etg R | $499.20 | $832.00 | — | 414% above | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Immunoassay Panel U R | $159.60 | $266.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen 5 R | $178.80 | $298.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen Panel 9 | $196.80 | $328.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen 7 R | $200.40 | $334.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Amphetamine Screen, Urine | $240.60 | $401.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Synthetic Cannabinoids Panel R | $240.60 | $401.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Urine Drug Scrn Infant 12Coc R | $240.60 | $401.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hypoglycemic Agent Screen S R | $240.60 | $401.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Methadone Screen Urine R | $240.60 | $401.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Meconium Drug Screen 12 R | $240.60 | $401.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cocaine Screen, Urine | $240.60 | $401.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Tricyclic Screen, Urine | $240.60 | $401.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Thc Screen, Urine | $240.60 | $401.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Etoh Screen, Urine | $240.60 | $401.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Benzodiazepine Screen, Urine | $240.60 | $401.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen 12 R | $242.40 | $404.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen 5 + Etg R | $243.00 | $405.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen 9 R | $257.40 | $429.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen 13 R | $267.00 | $445.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen 14 R | $289.80 | $483.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen 15 R | $312.60 | $521.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen 13 + Etg R | $331.20 | $552.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen 14 + Etg R | $354.00 | $590.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Meconium Drug Screen 13 R | $372.00 | $620.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen 17 R | $460.20 | $767.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen 17 + Etg R | $499.20 | $832.00 | — | — | 40% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolytes | $73.20 | $122.00 | — | 21% above | 40% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolytes | $73.20 | $122.00 | — | — | 40% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 Ebv Vca Igg R | $45.00 | $75.00 | — | 35% below | 40% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 Ebv Vca Igm R | $89.40 | $149.00 | — | 29% above | 40% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Ebv Vca Igg R | $45.00 | $75.00 | — | — | 40% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Ebv Vca Igm R | $89.40 | $149.00 | — | — | 40% |
| Estradiol blood test CPT 82670 Estradiol Lcms R, Code Eest | $57.00 | $95.00 | — | 37% below | 40% |
| Estradiol blood test CPT 82670 Estradiol Total Serum | $120.00 | $200.00 | — | 32% above | 40% |
| Estradiol blood test CPT 82670 Estradiol Lcms R, Ffes Panel | $132.60 | $221.00 | — | 46% above | 40% |
| Estradiol blood test inpatient CPT 82670 Estradiol Lcms R, Code Eest | $57.00 | $95.00 | — | — | 40% |
| Estradiol blood test inpatient CPT 82670 Estradiol Total Serum | $120.00 | $200.00 | — | — | 40% |
| Estradiol blood test inpatient CPT 82670 Estradiol Lcms R, Ffes Panel | $132.60 | $221.00 | — | — | 40% |
| FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone | $94.80 | $158.00 | — | 35% above | 40% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stimulating Hormone | $94.80 | $158.00 | — | — | 40% |
| Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin Feces | $206.40 | $344.00 | — | 43% above | 40% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin Feces | $206.40 | $344.00 | — | — | 40% |
| Ferritin blood test (iron stores) CPT 82728 Ferritin | $82.20 | $137.00 | — | 27% above | 40% |
| Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin | $82.20 | $137.00 | — | — | 40% |
| Fibrinogen blood test CPT 85384 Fibrinogen | $112.20 | $187.00 | — | 59% above | 40% |
| Fibrinogen blood test CPT 85384 Fibrinogen Clauss R | $112.20 | $187.00 | — | 59% above | 40% |
| Fibrinogen blood test inpatient CPT 85384 Fibrinogen Clauss R | $112.20 | $187.00 | — | — | 40% |
| Fibrinogen blood test inpatient CPT 85384 Fibrinogen | $112.20 | $187.00 | — | — | 40% |
| Folate (folic acid) blood test CPT 82746 Folate | $99.60 | $166.00 | — | 52% above | 40% |
| Folate (folic acid) blood test inpatient CPT 82746 Folate | $99.60 | $166.00 | — | — | 40% |
| Free T3 thyroid hormone test CPT 84481 T3 Free | $123.00 | $205.00 | — | 37% above | 40% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3 Free | $123.00 | $205.00 | — | — | 40% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 (Free Thyroxine) | $111.60 | $186.00 | — | 82% above | 40% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4 (Free Thyroxine) | $111.60 | $186.00 | — | — | 40% |
| Free testosterone test CPT 84402 Testosterone Free | $109.20 | $182.00 | — | 26% above | 40% |
| Free testosterone test inpatient CPT 84402 Testosterone Free | $109.20 | $182.00 | — | — | 40% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transpeptidase | $59.40 | $99.00 | — | 21% above | 40% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Gamma Glutamyl Transpeptidase | $59.40 | $99.00 | — | — | 40% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel | $420.60 | $701.00 | — | 115% above | 40% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General Health Panel | $420.60 | $701.00 | — | — | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose,1H Pp (Preg) | $56.40 | $94.00 | — | 85% above | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose,2H Pp | $56.40 | $94.00 | — | 85% above | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose,2H Pp | $56.40 | $94.00 | — | — | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose,1H Pp (Preg) | $56.40 | $94.00 | — | — | 40% |
| Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerance 1St 3 Spec | $104.40 | $174.00 | — | 55% above | 40% |
| Glucose tolerance test, 3 samples CPT 82951 Lactose Tolerance 1St 3 Spec | $104.40 | $174.00 | — | 55% above | 40% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 Lactose Tolerance 1St 3 Spec | $104.40 | $174.00 | — | — | 40% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose Tolerance 1St 3 Spec | $104.40 | $174.00 | — | — | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N. Gonorrhoeae Pap | $106.20 | $177.00 | — | 28% above | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N. Gonorrhoeae Urine | $106.20 | $177.00 | — | 28% above | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N. Gonorrhoeae By Dna Probe | $106.20 | $177.00 | — | 28% above | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N. Gonorrhoeae Dna Probe R | $106.20 | $177.00 | — | 28% above | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N. Gonorrhoeae Pap | $106.20 | $177.00 | — | — | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N. Gonorrhoeae Dna Probe R | $106.20 | $177.00 | — | — | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N. Gonorrhoeae By Dna Probe | $106.20 | $177.00 | — | — | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N. Gonorrhoeae Urine | $106.20 | $177.00 | — | — | 40% |
| H. pylori antibody blood test CPT 86677 Helicobacter Pylori Iga | $65.40 | $109.00 | — | 13% below | 40% |
| H. pylori antibody blood test CPT 86677 Helicobacter Pylori Igg | $65.40 | $109.00 | — | 13% below | 40% |
| H. pylori antibody blood test CPT 86677 Helicobacter Pylori Igm | $65.40 | $109.00 | — | 13% below | 40% |
| H. pylori antibody blood test inpatient CPT 86677 Helicobacter Pylori Igg | $65.40 | $109.00 | — | — | 40% |
| H. pylori antibody blood test inpatient CPT 86677 Helicobacter Pylori Iga | $65.40 | $109.00 | — | — | 40% |
| H. pylori antibody blood test inpatient CPT 86677 Helicobacter Pylori Igm | $65.40 | $109.00 | — | — | 40% |
| H. pylori stool antigen test CPT 87338 H. Pylori Ag, Fecal R | $89.40 | $149.00 | — | 21% below | 40% |
| H. pylori stool antigen test inpatient CPT 87338 H. Pylori Ag, Fecal R | $89.40 | $149.00 | — | — | 40% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv - 1 Quantitative Pcr | $299.40 | $499.00 | — | 47% above | 40% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Hiv - 1 Quantitative Pcr | $299.40 | $499.00 | — | — | 40% |
| HIV-1 and HIV-2 antibody test CPT 86703 Hiv 1-2 Antibody | $86.40 | $144.00 | — | 65% above | 40% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 Hiv 1-2 Antibody | $86.40 | $144.00 | — | — | 40% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hiv 1-2 Ag/Ab Combo | $135.00 | $225.00 | — | 185% above | 40% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Hiv 1-2 Ag/Ab Combo | $135.00 | $225.00 | — | — | 40% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 Hpv High Risk Screen | $123.60 | $206.00 | — | 34% above | 40% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Hpv High Risk Screen | $123.60 | $206.00 | — | — | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C Grp | $70.20 | $117.00 | — | 63% above | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C Grp | $70.20 | $117.00 | — | — | 40% |
| Hemoglobin blood test CPT 85018 Poc Hemoglobin | $39.00 | $65.00 | — | 94% above | 40% |
| Hemoglobin blood test CPT 85018 Hemoglobin | $39.00 | $65.00 | — | 94% above | 40% |
| Hemoglobin blood test inpatient CPT 85018 Poc Hemoglobin | $39.00 | $65.00 | — | — | 40% |
| Hemoglobin blood test inpatient CPT 85018 Hemoglobin | $39.00 | $65.00 | — | — | 40% |
| Hepatitis B core antibody test (total) CPT 86704 Hep B Core Ab Total | $91.20 | $152.00 | — | 86% above | 40% |
| Hepatitis B core antibody test (total) CPT 86704 Noncdm Charge Record | $91.20 | $152.00 | — | 86% above | 40% |
| Hepatitis B core antibody test (total) CPT 86704 Hep B Core Antibody Total R | $91.20 | $152.00 | — | 86% above | 40% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 Hep B Core Ab Total | $91.20 | $152.00 | — | — | 40% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 Hep B Core Antibody Total R | $91.20 | $152.00 | — | — | 40% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 Noncdm Charge Record | $91.20 | $152.00 | — | — | 40% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab | $97.20 | $162.00 | — | 106% above | 40% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Ab | $97.20 | $162.00 | — | — | 40% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen | $97.20 | $162.00 | — | 113% above | 40% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen | $97.20 | $162.00 | — | — | 40% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Virus Antibody | $139.20 | $232.00 | — | 148% above | 40% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Virus Antibody | $139.20 | $232.00 | — | — | 40% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Hcv Quantitative Rna By Pcr | $276.60 | $461.00 | — | 24% above | 40% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hcv Quantitative Rna By Pcr | $276.60 | $461.00 | — | — | 40% |
| Herpes blood test, HSV-1 antibody CPT 86695 Hsv Type 1 Igg R | $82.20 | $137.00 | — | 28% above | 40% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 Hsv Type 1 Igg R | $82.20 | $137.00 | — | — | 40% |
| Herpes blood test, HSV-2 antibody CPT 86696 Hsv Type 2 Igg R | $88.20 | $147.00 | — | 48% above | 40% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 Hsv Type 2 Igg R | $88.20 | $147.00 | — | — | 40% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein Card(Hscrp) | $72.00 | $120.00 | — | 31% above | 40% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein Card(Hscrp) | $72.00 | $120.00 | — | — | 40% |
| Homocysteine blood test CPT 83090 Homocysteine Serum | $48.60 | $81.00 | — | 58% below | 40% |
| Homocysteine blood test inpatient CPT 83090 Homocysteine Serum | $48.60 | $81.00 | — | — | 40% |
| Insulin blood test CPT 83525 Insulin Serum R | $67.80 | $113.00 | — | 29% above | 40% |
| Insulin blood test CPT 83525 Insulin | $67.80 | $113.00 | — | 29% above | 40% |
| Insulin blood test inpatient CPT 83525 Insulin | $67.80 | $113.00 | — | — | 40% |
| Insulin blood test inpatient CPT 83525 Insulin Serum R | $67.80 | $113.00 | — | — | 40% |
| Iron blood test (serum iron) CPT 83540 Iron Liver Tissue R | $79.20 | $132.00 | — | 118% above | 40% |
| Iron blood test (serum iron) CPT 83540 Iron | $79.20 | $132.00 | — | 118% above | 40% |
| Iron blood test (serum iron) inpatient CPT 83540 Iron | $79.20 | $132.00 | — | — | 40% |
| Iron blood test (serum iron) inpatient CPT 83540 Iron Liver Tissue R | $79.20 | $132.00 | — | — | 40% |
| Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity | $79.20 | $132.00 | — | 67% above | 40% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity | $79.20 | $132.00 | — | — | 40% |
| Kidney function blood test panel CPT 80069 Renal Panel | $126.60 | $211.00 | — | 68% above | 40% |
| Kidney function blood test panel inpatient CPT 80069 Renal Panel | $126.60 | $211.00 | — | — | 40% |
| LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone | $120.00 | $200.00 | — | 64% above | 40% |
| LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone | $120.00 | $200.00 | — | — | 40% |
| Lactate (lactic acid) blood test CPT 83605 Lactic Acid | $95.40 | $159.00 | — | 62% above | 40% |
| Lactate (lactic acid) blood test CPT 83605 Poc Lactate Arterial | $95.40 | $159.00 | — | 62% above | 40% |
| Lactate (lactic acid) blood test CPT 83605 Poc Lactate Venous | $95.40 | $159.00 | — | 62% above | 40% |
| Lactate (lactic acid) blood test CPT 83605 Lactic Acid Csf | $95.40 | $159.00 | — | 62% above | 40% |
| Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid Csf | $95.40 | $159.00 | — | — | 40% |
| Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid | $95.40 | $159.00 | — | — | 40% |
| Lactate (lactic acid) blood test inpatient CPT 83605 Poc Lactate Venous | $95.40 | $159.00 | — | — | 40% |
| Lactate (lactic acid) blood test inpatient CPT 83605 Poc Lactate Arterial | $95.40 | $159.00 | — | — | 40% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Ldh,Body Fluid R | $42.00 | $70.00 | — | 20% above | 40% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase | $42.00 | $70.00 | — | 20% above | 40% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase,Csf | $42.00 | $70.00 | — | 20% above | 40% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Ldh,Body Fluid | $42.00 | $70.00 | — | 20% above | 40% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Ldh,Body Fluid | $42.00 | $70.00 | — | — | 40% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase,Csf | $42.00 | $70.00 | — | — | 40% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase | $42.00 | $70.00 | — | — | 40% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Ldh,Body Fluid R | $42.00 | $70.00 | — | — | 40% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase,Body Fluid | $87.00 | $145.00 | — | 62% above | 40% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase | $87.00 | $145.00 | — | 62% above | 40% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase | $87.00 | $145.00 | — | — | 40% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase,Body Fluid | $87.00 | $145.00 | — | — | 40% |
| Liver function blood test panel CPT 80076 Liver Function Panel | $130.20 | $217.00 | — | 125% above | 40% |
| Liver function blood test panel inpatient CPT 80076 Liver Function Panel | $130.20 | $217.00 | — | — | 40% |
| Lyme disease antibody test CPT 86618 Lyme Antibody Eia R | $137.40 | $229.00 | — | 70% above | 40% |
| Lyme disease antibody test CPT 86618 Lyme Igm Csf | $137.40 | $229.00 | — | 70% above | 40% |
| Lyme disease antibody test CPT 86618 Lyme Igg Csf | $137.40 | $229.00 | — | 70% above | 40% |
| Lyme disease antibody test inpatient CPT 86618 Lyme Antibody Eia R | $137.40 | $229.00 | — | — | 40% |
| Lyme disease antibody test inpatient CPT 86618 Lyme Igg Csf | $137.40 | $229.00 | — | — | 40% |
| Lyme disease antibody test inpatient CPT 86618 Lyme Igm Csf | $137.40 | $229.00 | — | — | 40% |
| Magnesium blood test CPT 83735 Magnesium | $69.00 | $115.00 | — | 85% above | 40% |
| Magnesium blood test CPT 83735 Magnesium Urine R | $69.00 | $115.00 | — | 85% above | 40% |
| Magnesium blood test CPT 83735 Super Saturation Magnesium R | $69.00 | $115.00 | — | 85% above | 40% |
| Magnesium blood test CPT 83735 Magnesium, Rbc R | $113.40 | $189.00 | — | 205% above | 40% |
| Magnesium blood test inpatient CPT 83735 Super Saturation Magnesium R | $69.00 | $115.00 | — | — | 40% |
| Magnesium blood test inpatient CPT 83735 Magnesium | $69.00 | $115.00 | — | — | 40% |
| Magnesium blood test inpatient CPT 83735 Magnesium Urine R | $69.00 | $115.00 | — | — | 40% |
| Magnesium blood test inpatient CPT 83735 Magnesium, Rbc R | $113.40 | $189.00 | — | — | 40% |
| Measles (rubeola) antibody test CPT 86765 Rubeola Measles Ab Igm R | $48.60 | $81.00 | — | 11% above | 40% |
| Measles (rubeola) antibody test CPT 86765 Rubeola Ab Igg | $76.20 | $127.00 | — | 74% above | 40% |
| Measles (rubeola) antibody test CPT 86765 Rubeola Ab Igg R | $76.20 | $127.00 | — | 74% above | 40% |
| Measles (rubeola) antibody test inpatient CPT 86765 Rubeola Measles Ab Igm R | $48.60 | $81.00 | — | — | 40% |
| Measles (rubeola) antibody test inpatient CPT 86765 Rubeola Ab Igg | $76.20 | $127.00 | — | — | 40% |
| Measles (rubeola) antibody test inpatient CPT 86765 Rubeola Ab Igg R | $76.20 | $127.00 | — | — | 40% |
| Mono test (heterophile antibody, Monospot) CPT 86308 Monoscreen | $123.00 | $205.00 | — | 199% above | 40% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Monoscreen | $123.00 | $205.00 | — | — | 40% |
| Mumps immunity blood test CPT 86735 Mumps Antibody Igg | $118.80 | $198.00 | — | 102% above | 40% |
| Mumps immunity blood test CPT 86735 Mumps Ab Igm R | $118.80 | $198.00 | — | 102% above | 40% |
| Mumps immunity blood test CPT 86735 Mumps Ab Igg R | $118.80 | $198.00 | — | 102% above | 40% |
| Mumps immunity blood test inpatient CPT 86735 Mumps Antibody Igg | $118.80 | $198.00 | — | — | 40% |
| Mumps immunity blood test inpatient CPT 86735 Mumps Ab Igg R | $118.80 | $198.00 | — | — | 40% |
| Mumps immunity blood test inpatient CPT 86735 Mumps Ab Igm R | $118.80 | $198.00 | — | — | 40% |
| Obstetric blood test panel CPT 80055 Prenatal Profile | $598.80 | $998.00 | — | 242% above | 40% |
| Obstetric blood test panel inpatient CPT 80055 Prenatal Profile | $598.80 | $998.00 | — | — | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Psa Free | $60.00 | $100.00 | — | 34% below | 40% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Psa Free | $60.00 | $100.00 | — | — | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Total Psa | $96.00 | $160.00 | — | 25% above | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen | $141.60 | $236.00 | — | 84% above | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Total Psa | $96.00 | $160.00 | — | — | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen | $141.60 | $236.00 | — | — | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Pap Surepath Cpl R | $69.00 | $115.00 | — | 2% below | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Pap Surepath Cpl R | $69.00 | $115.00 | — | — | 40% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Io, Baseli | $175.20 | $292.00 | — | 26% above | 40% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone | $175.20 | $292.00 | — | 26% above | 40% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Fna Rinse | $175.20 | $292.00 | — | 26% above | 40% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone Fna Rinse | $175.20 | $292.00 | — | — | 40% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone | $175.20 | $292.00 | — | — | 40% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone Io, Baseli | $175.20 | $292.00 | — | — | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Ptt R | $39.60 | $66.00 | — | 22% above | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $39.60 | $66.00 | — | 22% above | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $39.60 | $66.00 | — | — | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Ptt R | $39.60 | $66.00 | — | — | 40% |
| Phosphorus (phosphate) blood test CPT 84100 Phosphorus | $42.00 | $70.00 | — | 28% above | 40% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus | $42.00 | $70.00 | — | — | 40% |
| Potassium blood test CPT 84132 Poc Potassium | $52.20 | $87.00 | — | 56% above | 40% |
| Potassium blood test CPT 84132 Potassium | $52.20 | $87.00 | — | 56% above | 40% |
| Potassium blood test CPT 84132 Potassium,Body Fluid | $52.20 | $87.00 | — | 56% above | 40% |
| Potassium blood test inpatient CPT 84132 Poc Potassium | $52.20 | $87.00 | — | — | 40% |
| Potassium blood test inpatient CPT 84132 Potassium | $52.20 | $87.00 | — | — | 40% |
| Potassium blood test inpatient CPT 84132 Potassium,Body Fluid | $52.20 | $87.00 | — | — | 40% |
| Progesterone blood test CPT 84144 Progesterone | $87.60 | $146.00 | — | 17% above | 40% |
| Progesterone blood test inpatient CPT 84144 Progesterone | $87.60 | $146.00 | — | — | 40% |
| Prolactin blood test CPT 84146 Prolactin Pituitary Macroade R | $100.20 | $167.00 | — | 7% above | 40% |
| Prolactin blood test CPT 84146 Prolactin | $100.80 | $168.00 | — | 7% above | 40% |
| Prolactin blood test inpatient CPT 84146 Prolactin Pituitary Macroade R | $100.20 | $167.00 | — | — | 40% |
| Prolactin blood test inpatient CPT 84146 Prolactin | $100.80 | $168.00 | — | — | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $34.80 | $58.00 | — | 6% above | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time R | $34.80 | $58.00 | — | 6% above | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Therapeutic Inr | $34.80 | $58.00 | — | 6% above | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Therapeutic Inr | $34.80 | $58.00 | — | — | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time R | $34.80 | $58.00 | — | — | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $34.80 | $58.00 | — | — | 40% |
| Rapid flu test (influenza antigen) CPT 87804 Influenza Virus A Antibody | $180.00 | $300.00 | — | 229% above | 40% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza Virus A Antibody | $180.00 | $300.00 | — | — | 40% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 Group A Beta Strep Screen | $114.00 | $190.00 | — | 135% above | 40% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Group A Beta Strep Screen | $114.00 | $190.00 | — | — | 40% |
| Renin blood test CPT 84244 Renin Activity Plasma R | $95.40 | $159.00 | — | 9% below | 40% |
| Renin blood test inpatient CPT 84244 Renin Activity Plasma R | $95.40 | $159.00 | — | — | 40% |
| Rh blood typing CPT 86901 Rh | $69.00 | $115.00 | — | 53% above | 40% |
| Rh blood typing inpatient CPT 86901 Rh | $69.00 | $115.00 | — | — | 40% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Quant | $73.80 | $123.00 | — | 151% above | 40% |
| Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor Quant | $73.80 | $123.00 | — | — | 40% |
| Rubella antibody test (immunity check) CPT 86762 Rubella Igg Antibody | $76.20 | $127.00 | — | 45% above | 40% |
| Rubella antibody test (immunity check) CPT 86762 Rubella Ab Igm | $76.20 | $127.00 | — | 45% above | 40% |
| Rubella antibody test (immunity check) CPT 86762 Rubella Igm | $76.20 | $127.00 | — | 45% above | 40% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Ab Igm | $76.20 | $127.00 | — | — | 40% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Igm | $76.20 | $127.00 | — | — | 40% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Igg Antibody | $76.20 | $127.00 | — | — | 40% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Erythrocyte Sedimentation Rate | $67.20 | $112.00 | — | 174% above | 40% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Erythrocyte Sedimentation Rate | $67.20 | $112.00 | — | — | 40% |
| Sodium blood test CPT 84295 Poc Sodium | $52.20 | $87.00 | — | 62% above | 40% |
| Sodium blood test CPT 84295 Sodium | $52.20 | $87.00 | — | 62% above | 40% |
| Sodium blood test inpatient CPT 84295 Sodium | $52.20 | $87.00 | — | — | 40% |
| Sodium blood test inpatient CPT 84295 Poc Sodium | $52.20 | $87.00 | — | — | 40% |
| Stool ova and parasites exam CPT 87177 Parasite Direct Smear | $72.00 | $120.00 | — | 14% above | 40% |
| Stool ova and parasites exam CPT 87177 Parasite Direct Smear R | $72.00 | $120.00 | — | 14% above | 40% |
| Stool ova and parasites exam inpatient CPT 87177 Parasite Direct Smear | $72.00 | $120.00 | — | — | 40% |
| Stool ova and parasites exam inpatient CPT 87177 Parasite Direct Smear R | $72.00 | $120.00 | — | — | 40% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fit Test | $41.40 | $69.00 | — | 29% below | 40% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Fit Test | $41.40 | $69.00 | — | — | 40% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 Fta Abs Rml R | $54.00 | $90.00 | — | 30% above | 40% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema Pallidum Ab Total | $54.00 | $90.00 | — | 30% above | 40% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Ab By Tp-Pa Mayo R | $73.20 | $122.00 | — | 76% above | 40% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Fta Abs Rml R | $54.00 | $90.00 | — | — | 40% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema Pallidum Ab Total | $54.00 | $90.00 | — | — | 40% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis Ab By Tp-Pa Mayo R | $73.20 | $122.00 | — | — | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin | $72.00 | $120.00 | — | 131% above | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl Spinal Fluid | $72.00 | $120.00 | — | 131% above | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagin | $72.00 | $120.00 | — | — | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Vdrl Spinal Fluid | $72.00 | $120.00 | — | — | 40% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon Tb Gold | $181.20 | $302.00 | — | 3% above | 40% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon Tb Gold R | $181.20 | $302.00 | — | 3% above | 40% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon Tb Gold R | $181.20 | $302.00 | — | — | 40% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon Tb Gold | $181.20 | $302.00 | — | — | 40% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total | $109.20 | $182.00 | — | 18% above | 40% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Ultrasensitive R | $109.20 | $182.00 | — | 18% above | 40% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total | $109.20 | $182.00 | — | — | 40% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Ultrasensitive R | $109.20 | $182.00 | — | — | 40% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Tpo Ab R | $100.20 | $167.00 | — | 65% above | 40% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Liver Kidney Microsome 1 Ab R | $100.20 | $167.00 | — | 65% above | 40% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Tpo Ab | $129.60 | $216.00 | — | 113% above | 40% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Liver Kidney Microsome 1 Ab R | $100.20 | $167.00 | — | — | 40% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Tpo Ab R | $100.20 | $167.00 | — | — | 40% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Tpo Ab | $129.60 | $216.00 | — | — | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Nbs Thyroid Stim Hormone R | $49.80 | $83.00 | — | 8% below | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $129.60 | $216.00 | — | 140% above | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Nbs Thyroid Stim Hormone R | $49.80 | $83.00 | — | — | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $129.60 | $216.00 | — | — | 40% |
| Total IgE blood test CPT 82785 Ige Total Serum R | $54.00 | $90.00 | — | 4% above | 40% |
| Total IgE blood test inpatient CPT 82785 Ige Total Serum R | $54.00 | $90.00 | — | — | 40% |
| Total cholesterol blood test CPT 82465 Cholesterol | $50.40 | $84.00 | — | 51% above | 40% |
| Total cholesterol blood test inpatient CPT 82465 Cholesterol | $50.40 | $84.00 | — | — | 40% |
| Total thyroxine (T4) blood test CPT 84436 T4 (Thyroxine) Total Only | $41.40 | $69.00 | — | 4% below | 40% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4 (Thyroxine) Total Only | $41.40 | $69.00 | — | — | 40% |
| Total triiodothyronine (T3) blood test CPT 84480 T3 Total | $41.40 | $69.00 | — | 30% below | 40% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 Total | $41.40 | $69.00 | — | — | 40% |
| Transferrin blood test CPT 84466 Transferrin | $103.80 | $173.00 | — | 81% above | 40% |
| Transferrin blood test inpatient CPT 84466 Transferrin | $103.80 | $173.00 | — | — | 40% |
| Trichomonas test (NAAT) CPT 87661 Trichomonas | $121.20 | $202.00 | — | 38% above | 40% |
| Trichomonas test (NAAT) CPT 87661 Trichomonas Pap | $121.20 | $202.00 | — | 38% above | 40% |
| Trichomonas test (NAAT) CPT 87661 Trichomonas Male R | $121.20 | $202.00 | — | 38% above | 40% |
| Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Pap | $121.20 | $202.00 | — | — | 40% |
| Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas | $121.20 | $202.00 | — | — | 40% |
| Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Male R | $121.20 | $202.00 | — | — | 40% |
| Triglycerides blood test CPT 84478 Body Fluid Triglycerides | $53.40 | $89.00 | — | 55% above | 40% |
| Triglycerides blood test CPT 84478 Triglycerides | $53.40 | $89.00 | — | 55% above | 40% |
| Triglycerides blood test inpatient CPT 84478 Body Fluid Triglycerides | $53.40 | $89.00 | — | — | 40% |
| Triglycerides blood test inpatient CPT 84478 Triglycerides | $53.40 | $89.00 | — | — | 40% |
| Troponin test, quantitative CPT 84484 Troponin I | $128.40 | $214.00 | — | 81% above | 40% |
| Troponin test, quantitative CPT 84484 Poc Troponin I | $128.40 | $214.00 | — | 81% above | 40% |
| Troponin test, quantitative inpatient CPT 84484 Poc Troponin I | $128.40 | $214.00 | — | — | 40% |
| Troponin test, quantitative inpatient CPT 84484 Troponin I | $128.40 | $214.00 | — | — | 40% |
| Uric acid blood test CPT 84550 Uric Acid | $38.40 | $64.00 | — | 42% above | 40% |
| Uric acid blood test inpatient CPT 84550 Uric Acid | $38.40 | $64.00 | — | — | 40% |
| Urinalysis with microscope exam, automated CPT 81001 Ua Auto With Microscopic | $83.40 | $139.00 | — | 161% above | 40% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis Auto W/Scope | $83.40 | $139.00 | — | 161% above | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Ua Auto With Microscopic | $83.40 | $139.00 | — | — | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Auto W/Scope | $83.40 | $139.00 | — | — | 40% |
| Urinalysis without microscope exam, automated CPT 81003 Ua Auto W/O Microscopic | $25.20 | $42.00 | — | 76% above | 40% |
| Urinalysis without microscope exam, automated CPT 81003 Ph,Urine (Ua) | $25.20 | $42.00 | — | 76% above | 40% |
| Urinalysis without microscope exam, automated CPT 81003 Specific Gravity, Urine | $25.20 | $42.00 | — | 76% above | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Ph,Urine (Ua) | $25.20 | $42.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Specific Gravity, Urine | $25.20 | $42.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Ua Auto W/O Microscopic | $25.20 | $42.00 | — | — | 40% |
| Urinalysis without microscope exam, manual CPT 81002 Acetone Urine | $30.00 | $50.00 | — | 82% above | 40% |
| Urinalysis without microscope exam, manual CPT 81002 Dipstick Ua | $30.00 | $50.00 | — | 82% above | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Acetone Urine | $30.00 | $50.00 | — | — | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Dipstick Ua | $30.00 | $50.00 | — | — | 40% |
| Urine culture for bacteria, with colony count CPT 87086 Urine Culture | $135.00 | $225.00 | — | 180% above | 40% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture | $135.00 | $225.00 | — | — | 40% |
| Urine microalbumin (albumin) test CPT 82043 Microalbumin,Urine | $97.20 | $162.00 | — | 154% above | 40% |
| Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin,Urine | $97.20 | $162.00 | — | — | 40% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 | $111.60 | $186.00 | — | 71% above | 40% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 | $111.60 | $186.00 | — | — | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D Total | $152.40 | $254.00 | — | 16% above | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy R | $152.40 | $254.00 | — | 16% above | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D Total | $152.40 | $254.00 | — | — | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy R | $152.40 | $254.00 | — | — | 40% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vitamin D 1 25 Dihydroxy R | $152.40 | $254.00 | — | 1% below | 40% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Vitamin D 1 25 Dihydroxy R | $152.40 | $254.00 | — | — | 40% |
| Zinc blood test CPT 84630 Zinc 24 Hr Urine | $75.60 | $126.00 | — | 31% above | 40% |
| Zinc blood test CPT 84630 Zinc Plasma | $75.60 | $126.00 | — | 31% above | 40% |
| Zinc blood test inpatient CPT 84630 Zinc Plasma | $75.60 | $126.00 | — | — | 40% |
| Zinc blood test inpatient CPT 84630 Zinc 24 Hr Urine | $75.60 | $126.00 | — | — | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Quantitative R | $134.40 | $224.00 | — | 117% above | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg,Quantitative | $134.40 | $224.00 | — | 117% above | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hcg,Quantitative | $134.40 | $224.00 | — | — | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hcg Quantitative R | $134.40 | $224.00 | — | — | 40% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Oklahoma | Off list |
|---|---|---|---|---|---|
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Tc-Breast Bx 1St Lesn Strtctc | $288.07 | $480.11 | — | 86% below | 40% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Breast Bx 1St Lesion Strtctc | $4,609.20 | $7,682.00 | — | 131% above | 40% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Tc-Breast Bx 1St Lesn Strtctc | $288.07 | $480.11 | — | — | 40% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Breast Bx 1St Lesion Strtctc | $4,609.20 | $7,682.00 | — | — | 40% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Tx Distal Fibular Fx W/O Manj | $1,519.20 | $2,532.00 | — | 495% above | 40% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Tx Distal Fibular Fx W/O Manj | $1,519.20 | $2,532.00 | — | — | 40% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Tx Metatarsal Fx W/O Manj,Ea | $1,356.60 | $2,261.00 | — | 572% above | 40% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Tx Metatarsal Fx W/O Manj,Ea | $1,356.60 | $2,261.00 | — | — | 40% |
| Cardiac catheterization with coronary angiogram CPT 93458 L Hrt Artery/Ventricle Angio | $11,677.20 | $19,462.00 | — | 79% above | 40% |
| Cardiac catheterization with coronary angiogram inpatient CPT 93458 L Hrt Artery/Ventricle Angio | $11,677.20 | $19,462.00 | — | — | 40% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Electric Ext | $1,485.82 | $2,476.36 | — | 53% above | 40% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion | $1,677.60 | $2,796.00 | — | 73% above | 40% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Electric Ext | $1,485.82 | $2,476.36 | — | — | 40% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion | $1,677.60 | $2,796.00 | — | — | 40% |
| Catheter ablation for atrial fibrillation CPT 93656 Comp Ep Eval Ablt A-Fib Plm Vn | $24,560.90 | $40,934.84 | — | 59% above | 40% |
| Catheter ablation for atrial fibrillation inpatient CPT 93656 Comp Ep Eval Ablt A-Fib Plm Vn | $24,560.90 | $40,934.84 | — | — | 40% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Circumcision >28 Days Of Age | $3,997.20 | $6,662.00 | — | 16% above | 40% |
| Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 Circumcision >28 Days Of Age | $3,997.20 | $6,662.00 | — | — | 40% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision W/Regional Block | $4,760.40 | $7,934.00 | — | 930% above | 40% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision W/Regional Block | $4,760.40 | $7,934.00 | — | — | 40% |
| Circumcision, surgical, older than a newborn CPT 54160 Circumcision Neonate <=28 Days | $2,902.20 | $4,837.00 | — | 448% above | 40% |
| Circumcision, surgical, older than a newborn inpatient CPT 54160 Circumcision Neonate <=28 Days | $2,902.20 | $4,837.00 | — | — | 40% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Tx Distal Radial Fx W/O Manj | $1,356.60 | $2,261.00 | — | 417% above | 40% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Tx Distal Radial Fx W/O Manj | $1,356.60 | $2,261.00 | — | — | 40% |
| Colonoscopy with endoscopic ultrasound CPT 45391 Colonoscopy W/Endoscope Us | $1,504.20 | $2,507.00 | — | 4% above | 40% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Colonoscopy W/Endoscope Us | $1,504.20 | $2,507.00 | — | — | 40% |
| Colonoscopy with polyp removal CPT 45385 Colsc Flx W/Rmvl Snare Tq | $1,988.40 | $3,314.00 | — | 22% above | 40% |
| Colonoscopy with polyp removal inpatient CPT 45385 Colsc Flx W/Rmvl Snare Tq | $1,988.40 | $3,314.00 | — | — | 40% |
| Colonoscopy with tissue sample CPT 45380 Colsc W/Biopsy Sing/Mult | $2,172.60 | $3,621.00 | — | 39% above | 40% |
| Colonoscopy with tissue sample inpatient CPT 45380 Colsc W/Biopsy Sing/Mult | $2,172.60 | $3,621.00 | — | — | 40% |
| Colonoscopy, diagnostic CPT 45378 Colonoscopy, Diagnostic | $1,503.61 | $2,506.01 | — | 2% above | 40% |
| Colonoscopy, diagnostic inpatient CPT 45378 Colonoscopy, Diagnostic | $1,503.61 | $2,506.01 | — | — | 40% |
| Coronary stent placement, one artery CPT 92928 Prq Card Stent W/Angio 1 Vsl | $15,048.60 | $25,081.00 | — | 52% above | 40% |
| Coronary stent placement, one artery inpatient CPT 92928 Prq Card Stent W/Angio 1 Vsl | $15,048.60 | $25,081.00 | — | — | 40% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 Cerumen Removal By Irrigation | $280.20 | $467.00 | — | 353% above | 40% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Cerumen Removal By Irrigation | $280.20 | $467.00 | — | — | 40% |
| Earwax removal with instruments, one ear CPT 69210 Cerumen Removal By Instrument | $280.20 | $467.00 | — | 274% above | 40% |
| Earwax removal with instruments, one ear inpatient CPT 69210 Cerumen Removal By Instrument | $280.20 | $467.00 | — | — | 40% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy Diagnostic | $1,120.80 | $1,868.00 | — | 10% above | 40% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Sigmoidoscopy Diagnostic | $1,120.80 | $1,868.00 | — | — | 40% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoidectomy,Int,Rb Ligatn | $1,989.60 | $3,316.00 | — | 102% above | 40% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 Ligation Of Hemorrhoid(S) | $1,989.60 | $3,316.00 | — | 102% above | 40% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 Ligation Of Hemorrhoid(S) | $1,989.60 | $3,316.00 | — | — | 40% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 Hemorrhoidectomy,Int,Rb Ligatn | $1,989.60 | $3,316.00 | — | — | 40% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Cath/Intro Saline/Cont Hystero | $333.60 | $556.00 | — | 74% above | 40% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Cath/Intro Saline/Cont Hystero | $333.60 | $556.00 | — | — | 40% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I & D Abscess-Simple/Single | $925.80 | $1,543.00 | — | 255% above | 40% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I & D Abscess-Simple | $925.80 | $1,543.00 | — | 255% above | 40% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D Abscess-Simple/Single | $925.80 | $1,543.00 | — | — | 40% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D Abscess-Simple | $925.80 | $1,543.00 | — | — | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Tendon Sheath/Ligament | $987.00 | $1,645.00 | — | 317% above | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj Tendon Sheath/Ligament | $987.00 | $1,645.00 | — | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drn/Inj Major Jt/Bursa W/O Us | $1,405.20 | $2,342.00 | — | 284% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drn/Inj Major Jnt/Bursa W/O Us | $1,405.20 | $2,342.00 | — | 284% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Drn/Inj Major Jt/Bursa W/O Us | $1,405.20 | $2,342.00 | — | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Drn/Inj Major Jnt/Bursa W/O Us | $1,405.20 | $2,342.00 | — | — | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drn/Inj Inter Jnt/Bursa W/O Us | $970.80 | $1,618.00 | — | 260% above | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drn/Inj Inter Jt/Bursa W/O Us | $970.80 | $1,618.00 | — | 260% above | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Drn/Inj Inter Jt/Bursa W/O Us | $970.80 | $1,618.00 | — | — | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Drn/Inj Inter Jnt/Bursa W/O Us | $970.80 | $1,618.00 | — | — | 40% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Drn/Inj Small Jnt/Bursa W/O Us | $919.20 | $1,532.00 | — | 278% above | 40% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Drn/Inj Small Jt/Bursa W/O Us | $919.20 | $1,532.00 | — | 278% above | 40% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Drn/Inj Small Jnt/Bursa W/O Us | $919.20 | $1,532.00 | — | — | 40% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Drn/Inj Small Jt/Bursa W/O Us | $919.20 | $1,532.00 | — | — | 40% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Intmd Rpr S/A/T/Ext 2.5Cm/< | $840.00 | $1,400.00 | — | 150% above | 40% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Intmd Rpr S/A/T/Ext 2.5Cm/< | $840.00 | $1,400.00 | — | — | 40% |
| Left heart catheterization, diagnostic one side CPT 93452 Left Hrt Cath W/Ventrclgrphy | $9,200.40 | $15,334.00 | — | 95% above | 40% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 Left Hrt Cath W/Ventrclgrphy | $9,200.40 | $15,334.00 | — | — | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Inj Interlaminar Lmbr/Sac W/Ig | $2,143.20 | $3,572.00 | — | 193% above | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Inj Interlaminar Lmbr/Sac W/Ig | $2,143.20 | $3,572.00 | — | — | 40% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Excision Benign Lesion <=0.5Cm | $2,274.60 | $3,791.00 | — | 687% above | 40% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Excision Benign Lesion <=0.5Cm | $2,274.60 | $3,791.00 | — | — | 40% |
| Nail removal (partial or complete), one nail CPT 11730 Avulsion-Nail Plate,Simpl/Sngl | $1,080.00 | $1,800.00 | — | 389% above | 40% |
| Nail removal (partial or complete), one nail CPT 11730 Avulsion Of Nail Plate | $1,080.00 | $1,800.00 | — | 389% above | 40% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion Of Nail Plate | $1,080.00 | $1,800.00 | — | — | 40% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion-Nail Plate,Simpl/Sngl | $1,080.00 | $1,800.00 | — | — | 40% |
| Occipital nerve block (injection for headaches) CPT 64405 Inj, Aa&Strd; Occipital Nerve | $1,209.00 | $2,015.00 | — | 217% above | 40% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 Inj, Aa&Strd; Occipital Nerve | $1,209.00 | $2,015.00 | — | — | 40% |
| Pacemaker implant (dual chamber) CPT 33208 Ins/Repl Perm Pacemaker; Av | $13,873.80 | $23,123.00 | — | 52% above | 40% |
| Pacemaker implant (dual chamber) inpatient CPT 33208 Ins/Repl Perm Pacemaker; Av | $13,873.80 | $23,123.00 | — | — | 40% |
| Paracentesis with imaging guidance CPT 49083 Abd Paracentesis W/Imaging | $1,141.80 | $1,903.00 | — | 23% above | 40% |
| Paracentesis with imaging guidance inpatient CPT 49083 Abd Paracentesis W/Imaging | $1,141.80 | $1,903.00 | — | — | 40% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision,Nail Matrix Perm Reml | $2,228.40 | $3,714.00 | — | 416% above | 40% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision Of Nail & Nail Matrix | $2,228.40 | $3,714.00 | — | 416% above | 40% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excision Of Nail & Nail Matrix | $2,228.40 | $3,714.00 | — | — | 40% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excision,Nail Matrix Perm Reml | $2,228.40 | $3,714.00 | — | — | 40% |
| Prostate biopsy CPT 55700 Prostate Biopsy | $4,116.00 | $6,860.00 | — | 26% above | 40% |
| Prostate biopsy inpatient CPT 55700 Prostate Biopsy | $4,116.00 | $6,860.00 | — | — | 40% |
| Removal of a foreign object under the skin, simple CPT 10120 Incision&Rem Fb Subq Tiss;Smpl | $755.40 | $1,259.00 | — | 107% above | 40% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision&Rem Fb Subq Tiss;Smpl | $755.40 | $1,259.00 | — | — | 40% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colon Canc Scrn Not Hi Rsk Ind | $676.23 | $1,127.05 | — | 49% below | 40% |
| Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 Colon Canc Scrn Not Hi Rsk Ind | $676.23 | $1,127.05 | — | — | 40% |
| Short arm cast (elbow to hand) CPT 29075 Apply Elbow To Finger Cast | $1,855.80 | $3,093.00 | — | 652% above | 40% |
| Short arm cast (elbow to hand) inpatient CPT 29075 Apply Elbow To Finger Cast | $1,855.80 | $3,093.00 | — | — | 40% |
| Short arm splint (forearm and hand) CPT 29125 Splinting Shortarm Static Appl | $586.20 | $977.00 | — | 330% above | 40% |
| Short arm splint (forearm and hand) CPT 29125 Apply Forearm To Hand Splint | $586.20 | $977.00 | — | 330% above | 40% |
| Short arm splint (forearm and hand) inpatient CPT 29125 Apply Forearm To Hand Splint | $586.20 | $977.00 | — | — | 40% |
| Short arm splint (forearm and hand) inpatient CPT 29125 Splinting Shortarm Static Appl | $586.20 | $977.00 | — | — | 40% |
| Short leg cast (below the knee) CPT 29405 Apply Below Knee To Toes Cast | $1,855.80 | $3,093.00 | — | 962% above | 40% |
| Short leg cast (below the knee) CPT 29405 Application Of Short Leg Cast | $1,855.80 | $3,093.00 | — | 962% above | 40% |
| Short leg cast (below the knee) one side CPT 29405 Pt Cast Apply Short Leg Lt | $1,855.80 | $3,093.00 | — | 962% above | 40% |
| Short leg cast (below the knee) one side CPT 29405 Pt Cast Apply Short Leg Rt | $1,855.80 | $3,093.00 | — | 962% above | 40% |
| Short leg cast (below the knee) inpatient CPT 29405 Apply Below Knee To Toes Cast | $1,855.80 | $3,093.00 | — | — | 40% |
| Short leg cast (below the knee) inpatient CPT 29405 Application Of Short Leg Cast | $1,855.80 | $3,093.00 | — | — | 40% |
| Short leg cast (below the knee) inpatient one side CPT 29405 Pt Cast Apply Short Leg Lt | $1,855.80 | $3,093.00 | — | — | 40% |
| Short leg cast (below the knee) inpatient one side CPT 29405 Pt Cast Apply Short Leg Rt | $1,855.80 | $3,093.00 | — | — | 40% |
| Short leg splint (calf to foot) CPT 29515 Apply Calf To Foot Splint | $586.20 | $977.00 | — | 197% above | 40% |
| Short leg splint (calf to foot) inpatient CPT 29515 Apply Calf To Foot Splint | $586.20 | $977.00 | — | — | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Smpl Rpr S/N/Ax/G/Trk 2.5Cm/< | $477.00 | $795.00 | — | 142% above | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Smpl Rpr S/N/Ax/G/Trk 2.5Cm/< | $477.00 | $795.00 | — | — | 40% |
| Skin biopsy, punch, one lesion CPT 11104 Punch Bx Skin,Sngl Lesion | $786.00 | $1,310.00 | — | 124% above | 40% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Bx Skin,Sngl Lesion | $786.00 | $1,310.00 | — | — | 40% |
| Skin tag removal, up to 15 tags CPT 11200 Skin Tag Removal Up To&Inc 15 | $118.80 | $198.00 | — | 24% below | 40% |
| Skin tag removal, up to 15 tags CPT 11200 Remove Skin Tags <=15 Lesions | $303.60 | $506.00 | — | 95% above | 40% |
| Skin tag removal, up to 15 tags CPT 11200 Digit Removal-Soft Tissue Only | $303.60 | $506.00 | — | 95% above | 40% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 Skin Tag Removal Up To&Inc 15 | $118.80 | $198.00 | — | — | 40% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 Remove Skin Tags <=15 Lesions | $303.60 | $506.00 | — | — | 40% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 Digit Removal-Soft Tissue Only | $303.60 | $506.00 | — | — | 40% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar Puncture,Dx,W/O Imag | $1,393.20 | $2,322.00 | — | 124% above | 40% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Nicu Lumbar Punctr,Dx,W/O Imag | $1,393.20 | $2,322.00 | — | 124% above | 40% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Nicu Lumbar Punctr,Dx,W/O Imag | $1,393.20 | $2,322.00 | — | — | 40% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Lumbar Puncture,Dx,W/O Imag | $1,393.20 | $2,322.00 | — | — | 40% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Smpl Rpr S/N/Ax/G/Tk 2.6-7.5Cm | $534.00 | $890.00 | — | 149% above | 40% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Smpl Rpr S/N/Ax/G/Tk 2.6-7.5Cm | $534.00 | $890.00 | — | — | 40% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Smpl Rpr F/E/E/N/L/M 2.5Cm/< | $477.00 | $795.00 | — | 158% above | 40% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Smpl Rpr F/E/E/N/L/M 2.5Cm/< | $477.00 | $795.00 | — | — | 40% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential Bx Skin,Sngl Lesion | $369.60 | $616.00 | — | 30% above | 40% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential Bx Skin,Sngl Lesion | $369.60 | $616.00 | — | — | 40% |
| Thoracentesis with imaging guidance CPT 32555 Aspirate Pleura W/ Imaging | $1,951.20 | $3,252.00 | — | 185% above | 40% |
| Thoracentesis with imaging guidance CPT 32555 Us Guided Thoracentesis | $1,951.20 | $3,252.00 | — | 185% above | 40% |
| Thoracentesis with imaging guidance inpatient CPT 32555 Us Guided Thoracentesis | $1,951.20 | $3,252.00 | — | — | 40% |
| Thoracentesis with imaging guidance inpatient CPT 32555 Aspirate Pleura W/ Imaging | $1,951.20 | $3,252.00 | — | — | 40% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Point 1-2 Muscles | $756.60 | $1,261.00 | — | 187% above | 40% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Trigger Point 1-2 Muscles | $756.60 | $1,261.00 | — | — | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Tc-Breast Bx 1St Lesn Us Imag | $291.09 | $485.15 | — | 84% below | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Breast Bx 1St Lesion Us Imag | $2,634.00 | $4,390.00 | — | 46% above | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Tc-Breast Bx 1St Lesn Us Imag | $291.09 | $485.15 | — | — | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Breast Bx 1St Lesion Us Imag | $2,634.00 | $4,390.00 | — | — | 40% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Egd Esoph Balln Dilation <30Mm | $2,814.00 | $4,690.00 | — | 56% above | 40% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 Egd Esoph Balln Dilation <30Mm | $2,814.00 | $4,690.00 | — | — | 40% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Egd Complex Diag For Biopsy | $2,727.00 | $4,545.00 | — | 155% above | 40% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Egd Complex Diag For Biopsy | $2,727.00 | $4,545.00 | — | — | 40% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 Egd W/ Submucos Inj | $2,727.00 | $4,545.00 | — | 77% above | 40% |
| Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 Egd W/ Submucos Inj | $2,727.00 | $4,545.00 | — | — | 40% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Egd Removal Polyp/Lesion Snare | $2,727.00 | $4,545.00 | — | 24% above | 40% |
| Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 Egd Removal Polyp/Lesion Snare | $2,727.00 | $4,545.00 | — | — | 40% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Egd Dilation Over Guide Wire | $2,727.00 | $4,545.00 | — | 95% above | 40% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 Egd Dilation Over Guide Wire | $2,727.00 | $4,545.00 | — | — | 40% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Egd Complex Diagnostic | $2,475.00 | $4,125.00 | — | 117% above | 40% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Egd Complex Diagnostic | $2,475.00 | $4,125.00 | — | — | 40% |
| Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 Egd W/Transmural Drain Cyst | $3,279.00 | $5,465.00 | — | 40% below | 40% |
| Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 Egd W/Transmural Drain Cyst | $3,279.00 | $5,465.00 | — | — | 40% |
| Vein ablation, radiofrequency, first vein CPT 36475 Endovenous Rf Ablation Vein 1 | $8,977.20 | $14,962.00 | — | 37% above | 40% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 Endovenous Rf Ablation Vein 1 | $8,977.20 | $14,962.00 | — | — | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Skin/Subq <= 20 Sq Cm | $2,229.00 | $3,715.00 | — | 370% above | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Subq Tissue 20 Sq Cm/< | $2,229.00 | $3,715.00 | — | 370% above | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride Skin/Subq <= 20 Sq Cm | $2,229.00 | $3,715.00 | — | — | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride Subq Tissue 20 Sq Cm/< | $2,229.00 | $3,715.00 | — | — | 40% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Oklahoma | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Transfusion,Blood/Bld Componts | $1,522.20 | $2,537.00 | — | 110% above | 40% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion,Blood/Bld Componts | $1,522.20 | $2,537.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hhn, Initial Treatment | $201.60 | $336.00 | — | 53% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mist Tent, Initial Treatment | $201.60 | $336.00 | — | 53% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nicu Hhn, Initial Treatment | $201.60 | $336.00 | — | 53% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Ez Pap, Initial Treatment | $201.60 | $336.00 | — | 53% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mdi, Initial Treatment | $201.60 | $336.00 | — | 53% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nicu Oxi-Hood,Initial Treatmnt | $201.60 | $336.00 | — | 53% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nicu Oxy Pt Assessment Ck 99 D | $201.60 | $336.00 | — | 53% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Metaneb Pep Therapy,Initial Tx | $201.60 | $336.00 | — | 53% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Peak Flow, Initial Treatment | $201.60 | $336.00 | — | 53% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mist Tent, Initial Treatment | $201.60 | $336.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Nicu Oxy Pt Assessment Ck 99 D | $201.60 | $336.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Nicu Hhn, Initial Treatment | $201.60 | $336.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Nicu Oxi-Hood,Initial Treatmnt | $201.60 | $336.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mdi, Initial Treatment | $201.60 | $336.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hhn, Initial Treatment | $201.60 | $336.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Peak Flow, Initial Treatment | $201.60 | $336.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Metaneb Pep Therapy,Initial Tx | $201.60 | $336.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Ez Pap, Initial Treatment | $201.60 | $336.00 | — | — | 40% |
| Chemotherapy IV infusion, first hour CPT 96413 Chemo 1St Hr (Infusion) | $455.40 | $759.00 | — | 23% above | 40% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemo 1St Hr (Infusion) | $455.40 | $759.00 | — | — | 40% |
| Critical care, first 30 to 74 minutes CPT 99291 Ed Cc 1St 30-74Min W/O Proced | $2,550.00 | $4,250.00 | — | 110% above | 40% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 Ed Cc 1St 30-74Min W/O Proced | $2,550.00 | $4,250.00 | — | — | 40% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 Eeg W/Rec Awake And Drowsy | $1,168.36 | $1,947.27 | — | 118% above | 40% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Eeg W/Rec Awake And Drowsy | $1,168.36 | $1,947.27 | — | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ecg,Routine,Trcng Only,W/O I&R | $245.40 | $409.00 | — | 91% above | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Ecg,Routine,Trcng Only,W/O I&R | $245.40 | $409.00 | — | — | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Ed Srvs Lvl 1 W/O Procedures | $411.00 | $685.00 | — | 152% above | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Ed Triage Only | $411.00 | $685.00 | — | 152% above | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Ed Srvs Lvl 1 W/O Procedures | $411.00 | $685.00 | — | — | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Ed Triage Only | $411.00 | $685.00 | — | — | 40% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Ed Srvs Lvl 2 W/O Procedures | $597.00 | $995.00 | — | 90% above | 40% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Ed Srvs Lvl 2 W/O Procedures | $597.00 | $995.00 | — | — | 40% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Ed Srvs Lvl 3 W/O Procedures | $879.00 | $1,465.00 | — | 66% above | 40% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Ed Srvs Lvl 3 W/O Procedures | $879.00 | $1,465.00 | — | — | 40% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Ed Srvs Lvl 4 W/O Procedures | $1,350.00 | $2,250.00 | — | 78% above | 40% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Ed Srvs Lvl 4 W/O Procedures | $1,350.00 | $2,250.00 | — | — | 40% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Ed Srvs Lvl 5 W/O Procedures | $1,650.00 | $2,750.00 | — | 43% above | 40% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Ed Srvs Lvl 5 W/O Procedures | $1,650.00 | $2,750.00 | — | — | 40% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Nm Stress Test | $892.20 | $1,487.00 | — | 131% above | 40% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiac Stress Test(Treadmill) | $892.20 | $1,487.00 | — | 131% above | 40% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Nm Stress Test | $892.20 | $1,487.00 | — | — | 40% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiac Stress Test(Treadmill) | $892.20 | $1,487.00 | — | — | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 Family Therapy W Pt 50 Min | $397.80 | $663.00 | — | 24% above | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 Family/Marital Psytx W/Pt50Min | $397.80 | $663.00 | — | 24% above | 40% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Family Therapy W Pt 50 Min | $397.80 | $663.00 | — | — | 40% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Family/Marital Psytx W/Pt50Min | $397.80 | $663.00 | — | — | 40% |
| Family therapy without the patient, 50 minutes CPT 90846 Family Therapy W/O Pt 50 Min | $397.80 | $663.00 | — | 35% above | 40% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 Family Therapy W/O Pt 50 Min | $397.80 | $663.00 | — | — | 40% |
| Group psychotherapy session CPT 90853 Group Therapy Not Multi-Family | $159.00 | $265.00 | — | 18% below | 40% |
| Group psychotherapy session inpatient CPT 90853 Group Therapy Not Multi-Family | $159.00 | $265.00 | — | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Infus Hydrate Init 31-90Min | $291.00 | $485.00 | — | 60% above | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Iv Infus Hydrate Init 31-90Min | $291.00 | $485.00 | — | — | 40% |
| IV infusion of a medicine, first hour CPT 96365 Inf O/P Initial, Up To 1Hr | $306.60 | $511.00 | — | 30% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 Infusion O/P Initial,Up To 1Hr | $306.60 | $511.00 | — | 30% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 Wc Iv Inf Thrpy Init-Up To 1Hr | $306.60 | $511.00 | — | 30% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 Iv Inf Ther/Dx Initl-Up To 1Hr | $306.60 | $511.00 | — | 30% above | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 Inf O/P Initial, Up To 1Hr | $306.60 | $511.00 | — | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 Iv Inf Ther/Dx Initl-Up To 1Hr | $306.60 | $511.00 | — | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 Infusion O/P Initial,Up To 1Hr | $306.60 | $511.00 | — | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 Wc Iv Inf Thrpy Init-Up To 1Hr | $306.60 | $511.00 | — | — | 40% |
| IV push of a medicine, first drug CPT 96374 Injection Iv Push, Initial | $237.60 | $396.00 | — | 59% above | 40% |
| IV push of a medicine, first drug CPT 96374 Wc Injection Iv Push | $237.60 | $396.00 | — | 59% above | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 Wc Injection Iv Push | $237.60 | $396.00 | — | — | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 Injection Iv Push, Initial | $237.60 | $396.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Ther/Proph/Diag Inj, Sc/Im | $112.20 | $187.00 | — | 69% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 3Ne Injection Im - Antibiotic | $112.20 | $187.00 | — | 69% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 3Ne Injection Subq/Im | $112.20 | $187.00 | — | 69% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Wc Injection Im-Antibiotic | $112.20 | $187.00 | — | 69% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Wc Injection Subq/Im | $112.20 | $187.00 | — | 69% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Wc-Betamethasone Injection | $112.20 | $187.00 | — | 69% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection Subq/Im | $112.20 | $187.00 | — | 69% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic Im Inj | $112.20 | $187.00 | — | 69% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Ct Guided Therapeutic Im Inj. | $112.20 | $187.00 | — | 69% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Ther/Proph/Dx Injection Sq/Im | $112.20 | $187.00 | — | 69% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Wc Injection Im-Antibiotic | $112.20 | $187.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Wc Injection Subq/Im | $112.20 | $187.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Wc-Betamethasone Injection | $112.20 | $187.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection Subq/Im | $112.20 | $187.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Ther/Proph/Diag Inj, Sc/Im | $112.20 | $187.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapeutic Im Inj | $112.20 | $187.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Ct Guided Therapeutic Im Inj. | $112.20 | $187.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Ther/Proph/Dx Injection Sq/Im | $112.20 | $187.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 3Ne Injection Im - Antibiotic | $112.20 | $187.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 3Ne Injection Subq/Im | $112.20 | $187.00 | — | — | 40% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 Social History | $436.80 | $728.00 | — | 137% above | 40% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Social History | $436.80 | $728.00 | — | — | 40% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 Nrv Cndj Test 7-8 Studies | $802.20 | $1,337.00 | — | 68% above | 40% |
| Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 Nrv Cndj Test 7-8 Studies | $802.20 | $1,337.00 | — | — | 40% |
| Neuromuscular re-education, 15 minutes CPT 97112 Pt Neuromuscular Re Ed,15M | $89.40 | $149.00 | — | 28% above | 40% |
| Neuromuscular re-education, 15 minutes CPT 97112 Ot Neuromuscular Re Ed,15M | $89.40 | $149.00 | — | 28% above | 40% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 Pt Neuromuscular Re Ed,15M | $89.40 | $149.00 | — | — | 40% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 Ot Neuromuscular Re Ed,15M | $89.40 | $149.00 | — | — | 40% |
| New patient office visit, about 30 minutes CPT 99203 E&M New O/P Low 30-44 Min/Fac | $130.80 | $218.00 | — | 21% below | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 E&M New O/P Low 30-44 Min/Fac | $130.80 | $218.00 | — | — | 40% |
| New patient office visit, about 45 minutes CPT 99204 E&M New O/P Mod 45-59 Min/Fac | $201.00 | $335.00 | — | 12% below | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 E&M New O/P Mod 45-59 Min/Fac | $201.00 | $335.00 | — | — | 40% |
| New patient office visit, about 60 minutes CPT 99205 E&M New O/P Hi 60-74 Min/Fac | $202.20 | $337.00 | — | 27% below | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 E&M New O/P Hi 60-74 Min/Fac | $202.20 | $337.00 | — | — | 40% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Radiation Therapy New | $91.20 | $152.00 | — | 30% below | 40% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 E&M New O/P Sf 15-29 Min/Fac | $91.20 | $152.00 | — | 30% below | 40% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Radiation Therapy New | $91.20 | $152.00 | — | — | 40% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 E&M New O/P Sf 15-29 Min/Fac | $91.20 | $152.00 | — | — | 40% |
| Occupational therapy evaluation, low complexity CPT 97165 Ot Eval-Low Complexity-30 Min. | $201.00 | $335.00 | — | 81% above | 40% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 Ot Eval-Low Complexity-30 Min. | $201.00 | $335.00 | — | — | 40% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval-High Complexity-45 Min | $334.80 | $558.00 | — | 105% above | 40% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Pt Eval-High Complexity-45 Min | $334.80 | $558.00 | — | — | 40% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval-Low Complexity-20 Min. | $201.00 | $335.00 | — | 79% above | 40% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Pt Eval-Low Complexity-20 Min. | $201.00 | $335.00 | — | — | 40% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval-Mod Complexity-30 Min. | $267.00 | $445.00 | — | 97% above | 40% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Pt Eval-Mod Complexity-30 Min. | $267.00 | $445.00 | — | — | 40% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Pt Manual Therapy,15Min | $127.80 | $213.00 | — | 86% above | 40% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Ot Manual Therapy,15Min | $127.80 | $213.00 | — | 86% above | 40% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Ot Manual Therapy,15Min | $127.80 | $213.00 | — | — | 40% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Pt Manual Therapy,15Min | $127.80 | $213.00 | — | — | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Pt Ther Exercise,15Min | $97.80 | $163.00 | — | 42% above | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 St Ther Exercise 15 Min | $97.80 | $163.00 | — | 42% above | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ot Ther Exercise,15Min | $97.80 | $163.00 | — | 42% above | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Ot Ther Exercise,15Min | $97.80 | $163.00 | — | — | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Pt Ther Exercise,15Min | $97.80 | $163.00 | — | — | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 St Ther Exercise 15 Min | $97.80 | $163.00 | — | — | 40% |
| Psychotherapy session, 30 minutes CPT 90832 Psytx W Pt 30 Minutes | $156.00 | $260.00 | — | 28% below | 40% |
| Psychotherapy session, 30 minutes CPT 90832 Individual Php Treatment 20-30 | $156.00 | $260.00 | — | 28% below | 40% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Psytx W Pt 30 Minutes | $156.00 | $260.00 | — | — | 40% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Individual Php Treatment 20-30 | $156.00 | $260.00 | — | — | 40% |
| Psychotherapy session, 45 minutes CPT 90834 Individual Php Treatment 45-50 | $266.40 | $444.00 | — | 4% below | 40% |
| Psychotherapy session, 45 minutes CPT 90834 Psytx W Pt 45 Minutes | $266.40 | $444.00 | — | 4% below | 40% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psytx W Pt 45 Minutes | $266.40 | $444.00 | — | — | 40% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Individual Php Treatment 45-50 | $266.40 | $444.00 | — | — | 40% |
| Psychotherapy session, 60 minutes CPT 90837 Psytx W Pt 60 Minutes | $306.60 | $511.00 | — | 2% below | 40% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psytx W Pt 60 Minutes | $306.60 | $511.00 | — | — | 40% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco-Use Counsel 3-10 Min | $67.80 | $113.00 | — | 80% above | 40% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Behav Chng Smoking 3-10 Min | $67.80 | $113.00 | — | 80% above | 40% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Behav Chng Smoking 3-10 Min | $67.80 | $113.00 | — | — | 40% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco-Use Counsel 3-10 Min | $67.80 | $113.00 | — | — | 40% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 E&M O/P Est Hi 40-54 Min /Fac | $177.00 | $295.00 | — | 22% below | 40% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E&M O/P Est Hi 40-54 Min /Fac | $177.00 | $295.00 | — | — | 40% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M O/P Est Low 20-29 Min /Fac | $88.20 | $147.00 | — | 34% below | 40% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E&M O/P Est Low 20-29 Min /Fac | $88.20 | $147.00 | — | — | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E&M O/P Est Mod 30-39 Min /Fac | $130.80 | $218.00 | — | 25% below | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E&M O/P Est Mod 30-39 Min /Fac | $130.80 | $218.00 | — | — | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M O/P Est Sf 10-19 Min /Fac | $84.00 | $140.00 | — | 31% below | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E&M O/P Est Sf 10-19 Min /Fac | $84.00 | $140.00 | — | — | 40% |
| Speech and language evaluation CPT 92523 Speech Sound/Language Comprehe | $352.20 | $587.00 | — | 89% above | 40% |
| Speech and language evaluation inpatient CPT 92523 Speech Sound/Language Comprehe | $352.20 | $587.00 | — | — | 40% |
| Speech therapy session, individual CPT 92507 Speech Path Tx | $243.00 | $405.00 | — | 96% above | 40% |
| Speech therapy session, individual inpatient CPT 92507 Speech Path Tx | $243.00 | $405.00 | — | — | 40% |
| Spirometry (breathing test) CPT 94010 Pulmonary Func Test(Spirometry | $282.00 | $470.00 | — | 31% above | 40% |
| Spirometry (breathing test) inpatient CPT 94010 Pulmonary Func Test(Spirometry | $282.00 | $470.00 | — | — | 40% |
| Spirometry before and after a bronchodilator CPT 94060 Spirogram B&A Test | $468.60 | $781.00 | — | 19% above | 40% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 Spirogram B&A Test | $468.60 | $781.00 | — | — | 40% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Ot Therapeutic Activities,15M | $100.20 | $167.00 | — | 64% above | 40% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 St Thera Funct Activity 15Min | $100.20 | $167.00 | — | 64% above | 40% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Pt Therapeutic Activities,15M | $100.20 | $167.00 | — | 64% above | 40% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Ot Therapeutic Activities,15M | $100.20 | $167.00 | — | — | 40% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Pt Therapeutic Activities,15M | $100.20 | $167.00 | — | — | 40% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 St Thera Funct Activity 15Min | $100.20 | $167.00 | — | — | 40% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy | $177.00 | $295.00 | — | 44% above | 40% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Obi Therapeutic Phlebotomy I R | $1,133.40 | $1,889.00 | — | 819% above | 40% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Therapeutic Phlebotomy | $177.00 | $295.00 | — | — | 40% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Obi Therapeutic Phlebotomy I R | $1,133.40 | $1,889.00 | — | — | 40% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Oklahoma | Off list |
|---|---|---|---|---|---|
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Infanrix: 10 Syringe In 1 Carton (58160-810-52) / .5 Ml In 1 Syringe (58160-810-43) | $117.67 | $196.12 | — | 74% above | 40% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Infanrix: 10 Syringe In 1 Carton (58160-810-52) / .5 Ml In 1 Syringe (58160-810-43) | $117.67 | $196.12 | — | — | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Noncdm Charge Record Pharmacy | $62.10 | $103.50 | — | 22% above | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Flulaval 2025/2026: 10 Syringe In 1 Carton (19515-904-52) / .5 Ml In 1 Syringe (19515-904-41) | $85.80 | $143.00 | — | 68% above | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Noncdm Charge Record Pharmacy | $62.10 | $103.50 | — | — | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Flulaval 2025/2026: 10 Syringe In 1 Carton (19515-904-52) / .5 Ml In 1 Syringe (19515-904-41) | $85.80 | $143.00 | — | — | 40% |
| Hepatitis A vaccine, adult dose CPT 90632 Havrix: 10 Syringe In 1 Carton (58160-826-52) / 1 Ml In 1 Syringe (58160-826-43) | $261.90 | $436.50 | — | 51% above | 40% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 Havrix: 10 Syringe In 1 Carton (58160-826-52) / 1 Ml In 1 Syringe (58160-826-43) | $261.90 | $436.50 | — | — | 40% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Engerix-B: 10 Syringe In 1 Carton (58160-820-52) / .5 Ml In 1 Syringe (58160-820-43) | $122.55 | $204.25 | — | 104% above | 40% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Engerix-B: 10 Syringe In 1 Carton (58160-820-52) / .5 Ml In 1 Syringe (58160-820-43) | $122.55 | $204.25 | — | — | 40% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 Pedvaxhib: 10 Vial, Single-Dose In 1 Carton (0006-4897-00) / .5 Ml In 1 Vial, Single-Dose (0006-4897-01) | $129.30 | $215.50 | — | 42% above | 40% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 Pedvaxhib: 10 Vial, Single-Dose In 1 Carton (0006-4897-00) / .5 Ml In 1 Vial, Single-Dose (0006-4897-01) | $129.30 | $215.50 | — | — | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Noncdm Charge Record Pharmacy | $186.30 | $310.50 | — | 9% above | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High Dose Northern Hemisphere: 5 Syringe, Glass In 1 Package (49281-125-65) / .5 Ml In 1 Syringe, Glass (49281-125-88) | $261.90 | $436.50 | — | 54% above | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Noncdm Charge Record Pharmacy | $186.30 | $310.50 | — | — | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone High Dose Northern Hemisphere: 5 Syringe, Glass In 1 Package (49281-125-65) / .5 Ml In 1 Syringe, Glass (49281-125-88) | $261.90 | $436.50 | — | — | 40% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 Menveo: 10 Vial In 1 Carton (58160-827-30) / .5 Ml In 1 Vial (58160-827-03) | $508.50 | $847.50 | — | 216% above | 40% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Menveo: 10 Vial In 1 Carton (58160-827-30) / .5 Ml In 1 Vial (58160-827-03) | $508.50 | $847.50 | — | — | 40% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal 13-Val Conj Vacc | $61.20 | $102.00 | — | 77% below | 40% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Pneumococcal 13-Val Conj Vacc | $61.20 | $102.00 | — | — | 40% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02) / .5 Ml In 1 Syringe (0005-2000-01) | $852.48 | $1,420.80 | — | 13% above | 40% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02) / .5 Ml In 1 Syringe (0005-2000-01) | $852.48 | $1,420.80 | — | — | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal 23-Val Polyvalent | $61.20 | $102.00 | — | 63% below | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumo 23-Val Vacc 0.5Ml Syrng | $358.80 | $598.00 | — | 117% above | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal 23-Val Polyvalent | $61.20 | $102.00 | — | — | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumo 23-Val Vacc 0.5Ml Syrng | $358.80 | $598.00 | — | — | 40% |
| Rabies vaccine, one dose CPT 90675 Rabavert: 1 Kit In 1 Carton (50632-010-01) * 1 Ml In 1 Syringe (50632-011-01) * 1 Ml In 1 Vial, Glass (50632-013-01) | $1,429.16 | $2,381.93 | — | 133% above | 40% |
| Rabies vaccine, one dose inpatient CPT 90675 Rabavert: 1 Kit In 1 Carton (50632-010-01) * 1 Ml In 1 Syringe (50632-011-01) * 1 Ml In 1 Vial, Glass (50632-013-01) | $1,429.16 | $2,381.93 | — | — | 40% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tenivac: 10 Syringe In 1 Package (49281-215-15) / .5 Ml In 1 Syringe (49281-215-88) | $170.75 | $284.59 | — | 102% above | 40% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tenivac: 10 Syringe In 1 Package (49281-215-15) / .5 Ml In 1 Syringe (49281-215-88) | $170.75 | $284.59 | — | — | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix: 10 Syringe In 1 Carton (58160-842-52) / .5 Ml In 1 Syringe (58160-842-43) | $199.88 | $333.14 | — | 134% above | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Boostrix: 10 Syringe In 1 Carton (58160-842-52) / .5 Ml In 1 Syringe (58160-842-43) | $199.88 | $333.14 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Administration Nirsevimab-Alip | $11.75 | $19.58 | — | 79% below | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Ed-Immunization Admin-One Vac | $83.40 | $139.00 | — | 47% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 NDC Description Not Available | $83.40 | $139.00 | — | 47% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pneumo Vaccine Administration | $83.40 | $139.00 | — | 47% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Administration | $83.40 | $139.00 | — | 47% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Bexsero: 10 Syringe In 1 Carton (58160-976-20) / .5 Ml In 1 Syringe (58160-976-02) | $723.90 | $1,206.50 | — | 1180% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Administration Nirsevimab-Alip | $11.75 | $19.58 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Administration | $83.40 | $139.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pneumo Vaccine Administration | $83.40 | $139.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 NDC Description Not Available | $83.40 | $139.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Ed-Immunization Admin-One Vac | $83.40 | $139.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Bexsero: 10 Syringe In 1 Carton (58160-976-20) / .5 Ml In 1 Syringe (58160-976-02) | $723.90 | $1,206.50 | — | — | 40% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin-Addl Vac | $62.40 | $104.00 | — | 109% above | 40% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Admin-Addl Vac | $62.40 | $104.00 | — | — | 40% |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.
Source file: https://www.normanregional.com/documents/736048282_norman-regional-health-system_standardcharges.csv