Hospital Janesville-Beloit, WI

Beloit Memorial Hospital

Beloit Memorial Hospital in Beloit, WI publishes cash prices for 387 common procedures listed here, from its own machine-readable price file updated Oct 12, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Wisconsin median for 361 of 384 procedures and above it for 21. By typical cash price it ranks #3 of 103 Wisconsin hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

1969 West Hart Road, Beloit, WI 53511 Collected Nov 4, 2026 Source price file Check a bill from this hospital (608) 364-5011

Acute care hospital Nonprofit hospital Emergency department CMS star rating 3 of 5 CCN 520100 · CMS hospital register NPI 1982780094

Financial assistance

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

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

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

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

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 4 actions for a hospital named Beloit Memorial Hospital in Beloit, WI:

Jun 29, 2022 Warning notice
Oct 24, 2022 Corrective action plan requested
Nov 14, 2022 Case closed
Sep 12, 2025 Met requirements

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems. Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen w/ + w/o Contrast	$1,333.80	$4,446.00	$184.59–$4,253.93	44% below	70%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen w/ + w/o Contrast	$1,333.80	$4,446.00	$2,265.68–$4,253.93	—	70%
Abdominal X-ray, 2 views CPT 74019 XR OR Stone Manip/Removal	$159.00	$530.00	$110.02–$507.10	34% below	70%
Abdominal X-ray, 2 views inpatient CPT 74019 XR OR Stone Manip/Removal	$159.00	$530.00	$270.09–$507.10	—	70%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 XR Pod Ankle Complete Bilateral	$173.10	$577.00	$168.02–$552.07	—	70%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 XR Pod Ankle Complete Bilateral	$321.00	$1,070.00	$91.58–$1,023.78	—	70%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 XR Ankle Complete Bilateral	$321.00	$1,070.00	$91.58–$1,023.78	—	70%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Pod Ankle Complete Right	$160.50	$535.00	$91.58–$511.89	32% below	70%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete Left	$160.50	$535.00	$91.58–$511.89	32% below	70%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete Right	$160.50	$535.00	$91.58–$511.89	32% below	70%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Pod Ankle Complete Left	$160.50	$535.00	$91.58–$511.89	32% below	70%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Pod Ankle Complete Right	$173.10	$577.00	$168.02–$552.07	26% below	70%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Pod Ankle Complete Left	$173.10	$577.00	$168.02–$552.07	26% below	70%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 XR Pod Ankle Complete Bilateral	$173.10	$577.00	$294.04–$552.07	—	70%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 XR Ankle Complete Bilateral	$321.00	$1,070.00	$545.27–$1,023.78	—	70%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 XR Pod Ankle Complete Bilateral	$321.00	$1,070.00	$545.27–$1,023.78	—	70%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete Right	$160.50	$535.00	$272.64–$511.89	—	70%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Pod Ankle Complete Right	$160.50	$535.00	$272.64–$511.89	—	70%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Pod Ankle Complete Left	$160.50	$535.00	$272.64–$511.89	—	70%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete Left	$160.50	$535.00	$272.64–$511.89	—	70%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Pod Ankle Complete Right	$173.10	$577.00	$294.04–$552.07	—	70%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Pod Ankle Complete Left	$173.10	$577.00	$294.04–$552.07	—	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Vascular Acquisition	$237.60	$792.00	$140.02–$757.79	38% below	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Vascular Acquisition	$237.60	$792.00	$403.60–$757.79	—	70%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Forearm w/o Contrast Bilateral	$1,584.30	$5,281.00	$110.02–$5,052.86	—	70%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Wrist w/o Contrast Bilateral	$1,584.30	$5,281.00	$110.02–$5,052.86	—	70%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Hand w/o Contrast Bilateral	$1,584.30	$5,281.00	$110.02–$5,052.86	—	70%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Humerus w/o Contrast Bilateral	$1,584.30	$5,281.00	$110.02–$5,052.86	—	70%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Shoulder w/o Contrast Bilateral	$1,584.30	$5,281.00	$110.02–$5,052.86	—	70%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Upper Extremity w/o Contrast Bilat	$1,584.30	$5,281.00	$110.02–$5,052.86	—	70%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Elbow w/o Contrast Bilateral	$2,129.10	$7,097.00	$110.02–$6,790.41	—	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus w/o Contrast Left	$792.30	$2,641.00	$110.02–$2,526.91	45% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist w/o Contrast Right	$792.30	$2,641.00	$110.02–$2,526.91	45% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist w/o Contrast Left	$792.30	$2,641.00	$110.02–$2,526.91	45% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Upper Extremity w/o Contrast Right	$792.30	$2,641.00	$110.02–$2,526.91	45% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Upper Extremity w/o Contrast Left	$792.30	$2,641.00	$110.02–$2,526.91	45% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder w/o Contrast Right	$792.30	$2,641.00	$110.02–$2,526.91	45% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder w/o Contrast Left	$792.30	$2,641.00	$110.02–$2,526.91	45% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus w/o Contrast Right	$792.30	$2,641.00	$110.02–$2,526.91	45% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand w/o Contrast Right	$792.30	$2,641.00	$110.02–$2,526.91	45% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand w/o Contrast Left	$792.30	$2,641.00	$110.02–$2,526.91	45% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm w/o Contrast Right	$792.30	$2,641.00	$110.02–$2,526.91	45% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm w/o Contrast Left	$792.30	$2,641.00	$110.02–$2,526.91	45% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow w/o Contrast Left	$1,064.10	$3,547.00	$110.02–$3,393.77	26% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow w/o Contrast Right	$1,064.10	$3,547.00	$110.02–$3,393.77	26% below	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Upper Extremity w/o Contrast Bilat	$1,584.30	$5,281.00	$2,691.20–$5,052.86	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Forearm w/o Contrast Bilateral	$1,584.30	$5,281.00	$2,691.20–$5,052.86	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Wrist w/o Contrast Bilateral	$1,584.30	$5,281.00	$2,691.20–$5,052.86	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Hand w/o Contrast Bilateral	$1,584.30	$5,281.00	$2,691.20–$5,052.86	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Humerus w/o Contrast Bilateral	$1,584.30	$5,281.00	$2,691.20–$5,052.86	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Shoulder w/o Contrast Bilateral	$1,584.30	$5,281.00	$2,691.20–$5,052.86	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Elbow w/o Contrast Bilateral	$2,129.10	$7,097.00	$3,616.63–$6,790.41	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Upper Extremity w/o Contrast Right	$792.30	$2,641.00	$1,345.85–$2,526.91	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Upper Extremity w/o Contrast Left	$792.30	$2,641.00	$1,345.85–$2,526.91	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Humerus w/o Contrast Right	$792.30	$2,641.00	$1,345.85–$2,526.91	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder w/o Contrast Right	$792.30	$2,641.00	$1,345.85–$2,526.91	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder w/o Contrast Left	$792.30	$2,641.00	$1,345.85–$2,526.91	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Forearm w/o Contrast Left	$792.30	$2,641.00	$1,345.85–$2,526.91	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Forearm w/o Contrast Right	$792.30	$2,641.00	$1,345.85–$2,526.91	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Humerus w/o Contrast Left	$792.30	$2,641.00	$1,345.85–$2,526.91	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand w/o Contrast Left	$792.30	$2,641.00	$1,345.85–$2,526.91	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist w/o Contrast Right	$792.30	$2,641.00	$1,345.85–$2,526.91	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand w/o Contrast Right	$792.30	$2,641.00	$1,345.85–$2,526.91	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist w/o Contrast Left	$792.30	$2,641.00	$1,345.85–$2,526.91	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow w/o Contrast Left	$1,064.10	$3,547.00	$1,807.55–$3,393.77	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow w/o Contrast Right	$1,064.10	$3,547.00	$1,807.55–$3,393.77	—	70%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus	$300.90	$1,003.00	$184.59–$959.67	43% below	70%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Gastrografin Swallow	$300.90	$1,003.00	$184.59–$959.67	43% below	70%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus	$300.90	$1,003.00	$511.13–$959.67	—	70%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Gastrografin Swallow	$300.90	$1,003.00	$511.13–$959.67	—	70%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Imaging Whole Body	$799.80	$2,666.00	$420.71–$2,550.83	46% below	70%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Imaging Whole Body	$799.80	$2,666.00	$1,358.59–$2,550.83	—	70%
Breast ultrasound, complete, one breast both sides CPT 76641 US Breast Bilateral	$978.00	$3,260.00	$110.02–$3,119.17	—	70%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Right	$489.00	$1,630.00	$110.02–$1,559.58	8% below	70%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Left	$489.00	$1,630.00	$110.02–$1,559.58	8% below	70%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 US Breast Bilateral	$978.00	$3,260.00	$1,661.30–$3,119.17	—	70%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Left	$489.00	$1,630.00	$830.65–$1,559.58	—	70%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Right	$489.00	$1,630.00	$830.65–$1,559.58	—	70%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Angiography Abdomen, Pelvis	$2,376.60	$7,922.00	$367.15–$7,579.77	22% below	70%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Angiography Abdomen, Pelvis	$2,376.60	$7,922.00	$4,037.05–$7,579.77	—	70%
CT angiography (CTA) of the head CPT 70496 CT Angiography Head	$1,508.70	$5,029.00	$184.59–$4,811.75	27% below	70%
CT angiography (CTA) of the head inpatient CPT 70496 CT Angiography Head	$1,508.70	$5,029.00	$2,562.78–$4,811.75	—	70%
CT angiography (CTA) of the neck CPT 70498 CT Angiography Neck	$1,222.50	$4,075.00	$184.59–$3,898.96	40% below	70%
CT angiography (CTA) of the neck inpatient CPT 70498 CT Angiography Neck	$1,222.50	$4,075.00	$2,076.62–$3,898.96	—	70%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Chest w, R/O PE	$1,311.30	$4,371.00	$184.59–$4,182.17	35% below	70%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angiography Chest	$1,992.30	$6,641.00	$184.59–$6,354.11	2% below	70%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Chest w, R/O PE	$1,311.30	$4,371.00	$2,227.46–$4,182.17	—	70%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angiography Chest	$1,992.30	$6,641.00	$3,384.25–$6,354.11	—	70%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT Angiography Coronary Artery w/ Eval	$1,464.90	$4,883.00	$853.63–$4,672.05	16% below	70%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT Angiography Coronary Artery w/ Eval	$1,464.90	$4,883.00	$2,488.38–$4,672.05	—	70%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Coronary Calcium Scoring w/o Contrast	$62.70	$209.00	$91.58–$366.33	3% below	70%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Coronary Calcium Scoring w/o Contrast	$62.70	$209.00	$106.51–$199.97	—	70%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen, Pelvis w/o Contrast	$1,561.20	$5,204.00	$251.10–$4,979.19	38% below	70%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen, Pelvis w/o Contrast	$1,561.20	$5,204.00	$2,651.96–$4,979.19	—	70%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen, Pelvis w/ Contrast	$1,826.70	$6,089.00	$367.15–$5,825.96	43% below	70%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen, Pelvis w/ Contrast	$1,826.70	$6,089.00	$3,102.95–$5,825.96	—	70%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen, Pelvis w/ + w/o Contrast	$2,367.90	$7,893.00	$367.15–$7,552.02	36% below	70%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen, Pelvis w/ + w/o Contrast	$2,367.90	$7,893.00	$4,022.27–$7,552.02	—	70%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast	$989.70	$3,299.00	$184.59–$3,156.48	40% below	70%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Contrast	$989.70	$3,299.00	$1,681.17–$3,156.48	—	70%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast	$784.80	$2,616.00	$110.02–$2,502.99	38% below	70%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Contrast	$784.80	$2,616.00	$1,333.11–$2,502.99	—	70%
CT scan of the face and sinuses, no contrast dye both sides CPT 70486 CT TMJ w/o Contrast Bilateral	$1,567.50	$5,225.00	$110.02–$4,999.28	—	70%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Stereo Nav for Sinus Surgery	$713.40	$2,378.00	$110.02–$2,275.27	49% below	70%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus w/o Contrast	$783.60	$2,612.00	$110.02–$2,499.16	44% below	70%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Contrast	$783.60	$2,612.00	$110.02–$2,499.16	44% below	70%
CT scan of the face and sinuses, no contrast dye one side CPT 70486 CT TMJ w/o Contrast Right	$783.60	$2,612.00	$110.02–$2,499.16	44% below	70%
CT scan of the face and sinuses, no contrast dye one side CPT 70486 CT TMJ w/o Contrast Left	$783.60	$2,612.00	$110.02–$2,499.16	44% below	70%
CT scan of the face and sinuses, no contrast dye inpatient both sides CPT 70486 CT TMJ w/o Contrast Bilateral	$1,567.50	$5,225.00	$2,662.66–$4,999.28	—	70%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Stereo Nav for Sinus Surgery	$713.40	$2,378.00	$1,211.83–$2,275.27	—	70%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus w/o Contrast	$783.60	$2,612.00	$1,331.08–$2,499.16	—	70%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Contrast	$783.60	$2,612.00	$1,331.08–$2,499.16	—	70%
CT scan of the face and sinuses, no contrast dye inpatient one side CPT 70486 CT TMJ w/o Contrast Left	$783.60	$2,612.00	$1,331.08–$2,499.16	—	70%
CT scan of the face and sinuses, no contrast dye inpatient one side CPT 70486 CT TMJ w/o Contrast Right	$783.60	$2,612.00	$1,331.08–$2,499.16	—	70%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Contrast	$708.60	$2,362.00	$110.02–$2,259.96	45% below	70%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Contrast	$708.60	$2,362.00	$1,203.68–$2,259.96	—	70%
CT scan of the head with contrast CPT 70460 CT Head or Brain w/ Contrast	$918.00	$3,060.00	$184.59–$2,927.81	41% below	70%
CT scan of the head with contrast inpatient CPT 70460 CT Head or Brain w/ Contrast	$918.00	$3,060.00	$1,559.38–$2,927.81	—	70%
CT scan of the head without and with contrast CPT 70470 CT Brain w/ + w/o Contrast	$1,008.60	$3,362.00	$184.59–$3,216.76	45% below	70%
CT scan of the head without and with contrast inpatient CPT 70470 CT Brain w/ + w/o Contrast	$1,008.60	$3,362.00	$1,713.28–$3,216.76	—	70%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Contrast	$959.40	$3,198.00	$110.02–$3,059.85	38% below	70%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Contrast	$959.40	$3,198.00	$1,629.70–$3,059.85	—	70%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Contrast	$1,001.40	$3,338.00	$110.02–$3,193.80	35% below	70%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Contrast	$1,001.40	$3,338.00	$1,701.04–$3,193.80	—	70%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast	$948.60	$3,162.00	$184.59–$3,025.40	42% below	70%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast	$948.60	$3,162.00	$1,611.36–$3,025.40	—	70%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Vascular Acquisition	$537.30	$1,791.00	$251.10–$1,713.63	46% below	70%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 Vascular Acquisition	$537.30	$1,791.00	$912.69–$1,713.63	—	70%
Chest CT scan without and with contrast CPT 71270 CT Thorax w/ + w/o Contrast	$1,119.00	$3,730.00	$184.59–$3,568.86	51% below	70%
Chest CT scan without and with contrast inpatient CPT 71270 CT Thorax w/ + w/o Contrast	$1,119.00	$3,730.00	$1,900.81–$3,568.86	—	70%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$143.40	$478.00	$91.58–$457.35	33% below	70%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views w/ Fluoroscopy	$357.00	$1,190.00	$91.58–$1,138.59	66% above	70%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$143.40	$478.00	$243.59–$457.35	—	70%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views w/ Fluoroscopy	$357.00	$1,190.00	$606.42–$1,138.59	—	70%
Chest X-ray, single view CPT 71045 BCE XR Chest 1 View Frontal	$123.90	$413.00	$66.98–$395.16	23% below	70%
Chest X-ray, single view CPT 71045 XR Chest 1 View, Abdomen 1 View	$145.20	$484.00	$66.98–$463.09	10% below	70%
Chest X-ray, single view CPT 71045 XR Trauma Chest 1 View, Pelvis 1 View	$145.20	$484.00	$66.98–$463.09	10% below	70%
Chest X-ray, single view CPT 71045 XR Babygram	$145.20	$484.00	$66.98–$463.09	10% below	70%
Chest X-ray, single view CPT 71045 XR Chest 1 View Frontal	$145.20	$484.00	$66.98–$463.09	10% below	70%
Chest X-ray, single view CPT 71045 XR Chest Special Views	$155.70	$519.00	$66.98–$496.58	4% below	70%
Chest X-ray, single view inpatient CPT 71045 BCE XR Chest 1 View Frontal	$123.90	$413.00	$210.46–$395.16	—	70%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View Frontal	$145.20	$484.00	$246.65–$463.09	—	70%
Chest X-ray, single view inpatient CPT 71045 XR Trauma Chest 1 View, Pelvis 1 View	$145.20	$484.00	$246.65–$463.09	—	70%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View, Abdomen 1 View	$145.20	$484.00	$246.65–$463.09	—	70%
Chest X-ray, single view inpatient CPT 71045 XR Babygram	$145.20	$484.00	$246.65–$463.09	—	70%
Chest X-ray, single view inpatient CPT 71045 XR Chest Special Views	$155.70	$519.00	$264.48–$496.58	—	70%
Collarbone (clavicle) X-ray, complete both sides CPT 73000 XR Clavicle Bilateral	$330.00	$1,100.00	$91.58–$1,052.48	—	70%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Right	$165.00	$550.00	$91.58–$526.24	20% below	70%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Left	$165.00	$550.00	$91.58–$526.24	20% below	70%
Collarbone (clavicle) X-ray, complete inpatient both sides CPT 73000 XR Clavicle Bilateral	$330.00	$1,100.00	$560.56–$1,052.48	—	70%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Left	$165.00	$550.00	$280.28–$526.24	—	70%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Right	$165.00	$550.00	$280.28–$526.24	—	70%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Aorta Complete	$345.60	$1,152.00	$110.02–$1,102.23	37% below	70%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$380.70	$1,269.00	$110.02–$1,214.18	31% below	70%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Aorta Complete	$345.60	$1,152.00	$587.06–$1,102.23	—	70%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete	$380.70	$1,269.00	$646.68–$1,214.18	—	70%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton	$219.60	$732.00	$110.02–$700.38	45% below	70%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Density DEXA Axial Skeleton	$219.60	$732.00	$373.03–$700.38	—	70%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD Bone Density DEXA App Skeleton	$142.50	$475.00	$88.28–$454.48	50% below	70%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD Bone Density DEXA App Skeleton	$142.50	$475.00	$242.06–$454.48	—	70%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Thorax w/o Contrast	$848.40	$2,828.00	$110.02–$2,705.83	41% below	70%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Thorax w/o Contrast	$848.40	$2,828.00	$1,441.15–$2,705.83	—	70%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Thorax w/ Contrast	$1,005.90	$3,353.00	$184.59–$3,208.15	39% below	70%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Thorax w/ Contrast	$1,005.90	$3,353.00	$1,708.69–$3,208.15	—	70%
Diagnostic mammogram, both breasts both sides CPT 77066 MA Mam Digital WWHSP Diag Bilat w/ CAD	$133.50	$445.00	$129.58–$624.12	—	70%
Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Digital WWHSP Diag Bilat	$133.50	$445.00	$129.58–$624.12	—	70%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mammogram Digital WWHSP Diag Bilat	$133.50	$445.00	$226.77–$425.78	—	70%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mam Digital WWHSP Diag Bilat w/ CAD	$133.50	$445.00	$226.77–$425.78	—	70%
Diagnostic mammogram, one breast one side CPT 77065 MA Mam Digital WWHSP Diag Right w/ CAD	$117.90	$393.00	$114.44–$376.02	62% below	70%
Diagnostic mammogram, one breast one side CPT 77065 MA Mam Digital WWHSP Diag Left w/ CAD	$117.90	$393.00	$114.44–$376.02	62% below	70%
Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Digital WWHSP Diag RT	$117.90	$393.00	$114.44–$376.02	62% below	70%
Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Digital WWHSP Diag LT	$117.90	$393.00	$114.44–$376.02	62% below	70%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mam Digital WWHSP Diag Left w/ CAD	$117.90	$393.00	$200.27–$376.02	—	70%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Digital WWHSP Diag LT	$117.90	$393.00	$200.27–$376.02	—	70%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mam Digital WWHSP Diag Right w/ CAD	$117.90	$393.00	$200.27–$376.02	—	70%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Digital WWHSP Diag RT	$117.90	$393.00	$200.27–$376.02	—	70%
Duplex ultrasound of the leg arteries, both legs CPT 93925 ICD Check Remote 90 Day	$78.90	$263.00	$131.29–$1,004.39	86% below	70%
Duplex ultrasound of the leg arteries, both legs CPT 93925 Vascular Acquisition	$732.60	$2,442.00	$251.10–$2,336.51	27% above	70%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 ICD Check Remote 90 Day	$78.90	$263.00	$134.02–$251.64	—	70%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 Vascular Acquisition	$732.60	$2,442.00	$1,244.44–$2,336.51	—	70%
Duplex ultrasound of the leg veins, both legs CPT 93970 Vascular Acquisition	$625.50	$2,085.00	$251.10–$1,994.93	47% below	70%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Vascular Acquisition	$625.50	$2,085.00	$1,062.52–$1,994.93	—	70%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 BCE CV Echocardiogram W Contrast Acquisition	$1,036.80	$3,456.00	$575.04–$3,306.70	41% below	70%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 BCE CV Echo Complete WO Contrast Acqusition	$1,036.80	$3,456.00	$575.04–$3,306.70	41% below	70%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echo Acquisition	$1,110.30	$3,701.00	$575.04–$3,541.12	37% below	70%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 BCE CV Echo Complete WO Contrast Acqusition	$1,036.80	$3,456.00	$1,761.18–$3,306.70	—	70%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 BCE CV Echocardiogram W Contrast Acquisition	$1,036.80	$3,456.00	$1,761.18–$3,306.70	—	70%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Echo Acquisition	$1,110.30	$3,701.00	$1,886.03–$3,541.12	—	70%
Elbow X-ray, 2 views both sides CPT 73070 XR Elbow 2 Views Bilateral	$301.80	$1,006.00	$91.58–$962.54	—	70%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Left	$150.90	$503.00	$91.58–$481.27	21% below	70%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Right	$150.90	$503.00	$91.58–$481.27	21% below	70%
Elbow X-ray, 2 views inpatient both sides CPT 73070 XR Elbow 2 Views Bilateral	$301.80	$1,006.00	$512.66–$962.54	—	70%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Left	$150.90	$503.00	$256.33–$481.27	—	70%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Right	$150.90	$503.00	$256.33–$481.27	—	70%
Elbow X-ray, complete, 3 or more views both sides CPT 73080 XR Elbow Complete Bilateral	$331.20	$1,104.00	$91.58–$1,056.31	—	70%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete Right	$165.60	$552.00	$91.58–$528.15	30% below	70%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete Left	$165.60	$552.00	$91.58–$528.15	30% below	70%
Elbow X-ray, complete, 3 or more views inpatient both sides CPT 73080 XR Elbow Complete Bilateral	$331.20	$1,104.00	$562.60–$1,056.31	—	70%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Complete Right	$165.60	$552.00	$281.30–$528.15	—	70%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Complete Left	$165.60	$552.00	$281.30–$528.15	—	70%
Eye socket (orbit) CT scan without contrast CPT 70480 CT IAC/Sella/Orbit/Temporal w/o Con	$803.10	$2,677.00	$110.02–$2,561.35	44% below	70%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT IAC/Sella/Orbit/Temporal w/o Con	$803.10	$2,677.00	$1,364.20–$2,561.35	—	70%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR Facial Bones Minimum 3 Views	$209.10	$697.00	$110.02–$666.89	30% below	70%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR Facial Bones Minimum 3 Views	$209.10	$697.00	$355.19–$666.89	—	70%
Forearm X-ray (radius and ulna), 2 views both sides CPT 73090 XR Forearm 2 Views Bilateral	$303.90	$1,013.00	$91.58–$969.24	—	70%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Right	$151.80	$506.00	$91.58–$484.14	23% below	70%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Left	$151.80	$506.00	$91.58–$484.14	23% below	70%
Forearm X-ray (radius and ulna), 2 views inpatient both sides CPT 73090 XR Forearm 2 Views Bilateral	$303.90	$1,013.00	$516.22–$969.24	—	70%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Right	$151.80	$506.00	$257.86–$484.14	—	70%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Left	$151.80	$506.00	$257.86–$484.14	—	70%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary Duct System Imaging	$680.70	$2,269.00	$420.71–$2,170.98	54% below	70%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary Duct System Imaging	$680.70	$2,269.00	$1,156.28–$2,170.98	—	70%
Hand X-ray, 2 views both sides CPT 73120 XR Hand 2 Views Bilateral	$210.00	$700.00	$110.02–$669.76	—	70%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Left	$104.70	$349.00	$110.02–$440.09	44% below	70%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Right	$104.70	$349.00	$110.02–$440.09	44% below	70%
Hand X-ray, 2 views inpatient both sides CPT 73120 XR Hand 2 Views Bilateral	$210.00	$700.00	$356.72–$669.76	—	70%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Right	$104.70	$349.00	$177.85–$333.92	—	70%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Left	$104.70	$349.00	$177.85–$333.92	—	70%
Heel bone (calcaneus) X-ray, 2 or more views both sides CPT 73650 XR Pod Calcaneous Bilat	$260.40	$868.00	$91.58–$830.50	—	70%
Heel bone (calcaneus) X-ray, 2 or more views both sides CPT 73650 XR Calcaneous Bilateral	$260.40	$868.00	$91.58–$830.50	—	70%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Pod Calcaneous Left	$130.20	$434.00	$91.58–$415.25	34% below	70%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneous Left	$130.20	$434.00	$91.58–$415.25	34% below	70%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneous Right	$130.20	$434.00	$91.58–$415.25	34% below	70%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Pod Calcaneous Right	$130.20	$434.00	$91.58–$415.25	34% below	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient both sides CPT 73650 XR Calcaneous Bilateral	$260.40	$868.00	$442.33–$830.50	—	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient both sides CPT 73650 XR Pod Calcaneous Bilat	$260.40	$868.00	$442.33–$830.50	—	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Pod Calcaneous Right	$130.20	$434.00	$221.17–$415.25	—	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneous Left	$130.20	$434.00	$221.17–$415.25	—	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneous Right	$130.20	$434.00	$221.17–$415.25	—	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Pod Calcaneous Left	$130.20	$434.00	$221.17–$415.25	—	70%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Home Sleep Test	$278.10	$927.00	$227.24–$1,452.88	55% below	70%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Home Sleep Test	$278.10	$927.00	$472.40–$886.95	—	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 CPAP Titration	$2,300.40	$7,668.00	$903.73–$7,336.74	37% below	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnogram With CPAP	$2,300.40	$7,668.00	$903.73–$7,336.74	37% below	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP APNEA CPAP	$2,300.40	$7,668.00	$903.73–$7,336.74	37% below	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 NOCTURNAL PSG FOLLOW UP	$2,300.40	$7,668.00	$903.73–$7,336.74	37% below	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 NOCTURNAL POLYSOMNOGRAM-SAS	$2,300.40	$7,668.00	$903.73–$7,336.74	37% below	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnogram CPAP - Sleep Test	$2,514.00	$8,380.00	$903.73–$8,017.98	31% below	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnogram CPAP With Titration - Sleep Test	$2,514.00	$8,380.00	$903.73–$8,017.98	31% below	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 NOCTURNAL POLYSOMNOGRAM-SAS	$2,300.40	$7,668.00	$3,907.61–$7,336.74	—	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 NOCTURNAL PSG FOLLOW UP	$2,300.40	$7,668.00	$3,907.61–$7,336.74	—	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP APNEA CPAP	$2,300.40	$7,668.00	$3,907.61–$7,336.74	—	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 CPAP Titration	$2,300.40	$7,668.00	$3,907.61–$7,336.74	—	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysomnogram With CPAP	$2,300.40	$7,668.00	$3,907.61–$7,336.74	—	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysomnogram CPAP With Titration - Sleep Test	$2,514.00	$8,380.00	$4,270.45–$8,017.98	—	70%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysomnogram CPAP - Sleep Test	$2,514.00	$8,380.00	$4,270.45–$8,017.98	—	70%
Knee X-ray, 3 views both sides CPT 73562 XR Knee 3 Views Bilateral	$351.00	$1,170.00	$91.58–$1,119.46	—	70%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Right	$175.80	$586.00	$91.58–$560.68	31% below	70%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Left	$175.80	$586.00	$91.58–$560.68	31% below	70%
Knee X-ray, 3 views inpatient both sides CPT 73562 XR Knee 3 Views Bilateral	$351.00	$1,170.00	$596.23–$1,119.46	—	70%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Right	$175.80	$586.00	$298.63–$560.68	—	70%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Left	$175.80	$586.00	$298.63–$560.68	—	70%
Knee X-ray, complete, 4 or more views both sides CPT 73564 XR Knee Complete Bilateral	$456.00	$1,520.00	$110.02–$1,454.34	—	70%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee 4 Views w/ Patella Left	$228.00	$760.00	$110.02–$727.17	18% below	70%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee 4 Views w/ Tunnel + Sunrise Left	$228.00	$760.00	$110.02–$727.17	18% below	70%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee 4 Views w/ Patella Right	$228.00	$760.00	$110.02–$727.17	18% below	70%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee 4 Views w/ Tunnel + Sunrise Right	$228.00	$760.00	$110.02–$727.17	18% below	70%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Complete Left	$228.00	$760.00	$110.02–$727.17	18% below	70%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Complete Right	$228.00	$760.00	$110.02–$727.17	18% below	70%
Knee X-ray, complete, 4 or more views inpatient both sides CPT 73564 XR Knee Complete Bilateral	$456.00	$1,520.00	$774.59–$1,454.34	—	70%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Complete Left	$228.00	$760.00	$387.30–$727.17	—	70%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee 4 Views w/ Tunnel + Sunrise Right	$228.00	$760.00	$387.30–$727.17	—	70%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee 4 Views w/ Patella Left	$228.00	$760.00	$387.30–$727.17	—	70%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee 4 Views w/ Patella Right	$228.00	$760.00	$387.30–$727.17	—	70%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Complete Right	$228.00	$760.00	$387.30–$727.17	—	70%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee 4 Views w/ Tunnel + Sunrise Left	$228.00	$760.00	$387.30–$727.17	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Knee w/o Contrast Bilateral	$1,551.30	$5,171.00	$110.02–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Femur w/o Contrast Bilateral	$1,551.30	$5,171.00	$110.02–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Ankle w/o Contrast Bilateral	$1,551.30	$5,171.00	$110.02–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Tibia/Fibula w/o Contrast Bilateral	$1,551.30	$5,171.00	$110.02–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Foot w/o Contrast Bilateral	$1,551.30	$5,171.00	$110.02–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Hip w/o Contrast Bilateral	$1,551.30	$5,171.00	$110.02–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Lower Extremity w/o Contrast Bilat	$1,551.30	$5,171.00	$110.02–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot w/o Contrast Left	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle w/o Contrast Left	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle w/o Contrast Right	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot w/o Contrast Right	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur w/o Contrast Left	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity w/o Contrast Left	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity w/o Contrast Right	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur w/o Contrast Right	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Hip w/o Contrast Left	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia/Fibula w/o Contrast Right	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee w/o Contrast Right	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee w/o Contrast Left	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia/Fibula w/o Contrast Left	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Hip w/o Contrast Right	$775.50	$2,585.00	$110.02–$2,473.33	47% below	70%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Tibia/Fibula w/o Contrast Bilateral	$1,551.30	$5,171.00	$2,635.14–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Lower Extremity w/o Contrast Bilat	$1,551.30	$5,171.00	$2,635.14–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Knee w/o Contrast Bilateral	$1,551.30	$5,171.00	$2,635.14–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Hip w/o Contrast Bilateral	$1,551.30	$5,171.00	$2,635.14–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Foot w/o Contrast Bilateral	$1,551.30	$5,171.00	$2,635.14–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Femur w/o Contrast Bilateral	$1,551.30	$5,171.00	$2,635.14–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Ankle w/o Contrast Bilateral	$1,551.30	$5,171.00	$2,635.14–$4,947.61	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Femur w/o Contrast Right	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle w/o Contrast Right	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle w/o Contrast Left	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Tibia/Fibula w/o Contrast Right	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Tibia/Fibula w/o Contrast Left	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity w/o Contrast Right	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity w/o Contrast Left	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee w/o Contrast Right	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee w/o Contrast Left	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Hip w/o Contrast Right	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Hip w/o Contrast Left	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot w/o Contrast Right	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot w/o Contrast Left	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Femur w/o Contrast Left	$775.50	$2,585.00	$1,317.32–$2,473.33	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ED Soft Tissue Abdominal Wall	$432.30	$1,441.00	$110.02–$1,378.75	3% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ED Soft Tissue Lower Back	$432.30	$1,441.00	$110.02–$1,378.75	3% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Liver	$449.70	$1,499.00	$110.02–$1,434.24	1% above	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Spleen	$449.70	$1,499.00	$110.02–$1,434.24	1% above	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Gallbladder	$449.70	$1,499.00	$110.02–$1,434.24	1% above	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited	$449.70	$1,499.00	$110.02–$1,434.24	1% above	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder one side CPT 76705 US Right Lower Quadrant	$441.60	$1,472.00	$110.02–$1,408.41	1% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder one side CPT 76705 US Right Upper Quadrant	$441.60	$1,472.00	$110.02–$1,408.41	1% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder one side CPT 76705 US Left Lower Quadrant	$449.70	$1,499.00	$110.02–$1,434.24	1% above	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder one side CPT 76705 US Left Upper Quadrant	$449.70	$1,499.00	$110.02–$1,434.24	1% above	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ED Soft Tissue Abdominal Wall	$432.30	$1,441.00	$734.33–$1,378.75	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ED Soft Tissue Lower Back	$432.30	$1,441.00	$734.33–$1,378.75	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Gallbladder	$449.70	$1,499.00	$763.89–$1,434.24	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Spleen	$449.70	$1,499.00	$763.89–$1,434.24	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Limited	$449.70	$1,499.00	$763.89–$1,434.24	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Liver	$449.70	$1,499.00	$763.89–$1,434.24	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient one side CPT 76705 US Right Lower Quadrant	$441.60	$1,472.00	$750.13–$1,408.41	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient one side CPT 76705 US Right Upper Quadrant	$441.60	$1,472.00	$750.13–$1,408.41	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient one side CPT 76705 US Left Upper Quadrant	$449.70	$1,499.00	$763.89–$1,434.24	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient one side CPT 76705 US Left Lower Quadrant	$449.70	$1,499.00	$763.89–$1,434.24	—	70%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US ED Soft Tissue Upper Extremity	$289.20	$964.00	$110.02–$922.36	1% above	70%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US ED Soft Tissue Axilla	$289.20	$964.00	$110.02–$922.36	1% above	70%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US ED Soft Tissue Axilla	$289.20	$964.00	$491.25–$922.36	—	70%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US ED Soft Tissue Upper Extremity	$289.20	$964.00	$491.25–$922.36	—	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Screening Follow Up 12 Months	$1,015.80	$3,386.00	$344.28–$3,333.20	128% above	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Screening Low Dose Initial	$1,015.80	$3,386.00	$344.28–$3,333.20	128% above	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Screening Low Dose Initial	$1,015.80	$3,386.00	$1,725.51–$3,239.72	—	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Screening Follow Up 12 Months	$1,015.80	$3,386.00	$1,725.51–$3,239.72	—	70%
Lower leg X-ray (tibia and fibula), 2 views both sides CPT 73590 XR Tibia/Fibula Bilateral	$336.90	$1,123.00	$91.58–$1,074.49	—	70%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia/Fibula Left	$168.60	$562.00	$91.58–$537.72	21% below	70%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia/Fibula Right	$168.60	$562.00	$91.58–$537.72	21% below	70%
Lower leg X-ray (tibia and fibula), 2 views inpatient both sides CPT 73590 XR Tibia/Fibula Bilateral	$336.90	$1,123.00	$572.28–$1,074.49	—	70%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia/Fibula Right	$168.60	$562.00	$286.40–$537.72	—	70%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia/Fibula Left	$168.60	$562.00	$286.40–$537.72	—	70%
MR angiography (MRA) of the head without contrast CPT 70544 MRV Head Venous Angiogram w/o Contrast	$1,287.90	$4,293.00	$633.57–$4,107.54	42% below	70%
MR angiography (MRA) of the head without contrast CPT 70544 MRA Head w/o Contrast	$1,287.90	$4,293.00	$633.57–$4,107.54	42% below	70%
MR angiography (MRA) of the head without contrast CPT 70544 MRV Head Venous Angiogram w/o	$1,789.50	$5,965.00	$633.57–$5,707.31	19% below	70%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV Head Venous Angiogram w/o Contrast	$1,287.90	$4,293.00	$2,187.71–$4,107.54	—	70%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA Head w/o Contrast	$1,287.90	$4,293.00	$2,187.71–$4,107.54	—	70%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV Head Venous Angiogram w/o	$1,789.50	$5,965.00	$3,039.76–$5,707.31	—	70%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI Breast w/ + w/o Contrast Bilateral	$1,692.00	$5,640.00	$929.09–$5,396.35	—	70%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI Breast w/ + w/o Contrast Bilateral	$1,692.00	$5,640.00	$2,874.14–$5,396.35	—	70%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Hip w/o Contrast Bilateral	$2,714.40	$9,048.00	$251.10–$8,657.13	—	70%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Knee w/o Contrast Bilateral	$2,714.40	$9,048.00	$251.10–$8,657.13	—	70%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Ankle w/o Contrast Bilateral	$2,714.40	$9,048.00	$251.10–$8,657.13	—	70%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI LE Joint w/o Contrast Bilateral	$2,714.40	$9,048.00	$251.10–$8,657.13	—	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE Joint w/o Contrast Right	$1,357.20	$4,524.00	$251.10–$4,328.56	39% below	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Contrast Left	$1,357.20	$4,524.00	$251.10–$4,328.56	39% below	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Left	$1,357.20	$4,524.00	$251.10–$4,328.56	39% below	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Contrast Right	$1,357.20	$4,524.00	$251.10–$4,328.56	39% below	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE Joint w/o Contrast Left	$1,357.20	$4,524.00	$251.10–$4,328.56	39% below	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Right	$1,357.20	$4,524.00	$251.10–$4,328.56	39% below	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Contrast Left	$1,357.20	$4,524.00	$251.10–$4,328.56	39% below	70%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Contrast Right	$1,357.20	$4,524.00	$251.10–$4,328.56	39% below	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI Hip w/o Contrast Bilateral	$2,714.40	$9,048.00	$4,610.86–$8,657.13	—	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI Knee w/o Contrast Bilateral	$2,714.40	$9,048.00	$4,610.86–$8,657.13	—	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI LE Joint w/o Contrast Bilateral	$2,714.40	$9,048.00	$4,610.86–$8,657.13	—	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI Ankle w/o Contrast Bilateral	$2,714.40	$9,048.00	$4,610.86–$8,657.13	—	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Contrast Right	$1,357.20	$4,524.00	$2,305.43–$4,328.56	—	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Contrast Right	$1,357.20	$4,524.00	$2,305.43–$4,328.56	—	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Contrast Left	$1,357.20	$4,524.00	$2,305.43–$4,328.56	—	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Contrast Right	$1,357.20	$4,524.00	$2,305.43–$4,328.56	—	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE Joint w/o Contrast Right	$1,357.20	$4,524.00	$2,305.43–$4,328.56	—	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Contrast Left	$1,357.20	$4,524.00	$2,305.43–$4,328.56	—	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Contrast Left	$1,357.20	$4,524.00	$2,305.43–$4,328.56	—	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE Joint w/o Contrast Left	$1,357.20	$4,524.00	$2,305.43–$4,328.56	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MRI Ankle w/ + w/o Contrast Bilateral	$3,648.00	$12,160.00	$367.15–$11,634.69	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MRI LE Joint w/ + w/o Contrast Bilateral	$3,648.00	$12,160.00	$367.15–$11,634.69	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MRI Knee w/ + w/o Contrast Bilateral	$3,648.00	$12,160.00	$367.15–$11,634.69	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE Joint w/ + w/o Contrast Left	$1,824.00	$6,080.00	$367.15–$5,817.34	47% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE Joint w/ + w/o Contrast Right	$1,824.00	$6,080.00	$367.15–$5,817.34	47% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Right	$1,824.00	$6,080.00	$367.15–$5,817.34	47% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Left	$1,824.00	$6,080.00	$367.15–$5,817.34	47% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Right	$1,824.00	$6,080.00	$367.15–$5,817.34	47% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Left	$1,824.00	$6,080.00	$367.15–$5,817.34	47% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Contrast Right	$1,824.00	$6,080.00	$367.15–$5,817.34	47% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Contrast Left	$1,824.00	$6,080.00	$367.15–$5,817.34	47% below	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 MRI Knee w/ + w/o Contrast Bilateral	$3,648.00	$12,160.00	$6,196.74–$11,634.69	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 MRI Ankle w/ + w/o Contrast Bilateral	$3,648.00	$12,160.00	$6,196.74–$11,634.69	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 MRI LE Joint w/ + w/o Contrast Bilateral	$3,648.00	$12,160.00	$6,196.74–$11,634.69	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Contrast Left	$1,824.00	$6,080.00	$3,098.37–$5,817.34	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Contrast Right	$1,824.00	$6,080.00	$3,098.37–$5,817.34	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Contrast Right	$1,824.00	$6,080.00	$3,098.37–$5,817.34	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE Joint w/ + w/o Contrast Right	$1,824.00	$6,080.00	$3,098.37–$5,817.34	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Contrast Left	$1,824.00	$6,080.00	$3,098.37–$5,817.34	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Contrast Right	$1,824.00	$6,080.00	$3,098.37–$5,817.34	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE Joint w/ + w/o Contrast Left	$1,824.00	$6,080.00	$3,098.37–$5,817.34	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Contrast Left	$1,824.00	$6,080.00	$3,098.37–$5,817.34	—	70%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Contrast	$1,204.20	$4,014.00	$251.10–$3,840.60	46% below	70%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Contrast	$1,204.20	$4,014.00	$2,045.53–$3,840.60	—	70%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRCP MRI Common Duct/Pancreas w/ +w/o	$1,738.50	$5,795.00	$367.15–$5,544.66	49% below	70%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Contrast	$1,738.50	$5,795.00	$367.15–$5,544.66	49% below	70%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Contrast	$1,738.50	$5,795.00	$2,953.13–$5,544.66	—	70%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRCP MRI Common Duct/Pancreas w/ +w/o	$1,738.50	$5,795.00	$2,953.13–$5,544.66	—	70%
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast	$1,307.70	$4,359.00	$251.10–$4,170.69	41% below	70%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast	$1,307.70	$4,359.00	$2,221.35–$4,170.69	—	70%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast	$1,884.00	$6,280.00	$367.15–$6,008.70	45% below	70%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain, IAC w + w/o	$1,915.50	$6,385.00	$367.15–$6,109.17	44% below	70%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast	$1,884.00	$6,280.00	$3,200.29–$6,008.70	—	70%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain, IAC w + w/o	$1,915.50	$6,385.00	$3,253.80–$6,109.17	—	70%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast	$1,393.20	$4,644.00	$251.10–$4,443.38	37% below	70%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast	$1,393.20	$4,644.00	$2,366.58–$4,443.38	—	70%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$1,870.50	$6,235.00	$367.15–$5,965.65	45% below	70%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$1,870.50	$6,235.00	$3,177.36–$5,965.65	—	70%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast	$1,388.10	$4,627.00	$251.10–$4,427.11	37% below	70%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Contrast	$1,388.10	$4,627.00	$2,357.92–$4,427.11	—	70%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$1,870.50	$6,235.00	$367.15–$5,965.65	45% below	70%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$1,870.50	$6,235.00	$3,177.36–$5,965.65	—	70%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast	$1,389.90	$4,633.00	$251.10–$4,432.85	37% below	70%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Contrast	$1,389.90	$4,633.00	$2,360.98–$4,432.85	—	70%
MRI of the pelvis without and with contrast CPT 72197 MRI Sacrum/ SI Joint w + w/o	$1,827.60	$6,092.00	$367.15–$5,828.83	46% below	70%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Contrast	$1,827.60	$6,092.00	$367.15–$5,828.83	46% below	70%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Contrast	$1,827.60	$6,092.00	$3,104.48–$5,828.83	—	70%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Sacrum/ SI Joint w + w/o	$1,827.60	$6,092.00	$3,104.48–$5,828.83	—	70%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast	$1,372.80	$4,576.00	$251.10–$4,378.32	38% below	70%
MRI of the pelvis, no contrast dye CPT 72195 MRI Sacrum/ SI Joint w/o	$1,372.80	$4,576.00	$251.10–$4,378.32	38% below	70%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Contrast	$1,372.80	$4,576.00	$2,331.93–$4,378.32	—	70%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Sacrum/ SI Joint w/o	$1,372.80	$4,576.00	$2,331.93–$4,378.32	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MRI Elbow w/o Contrast Bilateral	$2,736.60	$9,122.00	$251.10–$8,727.93	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MRI UE Joint w/o Contrast Bilateral	$2,736.60	$9,122.00	$251.10–$8,727.93	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MRI Wrist w/o Contrast Bilateral	$2,736.60	$9,122.00	$251.10–$8,727.93	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MRI Shoulder w/o Contrast Bilateral	$2,736.60	$9,122.00	$251.10–$8,727.93	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Contrast Right	$1,368.30	$4,561.00	$251.10–$4,363.96	38% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Contrast Left	$1,368.30	$4,561.00	$251.10–$4,363.96	38% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE Joint w/o Contrast Left	$1,368.30	$4,561.00	$251.10–$4,363.96	38% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Contrast Left	$1,368.30	$4,561.00	$251.10–$4,363.96	38% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Contrast Right	$1,368.30	$4,561.00	$251.10–$4,363.96	38% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Contrast Right	$1,368.30	$4,561.00	$251.10–$4,363.96	38% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE Joint w/o Contrast Right	$1,368.30	$4,561.00	$251.10–$4,363.96	38% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Contrast Left	$1,368.30	$4,561.00	$251.10–$4,363.96	38% below	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MRI Elbow w/o Contrast Bilateral	$2,736.60	$9,122.00	$4,648.57–$8,727.93	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MRI UE Joint w/o Contrast Bilateral	$2,736.60	$9,122.00	$4,648.57–$8,727.93	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MRI Wrist w/o Contrast Bilateral	$2,736.60	$9,122.00	$4,648.57–$8,727.93	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MRI Shoulder w/o Contrast Bilateral	$2,736.60	$9,122.00	$4,648.57–$8,727.93	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Contrast Right	$1,368.30	$4,561.00	$2,324.29–$4,363.96	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Contrast Left	$1,368.30	$4,561.00	$2,324.29–$4,363.96	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Contrast Right	$1,368.30	$4,561.00	$2,324.29–$4,363.96	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Contrast Left	$1,368.30	$4,561.00	$2,324.29–$4,363.96	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Contrast Left	$1,368.30	$4,561.00	$2,324.29–$4,363.96	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Contrast Right	$1,368.30	$4,561.00	$2,324.29–$4,363.96	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE Joint w/o Contrast Left	$1,368.30	$4,561.00	$2,324.29–$4,363.96	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE Joint w/o Contrast Right	$1,368.30	$4,561.00	$2,324.29–$4,363.96	—	70%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR Spine Cervical Minimum 4 Views	$234.60	$782.00	$110.02–$748.22	27% below	70%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR Spine Cervical Minimum 4 Views	$234.60	$782.00	$398.51–$748.22	—	70%
Neck soft tissue CT scan with contrast CPT 70491 CT Soft Tissue Neck w/ Contrast	$994.20	$3,314.00	$184.59–$3,170.84	39% below	70%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Soft Tissue Neck w/ Contrast	$994.20	$3,314.00	$1,688.81–$3,170.84	—	70%
Neck soft tissue CT scan without contrast CPT 70490 CT Soft Tissue Neck w/o Contrast	$808.80	$2,696.00	$110.02–$2,579.53	43% below	70%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Soft Tissue Neck w/o Contrast	$808.80	$2,696.00	$1,373.88–$2,579.53	—	70%
Neck soft tissue X-ray CPT 70360 XR Neck Soft Tissue	$139.50	$465.00	$91.58–$444.91	34% below	70%
Neck soft tissue X-ray inpatient CPT 70360 XR Neck Soft Tissue	$139.50	$465.00	$236.96–$444.91	—	70%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nuclear Acquisition	$2,021.10	$6,737.00	$1,362.47–$6,445.96	35% below	70%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 CV NM Myo SPECT Multi R/S Acquisition	$2,241.00	$7,470.00	$1,362.47–$7,147.30	27% below	70%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 BCE Nuclear Acquisition Treadmill/Chemical	$2,241.00	$7,470.00	$1,362.47–$7,147.30	27% below	70%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Nuclear Acquisition	$2,021.10	$6,737.00	$3,433.18–$6,445.96	—	70%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 CV NM Myo SPECT Multi R/S Acquisition	$2,241.00	$7,470.00	$3,806.71–$7,147.30	—	70%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 BCE Nuclear Acquisition Treadmill/Chemical	$2,241.00	$7,470.00	$3,806.71–$7,147.30	—	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Esophageal CA Sub Tx	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Esophageal CA Initial Tx	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Lymphoma Initial Tx	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Breast CA Initial Tx	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Lung CA Initial Tx	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Initial Tx Unlisted	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Head/Neck CA Initial Tx	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Lymphoma Sub Tx	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Pulmonary Solitary Nodule	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Colorectal CA Sub Tx	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Lung CA Sub Tx	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Breast CA Sub Tx	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Colorectal CA Initial Tx	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Head/Neck CA Sub Tx	$2,613.30	$8,711.00	$1,504.86–$8,334.68	38% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Head/Neck CA Sub Tx	$2,834.40	$9,448.00	$1,504.86–$9,039.85	33% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Sub Treatment Unlisted	$2,834.40	$9,448.00	$1,504.86–$9,039.85	33% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT PSMA	$2,834.40	$9,448.00	$1,504.86–$9,039.85	33% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Dotatate	$2,834.40	$9,448.00	$1,504.86–$9,039.85	33% below	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT Axumin	$2,834.40	$9,448.00	$1,504.86–$9,039.85	33% below	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Esophageal CA Initial Tx	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Initial Tx Unlisted	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Head/Neck CA Sub Tx	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Lymphoma Initial Tx	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Colorectal CA Sub Tx	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Breast CA Initial Tx	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Colorectal CA Initial Tx	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Esophageal CA Sub Tx	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Lymphoma Sub Tx	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Lung CA Initial Tx	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Lung CA Sub Tx	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Head/Neck CA Initial Tx	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Breast CA Sub Tx	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Pulmonary Solitary Nodule	$2,613.30	$8,711.00	$4,439.13–$8,334.68	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Head/Neck CA Sub Tx	$2,834.40	$9,448.00	$4,814.70–$9,039.85	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT PSMA	$2,834.40	$9,448.00	$4,814.70–$9,039.85	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Dotatate	$2,834.40	$9,448.00	$4,814.70–$9,039.85	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Axumin	$2,834.40	$9,448.00	$4,814.70–$9,039.85	—	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT Sub Treatment Unlisted	$2,834.40	$9,448.00	$4,814.70–$9,039.85	—	70%
Pelvic CT scan without contrast CPT 72192 CT Pelvis w/o Contrast	$875.40	$2,918.00	$110.02–$2,791.94	31% below	70%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis w/o Contrast	$875.40	$2,918.00	$1,487.01–$2,791.94	—	70%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Bladder	$300.00	$1,000.00	$110.02–$956.80	25% below	70%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvis Non-OB Limited	$343.20	$1,144.00	$110.02–$1,094.58	14% below	70%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Bladder	$300.00	$1,000.00	$509.60–$956.80	—	70%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvis Non-OB Limited	$343.20	$1,144.00	$582.98–$1,094.58	—	70%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Non-OB Complete	$453.90	$1,513.00	$110.02–$1,447.64	13% below	70%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis Non-OB Complete	$453.90	$1,513.00	$771.02–$1,447.64	—	70%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pregnancy After 1st Trimester	$512.70	$1,709.00	$110.02–$1,635.17	11% below	70%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pregnancy After 1st Trimester	$512.70	$1,709.00	$870.91–$1,635.17	—	70%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Pregnancy 1st Trimester	$512.70	$1,709.00	$110.02–$1,635.17	at median	70%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Pregnancy 1st Trimester	$512.70	$1,709.00	$870.91–$1,635.17	—	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB Ultrasound-Simple - Individual Charges	$136.80	$456.00	$110.02–$848.64	63% below	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pregnancy Limited	$336.30	$1,121.00	$110.02–$1,072.57	8% below	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Placenta Localization	$336.30	$1,121.00	$110.02–$1,072.57	8% below	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB Ultrasound-Simple - Individual Charges	$136.80	$456.00	$232.38–$436.30	—	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Placenta Localization	$336.30	$1,121.00	$571.26–$1,072.57	—	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Pregnancy Limited	$336.30	$1,121.00	$571.26–$1,072.57	—	70%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 Views Right	$156.90	$523.00	$91.58–$500.41	30% below	70%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 Views Left	$156.90	$523.00	$91.58–$500.41	30% below	70%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 Views Right	$156.90	$523.00	$266.52–$500.41	—	70%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 Views Left	$156.90	$523.00	$266.52–$500.41	—	70%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w/ PA Chest Right	$218.70	$729.00	$110.02–$697.51	21% below	70%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w/ PA Chest Left	$218.70	$729.00	$110.02–$697.51	21% below	70%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs w/ PA Chest Left	$218.70	$729.00	$371.50–$697.51	—	70%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs w/ PA Chest Right	$218.70	$729.00	$371.50–$697.51	—	70%
Screening mammogram, both breasts both sides CPT 77067 MA Mam Digital WWHSP Screen Bilat	$121.50	$405.00	$117.94–$502.99	—	70%
Screening mammogram, both breasts both sides CPT 77067 MA Mam Digital WWHSP Screen Bilat w/ CAD	$121.50	$405.00	$117.94–$502.99	—	70%
Screening mammogram, both breasts inpatient both sides CPT 77067 MA Mam Digital WWHSP Screen Bilat w/ CAD	$121.50	$405.00	$206.39–$387.50	—	70%
Screening mammogram, both breasts inpatient both sides CPT 77067 MA Mam Digital WWHSP Screen Bilat	$121.50	$405.00	$206.39–$387.50	—	70%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 XR Shoulder Complete Bilateral	$372.60	$1,242.00	$91.58–$1,188.35	—	70%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 XR Shoulder Intern/Extern Rotation Bilat	$372.60	$1,242.00	$91.58–$1,188.35	—	70%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete Left	$186.30	$621.00	$91.58–$594.17	21% below	70%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete Right	$186.30	$621.00	$91.58–$594.17	21% below	70%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Intern/Extern Rotation Right	$186.30	$621.00	$91.58–$594.17	21% below	70%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Intern/Extern Rotation Left	$186.30	$621.00	$91.58–$594.17	21% below	70%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 XR Shoulder Complete Bilateral	$372.60	$1,242.00	$632.92–$1,188.35	—	70%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 XR Shoulder Intern/Extern Rotation Bilat	$372.60	$1,242.00	$632.92–$1,188.35	—	70%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete Left	$186.30	$621.00	$316.46–$594.17	—	70%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete Right	$186.30	$621.00	$316.46–$594.17	—	70%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Intern/Extern Rotation Right	$186.30	$621.00	$316.46–$594.17	—	70%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Intern/Extern Rotation Left	$186.30	$621.00	$316.46–$594.17	—	70%
Sinus X-ray, complete, 3 or more views CPT 70220 XR Sinuses Paranasal Complete	$161.40	$538.00	$91.58–$514.76	39% below	70%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR Sinuses Paranasal Complete	$161.40	$538.00	$274.16–$514.76	—	70%
Skull X-ray, fewer than 4 views CPT 70250 XR Skull < 4 Views	$175.80	$586.00	$110.02–$560.68	28% below	70%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR Skull < 4 Views	$175.80	$586.00	$298.63–$560.68	—	70%
Sleep study in a lab (polysomnography) CPT 95810 Polysomnogram	$2,100.00	$7,000.00	$903.73–$6,697.60	38% below	70%
Sleep study in a lab (polysomnography) CPT 95810 Polysomnogram - Sleep Test	$2,321.10	$7,737.00	$903.73–$7,402.76	32% below	70%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnogram	$2,100.00	$7,000.00	$3,567.20–$6,697.60	—	70%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnogram - Sleep Test	$2,321.10	$7,737.00	$3,942.78–$7,402.76	—	70%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Swallowing Function w/ Video	$297.60	$992.00	$184.59–$949.15	35% below	70%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Swallowing Function w/ Video	$297.60	$992.00	$505.52–$949.15	—	70%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur Left	$189.00	$630.00	$91.58–$602.78	23% below	70%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur Left	$189.00	$630.00	$321.05–$602.78	—	70%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Spine Thoracic w/o Contrast	$1,003.20	$3,344.00	$110.02–$3,199.54	35% below	70%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Spine Thoracic w/o Contrast	$1,003.20	$3,344.00	$1,704.10–$3,199.54	—	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Pod Toes 3rd Digit Left	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Pod Toes 4th Digit Left	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 2nd Digit Left	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 2nd Digit Right	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 3rd Digit Left	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Pod Toes Great Right	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 4th Digit Right	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Pod Toes 5th Digit Left	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 4th Digit Left	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Pod Toes Great Left	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Pod Toes 2nd Digit Right	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 3rd Digit Right	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes Great Right	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 5th Digit Left	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes Great Left	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Pod Toes 3rd Digit Right	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Pod Toes 4th Digit Right	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Pod Toes 5th Digit Right	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Pod Toes 2nd Digit Left	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 5th Digit Right	$117.30	$391.00	$91.58–$374.11	42% below	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 3rd Digit Right	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes Great Right	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes Great Left	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 5th Digit Right	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 5th Digit Left	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 4th Digit Right	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 4th Digit Left	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Pod Toes Great Right	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Pod Toes 5th Digit Right	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Pod Toes 4th Digit Right	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Pod Toes 3rd Digit Right	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Pod Toes 2nd Digit Right	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Pod Toes Great Left	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Pod Toes 5th Digit Left	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Pod Toes 4th Digit Left	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Pod Toes 3rd Digit Left	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Pod Toes 2nd Digit Left	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 2nd Digit Left	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 2nd Digit Right	$117.30	$391.00	$199.25–$374.11	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 3rd Digit Left	$117.30	$391.00	$199.25–$374.11	—	70%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB	$309.00	$1,030.00	$110.02–$985.50	34% below	70%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB	$309.00	$1,030.00	$524.89–$985.50	—	70%
Transvaginal ultrasound during pregnancy CPT 76817 US ED Pel, TV, Pregnancy	$123.60	$412.00	$119.97–$848.64	68% below	70%
Transvaginal ultrasound during pregnancy CPT 76817 BCE US Pregnancy Transvaginal	$325.50	$1,085.00	$228.05–$1,038.13	17% below	70%
Transvaginal ultrasound during pregnancy CPT 76817 US Transvaginal OB	$340.80	$1,136.00	$228.05–$1,086.92	13% below	70%
Transvaginal ultrasound during pregnancy CPT 76817 US Pregnancy Transvaginal	$340.80	$1,136.00	$228.05–$1,086.92	13% below	70%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US ED Pel, TV, Pregnancy	$123.60	$412.00	$209.96–$394.20	—	70%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 BCE US Pregnancy Transvaginal	$325.50	$1,085.00	$552.92–$1,038.13	—	70%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Pregnancy Transvaginal	$340.80	$1,136.00	$578.91–$1,086.92	—	70%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Transvaginal OB	$340.80	$1,136.00	$578.91–$1,086.92	—	70%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$428.10	$1,427.00	$110.02–$1,365.35	37% below	70%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$428.10	$1,427.00	$727.20–$1,365.35	—	70%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents)	$385.50	$1,285.00	$110.02–$1,229.49	22% below	70%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents)	$385.50	$1,285.00	$654.84–$1,229.49	—	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US ED Soft Tissue Neck	$300.90	$1,003.00	$110.02–$959.67	41% below	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head/Neck Soft Tissue	$312.90	$1,043.00	$110.02–$997.94	39% below	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Parotid	$412.20	$1,374.00	$110.02–$1,314.64	19% below	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid	$412.20	$1,374.00	$110.02–$1,314.64	19% below	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Parathyroid	$412.20	$1,374.00	$110.02–$1,314.64	19% below	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US ED Soft Tissue Neck	$300.90	$1,003.00	$511.13–$959.67	—	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head/Neck Soft Tissue	$312.90	$1,043.00	$531.51–$997.94	—	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Parotid	$412.20	$1,374.00	$700.19–$1,314.64	—	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Parathyroid	$412.20	$1,374.00	$700.19–$1,314.64	—	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid	$412.20	$1,374.00	$700.19–$1,314.64	—	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI w/ Gastrografin	$327.60	$1,092.00	$184.59–$1,044.83	52% below	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI	$327.60	$1,092.00	$184.59–$1,044.83	52% below	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI w/ Small Bowel	$582.00	$1,940.00	$184.59–$1,856.19	15% below	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI w/ Gastrografin	$327.60	$1,092.00	$556.48–$1,044.83	—	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI	$327.60	$1,092.00	$556.48–$1,044.83	—	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI w/ Small Bowel	$582.00	$1,940.00	$988.62–$1,856.19	—	70%
Upper arm X-ray (humerus), 2 views both sides CPT 73060 XR Humerus Bilateral	$309.00	$1,030.00	$91.58–$985.50	—	70%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Right	$154.50	$515.00	$91.58–$492.75	26% below	70%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Left	$154.50	$515.00	$91.58–$492.75	26% below	70%
Upper arm X-ray (humerus), 2 views inpatient both sides CPT 73060 XR Humerus Bilateral	$309.00	$1,030.00	$524.89–$985.50	—	70%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Left	$154.50	$515.00	$262.44–$492.75	—	70%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Right	$154.50	$515.00	$262.44–$492.75	—	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Vascular Acquisition	$492.30	$1,641.00	$110.02–$1,570.11	31% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Vascular Acquisition	$492.30	$1,641.00	$477.86–$1,570.11	31% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Vascular Acquisition	$492.30	$1,641.00	$477.86–$1,570.11	31% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Vascular Acquisition	$492.30	$1,641.00	$836.25–$1,570.11	—	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Vascular Acquisition	$492.30	$1,641.00	$836.25–$1,570.11	—	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Vascular Acquisition	$492.30	$1,641.00	$836.25–$1,570.11	—	70%
Wrist X-ray, 2 views both sides CPT 73100 XR Wrist 2 Views Bilateral	$262.50	$875.00	$91.58–$837.20	—	70%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Left	$131.40	$438.00	$91.58–$419.08	39% below	70%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Right	$131.40	$438.00	$91.58–$419.08	39% below	70%
Wrist X-ray, 2 views inpatient both sides CPT 73100 XR Wrist 2 Views Bilateral	$262.50	$875.00	$445.90–$837.20	—	70%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Right	$131.40	$438.00	$223.20–$419.08	—	70%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Left	$131.40	$438.00	$223.20–$419.08	—	70%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 XR Wrist Complete Bilateral	$287.70	$959.00	$91.58–$917.57	—	70%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete Right	$143.70	$479.00	$91.58–$458.31	43% below	70%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete Left	$143.70	$479.00	$91.58–$458.31	43% below	70%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete w/ Navicular Left	$143.70	$479.00	$91.58–$458.31	43% below	70%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete w/ Navicular Right	$143.70	$479.00	$91.58–$458.31	43% below	70%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 XR Wrist Complete Bilateral	$287.70	$959.00	$488.71–$917.57	—	70%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete Right	$143.70	$479.00	$244.10–$458.31	—	70%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete Left	$143.70	$479.00	$244.10–$458.31	—	70%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete w/ Navicular Right	$143.70	$479.00	$244.10–$458.31	—	70%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete w/ Navicular Left	$143.70	$479.00	$244.10–$458.31	—	70%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View	$159.30	$531.00	$82.95–$508.06	24% below	70%
X-ray of the abdomen, 1 view CPT 74018 BCE XR Abdomen AP	$159.30	$531.00	$82.95–$508.06	24% below	70%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen AP	$159.30	$531.00	$82.95–$508.06	24% below	70%
X-ray of the abdomen, 1 view inpatient CPT 74018 BCE XR Abdomen AP	$159.30	$531.00	$270.60–$508.06	—	70%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen AP	$159.30	$531.00	$270.60–$508.06	—	70%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View	$159.30	$531.00	$270.60–$508.06	—	70%
X-ray of the ankle, 2 views both sides CPT 73600 XR Pod Ankle 2 Views Bilateral	$149.70	$499.00	$145.31–$477.44	—	70%
X-ray of the ankle, 2 views both sides CPT 73600 XR Ankle 2 Views Bilateral	$288.60	$962.00	$91.58–$920.44	—	70%
X-ray of the ankle, 2 views both sides CPT 73600 XR Pod Ankle 2 Views Bilateral	$288.60	$962.00	$91.58–$920.44	—	70%
X-ray of the ankle, 2 views one side CPT 73600 XR Pod Ankle 2 Views Right	$144.00	$480.00	$91.58–$459.26	28% below	70%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Left	$144.00	$480.00	$91.58–$459.26	28% below	70%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Right	$144.00	$480.00	$91.58–$459.26	28% below	70%
X-ray of the ankle, 2 views one side CPT 73600 XR Pod Ankle 2 Views Left	$144.00	$480.00	$91.58–$459.26	28% below	70%
X-ray of the ankle, 2 views one side CPT 73600 XR Pod Ankle 2 Views Left	$149.70	$499.00	$145.31–$477.44	25% below	70%
X-ray of the ankle, 2 views one side CPT 73600 XR Pod Ankle 2 Views Right	$155.40	$518.00	$150.84–$495.62	22% below	70%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 XR Pod Ankle 2 Views Bilateral	$149.70	$499.00	$254.29–$477.44	—	70%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 XR Pod Ankle 2 Views Bilateral	$288.60	$962.00	$490.24–$920.44	—	70%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 XR Ankle 2 Views Bilateral	$288.60	$962.00	$490.24–$920.44	—	70%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Pod Ankle 2 Views Left	$144.00	$480.00	$244.61–$459.26	—	70%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Left	$144.00	$480.00	$244.61–$459.26	—	70%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Right	$144.00	$480.00	$244.61–$459.26	—	70%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Pod Ankle 2 Views Right	$144.00	$480.00	$244.61–$459.26	—	70%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Pod Ankle 2 Views Left	$149.70	$499.00	$254.29–$477.44	—	70%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Pod Ankle 2 Views Right	$155.40	$518.00	$263.97–$495.62	—	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 3rd Digit Right	$119.70	$399.00	$91.58–$381.76	51% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 4th Digit Left	$119.70	$399.00	$91.58–$381.76	51% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 3rd Digit Left	$119.70	$399.00	$91.58–$381.76	51% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 2nd Digit Right	$119.70	$399.00	$91.58–$381.76	51% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 2nd Digit Left	$119.70	$399.00	$91.58–$381.76	51% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 4th Digit Right	$119.70	$399.00	$91.58–$381.76	51% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 5th Digit Left	$119.70	$399.00	$91.58–$381.76	51% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 5th Digit Right	$119.70	$399.00	$91.58–$381.76	51% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Thumb Left	$119.70	$399.00	$91.58–$381.76	51% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Thumb Right	$119.70	$399.00	$91.58–$381.76	51% below	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Thumb Right	$119.70	$399.00	$203.33–$381.76	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 5th Digit Right	$119.70	$399.00	$203.33–$381.76	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 2nd Digit Left	$119.70	$399.00	$203.33–$381.76	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 4th Digit Left	$119.70	$399.00	$203.33–$381.76	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 4th Digit Right	$119.70	$399.00	$203.33–$381.76	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Thumb Left	$119.70	$399.00	$203.33–$381.76	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 3rd Digit Right	$119.70	$399.00	$203.33–$381.76	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 5th Digit Left	$119.70	$399.00	$203.33–$381.76	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 3rd Digit Left	$119.70	$399.00	$203.33–$381.76	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 2nd Digit Right	$119.70	$399.00	$203.33–$381.76	—	70%
X-ray of the foot, 2 views both sides CPT 73620 XR Pod Foot 2 Views Bilateral	$140.40	$468.00	$136.28–$447.78	—	70%
X-ray of the foot, 2 views both sides CPT 73620 XR Foot 2 Views Bilateral	$270.30	$901.00	$91.58–$862.08	—	70%
X-ray of the foot, 2 views both sides CPT 73620 XR Pod Foot 2 Views Bilateral	$270.30	$901.00	$91.58–$862.08	—	70%
X-ray of the foot, 2 views one side CPT 73620 XR Pod Foot 2 Views Left	$135.00	$450.00	$91.58–$430.56	29% below	70%
X-ray of the foot, 2 views one side CPT 73620 XR Pod Foot 2 Views Right	$135.00	$450.00	$91.58–$430.56	29% below	70%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Left	$135.00	$450.00	$91.58–$430.56	29% below	70%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Right	$135.00	$450.00	$91.58–$430.56	29% below	70%
X-ray of the foot, 2 views one side CPT 73620 XR Pod Foot 2 Views Right	$145.80	$486.00	$141.52–$465.00	23% below	70%
X-ray of the foot, 2 views one side CPT 73620 XR Pod Foot 2 Views Left	$145.80	$486.00	$141.52–$465.00	23% below	70%
X-ray of the foot, 2 views inpatient both sides CPT 73620 XR Pod Foot 2 Views Bilateral	$140.40	$468.00	$238.49–$447.78	—	70%
X-ray of the foot, 2 views inpatient both sides CPT 73620 XR Foot 2 Views Bilateral	$270.30	$901.00	$459.15–$862.08	—	70%
X-ray of the foot, 2 views inpatient both sides CPT 73620 XR Pod Foot 2 Views Bilateral	$270.30	$901.00	$459.15–$862.08	—	70%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Left	$135.00	$450.00	$229.32–$430.56	—	70%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Right	$135.00	$450.00	$229.32–$430.56	—	70%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Pod Foot 2 Views Left	$135.00	$450.00	$229.32–$430.56	—	70%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Pod Foot 2 Views Right	$135.00	$450.00	$229.32–$430.56	—	70%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Pod Foot 2 Views Left	$145.80	$486.00	$247.67–$465.00	—	70%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Pod Foot 2 Views Right	$145.80	$486.00	$247.67–$465.00	—	70%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 XR Pod Foot Complete Bilateral	$167.40	$558.00	$162.49–$533.89	—	70%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 XR Foot Complete Bilateral	$309.60	$1,032.00	$91.58–$987.42	—	70%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Pod Foot Complete Left	$154.80	$516.00	$91.58–$493.71	36% below	70%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete Left	$154.80	$516.00	$91.58–$493.71	36% below	70%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Pod Foot Complete Right	$154.80	$516.00	$91.58–$493.71	36% below	70%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete Right	$154.80	$516.00	$91.58–$493.71	36% below	70%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Pod Foot Complete Right	$167.40	$558.00	$162.49–$533.89	31% below	70%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Pod Foot Complete Left	$167.40	$558.00	$162.49–$533.89	31% below	70%
X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 XR Pod Foot Complete Bilateral	$167.40	$558.00	$284.36–$533.89	—	70%
X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 XR Foot Complete Bilateral	$309.60	$1,032.00	$525.91–$987.42	—	70%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete Left	$154.80	$516.00	$262.95–$493.71	—	70%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete Right	$154.80	$516.00	$262.95–$493.71	—	70%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Pod Foot Complete Left	$154.80	$516.00	$262.95–$493.71	—	70%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Pod Foot Complete Right	$154.80	$516.00	$262.95–$493.71	—	70%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Pod Foot Complete Right	$167.40	$558.00	$284.36–$533.89	—	70%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Pod Foot Complete Left	$167.40	$558.00	$284.36–$533.89	—	70%
X-ray of the hand, 3 or more views both sides CPT 73130 XR Hand Complete Bilateral	$306.60	$1,022.00	$91.58–$977.85	—	70%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete Right	$153.30	$511.00	$91.58–$488.92	35% below	70%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete Left	$153.30	$511.00	$91.58–$488.92	35% below	70%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 XR Hand Complete Bilateral	$306.60	$1,022.00	$520.81–$977.85	—	70%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete Left	$153.30	$511.00	$260.41–$488.92	—	70%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete Right	$153.30	$511.00	$260.41–$488.92	—	70%
X-ray of the knee, 1 or 2 views both sides CPT 73560 XR Knee 1 or 2 Views Bilateral	$315.60	$1,052.00	$91.58–$1,006.55	—	70%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Left	$157.80	$526.00	$91.58–$503.28	26% below	70%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Right	$157.80	$526.00	$91.58–$503.28	26% below	70%
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 XR Knee 1 or 2 Views Bilateral	$315.60	$1,052.00	$536.10–$1,006.55	—	70%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Right	$157.80	$526.00	$268.05–$503.28	—	70%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Left	$157.80	$526.00	$268.05–$503.28	—	70%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$203.40	$678.00	$110.02–$648.71	30% below	70%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbar Flexion + Extension	$203.40	$678.00	$110.02–$648.71	30% below	70%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$203.40	$678.00	$345.51–$648.71	—	70%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbar Flexion + Extension	$203.40	$678.00	$345.51–$648.71	—	70%
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Minimum 4 Views	$282.00	$940.00	$110.02–$899.39	24% below	70%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Minimum 4 Views	$282.00	$940.00	$479.02–$899.39	—	70%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views	$177.90	$593.00	$110.02–$567.38	25% below	70%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views	$177.90	$593.00	$302.19–$567.38	—	70%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Minimum 3 Views	$114.90	$383.00	$91.58–$366.45	53% below	70%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones Minimum 3 Views	$114.90	$383.00	$195.18–$366.45	—	70%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical Flexion + Extension	$184.50	$615.00	$91.58–$588.43	23% below	70%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 Views	$184.50	$615.00	$91.58–$588.43	23% below	70%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical 2 or 3 Views	$184.50	$615.00	$313.40–$588.43	—	70%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical Flexion + Extension	$184.50	$615.00	$313.40–$588.43	—	70%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views	$160.50	$535.00	$110.02–$511.89	28% below	70%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvimetry	$173.10	$577.00	$110.02–$552.07	22% below	70%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views	$160.50	$535.00	$272.64–$511.89	—	70%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvimetry	$173.10	$577.00	$294.04–$552.07	—	70%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx Minimum 2 Views	$174.00	$580.00	$91.58–$554.94	19% below	70%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Coccyx	$174.00	$580.00	$91.58–$554.94	19% below	70%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum/Coccyx Minimum 2 Views	$174.00	$580.00	$295.57–$554.94	—	70%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Coccyx	$174.00	$580.00	$295.57–$554.94	—	70%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
ACTH blood test CPT 82024 Adrenocorticotropic Hormone	$129.00	$430.00	$40.16–$411.42	41% below	70%
ACTH blood test inpatient CPT 82024 Adrenocorticotropic Hormone	$129.00	$430.00	$219.13–$411.42	—	70%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT	$13.20	$44.00	$5.51–$42.10	62% below	70%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (FSURE)	$18.60	$62.00	$5.51–$59.32	47% below	70%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase	$25.80	$86.00	$5.51–$82.28	26% below	70%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT	$13.20	$44.00	$22.42–$42.10	—	70%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT (FSURE)	$18.60	$62.00	$31.60–$59.32	—	70%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine Aminotransferase	$25.80	$86.00	$43.83–$82.28	—	70%
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate Aminotransferase	$25.50	$85.00	$5.39–$81.33	46% below	70%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Aspartate Aminotransferase	$25.50	$85.00	$43.32–$81.33	—	70%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute Hepatitis Panel	$168.90	$563.00	$49.54–$538.68	44% below	70%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute Hepatitis Panel	$168.90	$563.00	$286.90–$538.68	—	70%
Albumin blood test CPT 82040 IgG Synthesis Rate/Index, CSF	$12.78	$42.59	$5.15–$40.75	66% below	70%
Albumin blood test CPT 82040 Albumin	$14.70	$49.00	$5.15–$46.88	61% below	70%
Albumin blood test CPT 82040 zzAlbumin Serum (Quest)	$16.20	$54.00	$5.15–$51.67	57% below	70%
Albumin blood test CPT 82040 Albumin Level	$23.10	$77.00	$5.15–$73.67	38% below	70%
Albumin blood test inpatient CPT 82040 IgG Synthesis Rate/Index, CSF	$12.78	$42.59	$21.70–$40.75	—	70%
Albumin blood test inpatient CPT 82040 Albumin	$14.70	$49.00	$24.97–$46.88	—	70%
Albumin blood test inpatient CPT 82040 zzAlbumin Serum (Quest)	$16.20	$54.00	$27.52–$51.67	—	70%
Albumin blood test inpatient CPT 82040 Albumin Level	$23.10	$77.00	$39.24–$73.67	—	70%
Aldosterone blood test CPT 82088 Aldosterone/Plasma Renin Activity Ratio	$98.70	$329.00	$42.38–$314.79	49% below	70%
Aldosterone blood test CPT 82088 Aldosterone 24 Hour Urine	$132.60	$442.00	$42.38–$422.91	32% below	70%
Aldosterone blood test CPT 82088 Aldosterone	$221.10	$737.00	$42.38–$705.16	13% above	70%
Aldosterone blood test inpatient CPT 82088 Aldosterone/Plasma Renin Activity Ratio	$98.70	$329.00	$167.66–$314.79	—	70%
Aldosterone blood test inpatient CPT 82088 Aldosterone 24 Hour Urine	$132.60	$442.00	$225.24–$422.91	—	70%
Aldosterone blood test inpatient CPT 82088 Aldosterone	$221.10	$737.00	$375.58–$705.16	—	70%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$24.00	$80.00	$5.39–$76.54	51% below	70%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase Isoenzymes	$51.30	$171.00	$5.39–$163.61	5% above	70%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase Bone Specific	$59.40	$198.00	$5.39–$189.45	22% above	70%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase	$24.00	$80.00	$40.77–$76.54	—	70%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase Isoenzymes	$51.30	$171.00	$87.14–$163.61	—	70%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase Bone Specific	$59.40	$198.00	$100.90–$189.45	—	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Red Kidney Bean (f287) IgE	$2.10	$7.00	$3.57–$21.72	92% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Red Top Grass(g9) IgE	$2.10	$7.00	$3.57–$21.72	92% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Fusarium Moniliforme (M9) IgE	$2.10	$7.00	$3.57–$21.72	92% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Pine Nut	$2.11	$7.02	$3.58–$21.72	92% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Pumpkin (f225) IgE	$2.11	$7.02	$3.58–$21.72	92% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allery, Food Panel w/Rfxs	$2.63	$8.78	$4.47–$21.72	89% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel Food w/ Rfx	$2.63	$8.78	$4.47–$21.72	89% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel 13, Stinging Insect Group	$5.10	$17.00	$5.43–$21.72	80% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel 18, Nut Mix Group	$5.70	$19.00	$5.43–$21.72	77% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel 19, Seafood Group	$5.70	$19.00	$5.43–$21.72	77% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel, Stinging Insect Group	$6.30	$21.00	$5.43–$21.72	75% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel, Childhood (Food & Environ)	$6.90	$23.00	$5.43–$22.01	72% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel, Nut Mix Group	$6.90	$23.00	$5.43–$22.01	72% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel, Seafood Group	$6.90	$23.00	$5.43–$22.01	72% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Profile Region VIII: IA,IL,MO	$7.50	$25.00	$5.43–$23.92	70% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel, Food	$7.50	$25.00	$5.43–$23.92	70% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Profile Region VII:MI,MN,WI	$7.80	$26.00	$5.43–$24.88	69% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Ampicillin IgE	$9.00	$30.00	$5.43–$28.70	64% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Amoxicillin IgE	$9.00	$30.00	$5.43–$28.70	64% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Penicillin Profile	$9.60	$32.00	$5.43–$30.62	62% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel, Region 3, Grasses	$10.50	$35.01	$5.43–$33.50	58% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillin V	$11.10	$37.00	$5.43–$35.40	56% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Haddock	$12.76	$42.52	$5.43–$40.68	49% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Bahia Grass (g17) IgE	$13.80	$46.00	$5.43–$44.01	45% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Red Top Grass	$13.80	$46.00	$5.43–$44.01	45% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, June Grass (Kentucky Blue) (g8) IgE	$13.80	$46.00	$5.43–$44.01	45% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Stachybotrys IgE	$20.10	$67.00	$5.43–$64.11	20% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel 11, Mold Group	$21.90	$73.00	$5.43–$69.85	12% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cabbage	$23.70	$79.00	$5.43–$75.59	5% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Goose Feathers	$23.70	$79.00	$5.43–$75.59	5% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cauliflower	$23.70	$79.00	$5.43–$75.59	5% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Duck Feathers	$23.70	$79.00	$5.43–$75.59	5% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Turkey Feathers	$23.70	$79.00	$5.43–$75.59	5% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Black Pepper	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cockroach	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Clam	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Chicken Feathers	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Chestnut	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Celery	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cashew	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Canary Bird Feathers	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Box-elder Tree	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 A niger / 34938	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Alternaria alternata	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Abalone	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cow Dander	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Crayfish	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Elm Tree	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Ferret Epithelium	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Fig	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Grape	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Halibut	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Hamster Epithelium	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Helminthosporium halodes	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, House Dust	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Lima Bean	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Meadow Fescue (Grass)	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Mugwort	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Mushroom	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Oak Tree	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Orchard Grass	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Oyster	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Parrot Feathers	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Peanut	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Penicillium notatum	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Pepper, Green	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Plum	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Pork Meat	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Raspberry	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Sage	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Scallop	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Sesame Seed	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Squid	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Thyme	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Timothy Grass	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Walnut Tree	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Blue Mussel	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Common Ragweed	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Giant Ragweed	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Aspergillus fumigatus	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Birch	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cat Dander	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Chinchilla Epithelium	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Turkey Meat	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, June Grass (Kentucky Blue)	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Lamb's Quarters (Goose Foot)	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Pomegranate	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Rhubarb	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Rough Pigweed	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Dermatophagoides farinae	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Dermatophagoides pteronyssinus	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Olive, Black	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Lemon	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Nectarine	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Broccoli	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Barley	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Malt	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Poppy Seed	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Parmesan Cheese	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Crappie Black	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Parsnip	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Carrot	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Summer Squash	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Mint	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Sweet Vernal Grass	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Hickory/Pecan Tree	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cocklebur	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Firebush	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Perennial Rye Grass	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, English Plantain	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Beech Tree	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, White Ash	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Mountain Cedar	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cottonwood	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Rough Marsh Elder	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Botrytis cinerea	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Phoma betae	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Curvularia lunata	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Sheep Sorrel	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Epicoccum purpurascens	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Stemphylium botryosum	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Insulin, Human	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Mouse Urine Proteins	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Mouse	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Mouse Epithelia	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Mouse Serum Proteins	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Melons	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Trout	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Fire Ant	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Tea	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Mango	$24.60	$82.00	$5.43–$78.46	2% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Lobster	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Peach	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cinnamon	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Bovine Gelatin	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cherry	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Goat Milk	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Lentils	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Gluten	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Chick Pea	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Lime	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Coriander/Cilantro	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Corn Smut	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Egg Yolk	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Egg White	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Stachybotrys chartarum/atra IgE	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Dog Dander	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Avocado	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Spinach	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Dill	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Anchovy	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Kiwi	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Latex	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Vanilla	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Saltwort, Russian Thistle	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Corn/Maize	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Almond	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Common Wasp (Yellow Jacket)	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cacao/Cocoa	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Perch Ocean	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Yellow Hornet	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, White-faced Hornet	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Wheat	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Walnut	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Tuna	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Tomato	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Catfish	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Crab	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Basil	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Macadamia Nut	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Milk	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Oat	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Orange	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Beef	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Paper Wasp	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Horse Dander	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Honey Bee	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cotton Seed	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Sunflower Seed	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Strawberry	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Soybean	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Shrimp	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Onion	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Salmon	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Rice	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Chicken Meat	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Rabbit Epithelium	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Pistachio	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Pecan	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Hazelnut	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Pineapple	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Mosquito	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Lettuce	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Grapefruit	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Garlic	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Guinea Pig Epithelium	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Stachybotrys chartarum	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Bass Black	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Coconut	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Potato	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Banana	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Blueberry	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cod	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Rat Epithelia	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Beet	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Apple	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Yeast	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Rat	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Porcine Gelatin	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Mustard	$30.90	$103.00	$5.43–$98.55	24% above	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Red Top Grass(g9) IgE	$2.10	$7.00	$3.57–$6.70	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Fusarium Moniliforme (M9) IgE	$2.10	$7.00	$3.57–$6.70	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Red Kidney Bean (f287) IgE	$2.10	$7.00	$3.57–$6.70	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Pumpkin (f225) IgE	$2.11	$7.02	$3.58–$6.72	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Pine Nut	$2.11	$7.02	$3.58–$6.72	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel Food w/ Rfx	$2.63	$8.78	$4.47–$8.40	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allery, Food Panel w/Rfxs	$2.63	$8.78	$4.47–$8.40	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel 13, Stinging Insect Group	$5.10	$17.00	$8.66–$16.27	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel 18, Nut Mix Group	$5.70	$19.00	$9.68–$18.18	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel 19, Seafood Group	$5.70	$19.00	$9.68–$18.18	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel, Stinging Insect Group	$6.30	$21.00	$10.70–$20.09	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel, Seafood Group	$6.90	$23.00	$11.72–$22.01	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel, Nut Mix Group	$6.90	$23.00	$11.72–$22.01	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel, Childhood (Food & Environ)	$6.90	$23.00	$11.72–$22.01	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Profile Region VIII: IA,IL,MO	$7.50	$25.00	$12.74–$23.92	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel, Food	$7.50	$25.00	$12.74–$23.92	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Profile Region VII:MI,MN,WI	$7.80	$26.00	$13.25–$24.88	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Amoxicillin IgE	$9.00	$30.00	$15.29–$28.70	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Ampicillin IgE	$9.00	$30.00	$15.29–$28.70	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Penicillin Profile	$9.60	$32.00	$16.31–$30.62	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel, Region 3, Grasses	$10.50	$35.01	$17.84–$33.50	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillin V	$11.10	$37.00	$18.86–$35.40	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Haddock	$12.76	$42.52	$21.67–$40.68	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Bahia Grass (g17) IgE	$13.80	$46.00	$23.44–$44.01	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Red Top Grass	$13.80	$46.00	$23.44–$44.01	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, June Grass (Kentucky Blue) (g8) IgE	$13.80	$46.00	$23.44–$44.01	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Stachybotrys IgE	$20.10	$67.00	$34.14–$64.11	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel 11, Mold Group	$21.90	$73.00	$37.20–$69.85	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cauliflower	$23.70	$79.00	$40.26–$75.59	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cabbage	$23.70	$79.00	$40.26–$75.59	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Turkey Feathers	$23.70	$79.00	$40.26–$75.59	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Goose Feathers	$23.70	$79.00	$40.26–$75.59	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Duck Feathers	$23.70	$79.00	$40.26–$75.59	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cottonwood	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Mint	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Rough Marsh Elder	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Summer Squash	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Botrytis cinerea	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Carrot	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Phoma betae	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Mango	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Curvularia lunata	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Parsnip	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Sheep Sorrel	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cockroach	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Epicoccum purpurascens	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Celery	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Stemphylium botryosum	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Crappie Black	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Grape	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Tea	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Insulin, Human	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Chestnut	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Parmesan Cheese	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cashew	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Poppy Seed	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Halibut	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Mouse Urine Proteins	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Hamster Epithelium	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Mouse	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Helminthosporium halodes	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Penicillium notatum	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Chicken Feathers	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Pepper, Green	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Mouse Epithelia	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Plum	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Malt	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Pork Meat	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Mouse Serum Proteins	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Canary Bird Feathers	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Raspberry	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Barley	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Sage	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Melons	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Broccoli	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Scallop	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Box-elder Tree	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Sesame Seed	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Trout	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Nectarine	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Squid	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Clam	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Lemon	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Thyme	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Peanut	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Parrot Feathers	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Oyster	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Orchard Grass	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Olive, Black	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Oak Tree	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Mushroom	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Mugwort	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Dermatophagoides pteronyssinus	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Meadow Fescue (Grass)	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 A niger / 34938	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Aspergillus fumigatus	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Timothy Grass	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Dermatophagoides farinae	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, House Dust	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Rough Pigweed	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Alternaria alternata	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Walnut Tree	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Rhubarb	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Pomegranate	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Blue Mussel	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cow Dander	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Lamb's Quarters (Goose Foot)	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Common Ragweed	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Fire Ant	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, June Grass (Kentucky Blue)	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Giant Ragweed	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Turkey Meat	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Black Pepper	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Lima Bean	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Chinchilla Epithelium	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cat Dander	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Abalone	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Hickory/Pecan Tree	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Birch	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cocklebur	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Sweet Vernal Grass	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Firebush	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Crayfish	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Perennial Rye Grass	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, English Plantain	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Beech Tree	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Elm Tree	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Ferret Epithelium	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Fig	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, White Ash	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Mountain Cedar	$24.60	$82.00	$41.79–$78.46	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Lentils	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Yeast	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Porcine Gelatin	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Bovine Gelatin	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Corn/Maize	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Chick Pea	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Corn Smut	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Stachybotrys chartarum/atra IgE	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Avocado	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Spinach	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Dill	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Basil	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Anchovy	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cherry	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Mustard	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Rat	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Rat Epithelia	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Vanilla	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Pineapple	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Mosquito	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Lettuce	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Grapefruit	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Garlic	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Stachybotrys chartarum	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Lime	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Coriander/Cilantro	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cinnamon	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Peach	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Apple	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Beet	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Blueberry	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Banana	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Potato	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Coconut	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Bass Black	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Onion	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Sunflower Seed	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cotton Seed	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Catfish	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Perch Ocean	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Saltwort, Russian Thistle	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Common Wasp (Yellow Jacket)	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cacao/Cocoa	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Yellow Hornet	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, White-faced Hornet	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Wheat	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Walnut	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Tuna	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Tomato	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Strawberry	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Soybean	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Shrimp	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Salmon	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Rice	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Rabbit Epithelium	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Pistachio	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Pecan	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Paper Wasp	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Orange	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Oat	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Milk	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Macadamia Nut	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Lobster	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Latex	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Kiwi	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Horse Dander	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Honey Bee	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Hazelnut	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Guinea Pig Epithelium	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Goat Milk	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Gluten	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Egg Yolk	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Egg White	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Dog Dander	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Crab	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Almond	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Beef	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Chicken Meat	$30.90	$103.00	$52.49–$98.55	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cod	$30.90	$103.00	$52.49–$98.55	—	70%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP Maternal / 5059	$73.50	$245.00	$17.44–$234.42	12% below	70%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein Tumor Marker	$73.50	$245.00	$17.44–$234.42	12% below	70%
Alpha-fetoprotein (AFP) blood test CPT 82105 Quad Screen	$73.50	$245.00	$17.44–$234.42	12% below	70%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha Fetoprotein Tumor Marker	$73.50	$245.00	$124.85–$234.42	—	70%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Quad Screen	$73.50	$245.00	$124.85–$234.42	—	70%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP Maternal / 5059	$73.50	$245.00	$124.85–$234.42	—	70%
Ammonia blood test CPT 82140 Ammonium, Urine	$25.80	$86.00	$15.15–$82.28	71% below	70%
Ammonia blood test CPT 82140 Urine Ammonium	$39.30	$131.00	$15.15–$125.34	56% below	70%
Ammonia blood test CPT 82140 Ammonia Level	$66.00	$220.00	$15.15–$210.50	26% below	70%
Ammonia blood test inpatient CPT 82140 Ammonium, Urine	$25.80	$86.00	$43.83–$82.28	—	70%
Ammonia blood test inpatient CPT 82140 Urine Ammonium	$39.30	$131.00	$66.76–$125.34	—	70%
Ammonia blood test inpatient CPT 82140 Ammonia Level	$66.00	$220.00	$112.11–$210.50	—	70%
Amylase blood test CPT 82150 Amylase, Peritoneal Fluid	$16.20	$54.00	$6.74–$51.67	74% below	70%
Amylase blood test CPT 82150 Amylase, Pleural Fluid	$16.20	$54.00	$6.74–$51.67	74% below	70%
Amylase blood test CPT 82150 Amylase 24 Hour Urine	$20.10	$67.00	$6.74–$64.11	67% below	70%
Amylase blood test CPT 82150 Amylase Level	$48.60	$162.00	$6.74–$155.00	21% below	70%
Amylase blood test inpatient CPT 82150 Amylase, Pleural Fluid	$16.20	$54.00	$27.52–$51.67	—	70%
Amylase blood test inpatient CPT 82150 Amylase, Peritoneal Fluid	$16.20	$54.00	$27.52–$51.67	—	70%
Amylase blood test inpatient CPT 82150 Amylase 24 Hour Urine	$20.10	$67.00	$34.14–$64.11	—	70%
Amylase blood test inpatient CPT 82150 Amylase Level	$48.60	$162.00	$82.56–$155.00	—	70%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrulline Peptide	$54.30	$181.00	$13.47–$173.18	34% below	70%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrulline Peptide	$54.30	$181.00	$92.24–$173.18	—	70%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Screen IFA, w/Rfx Mutiplex Cascade	$52.20	$174.00	$12.57–$166.48	24% below	70%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Systemic Lupus (SLE) Comprehensive Diagnostics Panel	$52.20	$174.00	$12.57–$166.48	24% below	70%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Screen IFA w/ Rfx Titer & Pattern	$52.20	$174.00	$12.57–$166.48	24% below	70%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Screen IFA w/ Rfx Titer & Pattern	$52.20	$174.00	$88.67–$166.48	—	70%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Screen IFA, w/Rfx Mutiplex Cascade	$52.20	$174.00	$88.67–$166.48	—	70%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Systemic Lupus (SLE) Comprehensive Diagnostics Panel	$52.20	$174.00	$88.67–$166.48	—	70%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 pro BNP	$127.20	$424.00	$40.83–$405.68	11% below	70%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 pro BNP	$127.20	$424.00	$216.07–$405.68	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Tissue Culture	$67.50	$225.00	$8.96–$215.28	29% above	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Catheter Tip Culture	$67.50	$225.00	$8.96–$215.28	29% above	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Cerebrospinal Fluid Culture	$67.50	$225.00	$8.96–$215.28	29% above	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Eye Culture	$67.50	$225.00	$8.96–$215.28	29% above	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Wound Culture	$67.50	$225.00	$8.96–$215.28	29% above	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Ear Culture	$67.50	$225.00	$8.96–$215.28	29% above	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture	$67.50	$225.00	$8.96–$215.28	29% above	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Sputum Culture	$67.50	$225.00	$8.96–$215.28	29% above	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Respiratory Culture	$67.50	$225.00	$8.96–$215.28	29% above	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Throat Culture	$67.50	$225.00	$8.96–$215.28	29% above	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Body Fluid Culture	$67.50	$225.00	$8.96–$215.28	29% above	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Respiratory Culture	$67.50	$225.00	$114.66–$215.28	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Cerebrospinal Fluid Culture	$67.50	$225.00	$114.66–$215.28	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Catheter Tip Culture	$67.50	$225.00	$114.66–$215.28	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Ear Culture	$67.50	$225.00	$114.66–$215.28	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Eye Culture	$67.50	$225.00	$114.66–$215.28	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Sputum Culture	$67.50	$225.00	$114.66–$215.28	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Genital Culture	$67.50	$225.00	$114.66–$215.28	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Body Fluid Culture	$67.50	$225.00	$114.66–$215.28	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Tissue Culture	$67.50	$225.00	$114.66–$215.28	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Throat Culture	$67.50	$225.00	$114.66–$215.28	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Wound Culture	$67.50	$225.00	$114.66–$215.28	—	70%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$77.70	$259.00	$8.80–$247.81	12% below	70%
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel	$77.70	$259.00	$131.99–$247.81	—	70%
Bilirubin blood test, total CPT 82247 Bilirubin, Total	$18.60	$62.00	$5.22–$59.32	60% below	70%
Bilirubin blood test, total CPT 82247 TBIL (FSURE)	$23.40	$78.00	$5.22–$74.63	50% below	70%
Bilirubin blood test, total CPT 82247 Bilirubin Neonatal	$24.00	$80.00	$5.22–$76.54	49% below	70%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$24.00	$80.00	$5.22–$76.54	49% below	70%
Bilirubin blood test, total CPT 82247 Bilirubin, Body Fluid	$39.90	$133.00	$5.22–$127.25	15% below	70%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin, Total	$18.60	$62.00	$31.60–$59.32	—	70%
Bilirubin blood test, total inpatient CPT 82247 TBIL (FSURE)	$23.40	$78.00	$39.75–$74.63	—	70%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total	$24.00	$80.00	$40.77–$76.54	—	70%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Neonatal	$24.00	$80.00	$40.77–$76.54	—	70%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin, Body Fluid	$39.90	$133.00	$67.78–$127.25	—	70%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 85103 AP Bill Bone Marrow Needle Bx	$29.40	$98.00	$49.94–$219.36	86% below	70%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 88305 AP Bill Surgical Pathology Level IV Complexity	$36.90	$123.00	$54.84–$219.36	83% below	70%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 DermPath Level IV	$67.20	$224.00	$54.84–$219.36	69% below	70%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bone Marrow Complete Analysis to Mayo	$78.00	$260.00	$54.84–$248.77	64% below	70%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Mayo, Renal Path Level IV	$184.20	$614.00	$54.84–$587.48	15% below	70%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 85103 AP Bill Bone Marrow Needle Bx	$29.40	$98.00	$49.94–$93.77	—	70%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 88305 AP Bill Surgical Pathology Level IV Complexity	$36.90	$123.00	$62.68–$117.69	—	70%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 DermPath Level IV	$67.20	$224.00	$114.15–$214.32	—	70%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Bone Marrow Complete Analysis to Mayo	$78.00	$260.00	$132.50–$248.77	—	70%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Mayo, Renal Path Level IV	$184.20	$614.00	$312.89–$587.48	—	70%
Blood culture for bacteria CPT 87040 Transfusion Reaction Culture	$82.50	$275.00	$10.73–$263.12	4% below	70%
Blood culture for bacteria CPT 87040 Blood Culture	$90.60	$302.00	$10.73–$288.95	6% above	70%
Blood culture for bacteria inpatient CPT 87040 Transfusion Reaction Culture	$82.50	$275.00	$140.14–$263.12	—	70%
Blood culture for bacteria inpatient CPT 87040 Blood Culture	$90.60	$302.00	$153.90–$288.95	—	70%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$13.50	$45.00	$9.71–$43.06	8% below	70%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Legal Blood Draw	$13.50	$45.00	$9.71–$43.06	8% below	70%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BCE Venous Draw	$13.50	$45.00	$9.71–$43.06	8% below	70%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BCE Venous Draw	$13.50	$45.00	$22.93–$43.06	—	70%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$13.50	$45.00	$22.93–$43.06	—	70%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Legal Blood Draw	$13.50	$45.00	$22.93–$43.06	—	70%
Blood glucose (sugar) test CPT 82947 Glucose Level	$20.70	$69.00	$4.09–$66.02	15% below	70%
Blood glucose (sugar) test CPT 82947 Glucose 2 Hour Post Prandial	$21.90	$73.00	$4.09–$69.85	10% below	70%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level	$20.70	$69.00	$35.16–$66.02	—	70%
Blood glucose (sugar) test inpatient CPT 82947 Glucose 2 Hour Post Prandial	$21.90	$73.00	$37.20–$69.85	—	70%
Blood lead test CPT 83655 Lead Level 24 Hour Urine	$62.40	$208.00	$12.59–$199.01	13% above	70%
Blood lead test CPT 83655 Lead Level to WSLH	$65.10	$217.00	$12.59–$207.63	18% above	70%
Blood lead test CPT 83655 Lead Level	$121.50	$405.00	$12.59–$387.50	121% above	70%
Blood lead test CPT 83655 Urine Lead Level	$186.60	$622.00	$12.59–$595.13	239% above	70%
Blood lead test inpatient CPT 83655 Lead Level 24 Hour Urine	$62.40	$208.00	$106.00–$199.01	—	70%
Blood lead test inpatient CPT 83655 Lead Level to WSLH	$65.10	$217.00	$110.58–$207.63	—	70%
Blood lead test inpatient CPT 83655 Lead Level	$121.50	$405.00	$206.39–$387.50	—	70%
Blood lead test inpatient CPT 83655 Urine Lead Level	$186.60	$622.00	$316.97–$595.13	—	70%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Preg Serum	$41.70	$139.00	$7.82–$133.00	33% below	70%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Preg Serum	$41.70	$139.00	$70.83–$133.00	—	70%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Pre-TR ABO/Rh	$25.80	$86.00	$3.11–$492.41	39% below	70%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Post-TR ABO/Rh	$25.80	$86.00	$3.11–$492.41	39% below	70%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh Cord	$32.40	$108.00	$3.11–$492.41	24% below	70%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh Heel	$32.40	$108.00	$3.11–$492.41	24% below	70%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Type ABO/Rh Typing	$32.40	$108.00	$3.11–$492.41	24% below	70%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Post-TR ABO/Rh	$25.80	$86.00	$43.83–$82.28	—	70%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Pre-TR ABO/Rh	$25.80	$86.00	$43.83–$82.28	—	70%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh Cord	$32.40	$108.00	$55.04–$103.33	—	70%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh Heel	$32.40	$108.00	$55.04–$103.33	—	70%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood Type ABO/Rh Typing	$32.40	$108.00	$55.04–$103.33	—	70%
Blood urea nitrogen (BUN) test CPT 84520 Urea Nitrogen, PDI Fluid	$19.80	$66.00	$4.11–$63.15	23% below	70%
Blood urea nitrogen (BUN) test CPT 84520 Urea Nitrogen Urine	$22.80	$76.00	$4.11–$72.72	11% below	70%
Blood urea nitrogen (BUN) test CPT 84520 Blood Urea Nitrogen	$22.80	$76.00	$4.11–$72.72	11% below	70%
Blood urea nitrogen (BUN) test CPT 84520 BUN Post Dialysis	$22.80	$76.00	$4.11–$72.72	11% below	70%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea Nitrogen, PDI Fluid	$19.80	$66.00	$33.63–$63.15	—	70%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Blood Urea Nitrogen	$22.80	$76.00	$38.73–$72.72	—	70%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea Nitrogen Urine	$22.80	$76.00	$38.73–$72.72	—	70%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN Post Dialysis	$22.80	$76.00	$38.73–$72.72	—	70%
C-peptide blood test CPT 84681 C-Peptide	$72.60	$242.00	$21.64–$231.55	16% below	70%
C-peptide blood test inpatient CPT 84681 C-Peptide	$72.60	$242.00	$123.32–$231.55	—	70%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP	$29.40	$98.00	$5.39–$93.77	46% below	70%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$41.10	$137.00	$5.39–$131.08	25% below	70%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP	$29.40	$98.00	$49.94–$93.77	—	70%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$41.10	$137.00	$69.82–$131.08	—	70%
C. difficile toxin gene test (stool PCR) both sides CPT 87493 C diff 027-NAP1-BI	$50.40	$168.00	$38.76–$160.74	—	70%
C. difficile toxin gene test (stool PCR) CPT 87493 C diff, PCR w/Rfx Cdiff Toxin A/B	$40.80	$136.00	$38.76–$155.04	73% below	70%
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium difficile Toxin B, Qualitative PCR	$53.40	$178.00	$38.76–$170.31	65% below	70%
C. difficile toxin gene test (stool PCR) inpatient both sides CPT 87493 C diff 027-NAP1-BI	$50.40	$168.00	$85.61–$160.74	—	70%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C diff, PCR w/Rfx Cdiff Toxin A/B	$40.80	$136.00	$69.31–$130.12	—	70%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Clostridium difficile Toxin B, Qualitative PCR	$53.40	$178.00	$90.71–$170.31	—	70%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9, Peritoneal Fluid	$40.50	$135.00	$21.64–$129.17	64% below	70%
CA 19-9 blood test (tumor marker) CPT 86301 Carbohydrate Antigen 19-9	$112.80	$376.00	$21.64–$359.76	at median	70%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9, Peritoneal Fluid	$40.50	$135.00	$68.80–$129.17	—	70%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Carbohydrate Antigen 19-9	$112.80	$376.00	$191.61–$359.76	—	70%
CA-125 blood test (ovarian cancer marker) CPT 86304 Cancer Antigen 125	$99.60	$332.00	$21.64–$317.66	17% below	70%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Cancer Antigen 125	$99.60	$332.00	$169.19–$317.66	—	70%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19, PCR at BMH	$57.90	$193.00	$53.36–$213.45	57% below	70%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19, PCR at BMH	$57.90	$193.00	$98.35–$184.66	—	70%
Calcium blood test, total CPT 82310 Calcium Level Total	$25.80	$86.00	$5.37–$82.28	51% below	70%
Calcium blood test, total CPT 82310 Calcium	$38.40	$128.00	$5.37–$122.47	27% below	70%
Calcium blood test, total inpatient CPT 82310 Calcium Level Total	$25.80	$86.00	$43.83–$82.28	—	70%
Calcium blood test, total inpatient CPT 82310 Calcium	$38.40	$128.00	$65.23–$122.47	—	70%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA, Peritoneal Fluid	$33.30	$111.00	$19.72–$106.20	75% below	70%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen	$110.40	$368.00	$19.72–$352.10	19% below	70%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA, Peritoneal Fluid	$33.30	$111.00	$56.57–$106.20	—	70%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen	$110.40	$368.00	$187.53–$352.10	—	70%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Antibody IgM	$10.20	$34.00	$13.40–$53.58	86% below	70%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Virus Ab CSF	$15.90	$53.00	$13.40–$53.58	78% below	70%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Virus Antibody CSF	$23.40	$78.00	$13.40–$74.63	68% below	70%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Antibody IgG	$73.20	$244.00	$13.40–$233.46	at median	70%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Antibody IgM	$10.20	$34.00	$17.33–$32.53	—	70%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Virus Ab CSF	$15.90	$53.00	$27.01–$50.71	—	70%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Virus Antibody CSF	$23.40	$78.00	$39.75–$74.63	—	70%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Antibody IgG	$73.20	$244.00	$124.34–$233.46	—	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/Neisseria gonorrhoeae RNA, Throat	$25.20	$84.00	$36.49–$145.97	82% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/Neisseria gonorrhoeae RNA, Rectal	$25.20	$84.00	$36.49–$145.97	82% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/Gonorrhea RNA Misc	$30.30	$101.00	$36.49–$145.97	79% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia DNA Probe	$103.20	$344.00	$36.49–$329.14	28% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia PCR, Genital	$105.90	$353.00	$36.49–$337.75	26% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia PCR, Urine	$105.90	$353.00	$36.49–$337.75	26% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia & GC PCR, Genital	$105.90	$353.00	$36.49–$337.75	26% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/Neisseria gonorrhoeae RNA, Rectal	$25.20	$84.00	$42.81–$80.37	—	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/Neisseria gonorrhoeae RNA, Throat	$25.20	$84.00	$42.81–$80.37	—	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/Gonorrhea RNA Misc	$30.30	$101.00	$51.47–$96.64	—	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia DNA Probe	$103.20	$344.00	$175.30–$329.14	—	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia PCR, Urine	$105.90	$353.00	$179.89–$337.75	—	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia & GC PCR, Genital	$105.90	$353.00	$179.89–$337.75	—	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia PCR, Genital	$105.90	$353.00	$179.89–$337.75	—	70%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipoprotein B	$23.70	$79.00	$13.93–$75.59	73% below	70%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Cardio IQ Adv Lipid / 92145	$26.70	$89.00	$13.93–$85.16	70% below	70%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$94.50	$315.00	$13.93–$301.39	6% above	70%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipoprotein B	$23.70	$79.00	$40.26–$75.59	—	70%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Cardio IQ Adv Lipid / 92145	$26.70	$89.00	$45.35–$85.16	—	70%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$94.50	$315.00	$160.52–$301.39	—	70%
Complete blood count (CBC) with differential CPT 85025 .Auto Diff	$62.70	$209.00	$8.08–$199.97	14% below	70%
Complete blood count (CBC) with differential inpatient CPT 85025 .Auto Diff	$62.70	$209.00	$106.51–$199.97	—	70%
Complete blood count (CBC), no differential CPT 85027 Hemogram	$52.20	$174.00	$6.73–$166.48	1% below	70%
Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram	$52.20	$174.00	$88.67–$166.48	—	70%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$101.10	$337.00	$10.98–$322.44	11% below	70%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$101.10	$337.00	$171.74–$322.44	—	70%
Cortisol blood test, total CPT 82533 Dexamethasone Suppression Test	$21.00	$70.00	$16.95–$67.81	82% below	70%
Cortisol blood test, total CPT 82533 ACTH Stimulation, 3 Specimens	$34.20	$114.00	$16.95–$109.08	72% below	70%
Cortisol blood test, total CPT 82533 Cortisol Total	$34.50	$115.00	$16.95–$110.03	71% below	70%
Cortisol blood test, total CPT 82533 ACTH Stimulation, 2 Specimens	$36.30	$121.00	$16.95–$115.77	70% below	70%
Cortisol blood test, total CPT 82533 Cortisol Level	$54.60	$182.00	$16.95–$174.14	54% below	70%
Cortisol blood test, total CPT 82533 Cortisol Morning	$101.70	$339.00	$16.95–$324.36	15% below	70%
Cortisol blood test, total CPT 82533 Cortisol Evening	$101.70	$339.00	$16.95–$324.36	15% below	70%
Cortisol blood test, total inpatient CPT 82533 Dexamethasone Suppression Test	$21.00	$70.00	$35.67–$66.98	—	70%
Cortisol blood test, total inpatient CPT 82533 ACTH Stimulation, 3 Specimens	$34.20	$114.00	$58.09–$109.08	—	70%
Cortisol blood test, total inpatient CPT 82533 Cortisol Total	$34.50	$115.00	$58.60–$110.03	—	70%
Cortisol blood test, total inpatient CPT 82533 ACTH Stimulation, 2 Specimens	$36.30	$121.00	$61.66–$115.77	—	70%
Cortisol blood test, total inpatient CPT 82533 Cortisol Level	$54.60	$182.00	$92.75–$174.14	—	70%
Cortisol blood test, total inpatient CPT 82533 Cortisol Morning	$101.70	$339.00	$172.75–$324.36	—	70%
Cortisol blood test, total inpatient CPT 82533 Cortisol Evening	$101.70	$339.00	$172.75–$324.36	—	70%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase	$34.20	$114.00	$6.77–$109.08	46% below	70%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase only, No Reflex	$34.20	$114.00	$6.77–$109.08	46% below	70%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase Isoenzymes	$60.00	$200.00	$6.77–$191.36	6% below	70%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase only, No Reflex	$34.20	$114.00	$58.09–$109.08	—	70%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase	$34.20	$114.00	$58.09–$109.08	—	70%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase Isoenzymes	$60.00	$200.00	$101.92–$191.36	—	70%
Creatinine blood test CPT 82565 Creatinine	$28.20	$94.00	$5.32–$89.94	11% below	70%
Creatinine blood test inpatient CPT 82565 Creatinine	$28.20	$94.00	$47.90–$89.94	—	70%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus Antibody IgG	$105.90	$353.00	$14.97–$337.75	50% above	70%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus Antibody IgG	$105.90	$353.00	$179.89–$337.75	—	70%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$93.90	$313.00	$10.59–$299.48	18% above	70%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer	$93.90	$313.00	$159.50–$299.48	—	70%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone Sulfate	$52.20	$174.00	$23.12–$166.48	63% below	70%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone Sulfate	$52.20	$174.00	$88.67–$166.48	—	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Cocaine Level With Metabolites Serum	$26.13	$87.10	$44.39–$258.50	77% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology Cocaine, Saliva	$34.20	$114.00	$58.09–$258.50	70% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology MDMA, Saliva	$34.20	$114.00	$58.09–$258.50	70% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology Nicotine, Saliva	$34.20	$114.00	$58.09–$258.50	70% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology Marijuana, Saliva	$34.20	$114.00	$58.09–$258.50	70% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology Meprobamate, Saliva	$34.20	$114.00	$58.09–$258.50	70% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology Methadone, Saliva	$34.20	$114.00	$58.09–$258.50	70% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology Benzodiazepines, Saliva	$34.20	$114.00	$58.09–$258.50	70% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology Barbiturates, Saliva	$34.20	$114.00	$58.09–$258.50	70% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology Amphetamines, Saliva	$34.20	$114.00	$58.09–$258.50	70% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology Zolpidem, Saliva	$34.20	$114.00	$58.09–$258.50	70% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology PCP, Saliva	$34.20	$114.00	$58.09–$258.50	70% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology Opioids, Saliva	$34.20	$114.00	$58.09–$258.50	70% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Synthetic Cannabinoids Screen w/ Confirmation, Urine	$40.80	$136.00	$64.63–$258.50	65% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Cocaine Level With Metabolites Blood	$49.50	$165.00	$64.63–$258.50	57% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Gamma-Hydroxybutyric Acid Screen, Urine	$51.00	$170.00	$64.63–$258.50	56% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Panel 7, Serum	$69.30	$231.00	$64.63–$258.50	40% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 BCE Saliva Confirmation 5	$86.10	$287.00	$64.63–$274.60	26% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Pain Management Profile 1, Urine	$87.30	$291.00	$64.63–$278.43	25% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Panel 8, Serum	$91.80	$306.00	$64.63–$292.78	21% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Panel 9, Meconium	$92.10	$307.00	$64.63–$293.74	21% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Toxicology Panel, Saliva	$160.80	$536.00	$64.63–$512.84	39% above	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cocaine Level With Metabolites Serum	$26.13	$87.10	$44.39–$83.34	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology Meprobamate, Saliva	$34.20	$114.00	$58.09–$109.08	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology Nicotine, Saliva	$34.20	$114.00	$58.09–$109.08	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology Marijuana, Saliva	$34.20	$114.00	$58.09–$109.08	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology Opioids, Saliva	$34.20	$114.00	$58.09–$109.08	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology Cocaine, Saliva	$34.20	$114.00	$58.09–$109.08	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology PCP, Saliva	$34.20	$114.00	$58.09–$109.08	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology MDMA, Saliva	$34.20	$114.00	$58.09–$109.08	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology Methadone, Saliva	$34.20	$114.00	$58.09–$109.08	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology Benzodiazepines, Saliva	$34.20	$114.00	$58.09–$109.08	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology Amphetamines, Saliva	$34.20	$114.00	$58.09–$109.08	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology Zolpidem, Saliva	$34.20	$114.00	$58.09–$109.08	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology Barbiturates, Saliva	$34.20	$114.00	$58.09–$109.08	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Synthetic Cannabinoids Screen w/ Confirmation, Urine	$40.80	$136.00	$69.31–$130.12	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cocaine Level With Metabolites Blood	$49.50	$165.00	$84.08–$157.87	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Gamma-Hydroxybutyric Acid Screen, Urine	$51.00	$170.00	$86.63–$162.66	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen Panel 7, Serum	$69.30	$231.00	$117.72–$221.02	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 BCE Saliva Confirmation 5	$86.10	$287.00	$146.26–$274.60	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Pain Management Profile 1, Urine	$87.30	$291.00	$148.29–$278.43	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen Panel 8, Serum	$91.80	$306.00	$155.94–$292.78	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen Panel 9, Meconium	$92.10	$307.00	$156.45–$293.74	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Toxicology Panel, Saliva	$160.80	$536.00	$273.15–$512.84	—	70%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte Panel	$71.10	$237.00	$7.29–$226.76	46% above	70%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte Panel	$71.10	$237.00	$120.78–$226.76	—	70%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein-Barr Viral Capsid Antigen (VCA) Antibody (IgA)	$19.80	$66.00	$18.87–$75.46	76% below	70%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein Barr Virus Capsid IgM Antibody	$61.20	$204.00	$18.87–$195.19	26% below	70%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein Barr Virus Panel	$79.50	$265.00	$18.87–$253.55	4% below	70%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein Barr Virus Capsid Antibody IgM	$79.50	$265.00	$18.87–$253.55	4% below	70%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein Barr Virus Capsid Antibody IgG	$79.50	$265.00	$18.87–$253.55	4% below	70%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein-Barr Viral Capsid Antigen (VCA) Antibody (IgA)	$19.80	$66.00	$33.63–$63.15	—	70%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein Barr Virus Capsid IgM Antibody	$61.20	$204.00	$103.96–$195.19	—	70%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein Barr Virus Capsid Antibody IgM	$79.50	$265.00	$135.04–$253.55	—	70%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein Barr Virus Panel	$79.50	$265.00	$135.04–$253.55	—	70%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein Barr Virus Capsid Antibody IgG	$79.50	$265.00	$135.04–$253.55	—	70%
Estradiol blood test CPT 82670 Estradiol, Ultrasensitive, LC/MS/MS	$32.10	$107.00	$29.06–$116.23	75% below	70%
Estradiol blood test CPT 82670 Estradiol Level	$201.90	$673.00	$29.06–$643.93	57% above	70%
Estradiol blood test inpatient CPT 82670 Estradiol, Ultrasensitive, LC/MS/MS	$32.10	$107.00	$54.53–$102.38	—	70%
Estradiol blood test inpatient CPT 82670 Estradiol Level	$201.90	$673.00	$342.96–$643.93	—	70%
FSH (follicle-stimulating hormone) test CPT 83001 FSH Pediatrics	$27.00	$90.00	$19.32–$86.11	77% below	70%
FSH (follicle-stimulating hormone) test CPT 83001 FSH and LH, Pediatrics	$32.01	$106.69	$19.32–$102.08	72% below	70%
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone Level	$98.10	$327.00	$19.32–$312.87	15% below	70%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH Pediatrics	$27.00	$90.00	$45.86–$86.11	—	70%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH and LH, Pediatrics	$32.01	$106.69	$54.37–$102.08	—	70%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stimulating Hormone Level	$98.10	$327.00	$166.64–$312.87	—	70%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Stool	$138.60	$462.00	$20.42–$442.04	26% below	70%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Stool	$138.60	$462.00	$235.44–$442.04	—	70%
Ferritin blood test (iron stores) CPT 82728 Thalassemia & Hemoglobinopathy Comprehensive	$29.78	$99.27	$14.18–$94.98	67% below	70%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$73.50	$245.00	$14.18–$234.42	19% below	70%
Ferritin blood test (iron stores) inpatient CPT 82728 Thalassemia & Hemoglobinopathy Comprehensive	$29.78	$99.27	$50.59–$94.98	—	70%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$73.50	$245.00	$124.85–$234.42	—	70%
Fibrinogen blood test CPT 85384 Fibrinogen	$39.00	$130.00	$10.11–$124.38	42% below	70%
Fibrinogen blood test inpatient CPT 85384 Fibrinogen	$39.00	$130.00	$66.25–$124.38	—	70%
Folate (folic acid) blood test CPT 82746 Folate Level	$59.10	$197.00	$15.29–$188.49	40% below	70%
Folate (folic acid) blood test inpatient CPT 82746 Folate Level	$59.10	$197.00	$100.39–$188.49	—	70%
Free T3 thyroid hormone test CPT 84481 T3 Free	$63.00	$210.00	$17.62–$200.93	35% below	70%
Free T3 thyroid hormone test inpatient CPT 84481 T3 Free	$63.00	$210.00	$107.02–$200.93	—	70%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine Free	$88.80	$296.00	$9.38–$283.21	10% above	70%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Free, Direct Dialysis	$225.60	$752.00	$9.38–$719.51	179% above	70%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Thyroxine Free	$88.80	$296.00	$150.84–$283.21	—	70%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 Free, Direct Dialysis	$225.60	$752.00	$383.22–$719.51	—	70%
Free testosterone test CPT 84402 Testosterone Free	$53.40	$178.00	$26.49–$170.31	55% below	70%
Free testosterone test inpatient CPT 84402 Testosterone Free	$53.40	$178.00	$90.71–$170.31	—	70%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT	$22.80	$76.00	$7.49–$72.72	57% below	70%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT (FSURE)	$25.20	$84.00	$7.49–$80.37	53% below	70%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase	$34.80	$116.00	$7.49–$110.99	35% below	70%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT	$22.80	$76.00	$38.73–$72.72	—	70%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT (FSURE)	$25.20	$84.00	$42.81–$80.37	—	70%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Gamma Glutamyl Transferase	$34.80	$116.00	$59.11–$110.99	—	70%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel	$167.40	$558.00	$162.49–$533.89	39% below	70%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General Health Panel	$167.40	$558.00	$284.36–$533.89	—	70%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Tolerance 1 Hour	$31.20	$104.00	$4.94–$99.51	37% below	70%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose Tolerance 1 Hour	$31.20	$104.00	$53.00–$99.51	—	70%
Glucose tolerance test, 3 samples CPT 82951 Glucose 2 Hr	$63.00	$210.00	$13.38–$200.93	30% below	70%
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose 2 Hr	$63.00	$210.00	$107.02–$200.93	—	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhoeae RNA Throat	$11.40	$38.00	$19.36–$145.97	92% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N. gonorrhoeae RNA	$25.20	$84.00	$36.49–$145.97	82% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC RNA	$26.10	$87.00	$36.49–$145.97	82% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC RNA Ocular	$30.30	$101.00	$36.49–$145.97	79% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC DNA Probe	$102.00	$340.00	$36.49–$325.31	29% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC PCR, Genital	$117.00	$390.00	$36.49–$373.15	18% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC PCR, Urine	$117.00	$390.00	$36.49–$373.15	18% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria gonorrhoeae RNA Throat	$11.40	$38.00	$19.36–$36.36	—	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N. gonorrhoeae RNA	$25.20	$84.00	$42.81–$80.37	—	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC RNA	$26.10	$87.00	$44.34–$83.24	—	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC RNA Ocular	$30.30	$101.00	$51.47–$96.64	—	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC DNA Probe	$102.00	$340.00	$173.26–$325.31	—	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC PCR, Genital	$117.00	$390.00	$198.74–$373.15	—	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC PCR, Urine	$117.00	$390.00	$198.74–$373.15	—	70%
H. pylori stool antigen test CPT 87338 Helicobacter pylori Antigen, Stool	$56.10	$187.00	$14.96–$178.92	57% below	70%
H. pylori stool antigen test inpatient CPT 87338 Helicobacter pylori Antigen, Stool	$56.10	$187.00	$95.30–$178.92	—	70%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA PCR Quantitative	$237.60	$792.00	$88.50–$757.79	39% below	70%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA PCR Quantitative	$237.60	$792.00	$403.60–$757.79	—	70%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1 and 2 Antibodies, Antigen Screen	$79.50	$265.00	$14.26–$253.55	3% above	70%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1 and 2 Antibodies, Antigen Screen	$79.50	$265.00	$135.04–$253.55	—	70%
HPV test for high-risk types, one combined (pooled) result CPT 87624 .HPV DNA (High Risk) (OBSOLETE)	$25.80	$86.00	$36.49–$145.97	82% below	70%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV mRNA E6/E7	$27.90	$93.00	$36.49–$145.97	80% below	70%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV mRNA E6/E7 w/Rfx HPV 16, 18/45	$27.90	$93.00	$36.49–$145.97	80% below	70%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV mRNA E6/E7, Rectal w/Rfx Genotype	$35.40	$118.00	$36.49–$145.97	75% below	70%
HPV test for high-risk types, one combined (pooled) result CPT 87624 SurePath Pap and HPV DNA	$48.00	$160.00	$36.49–$153.09	66% below	70%
HPV test for high-risk types, one combined (pooled) result CPT 87624 OraRisk HPV	$89.40	$298.00	$36.49–$285.13	37% below	70%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV Low Risk	$91.20	$304.00	$36.49–$290.87	36% below	70%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV High Risk	$114.30	$381.00	$36.49–$364.54	20% below	70%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 .HPV DNA (High Risk) (OBSOLETE)	$25.80	$86.00	$43.83–$82.28	—	70%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV mRNA E6/E7	$27.90	$93.00	$47.39–$88.98	—	70%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV mRNA E6/E7 w/Rfx HPV 16, 18/45	$27.90	$93.00	$47.39–$88.98	—	70%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV mRNA E6/E7, Rectal w/Rfx Genotype	$35.40	$118.00	$60.13–$112.90	—	70%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 SurePath Pap and HPV DNA	$48.00	$160.00	$81.54–$153.09	—	70%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 OraRisk HPV	$89.40	$298.00	$151.86–$285.13	—	70%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV Low Risk	$91.20	$304.00	$154.92–$290.87	—	70%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV High Risk	$114.30	$381.00	$194.16–$364.54	—	70%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c	$72.00	$240.00	$10.10–$229.63	4% above	70%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c	$72.00	$240.00	$122.30–$229.63	—	70%
Hemoglobin blood test CPT 85018 Hemoglobin POC	$11.40	$38.00	$2.46–$36.36	35% below	70%
Hemoglobin blood test CPT 85018 Hemoglobin	$18.00	$60.00	$2.46–$57.41	3% above	70%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin POC	$11.40	$38.00	$19.36–$36.36	—	70%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin	$18.00	$60.00	$30.58–$57.41	—	70%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Antibody	$57.30	$191.00	$12.53–$182.75	28% below	70%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Antibody	$57.30	$191.00	$97.33–$182.75	—	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody, Qualitative	$61.20	$204.00	$11.17–$195.19	17% below	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Antibody, Qualitative	$61.20	$204.00	$103.96–$195.19	—	70%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen	$48.30	$161.00	$10.74–$154.04	26% below	70%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen, Qualitative	$60.60	$202.00	$10.74–$193.27	7% below	70%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen	$48.30	$161.00	$82.05–$154.04	—	70%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen, Qualitative	$60.60	$202.00	$102.94–$193.27	—	70%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody, Qualitative	$101.10	$337.00	$14.84–$322.44	26% above	70%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab w/Rfx Viral Load Confirm	$101.10	$337.00	$14.84–$322.44	26% above	70%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Ab w/Rfx Viral Load Confirm	$101.10	$337.00	$171.74–$322.44	—	70%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Antibody, Qualitative	$101.10	$337.00	$171.74–$322.44	—	70%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Qnt PCR w/rfx Genotype LiPA	$31.50	$105.00	$44.55–$178.21	87% below	70%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C RNA PCR Quantitative	$162.30	$541.00	$44.55–$517.63	31% below	70%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C RNA PCR Quantitative w/ Reflexes	$162.30	$541.00	$44.55–$517.63	31% below	70%
Hepatitis C viral load (HCV RNA) test CPT 87522 .Hepatitis C RNA, Quant PCR	$162.30	$541.00	$44.55–$517.63	31% below	70%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C RNA by PCR Quantitiative	$162.60	$542.00	$44.55–$518.59	31% below	70%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Qnt PCR w/rfx Genotype LiPA	$31.50	$105.00	$53.51–$100.46	—	70%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C RNA PCR Quantitative	$162.30	$541.00	$275.69–$517.63	—	70%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 .Hepatitis C RNA, Quant PCR	$162.30	$541.00	$275.69–$517.63	—	70%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C RNA PCR Quantitative w/ Reflexes	$162.30	$541.00	$275.69–$517.63	—	70%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C RNA by PCR Quantitiative	$162.60	$542.00	$276.20–$518.59	—	70%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Virus Type I & II IgG	$76.80	$256.00	$13.72–$244.94	13% above	70%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Type I IgG	$76.80	$256.00	$13.72–$244.94	13% above	70%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex Virus Type I & II IgG	$76.80	$256.00	$130.46–$244.94	—	70%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex Type I IgG	$76.80	$256.00	$130.46–$244.94	—	70%
Herpes blood test, HSV-2 antibody CPT 86696 .Herpes Simplex 2 IgM Titer	$19.80	$66.00	$20.12–$80.50	76% below	70%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Type II IgG	$60.00	$200.00	$20.12–$191.36	26% below	70%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 .Herpes Simplex 2 IgM Titer	$19.80	$66.00	$33.63–$63.15	—	70%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex Type II IgG	$60.00	$200.00	$101.92–$191.36	—	70%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein High Sensitivity	$62.40	$208.00	$13.47–$199.01	22% below	70%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein High Sensitivity	$62.40	$208.00	$106.00–$199.01	—	70%
Homocysteine blood test CPT 83090 Homocysteine, Cardio	$96.90	$323.00	$18.64–$309.05	18% below	70%
Homocysteine blood test CPT 83090 Homocysteine, Cardiovascular	$189.00	$630.00	$18.64–$602.78	60% above	70%
Homocysteine blood test inpatient CPT 83090 Homocysteine, Cardio	$96.90	$323.00	$164.60–$309.05	—	70%
Homocysteine blood test inpatient CPT 83090 Homocysteine, Cardiovascular	$189.00	$630.00	$321.05–$602.78	—	70%
Insulin blood test CPT 83525 Insulin Level Total	$45.90	$153.00	$11.89–$146.39	32% below	70%
Insulin blood test inpatient CPT 83525 Insulin Level Total	$45.90	$153.00	$77.97–$146.39	—	70%
Iron blood test (serum iron) CPT 83540 Iron Level	$41.40	$138.00	$6.73–$132.04	22% below	70%
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$41.40	$138.00	$70.32–$132.04	—	70%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity Total	$54.60	$182.00	$9.09–$174.14	12% below	70%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity Total	$54.60	$182.00	$92.75–$174.14	—	70%
Kidney function blood test panel CPT 80069 Renal Func Pnl	$67.50	$225.00	$9.03–$215.28	34% below	70%
Kidney function blood test panel inpatient CPT 80069 Renal Func Pnl	$67.50	$225.00	$114.66–$215.28	—	70%
LH (luteinizing hormone) test CPT 83002 LH Pediatrics	$29.40	$98.00	$19.26–$93.77	70% below	70%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone Level	$104.40	$348.00	$19.26–$332.97	7% above	70%
LH (luteinizing hormone) test inpatient CPT 83002 LH Pediatrics	$29.40	$98.00	$49.94–$93.77	—	70%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone Level	$104.40	$348.00	$177.34–$332.97	—	70%
Lactate (lactic acid) blood test CPT 83605 Lactate/Pyruvate	$31.80	$106.00	$12.03–$101.42	54% below	70%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid	$57.00	$190.00	$12.03–$181.79	18% below	70%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactate/Pyruvate	$31.80	$106.00	$54.02–$101.42	—	70%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid	$57.00	$190.00	$96.82–$181.79	—	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 LD, CSF to Mayo	$26.10	$87.00	$6.28–$83.24	48% below	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 LD, Pericardial Fluid	$30.90	$103.00	$6.28–$98.55	38% below	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 LD, Pleural Fluid	$30.90	$103.00	$6.28–$98.55	38% below	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 LD, Peritoneal Fluid	$30.90	$103.00	$6.28–$98.55	38% below	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 LD, Synovial Fluid	$30.90	$103.00	$6.28–$98.55	38% below	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase Isoenzyme Panel	$41.40	$138.00	$6.28–$132.04	17% below	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase	$42.60	$142.00	$6.28–$135.87	15% below	70%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LD, CSF to Mayo	$26.10	$87.00	$44.34–$83.24	—	70%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LD, Pericardial Fluid	$30.90	$103.00	$52.49–$98.55	—	70%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LD, Peritoneal Fluid	$30.90	$103.00	$52.49–$98.55	—	70%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LD, Pleural Fluid	$30.90	$103.00	$52.49–$98.55	—	70%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LD, Synovial Fluid	$30.90	$103.00	$52.49–$98.55	—	70%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase Isoenzyme Panel	$41.40	$138.00	$70.32–$132.04	—	70%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase	$42.60	$142.00	$72.36–$135.87	—	70%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase, Pancreatic Fluid	$9.30	$31.00	$7.17–$29.66	86% below	70%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase, Peritoneal Fluid	$9.30	$31.00	$7.17–$29.66	86% below	70%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase, Pleural Fluid	$9.30	$31.00	$7.17–$29.66	86% below	70%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$67.80	$226.00	$7.17–$216.24	at median	70%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase, Pleural Fluid	$9.30	$31.00	$15.80–$29.66	—	70%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase, Pancreatic Fluid	$9.30	$31.00	$15.80–$29.66	—	70%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase, Peritoneal Fluid	$9.30	$31.00	$15.80–$29.66	—	70%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$67.80	$226.00	$115.17–$216.24	—	70%
Liver function blood test panel CPT 80076 Hep Func Panel	$84.30	$281.00	$8.50–$268.86	17% below	70%
Liver function blood test panel inpatient CPT 80076 Hep Func Panel	$84.30	$281.00	$143.20–$268.86	—	70%
Lyme disease antibody test CPT 86618 Lyme Disease Antibodies (IgG, IgM) CSF	$38.40	$128.00	$17.71–$122.47	54% below	70%
Lyme disease antibody test CPT 86618 Lyme Disease Serology/C6 Peptide	$39.60	$132.00	$17.71–$126.30	53% below	70%
Lyme disease antibody test CPT 86618 Lyme Disease Antibody Total w/ Reflex Western Blot	$54.60	$182.00	$17.71–$174.14	35% below	70%
Lyme disease antibody test CPT 86618 Tick-Borne Disease, Antibody Panel	$124.20	$414.00	$17.71–$396.12	49% above	70%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Antibodies (IgG, IgM) CSF	$38.40	$128.00	$65.23–$122.47	—	70%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Serology/C6 Peptide	$39.60	$132.00	$67.27–$126.30	—	70%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Antibody Total w/ Reflex Western Blot	$54.60	$182.00	$92.75–$174.14	—	70%
Lyme disease antibody test inpatient CPT 86618 Tick-Borne Disease, Antibody Panel	$124.20	$414.00	$210.97–$396.12	—	70%
Magnesium blood test CPT 83735 Magnesium Level 24 Hour Urine	$8.40	$28.00	$6.97–$27.87	84% below	70%
Magnesium blood test CPT 83735 Magnesium, Urine	$11.40	$38.00	$6.97–$36.36	78% below	70%
Magnesium blood test CPT 83735 Urine Magnesium	$12.60	$42.00	$6.97–$40.19	76% below	70%
Magnesium blood test CPT 83735 Magnesium, Random Urine w/ Creatinine	$15.00	$50.00	$6.97–$47.84	71% below	70%
Magnesium blood test CPT 83735 Magnesium, RBC	$26.10	$87.00	$6.97–$83.24	50% below	70%
Magnesium blood test CPT 83735 Magnesium Level	$40.20	$134.00	$6.97–$128.21	23% below	70%
Magnesium blood test inpatient CPT 83735 Magnesium Level 24 Hour Urine	$8.40	$28.00	$14.27–$26.79	—	70%
Magnesium blood test inpatient CPT 83735 Magnesium, Urine	$11.40	$38.00	$19.36–$36.36	—	70%
Magnesium blood test inpatient CPT 83735 Urine Magnesium	$12.60	$42.00	$21.40–$40.19	—	70%
Magnesium blood test inpatient CPT 83735 Magnesium, Random Urine w/ Creatinine	$15.00	$50.00	$25.48–$47.84	—	70%
Magnesium blood test inpatient CPT 83735 Magnesium, RBC	$26.10	$87.00	$44.34–$83.24	—	70%
Magnesium blood test inpatient CPT 83735 Magnesium Level	$40.20	$134.00	$68.29–$128.21	—	70%
Measles (rubeola) antibody test CPT 86765 Measles IgG	$33.30	$111.00	$13.40–$106.20	60% below	70%
Measles (rubeola) antibody test CPT 86765 Measles IgM	$33.30	$111.00	$13.40–$106.20	60% below	70%
Measles (rubeola) antibody test CPT 86765 Measles IgM Antibody	$43.20	$144.00	$13.40–$137.78	48% below	70%
Measles (rubeola) antibody test CPT 86765 Measles Antibody IgG	$53.40	$178.00	$13.40–$170.31	35% below	70%
Measles (rubeola) antibody test CPT 86765 Measles Antibody, IgG & IgM	$55.50	$185.00	$13.40–$177.01	33% below	70%
Measles (rubeola) antibody test inpatient CPT 86765 Measles IgM	$33.30	$111.00	$56.57–$106.20	—	70%
Measles (rubeola) antibody test inpatient CPT 86765 Measles IgG	$33.30	$111.00	$56.57–$106.20	—	70%
Measles (rubeola) antibody test inpatient CPT 86765 Measles IgM Antibody	$43.20	$144.00	$73.38–$137.78	—	70%
Measles (rubeola) antibody test inpatient CPT 86765 Measles Antibody IgG	$53.40	$178.00	$90.71–$170.31	—	70%
Measles (rubeola) antibody test inpatient CPT 86765 Measles Antibody, IgG & IgM	$55.50	$185.00	$94.28–$177.01	—	70%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$34.50	$115.00	$5.39–$110.03	38% below	70%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen	$34.50	$115.00	$58.60–$110.03	—	70%
Mumps immunity blood test CPT 86735 Mumps Antibody IgM	$45.30	$151.00	$13.57–$144.48	47% below	70%
Mumps immunity blood test CPT 86735 Mumps Antibody IgG	$129.00	$430.00	$13.57–$411.42	50% above	70%
Mumps immunity blood test inpatient CPT 86735 Mumps Antibody IgM	$45.30	$151.00	$76.95–$144.48	—	70%
Mumps immunity blood test inpatient CPT 86735 Mumps Antibody IgG	$129.00	$430.00	$219.13–$411.42	—	70%
Obstetric blood test panel CPT 80055 Obstetric Panel	$310.50	$1,035.00	$49.72–$990.29	29% above	70%
Obstetric blood test panel inpatient CPT 80055 Obstetric Panel	$310.50	$1,035.00	$527.44–$990.29	—	70%
PSA (prostate-specific antigen) blood test, free CPT 84154 .PSA Free, Quest	$20.10	$67.00	$19.13–$76.50	78% below	70%
PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate Specific Antigen Free	$25.20	$84.00	$19.13–$80.37	73% below	70%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 .PSA Free, Quest	$20.10	$67.00	$34.14–$64.11	—	70%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Prostate Specific Antigen Free	$25.20	$84.00	$42.81–$80.37	—	70%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Health Index	$53.70	$179.00	$19.13–$171.27	44% below	70%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA only, No Rfx	$91.50	$305.00	$19.13–$291.82	4% below	70%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Total to Quest w/ Reflex Free PSA	$91.50	$305.00	$19.13–$291.82	4% below	70%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Quest Free	$91.50	$305.00	$19.13–$291.82	4% below	70%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA w/ Rfx Free PSA	$91.50	$305.00	$19.13–$291.82	4% below	70%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Health Index	$53.70	$179.00	$91.22–$171.27	—	70%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA w/ Rfx Free PSA	$91.50	$305.00	$155.43–$291.82	—	70%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA only, No Rfx	$91.50	$305.00	$155.43–$291.82	—	70%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Quest Free	$91.50	$305.00	$155.43–$291.82	—	70%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Total to Quest w/ Reflex Free PSA	$91.50	$305.00	$155.43–$291.82	—	70%
Pap test (liquid-based, automated screening with review) CPT 88175 ThinPrep Pap & HPV mRNA E6/E7 #90933	$44.10	$147.00	$27.67–$140.65	58% below	70%
Pap test (liquid-based, automated screening with review) CPT 88175 ThinPrep Pap w/Rfx HPV mRNA E6/E7 #90934	$44.10	$147.00	$27.67–$140.65	58% below	70%
Pap test (liquid-based, automated screening with review) CPT 88175 ThinPrep Pap & HPV mRNA w/Rfx HPV 16,18/45 #91414	$44.10	$147.00	$27.67–$140.65	58% below	70%
Pap test (liquid-based, automated screening with review) CPT 88175 ThinPrep Pap #58315	$44.10	$147.00	$27.67–$140.65	58% below	70%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 ThinPrep Pap & HPV mRNA E6/E7 #90933	$44.10	$147.00	$74.91–$140.65	—	70%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 ThinPrep Pap & HPV mRNA w/Rfx HPV 16,18/45 #91414	$44.10	$147.00	$74.91–$140.65	—	70%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 ThinPrep Pap w/Rfx HPV mRNA E6/E7 #90934	$44.10	$147.00	$74.91–$140.65	—	70%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 ThinPrep Pap #58315	$44.10	$147.00	$74.91–$140.65	—	70%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HPV 18/45	$32.70	$109.00	$21.07–$104.29	64% below	70%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HPV 18/45	$32.70	$109.00	$55.55–$104.29	—	70%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Intact	$160.20	$534.00	$42.93–$510.93	25% below	70%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone Intact	$160.20	$534.00	$272.13–$510.93	—	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT, Lupus	$7.20	$24.00	$6.25–$25.00	86% below	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 Lupus Anticoagulant Evaluation w/ Reflex	$22.50	$75.00	$6.25–$71.76	57% below	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 Mix PTT 1 Hour	$45.60	$152.00	$6.25–$145.43	13% below	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$45.60	$152.00	$6.25–$145.43	13% below	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 von Willebrand Comprehensive Panel	$45.60	$152.00	$6.25–$145.43	13% below	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 Mix PTT Immed	$45.60	$152.00	$6.25–$145.43	13% below	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 Thrombosis Hypercoagulability Panel	$96.90	$323.00	$6.25–$309.05	85% above	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT, Lupus	$7.20	$24.00	$12.23–$22.96	—	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Lupus Anticoagulant Evaluation w/ Reflex	$22.50	$75.00	$38.22–$71.76	—	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Mix PTT 1 Hour	$45.60	$152.00	$77.46–$145.43	—	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 von Willebrand Comprehensive Panel	$45.60	$152.00	$77.46–$145.43	—	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time	$45.60	$152.00	$77.46–$145.43	—	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Mix PTT Immed	$45.60	$152.00	$77.46–$145.43	—	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thrombosis Hypercoagulability Panel	$96.90	$323.00	$164.60–$309.05	—	70%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Level	$24.60	$82.00	$4.93–$78.46	41% below	70%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Level	$24.60	$82.00	$41.79–$78.46	—	70%
Potassium blood test CPT 84132 Potassium Level	$25.50	$85.00	$4.95–$81.33	7% below	70%
Potassium blood test inpatient CPT 84132 Potassium Level	$25.50	$85.00	$43.32–$81.33	—	70%
Progesterone blood test CPT 84144 Progesterone, LC/MS/MS	$26.40	$88.00	$21.69–$86.78	78% below	70%
Progesterone blood test CPT 84144 Progesterone Level	$87.90	$293.00	$21.69–$280.34	27% below	70%
Progesterone blood test inpatient CPT 84144 Progesterone, LC/MS/MS	$26.40	$88.00	$44.84–$84.20	—	70%
Progesterone blood test inpatient CPT 84144 Progesterone Level	$87.90	$293.00	$149.31–$280.34	—	70%
Prolactin blood test CPT 84146 Prolactin Level	$113.40	$378.00	$20.16–$361.67	6% below	70%
Prolactin blood test inpatient CPT 84146 Prolactin Level	$113.40	$378.00	$192.63–$361.67	—	70%
Prothrombin time (PT/INR) clotting test CPT 85610 PT Finger	$15.60	$52.00	$4.46–$49.75	54% below	70%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time	$32.10	$107.00	$4.46–$102.38	5% below	70%
Prothrombin time (PT/INR) clotting test CPT 85610 Mix PT 1 Hour	$32.10	$107.00	$4.46–$102.38	5% below	70%
Prothrombin time (PT/INR) clotting test CPT 85610 Mix PT Immed	$32.10	$107.00	$4.46–$102.38	5% below	70%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT Finger	$15.60	$52.00	$26.50–$49.75	—	70%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Mix PT 1 Hour	$32.10	$107.00	$54.53–$102.38	—	70%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Mix PT Immed	$32.10	$107.00	$54.53–$102.38	—	70%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time	$32.10	$107.00	$54.53–$102.38	—	70%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Urine Drug Screen POC Amb	$7.80	$26.00	$13.10–$52.42	86% below	70%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Urine Drug Screen POC Amb	$7.80	$26.00	$13.25–$24.88	—	70%
Rapid flu test (influenza antigen) CPT 87804 zzFlu A/B	$55.20	$184.00	$17.21–$176.05	5% above	70%
Rapid flu test (influenza antigen) CPT 87804 Influenza B Antibody 87804	$69.90	$233.00	$17.21–$222.93	32% above	70%
Rapid flu test (influenza antigen) CPT 87804 Influenza B Antibody	$85.50	$285.00	$17.21–$272.69	62% above	70%
Rapid flu test (influenza antigen) CPT 87804 Influenza A Antibody	$85.50	$285.00	$17.21–$272.69	62% above	70%
Rapid flu test (influenza antigen) CPT 87804 Infectious Agent Antigen, Influenza A/B POC	$94.80	$316.00	$17.21–$302.35	80% above	70%
Rapid flu test (influenza antigen) inpatient CPT 87804 zzFlu A/B	$55.20	$184.00	$93.77–$176.05	—	70%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza B Antibody 87804	$69.90	$233.00	$118.74–$222.93	—	70%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza A Antibody	$85.50	$285.00	$145.24–$272.69	—	70%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza B Antibody	$85.50	$285.00	$145.24–$272.69	—	70%
Rapid flu test (influenza antigen) inpatient CPT 87804 Infectious Agent Antigen, Influenza A/B POC	$94.80	$316.00	$161.03–$302.35	—	70%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Infectious Agent Antigen, Streptococcus Group A POC	$37.50	$125.00	$17.19–$119.60	18% below	70%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Rapid Strep POC (Clinics.)	$57.30	$191.00	$17.19–$182.75	26% above	70%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Positive - Rapid Strep Test	$59.70	$199.00	$17.19–$190.40	31% above	70%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Negative - Rapid Strep Test	$59.70	$199.00	$17.19–$190.40	31% above	70%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Infectious Agent Antigen, Streptococcus Group A POC	$37.50	$125.00	$63.70–$119.60	—	70%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Rapid Strep POC (Clinics.)	$57.30	$191.00	$97.33–$182.75	—	70%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Negative - Rapid Strep Test	$59.70	$199.00	$101.41–$190.40	—	70%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Positive - Rapid Strep Test	$59.70	$199.00	$101.41–$190.40	—	70%
Renin blood test CPT 84244 Renin Activity	$141.30	$471.00	$22.87–$450.65	4% below	70%
Renin blood test inpatient CPT 84244 Renin Activity	$141.30	$471.00	$240.02–$450.65	—	70%
Rh blood typing CPT 86901 D Antigen Typing	$30.60	$102.00	$3.11–$154.60	23% below	70%
Rh blood typing CPT 86901 Rh Typing	$34.50	$115.00	$3.11–$154.60	13% below	70%
Rh blood typing inpatient CPT 86901 D Antigen Typing	$30.60	$102.00	$51.98–$97.59	—	70%
Rh blood typing inpatient CPT 86901 Rh Typing	$34.50	$115.00	$58.60–$110.03	—	70%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Qnt	$31.50	$105.00	$5.90–$100.46	46% below	70%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Quantitative	$32.70	$109.00	$5.90–$104.29	44% below	70%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor, Syn Fluid, Screen w/ Rfx Titer	$40.20	$134.00	$5.90–$128.21	31% below	70%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor Qnt	$31.50	$105.00	$53.51–$100.46	—	70%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor Quantitative	$32.70	$109.00	$55.55–$104.29	—	70%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor, Syn Fluid, Screen w/ Rfx Titer	$40.20	$134.00	$68.29–$128.21	—	70%
Rubella antibody test (immunity check) CPT 86762 Rubella Imm Status	$49.80	$166.00	$14.97–$158.83	40% below	70%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibody IgM	$49.80	$166.00	$14.97–$158.83	40% below	70%
Rubella antibody test (immunity check) CPT 86762 Torch Panel, Acute	$84.24	$280.79	$14.97–$268.66	2% above	70%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Imm Status	$49.80	$166.00	$84.59–$158.83	—	70%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibody IgM	$49.80	$166.00	$84.59–$158.83	—	70%
Rubella antibody test (immunity check) inpatient CPT 86762 Torch Panel, Acute	$84.24	$280.79	$143.09–$268.66	—	70%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation Rate	$31.80	$106.00	$2.81–$101.42	24% below	70%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sedimentation Rate	$31.80	$106.00	$54.02–$101.42	—	70%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Analysis Complete	$72.60	$242.00	$12.80–$231.55	46% below	70%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen Analysis Complete	$72.60	$242.00	$123.32–$231.55	—	70%
Sodium blood test CPT 84295 Sodium Level	$23.40	$78.00	$5.00–$74.63	6% below	70%
Sodium blood test inpatient CPT 84295 Sodium Level	$23.40	$78.00	$39.75–$74.63	—	70%
Stool ova and parasites exam CPT 87177 Ova and Parasites Smears 87177PP	$31.80	$106.00	$9.26–$101.42	51% below	70%
Stool ova and parasites exam CPT 87177 Ova and Parasites	$65.70	$219.00	$9.26–$209.54	1% above	70%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasites Smears 87177PP	$31.80	$106.00	$54.02–$101.42	—	70%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasites	$65.70	$219.00	$111.60–$209.54	—	70%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Occ Bld Stl, Imm	$43.80	$146.00	$16.56–$139.69	28% below	70%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Occ Bld Stl, Imm	$43.80	$146.00	$74.40–$139.69	—	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema pallidum Antibody	$8.70	$29.00	$13.77–$55.08	84% below	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema pallidum, IFA, CSF	$9.30	$31.00	$13.77–$55.08	83% below	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema pallidum Ab IgM	$16.20	$54.00	$13.77–$55.08	71% below	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 .Treponema Pallidum Ab	$22.62	$75.40	$13.77–$72.14	59% below	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema pallidum Ab IgG, IgM	$24.30	$81.00	$13.77–$77.50	56% below	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 Fluorescent Treponemal Antibody-Absorption	$45.30	$151.00	$13.77–$144.48	18% below	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Antibody Cascading Reflex	$65.10	$217.00	$13.77–$207.63	18% above	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema pallidum Antibody	$8.70	$29.00	$14.78–$27.75	—	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema pallidum, IFA, CSF	$9.30	$31.00	$15.80–$29.66	—	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema pallidum Ab IgM	$16.20	$54.00	$27.52–$51.67	—	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 .Treponema Pallidum Ab	$22.62	$75.40	$38.42–$72.14	—	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema pallidum Ab IgG, IgM	$24.30	$81.00	$41.28–$77.50	—	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Fluorescent Treponemal Antibody-Absorption	$45.30	$151.00	$76.95–$144.48	—	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis Antibody Cascading Reflex	$65.10	$217.00	$110.58–$207.63	—	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR w/Rfx Titer and Treponema Pallidum	$24.00	$80.00	$4.44–$76.54	39% below	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin Test	$24.60	$82.00	$4.44–$78.46	38% below	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL with Reflex Titer, CSF	$26.70	$89.00	$4.44–$85.16	33% below	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL Screen Cerebrospinal Fluid	$90.60	$302.00	$4.44–$288.95	128% above	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR w/Rfx Titer and Treponema Pallidum	$24.00	$80.00	$40.77–$76.54	—	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagin Test	$24.60	$82.00	$41.79–$78.46	—	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL with Reflex Titer, CSF	$26.70	$89.00	$45.35–$85.16	—	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL Screen Cerebrospinal Fluid	$90.60	$302.00	$153.90–$288.95	—	70%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Free & Total	$97.80	$326.00	$26.84–$311.92	15% below	70%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Level Total	$97.80	$326.00	$26.84–$311.92	15% below	70%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Free, Bioavailable & Total	$97.80	$326.00	$26.84–$311.92	15% below	70%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total Males	$97.80	$326.00	$26.84–$311.92	15% below	70%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total Males	$97.80	$326.00	$166.13–$311.92	—	70%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Level Total	$97.80	$326.00	$166.13–$311.92	—	70%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Free & Total	$97.80	$326.00	$166.13–$311.92	—	70%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Free, Bioavailable & Total	$97.80	$326.00	$166.13–$311.92	—	70%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibody	$57.60	$192.00	$15.13–$183.71	18% below	70%
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver Kidney Microsome (LKM-1) Antibody, IgG	$64.80	$216.00	$15.13–$206.67	7% below	70%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Antibody	$57.60	$192.00	$97.84–$183.71	—	70%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Liver Kidney Microsome (LKM-1) Antibody, IgG	$64.80	$216.00	$110.07–$206.67	—	70%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH, Sensitive to Mayo	$18.30	$61.00	$17.47–$69.89	80% below	70%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$89.40	$298.00	$17.47–$285.13	1% below	70%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH, Sensitive to Mayo	$18.30	$61.00	$31.09–$58.36	—	70%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$89.40	$298.00	$151.86–$285.13	—	70%
Total IgE blood test CPT 82785 IgE	$72.60	$242.00	$17.12–$231.55	29% below	70%
Total IgE blood test inpatient CPT 82785 IgE	$72.60	$242.00	$123.32–$231.55	—	70%
Total cholesterol blood test CPT 82465 Cholesterol Total	$22.80	$76.00	$4.52–$72.72	51% below	70%
Total cholesterol blood test CPT 82465 Lipoprotein Electrophoresis	$36.90	$123.00	$4.52–$117.69	20% below	70%
Total cholesterol blood test inpatient CPT 82465 Cholesterol Total	$22.80	$76.00	$38.73–$72.72	—	70%
Total cholesterol blood test inpatient CPT 82465 Lipoprotein Electrophoresis	$36.90	$123.00	$62.68–$117.69	—	70%
Total thyroxine (T4) blood test CPT 84436 Thyroxine	$42.00	$140.00	$7.14–$133.95	19% below	70%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine	$42.00	$140.00	$71.34–$133.95	—	70%
Total triiodothyronine (T3) blood test CPT 84480 Triiodothyronine	$69.90	$233.00	$14.75–$222.93	35% below	70%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Triiodothyronine	$69.90	$233.00	$118.74–$222.93	—	70%
Transferrin blood test CPT 84466 Transferrin (CDT)	$22.80	$76.00	$13.27–$72.72	76% below	70%
Transferrin blood test CPT 84466 Transferrin	$53.70	$179.00	$13.27–$171.27	43% below	70%
Transferrin blood test inpatient CPT 84466 Transferrin (CDT)	$22.80	$76.00	$38.73–$72.72	—	70%
Transferrin blood test inpatient CPT 84466 Transferrin	$53.70	$179.00	$91.22–$171.27	—	70%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis RNA, Ql TMA	$66.00	$220.00	$36.49–$210.50	52% below	70%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis RNA Ql, Males	$71.40	$238.00	$36.49–$227.72	48% below	70%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis RNA, Ql TMA	$66.00	$220.00	$112.11–$210.50	—	70%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis RNA Ql, Males	$71.40	$238.00	$121.28–$227.72	—	70%
Triglycerides blood test CPT 84478 Triglycerides, Peritoneal Fluid	$14.70	$49.00	$5.97–$46.88	73% below	70%
Triglycerides blood test CPT 84478 Triglycerides, Pleural Fluid	$14.70	$49.00	$5.97–$46.88	73% below	70%
Triglycerides blood test CPT 84478 Triglycerides	$33.90	$113.00	$5.97–$108.12	37% below	70%
Triglycerides blood test CPT 84478 Triglycerides (LPE)	$34.20	$114.00	$5.97–$109.08	37% below	70%
Triglycerides blood test inpatient CPT 84478 Triglycerides, Peritoneal Fluid	$14.70	$49.00	$24.97–$46.88	—	70%
Triglycerides blood test inpatient CPT 84478 Triglycerides, Pleural Fluid	$14.70	$49.00	$24.97–$46.88	—	70%
Triglycerides blood test inpatient CPT 84478 Triglycerides	$33.90	$113.00	$57.58–$108.12	—	70%
Triglycerides blood test inpatient CPT 84478 Triglycerides (LPE)	$34.20	$114.00	$58.09–$109.08	—	70%
Troponin test, quantitative CPT 84484 Troponin T/34483	$22.80	$76.00	$12.97–$72.72	73% below	70%
Troponin test, quantitative CPT 84484 Troponin-I	$68.10	$227.00	$12.97–$217.19	19% below	70%
Troponin test, quantitative inpatient CPT 84484 Troponin T/34483	$22.80	$76.00	$38.73–$72.72	—	70%
Troponin test, quantitative inpatient CPT 84484 Troponin-I	$68.10	$227.00	$115.68–$217.19	—	70%
Uric acid blood test CPT 84550 Uric Acid	$24.60	$82.00	$4.70–$78.46	51% below	70%
Uric acid blood test inpatient CPT 84550 Uric Acid	$24.60	$82.00	$41.79–$78.46	—	70%
Urinalysis with microscope exam, automated CPT 81001 .Urine Microscopic	$39.30	$131.00	$3.30–$125.34	9% above	70%
Urinalysis with microscope exam, automated inpatient CPT 81001 .Urine Microscopic	$39.30	$131.00	$66.76–$125.34	—	70%
Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick POC Amb	$25.80	$86.00	$2.34–$82.28	3% above	70%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Macroscopic	$26.10	$87.00	$2.34–$83.24	4% above	70%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis with Microscopic if Indicated	$26.40	$88.00	$2.34–$84.20	6% above	70%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Dipstick POC Amb	$25.80	$86.00	$43.83–$82.28	—	70%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Macroscopic	$26.10	$87.00	$44.34–$83.24	—	70%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis with Microscopic if Indicated	$26.40	$88.00	$44.84–$84.20	—	70%
Urine culture for bacteria, with colony count CPT 87086 RAID	$24.90	$83.00	$8.39–$79.41	67% below	70%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture	$60.30	$201.00	$8.39–$192.32	20% below	70%
Urine culture for bacteria, with colony count inpatient CPT 87086 RAID	$24.90	$83.00	$42.30–$79.41	—	70%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture	$60.30	$201.00	$102.43–$192.32	—	70%
Urine microalbumin (albumin) test CPT 82043 Urine Microalbumin	$47.40	$158.00	$6.01–$151.17	27% below	70%
Urine microalbumin (albumin) test inpatient CPT 82043 Urine Microalbumin	$47.40	$158.00	$80.52–$151.17	—	70%
Urine pregnancy test, read by color change CPT 81025 Inconclusive - Urine Pregnancy POC	$49.80	$166.00	$8.95–$158.83	1% above	70%
Urine pregnancy test, read by color change CPT 81025 Positive - Urine Pregnancy POC	$50.40	$168.00	$8.95–$160.74	2% above	70%
Urine pregnancy test, read by color change CPT 81025 Negative - Urine Pregnancy POC	$50.40	$168.00	$8.95–$160.74	2% above	70%
Urine pregnancy test, read by color change CPT 81025 Pregnancy Test Urine	$50.40	$168.00	$8.95–$160.74	2% above	70%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test POC	$50.40	$168.00	$8.95–$160.74	2% above	70%
Urine pregnancy test, read by color change inpatient CPT 81025 Inconclusive - Urine Pregnancy POC	$49.80	$166.00	$84.59–$158.83	—	70%
Urine pregnancy test, read by color change inpatient CPT 81025 Positive - Urine Pregnancy POC	$50.40	$168.00	$85.61–$160.74	—	70%
Urine pregnancy test, read by color change inpatient CPT 81025 Negative - Urine Pregnancy POC	$50.40	$168.00	$85.61–$160.74	—	70%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Test POC	$50.40	$168.00	$85.61–$160.74	—	70%
Urine pregnancy test, read by color change inpatient CPT 81025 Pregnancy Test Urine	$50.40	$168.00	$85.61–$160.74	—	70%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$64.80	$216.00	$15.68–$206.67	37% below	70%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level	$64.80	$216.00	$110.07–$206.67	—	70%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 (D2, D3) LC/MS/MS	$10.20	$34.00	$17.33–$123.14	93% below	70%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy Level	$103.50	$345.00	$30.78–$330.10	33% below	70%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 (D2, D3) LC/MS/MS	$10.20	$34.00	$17.33–$32.53	—	70%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy Level	$103.50	$345.00	$175.81–$330.10	—	70%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Calcitriol 1,25 Dihyroxy Level	$181.80	$606.00	$40.04–$579.82	14% above	70%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Calcitriol 1,25 Dihyroxy Level	$181.80	$606.00	$308.82–$579.82	—	70%
Zinc blood test CPT 84630 Zinc, RBC	$26.10	$87.00	$11.85–$83.24	67% below	70%
Zinc blood test CPT 84630 Zinc Level	$48.60	$162.00	$11.85–$155.00	39% below	70%
Zinc blood test inpatient CPT 84630 Zinc, RBC	$26.10	$87.00	$44.34–$83.24	—	70%
Zinc blood test inpatient CPT 84630 Zinc Level	$48.60	$162.00	$82.56–$155.00	—	70%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta Human Chorionic Gonadotropin Tumor Marker	$13.20	$44.00	$15.65–$62.61	89% below	70%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG, Serum	$45.90	$153.00	$15.65–$146.39	61% below	70%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta Human Chorionic Gonadotropin Quantitative	$77.70	$259.00	$15.65–$247.81	34% below	70%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta Human Chorionic Gonadotropin Tumor Marker	$13.20	$44.00	$22.42–$42.10	—	70%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG, Serum	$45.90	$153.00	$77.97–$146.39	—	70%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta Human Chorionic Gonadotropin Quantitative	$77.70	$259.00	$131.99–$247.81	—	70%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion both sides CPT 19081 MA Stereotactic Localization Bilateral	$1,828.20	$6,094.00	$1,774.57–$5,830.74	—	70%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA Stereotactic Localization Right	$1,828.20	$6,094.00	$1,774.57–$5,830.74	28% below	70%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA Stereotactic Localization Left	$1,828.20	$6,094.00	$1,774.57–$5,830.74	28% below	70%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient both sides CPT 19081 MA Stereotactic Localization Bilateral	$1,828.20	$6,094.00	$3,105.50–$5,830.74	—	70%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MA Stereotactic Localization Right	$1,828.20	$6,094.00	$3,105.50–$5,830.74	—	70%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MA Stereotactic Localization Left	$1,828.20	$6,094.00	$3,105.50–$5,830.74	—	70%
Cardiac catheterization with coronary angiogram CPT 93458 LHC Coronaries w/wo LV	$5,805.90	$19,353.00	$3,411.77–$18,516.95	41% below	70%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 LHC Coronaries w/wo LV	$5,805.90	$19,353.00	$9,862.29–$18,516.95	—	70%
Cardioversion, elective (restoring heart rhythm) CPT 92960 ED Cardioversion, elective arrhythmia; external	$155.70	$519.00	$259.08–$2,782.29	84% below	70%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion	$353.40	$1,178.00	$588.06–$2,782.29	64% below	70%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Performed By	$1,808.40	$6,028.00	$313.04–$5,767.59	84% above	70%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ED Cardioversion, elective arrhythmia; external	$155.70	$519.00	$264.48–$496.58	—	70%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion	$353.40	$1,178.00	$600.31–$1,127.11	—	70%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Performed By	$1,808.40	$6,028.00	$3,071.87–$5,767.59	—	70%
Catheter ablation for atrial fibrillation CPT 93656 EP STUDY W/PULM VEIN ABLATION (PVI)-AF	$4,641.00	$15,470.00	$7,883.51–$110,028.80	74% below	70%
Catheter ablation for atrial fibrillation inpatient CPT 93656 EP STUDY W/PULM VEIN ABLATION (PVI)-AF	$4,641.00	$15,470.00	$7,883.51–$14,801.70	—	70%
Cervical biopsy CPT 57500 ED Biopsy Of Cervix, Single Or Multiple	$120.30	$401.00	$200.18–$4,386.95	80% below	70%
Cervical biopsy inpatient CPT 57500 ED Biopsy Of Cervix, Single Or Multiple	$120.30	$401.00	$204.35–$383.68	—	70%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision - Family Care Center	$212.70	$709.00	$353.93–$8,799.61	4% above	70%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision - Family Care Center	$212.70	$709.00	$361.31–$678.37	—	70%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 ED Colposcopy with Biopsy Cervix	$120.30	$401.00	$200.18–$4,386.95	73% below	70%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 ED Colposcopy with Biopsy Cervix	$120.30	$401.00	$204.35–$383.68	—	70%
Complex cataract surgery with lens implant CPT 66982 RING REFORM CAPSULAR TENSION 11MM ACTR11 8065225704	$601.50	$2,005.00	$1,000.90–$12,349.86	85% below	70%
Complex cataract surgery with lens implant inpatient CPT 66982 RING REFORM CAPSULAR TENSION 11MM ACTR11 8065225704	$601.50	$2,005.00	$1,021.75–$1,918.38	—	70%
Coronary stent placement, one artery CPT 92928 COR Stent W/PTCA Primary	$7,517.70	$25,059.00	$9,979.84–$48,595.91	4% below	70%
Coronary stent placement, one artery inpatient CPT 92928 COR Stent W/PTCA Primary	$7,517.70	$25,059.00	$12,770.07–$23,976.45	—	70%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 ED Cystourethroscopy	$235.20	$784.00	$313.04–$4,386.95	76% below	70%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 ED Cystourethroscopy	$235.20	$784.00	$399.53–$750.13	—	70%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 ED Destruction Of Precancerous Lesion	$60.30	$201.00	$100.34–$4,386.95	67% below	70%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 ED Destruction Of Precancerous Lesion	$60.30	$201.00	$102.43–$192.32	—	70%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 ED Tympanostomy With Tube	$162.90	$543.00	$271.07–$4,386.95	69% below	70%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 ED Tympanostomy With Tube	$162.90	$543.00	$276.71–$519.54	—	70%
Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 Bilateral - Ear, impacted cerumen removal	$66.90	$223.00	$62.09–$4,386.95	—	70%
Earwax removal by irrigation (rinsing), one ear CPT 69209 ED Remove Impacted Cerumen using Irrigation/lavage	$25.20	$84.00	$41.93–$4,386.95	73% below	70%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Left - Ear, impacted cerumen removal	$66.90	$223.00	$62.09–$4,386.95	28% below	70%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Right - Ear, impacted cerumen removal	$66.90	$223.00	$62.09–$4,386.95	28% below	70%
Earwax removal by irrigation (rinsing), one ear inpatient both sides CPT 69209 Bilateral - Ear, impacted cerumen removal	$66.90	$223.00	$113.64–$213.37	—	70%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ED Remove Impacted Cerumen using Irrigation/lavage	$25.20	$84.00	$42.81–$80.37	—	70%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 Left - Ear, impacted cerumen removal	$66.90	$223.00	$113.64–$213.37	—	70%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 Right - Ear, impacted cerumen removal	$66.90	$223.00	$113.64–$213.37	—	70%
Earwax removal with instruments, one ear CPT 69210 SWEA 69210 Removal impacted cerumen (separate procedure), 1 or both ears	$56.70	$189.00	$62.09–$4,386.95	32% below	70%
Earwax removal with instruments, one ear one side CPT 69210 ED Remove Impacted Cerumen w/instrumentation, unilateral	$25.50	$85.00	$42.43–$4,386.95	70% below	70%
Earwax removal with instruments, one ear inpatient CPT 69210 SWEA 69210 Removal impacted cerumen (separate procedure), 1 or both ears	$56.70	$189.00	$96.31–$180.84	—	70%
Earwax removal with instruments, one ear inpatient one side CPT 69210 ED Remove Impacted Cerumen w/instrumentation, unilateral	$25.50	$85.00	$43.32–$81.33	—	70%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ED Endometrial Aspiration	$112.80	$376.00	$187.70–$4,386.95	58% below	70%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ED Endometrial Aspiration	$112.80	$376.00	$191.61–$359.76	—	70%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 zzESOPHAGEAL ABLATION (HALO PROCEDURE)	$754.50	$2,515.00	$661.47–$3,914.73	12% below	70%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 zzESOPHAGEAL ABLATION (HALO PROCEDURE)	$754.50	$2,515.00	$1,281.64–$2,406.35	—	70%
Hemorrhoid banding (rubber band ligation) CPT 46221 ED Hemorrhoidectomy, Internal, By Rubber Band Ligation	$208.20	$694.00	$313.04–$4,386.95	84% below	70%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 ED Hemorrhoidectomy, Internal, By Rubber Band Ligation	$208.20	$694.00	$353.66–$664.02	—	70%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Inj Hysterosalpingogram	$369.90	$1,233.00	$200.01–$4,386.95	10% above	70%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Inj Hysterosalpingogram	$369.90	$1,233.00	$628.34–$1,179.73	—	70%
IUD insertion (the device itself billed separately) CPT 58300 ED Insertion Of Intrauterine Device	$76.80	$256.00	$74.55–$4,386.95	75% below	70%
IUD insertion (the device itself billed separately) CPT 58300 Insertion of Intrauterine Device 58300 - Admin Insertion of Intrauterine Device Charge	$285.90	$953.00	$277.51–$4,386.95	6% below	70%
IUD insertion (the device itself billed separately) inpatient CPT 58300 ED Insertion Of Intrauterine Device	$76.80	$256.00	$130.46–$244.94	—	70%
IUD insertion (the device itself billed separately) inpatient CPT 58300 Insertion of Intrauterine Device 58300 - Admin Insertion of Intrauterine Device Charge	$285.90	$953.00	$485.65–$911.83	—	70%
Incision and drainage of a simple or single skin abscess CPT 10060 ED I&D abscess simple or single	$93.00	$310.00	$154.75–$4,386.95	68% below	70%
Incision and drainage of a simple or single skin abscess CPT 10060 SWEA 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutan	$162.90	$543.00	$211.14–$4,386.95	44% below	70%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ED I&D abscess simple or single	$93.00	$310.00	$157.98–$296.61	—	70%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 SWEA 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutan	$162.90	$543.00	$276.71–$519.54	—	70%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 ED Injection of Tendon Sheath or Ligament; Single	$98.70	$329.00	$164.24–$4,386.95	71% below	70%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 ED Injection of Tendon Sheath or Ligament; Single	$98.70	$329.00	$167.66–$314.79	—	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ED Arthrocentesis, Aspiration and/or Injection; Major Joint or Bursa	$117.00	$390.00	$194.69–$4,386.95	73% below	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Inj Major Joint or Bursa 20610 - Admin Injection Major Joint or Bursa Charge	$183.60	$612.00	$305.51–$4,386.95	58% below	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Major Joint 20610 - Admin Intra-articular Injection Charge	$183.60	$612.00	$305.51–$4,386.95	58% below	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthro, Aspir or Inj; Major Joint 20610	$183.60	$612.00	$305.51–$4,386.95	58% below	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 XR Major Joint Injection, Asp	$264.90	$883.00	$323.03–$4,386.95	39% below	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ED Arthrocentesis, Aspiration and/or Injection; Major Joint or Bursa	$117.00	$390.00	$198.74–$373.15	—	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthro, Aspir or Inj; Major Joint 20610	$183.60	$612.00	$311.88–$585.56	—	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Major Joint 20610 - Admin Intra-articular Injection Charge	$183.60	$612.00	$311.88–$585.56	—	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Inj Major Joint or Bursa 20610 - Admin Injection Major Joint or Bursa Charge	$183.60	$612.00	$311.88–$585.56	—	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 XR Major Joint Injection, Asp	$264.90	$883.00	$449.98–$844.85	—	70%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 ED Insertion Of Non-Biodegradable Drug Delivery Implant	$59.10	$197.00	$98.34–$6,807.99	78% below	70%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insertion of Drug Delivery Implant 11981 - Admin Insertion of Drug Delivery Implant Charge	$188.70	$629.00	$140.02–$6,807.99	29% below	70%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 ED Insertion Of Non-Biodegradable Drug Delivery Implant	$59.10	$197.00	$100.39–$188.49	—	70%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Insertion of Drug Delivery Implant 11981 - Admin Insertion of Drug Delivery Implant Charge	$188.70	$629.00	$320.54–$601.83	—	70%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Intermediate Joint 20605 - Admin Intra-articular Injection Charge	$104.40	$348.00	$173.72–$4,386.95	67% below	70%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Intermediate Joint 20605 - Admin Intra-articular Injection Charge	$104.40	$348.00	$177.34–$332.97	—	70%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ED Arthrocentesis, Aspiration and/or Injection Small Joint or Bursa	$123.60	$412.00	$205.67–$4,386.95	67% below	70%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Small Joint 20600 - Admin Intra-articular Injection Charge	$147.90	$493.00	$246.11–$4,386.95	60% below	70%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ED Arthrocentesis, Aspiration and/or Injection Small Joint or Bursa	$123.60	$412.00	$209.96–$394.20	—	70%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Small Joint 20600 - Admin Intra-articular Injection Charge	$147.90	$493.00	$251.23–$471.70	—	70%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ED Layer closure of wounds (scalp, axillae, trunk, extremities) <= 2.5cm	$129.30	$431.00	$215.16–$4,386.95	75% below	70%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 ED Layer closure of wounds (scalp, axillae, trunk, extremities) <= 2.5cm	$129.30	$431.00	$219.64–$412.38	—	70%
Left heart catheterization, diagnostic CPT 93452 LHC w/wo LV	$5,618.70	$18,729.00	$3,411.77–$18,182.32	18% below	70%
Left heart catheterization, diagnostic inpatient CPT 93452 LHC w/wo LV	$5,618.70	$18,729.00	$9,544.30–$17,919.91	—	70%
Nail removal (partial or complete), one nail CPT 11730 ED Avulsion of Nail Plate	$29.10	$97.00	$48.42–$4,386.95	88% below	70%
Nail removal (partial or complete), one nail inpatient CPT 11730 ED Avulsion of Nail Plate	$29.10	$97.00	$49.43–$92.81	—	70%
Occipital nerve block (injection for headaches) CPT 64405 ED Injection of Anesthetic agent/steroid greater occipital nerve	$184.20	$614.00	$306.51–$4,386.95	60% below	70%
Occipital nerve block (injection for headaches) inpatient CPT 64405 ED Injection of Anesthetic agent/steroid greater occipital nerve	$184.20	$614.00	$312.89–$587.48	—	70%
Pacemaker implant (dual chamber) CPT 33208 Pace Gen INS/Rep Plus A/V Leads	$3,718.20	$12,394.00	$6,315.98–$43,998.28	41% below	70%
Pacemaker implant (dual chamber) inpatient CPT 33208 Pace Gen INS/Rep Plus A/V Leads	$3,718.20	$12,394.00	$6,315.98–$11,858.58	—	70%
Paracentesis with imaging guidance CPT 49083 ED Abdominal paracentesis (diagn or therap), w/ imaging guidance	$233.10	$777.00	$313.04–$4,947.89	82% below	70%
Paracentesis with imaging guidance CPT 49083 US Paracentesis	$526.20	$1,754.00	$875.60–$4,947.89	59% below	70%
Paracentesis with imaging guidance CPT 49083 Abdominal Paracentesis w/imaging	$547.20	$1,824.00	$313.04–$4,947.89	58% below	70%
Paracentesis with imaging guidance inpatient CPT 49083 ED Abdominal paracentesis (diagn or therap), w/ imaging guidance	$233.10	$777.00	$395.96–$743.43	—	70%
Paracentesis with imaging guidance inpatient CPT 49083 US Paracentesis	$526.20	$1,754.00	$893.84–$1,678.23	—	70%
Paracentesis with imaging guidance inpatient CPT 49083 Abdominal Paracentesis w/imaging	$547.20	$1,824.00	$929.51–$1,745.20	—	70%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 ED Excision of nail & nail matrix, partial or complete for permanent removal	$186.30	$621.00	$310.00–$4,386.95	43% below	70%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 ED Excision of nail & nail matrix, partial or complete for permanent removal	$186.30	$621.00	$316.46–$594.17	—	70%
Removal of a foreign object under the skin, simple CPT 10120 ED Incision and removal of foreign body, subcutaneous tissues; simple	$106.80	$356.00	$177.72–$4,386.95	68% below	70%
Removal of a foreign object under the skin, simple inpatient CPT 10120 ED Incision and removal of foreign body, subcutaneous tissues; simple	$106.80	$356.00	$181.42–$340.62	—	70%
Short arm cast (elbow to hand) CPT 29075 ED APPLICATION OF FOREARM CAST	$96.30	$321.00	$160.24–$4,386.95	62% below	70%
Short arm cast (elbow to hand) inpatient CPT 29075 ED APPLICATION OF FOREARM CAST	$96.30	$321.00	$163.58–$307.13	—	70%
Short arm splint (forearm and hand) CPT 29125 ED Application of short arm splint (forearm to hand); static	$65.40	$218.00	$108.83–$4,386.95	63% below	70%
Short arm splint (forearm and hand) CPT 29125 Splint, short arm applied - Treatments Done	$70.50	$235.00	$117.31–$4,386.95	60% below	70%
Short arm splint (forearm and hand) inpatient CPT 29125 ED Application of short arm splint (forearm to hand); static	$65.40	$218.00	$111.09–$208.58	—	70%
Short arm splint (forearm and hand) inpatient CPT 29125 Splint, short arm applied - Treatments Done	$70.50	$235.00	$119.76–$224.85	—	70%
Short leg cast (below the knee) CPT 29405 ED Application of Short Leg Cast	$102.60	$342.00	$170.73–$4,386.95	56% below	70%
Short leg cast (below the knee) inpatient CPT 29405 ED Application of Short Leg Cast	$102.60	$342.00	$174.28–$327.23	—	70%
Short leg splint (calf to foot) CPT 29515 ED Application of short leg splint (calf to foot)	$48.90	$163.00	$81.37–$4,386.95	76% below	70%
Short leg splint (calf to foot) CPT 29515 SWEA 29515 Application of short leg splint (calf to foot)	$99.90	$333.00	$166.23–$4,386.95	52% below	70%
Short leg splint (calf to foot) CPT 29515 Splint, short leg applied - Treatments Done	$135.30	$451.00	$171.02–$4,386.95	35% below	70%
Short leg splint (calf to foot) inpatient CPT 29515 ED Application of short leg splint (calf to foot)	$48.90	$163.00	$83.06–$155.96	—	70%
Short leg splint (calf to foot) inpatient CPT 29515 SWEA 29515 Application of short leg splint (calf to foot)	$99.90	$333.00	$169.70–$318.61	—	70%
Short leg splint (calf to foot) inpatient CPT 29515 Splint, short leg applied - Treatments Done	$135.30	$451.00	$229.83–$431.52	—	70%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ED Simple repair of wounds (scalp,neck,trunk) <=2.5 cm	$70.50	$235.00	$117.31–$4,386.95	78% below	70%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SWEA 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,	$150.60	$502.00	$211.14–$4,386.95	54% below	70%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 ED Simple repair of wounds (scalp,neck,trunk) <=2.5 cm	$70.50	$235.00	$119.76–$224.85	—	70%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SWEA 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,	$150.60	$502.00	$255.82–$480.31	—	70%
Skin biopsy, punch, one lesion CPT 11104 ED Punch Biopsy Skin Single Lesion	$64.50	$215.00	$107.33–$4,386.95	73% below	70%
Skin biopsy, punch, one lesion inpatient CPT 11104 ED Punch Biopsy Skin Single Lesion	$64.50	$215.00	$109.56–$205.71	—	70%
Skin tag removal, up to 15 tags CPT 11200 ED Removal Of Skin Tags 15 Or Less	$95.10	$317.00	$158.25–$4,386.95	33% below	70%
Skin tag removal, up to 15 tags inpatient CPT 11200 ED Removal Of Skin Tags 15 Or Less	$95.10	$317.00	$161.54–$303.31	—	70%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ED Simple repair of wounds (scalp,neck,trunk) 2.6-7.5 cm	$73.80	$246.00	$122.80–$4,386.95	63% below	70%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SWEA 12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,	$213.00	$710.00	$211.14–$4,386.95	5% above	70%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 ED Simple repair of wounds (scalp,neck,trunk) 2.6-7.5 cm	$73.80	$246.00	$125.36–$235.37	—	70%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SWEA 12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,	$213.00	$710.00	$361.82–$679.33	—	70%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ED Simple repair of wounds (face,ears,mucous membranes) <=2.5 cm	$62.40	$208.00	$103.83–$4,386.95	80% below	70%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SWEA 12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mu	$155.10	$517.00	$211.14–$4,386.95	50% below	70%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 ED Simple repair of wounds (face,ears,mucous membranes) <=2.5 cm	$62.40	$208.00	$106.00–$199.01	—	70%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SWEA 12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mu	$155.10	$517.00	$263.46–$494.67	—	70%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 ED Tangential Biopsy Skin Single Lesion	$64.50	$215.00	$107.33–$4,386.95	73% below	70%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 ED Tangential Biopsy Skin Single Lesion	$64.50	$215.00	$109.56–$205.71	—	70%
Thoracentesis with imaging guidance CPT 32555 ED Thoracentesis Needle/Cath Pleura w/Imaging	$635.10	$2,117.00	$313.04–$4,386.95	47% below	70%
Thoracentesis with imaging guidance CPT 32555 US Thoracentesis	$681.00	$2,270.00	$660.17–$4,386.95	43% below	70%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis w/Imaging	$708.30	$2,361.00	$313.04–$4,386.95	41% below	70%
Thoracentesis with imaging guidance inpatient CPT 32555 ED Thoracentesis Needle/Cath Pleura w/Imaging	$635.10	$2,117.00	$1,078.82–$2,025.55	—	70%
Thoracentesis with imaging guidance inpatient CPT 32555 US Thoracentesis	$681.00	$2,270.00	$1,156.79–$2,171.94	—	70%
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis w/Imaging	$708.30	$2,361.00	$1,203.17–$2,259.00	—	70%
Trigger point injections, 1 or 2 muscles CPT 20552 ED Injection(s); Single or Multiple Trigger Points	$98.70	$329.00	$164.24–$4,386.95	72% below	70%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ED Injection(s); Single or Multiple Trigger Points	$98.70	$329.00	$167.66–$314.79	—	70%
Ultrasound-guided breast needle biopsy with marker clip, first lesion both sides CPT 19083 US Biopsy Breast Bilateral	$896.70	$2,989.00	$596.96–$4,947.89	—	70%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Biopsy Breast Left	$1,173.00	$3,910.00	$596.96–$4,947.89	42% below	70%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Biopsy Breast Right	$1,173.00	$3,910.00	$596.96–$4,947.89	42% below	70%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient both sides CPT 19083 US Biopsy Breast Bilateral	$896.70	$2,989.00	$1,523.19–$2,859.88	—	70%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Biopsy Breast Left	$1,173.00	$3,910.00	$1,992.54–$3,741.09	—	70%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Biopsy Breast Right	$1,173.00	$3,910.00	$1,992.54–$3,741.09	—	70%
Upper endoscopy (EGD) with biopsy CPT 43239 ED Esophagogastroduodenoscopy, flexible, transoral; w/ biopsy, single or multiple	$335.70	$1,119.00	$313.04–$4,947.89	79% below	70%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 ED Esophagogastroduodenoscopy, flexible, transoral; w/ biopsy, single or multiple	$335.70	$1,119.00	$570.24–$1,070.66	—	70%
Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS ABLATION 1ST VEIN	$3,243.00	$10,810.00	$3,322.90–$13,291.62	17% below	70%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 ENDOVENOUS ABLATION 1ST VEIN	$3,243.00	$10,810.00	$5,508.78–$10,343.01	—	70%
Wart removal, up to 14 warts CPT 17110 ED Destruction of benign lesion; 1-14 lesions	$41.70	$139.00	$69.39–$4,386.95	79% below	70%
Wart removal, up to 14 warts inpatient CPT 17110 ED Destruction of benign lesion; 1-14 lesions	$41.70	$139.00	$70.83–$133.00	—	70%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Blood transfusion (giving blood or blood components) CPT 36430 ED Transfusion, blood or blood components	$79.80	$266.00	$132.79–$12,349.86	86% below	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 2 - 4 Hours	$124.20	$414.00	$206.67–$12,349.86	79% below	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 4 - 6 Hours	$206.10	$687.00	$342.95–$12,349.86	65% below	70%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 6 - 12 Hours	$371.70	$1,239.00	$464.29–$12,349.86	36% below	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED Transfusion, blood or blood components	$79.80	$266.00	$135.55–$254.51	—	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion 2 - 4 Hours	$124.20	$414.00	$210.97–$396.12	—	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion 4 - 6 Hours	$206.10	$687.00	$350.10–$657.32	—	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion 6 - 12 Hours	$371.70	$1,239.00	$631.39–$1,185.48	—	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Yes - EzPAP Treatment, subsequent Charge	$33.60	$112.00	$55.91–$921.81	61% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Inhalation 94640 - Admin Aerosol Inhalation Charge	$50.40	$168.00	$83.87–$921.81	42% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Yes - EZPAP Setup Charge	$84.30	$281.00	$140.28–$921.81	2% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Initial - Handheld Nebulizer Charge	$101.10	$337.00	$168.23–$921.81	17% above	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Yes - Sputum Collection with Treatment Charge	$113.70	$379.00	$189.20–$921.81	32% above	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Yes - EzPAP Treatment, subsequent Charge	$33.60	$112.00	$57.08–$107.16	—	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Inhalation 94640 - Admin Aerosol Inhalation Charge	$50.40	$168.00	$85.61–$160.74	—	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Yes - EZPAP Setup Charge	$84.30	$281.00	$143.20–$268.86	—	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Initial - Handheld Nebulizer Charge	$101.10	$337.00	$171.74–$322.44	—	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Yes - Sputum Collection with Treatment Charge	$113.70	$379.00	$193.14–$362.63	—	70%
Chemotherapy IV infusion, first hour CPT 96413 Chemo IV Infusion 1 Hour	$364.80	$1,216.00	$347.61–$1,390.44	35% below	70%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemo IV Infusion 1 Hour	$364.80	$1,216.00	$619.67–$1,163.47	—	70%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 Audiometry Threshold Evaluation; Comprehensive	$86.40	$288.00	$135.42–$541.67	44% below	70%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 Comprehensive Audiology Eval	$86.40	$288.00	$135.42–$541.67	44% below	70%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 Audiometry Threshold Evaluation; Comprehensive	$86.40	$288.00	$146.76–$275.56	—	70%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 Comprehensive Audiology Eval	$86.40	$288.00	$146.76–$275.56	—	70%
Critical care, first 30 to 74 minutes CPT 99291 SWEA 99291 Critical care, evaluation and management of the critically ill or critically inj	$470.40	$1,568.00	$108.49–$3,477.22	74% below	70%
Critical care, first 30 to 74 minutes CPT 99291 99291 - Critical Care - Lynx Visit Level	$1,338.00	$4,460.00	$869.30–$5,454.80	25% below	70%
Critical care, first 30 to 74 minutes CPT 99291 Critical Care 30-74 min - 99291	$1,338.00	$4,460.00	$869.30–$5,454.80	25% below	70%
Critical care, first 30 to 74 minutes inpatient CPT 99291 SWEA 99291 Critical care, evaluation and management of the critically ill or critically inj	$470.40	$1,568.00	$799.05–$1,500.26	—	70%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 - Critical Care - Lynx Visit Level	$1,338.00	$4,460.00	$2,272.82–$4,267.33	—	70%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care 30-74 min - 99291	$1,338.00	$4,460.00	$2,272.82–$4,267.33	—	70%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG - AWAKE	$517.80	$1,726.00	$227.24–$1,651.44	23% below	70%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG - AWAKE	$517.80	$1,726.00	$879.57–$1,651.44	—	70%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG Global 93000	$164.10	$547.00	$60.40–$523.37	143% above	70%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG Global 93000	$164.10	$547.00	$278.75–$523.37	—	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG Acquisition	$110.40	$368.00	$62.09–$352.10	25% below	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG Acquisition	$110.40	$368.00	$187.53–$352.10	—	70%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Post ED Visit/ Called Back - ED Other Charges	$68.40	$228.00	$88.74–$666.64	64% below	70%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 - Level 1 - Lynx Visit Level	$68.40	$228.00	$88.74–$666.64	64% below	70%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Level 1 - 99281	$114.30	$381.00	$88.74–$666.64	39% below	70%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Post ED Visit/ Called Back - ED Other Charges	$68.40	$228.00	$116.19–$218.15	—	70%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 - Level 1 - Lynx Visit Level	$68.40	$228.00	$116.19–$218.15	—	70%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Level 1 - 99281	$114.30	$381.00	$194.16–$364.54	—	70%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 - Level 2 - Lynx Visit Level	$189.30	$631.00	$161.58–$666.64	41% below	70%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Level 2 - 99282	$205.20	$684.00	$161.58–$666.64	36% below	70%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 - Level 2 - Lynx Visit Level	$189.30	$631.00	$321.56–$603.74	—	70%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Level 2 - 99282	$205.20	$684.00	$348.57–$654.45	—	70%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 - Level 3 - Lynx Visit Level	$341.10	$1,137.00	$287.28–$1,516.32	42% below	70%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Level 3 - 99283	$341.10	$1,137.00	$287.28–$1,516.32	42% below	70%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Level 3 - 99283	$341.10	$1,137.00	$579.42–$1,087.88	—	70%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 - Level 3 - Lynx Visit Level	$341.10	$1,137.00	$579.42–$1,087.88	—	70%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 - Level 4 - Lynx Visit Level	$530.40	$1,768.00	$439.12–$4,546.88	42% below	70%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Level 4 - 99284	$537.90	$1,793.00	$439.12–$4,546.88	42% below	70%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 - Level 4 - Lynx Visit Level	$530.40	$1,768.00	$900.97–$1,691.62	—	70%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Level 4 - 99284	$537.90	$1,793.00	$913.71–$1,715.54	—	70%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Level 5 - 99285	$947.40	$3,158.00	$626.74–$4,546.88	35% below	70%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 - Level 5 - Lynx Visit Level	$947.40	$3,158.00	$626.74–$4,546.88	35% below	70%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Level 5 - 99285	$947.40	$3,158.00	$1,609.32–$3,021.57	—	70%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 - Level 5 - Lynx Visit Level	$947.40	$3,158.00	$1,609.32–$3,021.57	—	70%
Exercise stress test, tracing only, the hospital charge CPT 93017 Stress Test Tracing ONLY	$454.80	$1,516.00	$227.24–$1,450.51	43% below	70%
Exercise stress test, tracing only, the hospital charge CPT 93017 Stress Test Tracing 93017	$472.50	$1,575.00	$227.24–$1,506.96	40% below	70%
Exercise stress test, tracing only, the hospital charge CPT 93017 Stress Test Tracing Treadmill	$472.50	$1,575.00	$227.24–$1,506.96	40% below	70%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Stress Test Tracing ONLY	$454.80	$1,516.00	$772.55–$1,450.51	—	70%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Stress Test Tracing Treadmill	$472.50	$1,575.00	$802.62–$1,506.96	—	70%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Stress Test Tracing 93017	$472.50	$1,575.00	$802.62–$1,506.96	—	70%
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 Holter Monitor Inclusive	$868.50	$2,895.00	$280.38–$2,769.94	at median	70%
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient CPT 93224 Holter Monitor Inclusive	$868.50	$2,895.00	$1,475.29–$2,769.94	—	70%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Infusion Hydration 1 hr	$152.40	$508.00	$223.85–$895.40	47% below	70%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Infusion For Hydration 1 Hr	$186.00	$620.00	$223.85–$895.40	35% below	70%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Infusion for Hydration 1 HR - 96360	$186.00	$620.00	$223.85–$895.40	35% below	70%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Infusion Hydration 1 hr	$152.40	$508.00	$258.88–$486.05	—	70%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Infusion For Hydration 1 Hr	$186.00	$620.00	$315.95–$593.22	—	70%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Infusion for Hydration 1 HR - 96360	$186.00	$620.00	$315.95–$593.22	—	70%
IV infusion of a medicine, first hour CPT 96365 IV Infusion For Therapy 1 Hour	$186.60	$622.00	$223.85–$895.40	41% below	70%
IV infusion of a medicine, first hour CPT 96365 IV Infusion For Therapy 1 HR - 96365	$186.60	$622.00	$223.85–$895.40	41% below	70%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Infusion For Therapy 1 HR - 96365	$186.60	$622.00	$316.97–$595.13	—	70%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Infusion For Therapy 1 Hour	$186.60	$622.00	$316.97–$595.13	—	70%
IV push of a medicine, first drug CPT 96374 Initial IV Push 96374 - Admin Initial IV Push Charge	$104.70	$349.00	$174.22–$895.40	37% below	70%
IV push of a medicine, first drug CPT 96374 Intravenous Injection - 96374	$104.70	$349.00	$174.22–$895.40	37% below	70%
IV push of a medicine, first drug CPT 96374 Intravenous Injection	$104.70	$349.00	$174.22–$895.40	37% below	70%
IV push of a medicine, first drug inpatient CPT 96374 Intravenous Injection - 96374	$104.70	$349.00	$177.85–$333.92	—	70%
IV push of a medicine, first drug inpatient CPT 96374 Intravenous Injection	$104.70	$349.00	$177.85–$333.92	—	70%
IV push of a medicine, first drug inpatient CPT 96374 Initial IV Push 96374 - Admin Initial IV Push Charge	$104.70	$349.00	$177.85–$333.92	—	70%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 therapeutic Inj Sub or Intra 96372	$35.40	$118.00	$58.91–$303.10	56% below	70%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic Inj	$35.40	$118.00	$58.91–$303.10	56% below	70%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic Injection sub or Intra 96372	$35.40	$118.00	$58.91–$303.10	56% below	70%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inj Admin SubQ/IM 96372 - Admin Injection Charge	$66.90	$223.00	$75.77–$303.10	17% below	70%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/Subsq Injection	$66.90	$223.00	$75.77–$303.10	17% below	70%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/Subsq Injection - 96372	$66.90	$223.00	$75.77–$303.10	17% below	70%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Outpatient IM/SQ Injections	$66.90	$223.00	$75.77–$303.10	17% below	70%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 therapeutic Inj Sub or Intra 96372	$35.40	$118.00	$60.13–$112.90	—	70%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapeutic Injection sub or Intra 96372	$35.40	$118.00	$60.13–$112.90	—	70%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapeutic Inj	$35.40	$118.00	$60.13–$112.90	—	70%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Inj Admin SubQ/IM 96372 - Admin Injection Charge	$66.90	$223.00	$113.64–$213.37	—	70%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/Subsq Injection	$66.90	$223.00	$113.64–$213.37	—	70%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Outpatient IM/SQ Injections	$66.90	$223.00	$113.64–$213.37	—	70%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/Subsq Injection - 96372	$66.90	$223.00	$113.64–$213.37	—	70%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Charges	$75.30	$251.00	$73.09–$362.96	21% below	70%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducation Charges	$75.30	$251.00	$127.91–$240.16	—	70%
New patient office visit, about 30 minutes CPT 99203 Office Visit New Pt Routine	$104.40	$348.00	$101.34–$332.97	47% below	70%
New patient office visit, about 30 minutes inpatient CPT 99203 Office Visit New Pt Routine	$104.40	$348.00	$177.34–$332.97	—	70%
New patient office visit, about 45 minutes CPT 99204 Established Pt Consult Level 3	$105.00	$350.00	$101.92–$459.39	53% below	70%
New patient office visit, about 45 minutes CPT 99204 Office Visit New Pt Extended	$132.60	$442.00	$128.71–$459.39	41% below	70%
New patient office visit, about 45 minutes inpatient CPT 99204 Established Pt Consult Level 3	$105.00	$350.00	$178.36–$334.88	—	70%
New patient office visit, about 45 minutes inpatient CPT 99204 Office Visit New Pt Extended	$132.60	$442.00	$225.24–$422.91	—	70%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New major dressing charge	$58.80	$196.00	$57.08–$187.53	55% below	70%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office Visit New Pt Brief	$74.40	$248.00	$72.22–$237.29	43% below	70%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New major dressing charge	$58.80	$196.00	$99.88–$187.53	—	70%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office Visit New Pt Brief	$74.40	$248.00	$126.38–$237.29	—	70%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Medical Nutrition Therapy, Initial Individual Each 15 Min	$29.10	$97.00	$28.25–$107.33	52% below	70%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Medical Nutrition Therapy, Initial Individual Each 15 Min	$29.10	$97.00	$49.43–$92.81	—	70%
Occupational therapy evaluation, low complexity CPT 97165 OT Evaluation Low Charge	$99.60	$332.00	$96.68–$408.76	46% below	70%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT Evaluation Low Charge	$99.60	$332.00	$169.19–$317.66	—	70%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT Evaluation High Complexity	$210.60	$702.00	$204.42–$671.67	33% below	70%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT Evaluation High Complexity	$210.60	$702.00	$357.74–$671.67	—	70%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Evaluation Low Complexity	$124.50	$415.00	$120.85–$398.11	33% below	70%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT Evaluation Low Complexity	$124.50	$415.00	$211.48–$397.07	—	70%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Evaluation Moderate Complex 30 min	$192.00	$640.00	$186.37–$612.35	23% below	70%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT Evaluation Moderate Complex 30 min	$192.00	$640.00	$326.14–$612.35	—	70%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Charge Units	$70.20	$234.00	$68.14–$362.96	28% below	70%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Charge Units	$70.20	$234.00	$68.14–$362.96	28% below	70%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Charge Units	$70.20	$234.00	$119.25–$223.89	—	70%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Charge Units	$70.20	$234.00	$119.25–$223.89	—	70%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Charge	$58.20	$194.00	$56.49–$362.96	40% below	70%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Charges	$70.80	$236.00	$68.72–$362.96	27% below	70%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise Charge	$58.20	$194.00	$98.86–$185.62	—	70%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Charges	$70.80	$236.00	$120.27–$225.80	—	70%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 SWEA 99215 Office or other outpatient visit for the evaluation and management of an establi	$221.40	$738.00	$108.49–$706.12	25% below	70%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Level 5 - Labor Level	$3,602.70	$12,009.00	$497.87–$11,490.21	1121% above	70%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 SWEA 99215 Office or other outpatient visit for the evaluation and management of an establi	$221.40	$738.00	$376.08–$706.12	—	70%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Level 5 - Labor Level	$3,602.70	$12,009.00	$6,119.79–$11,490.21	—	70%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Office Visit Routine	$78.30	$261.00	$76.00–$249.72	52% below	70%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 SWEA 99213 Office or other outpatient visit for the evaluation and management of an establi	$100.80	$336.00	$97.84–$606.32	39% below	70%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Consult, Routine	$110.10	$367.00	$106.87–$351.15	33% below	70%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Consult, Extended	$132.90	$443.00	$129.00–$423.86	19% below	70%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Level 3 - Labor Level	$1,142.40	$3,808.00	$228.43–$3,643.49	595% above	70%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Office Visit Routine	$78.30	$261.00	$133.01–$249.72	—	70%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 SWEA 99213 Office or other outpatient visit for the evaluation and management of an establi	$100.80	$336.00	$171.23–$321.48	—	70%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Consult, Routine	$110.10	$367.00	$187.02–$351.15	—	70%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Consult, Extended	$132.90	$443.00	$225.75–$423.86	—	70%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Level 3 - Labor Level	$1,142.40	$3,808.00	$1,940.56–$3,643.49	—	70%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Patient Office Visit Ext	$134.40	$448.00	$130.46–$428.65	28% below	70%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 SWEA 99214 Office or other outpatient visit for the evaluation and management of an establi	$165.30	$551.00	$108.49–$606.32	11% below	70%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Level 4 - Labor Level	$1,413.60	$4,712.00	$335.34–$4,508.44	659% above	70%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Est Patient Office Visit Ext	$134.40	$448.00	$228.30–$428.65	—	70%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 SWEA 99214 Office or other outpatient visit for the evaluation and management of an establi	$165.30	$551.00	$280.79–$527.20	—	70%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Level 4 - Labor Level	$1,413.60	$4,712.00	$2,401.24–$4,508.44	—	70%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 O.P.Dressing Change Major (includes nursing care, irrigate, - Daily Charges	$43.80	$146.00	$42.52–$139.69	55% below	70%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Established major dressing charge	$45.00	$150.00	$43.68–$143.52	53% below	70%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Major Dressing Change	$46.80	$156.00	$45.43–$149.26	52% below	70%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Complex Dressing - Incision, Wound Dressing:	$51.60	$172.00	$50.09–$164.57	47% below	70%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Patient Office Visit Brief	$69.30	$231.00	$67.27–$221.02	28% below	70%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 SWEA 99212 Office or other outpatient visit for the evaluation and management of an establi	$78.30	$261.00	$76.00–$606.32	19% below	70%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Consult, Brief	$89.10	$297.00	$86.49–$284.17	8% below	70%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Level 2 - Labor Level	$777.60	$2,592.00	$122.47–$2,480.03	705% above	70%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 O.P.Dressing Change Major (includes nursing care, irrigate, - Daily Charges	$43.80	$146.00	$74.40–$139.69	—	70%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Established major dressing charge	$45.00	$150.00	$76.44–$143.52	—	70%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Major Dressing Change	$46.80	$156.00	$79.50–$149.26	—	70%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Complex Dressing - Incision, Wound Dressing:	$51.60	$172.00	$87.65–$164.57	—	70%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Patient Office Visit Brief	$69.30	$231.00	$117.72–$221.02	—	70%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 SWEA 99212 Office or other outpatient visit for the evaluation and management of an establi	$78.30	$261.00	$133.01–$249.72	—	70%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Consult, Brief	$89.10	$297.00	$151.35–$284.17	—	70%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Level 2 - Labor Level	$777.60	$2,592.00	$1,320.88–$2,480.03	—	70%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Established Pt Consult Level 4	$121.80	$406.00	$118.23–$388.46	62% below	70%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Established Pt Consult Level 4	$121.80	$406.00	$206.90–$388.46	—	70%
Speech therapy session, individual CPT 92507 Aural Rehabilitation	$156.60	$522.00	$152.01–$499.45	38% below	70%
Speech therapy session, individual inpatient CPT 92507 Aural Rehabilitation	$156.60	$522.00	$266.01–$499.45	—	70%
Spirometry (breathing test) CPT 94010 Screen - Pulmonary Function Test Charge	$130.20	$434.00	$216.65–$908.96	53% below	70%
Spirometry (breathing test) inpatient CPT 94010 Screen - Pulmonary Function Test Charge	$130.20	$434.00	$221.17–$415.25	—	70%
Spirometry before and after a bronchodilator CPT 94060 Pre and Post - Pulmonary Function Test Charge	$161.10	$537.00	$268.07–$1,570.82	67% below	70%
Spirometry before and after a bronchodilator CPT 94060 Complete-PFT - Pulmonary Function Test Charge	$523.80	$1,746.00	$392.70–$1,670.57	8% above	70%
Spirometry before and after a bronchodilator inpatient CPT 94060 Pre and Post - Pulmonary Function Test Charge	$161.10	$537.00	$273.66–$513.80	—	70%
Spirometry before and after a bronchodilator inpatient CPT 94060 Complete-PFT - Pulmonary Function Test Charge	$523.80	$1,746.00	$889.76–$1,670.57	—	70%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activities Charge	$69.30	$231.00	$67.27–$362.96	23% below	70%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activities Charge	$69.30	$231.00	$117.72–$221.02	—	70%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Blood volume removed from patient	$69.90	$233.00	$116.31–$560.06	65% below	70%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Blood Volume Removed from Patient	$82.50	$275.00	$137.28–$560.06	59% below	70%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Blood volume removed from patient	$69.90	$233.00	$118.74–$222.93	—	70%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Blood Volume Removed from Patient	$82.50	$275.00	$140.14–$263.12	—	70%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Moderna 50mcg/0.5mL (12 yr & older) - Covid Vaccine	$52.50	$175.00	$50.96–$672.46	69% below	70%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Moderna 50mcg/0.5mL (12 yr & older) - Covid Vaccine	$52.50	$175.00	$89.18–$167.44	—	70%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Non-State Supplied - Varicella Charge	$90.30	$301.00	$87.65–$288.00	45% below	70%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Chicken Pox Vaccine, SC 90716	$91.80	$306.00	$89.11–$292.78	44% below	70%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Non-State Supplied - Varicella Charge	$90.30	$301.00	$153.39–$288.00	—	70%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Chicken Pox Vaccine, SC 90716	$91.80	$306.00	$155.94–$292.78	—	70%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 Non-State Supplied - DTaP-IPV Charge	$44.10	$147.00	$42.81–$140.65	48% below	70%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV Vacc 4-6 YR IM 90696	$49.80	$166.00	$48.34–$158.83	41% below	70%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 Non-State Supplied - DTaP-IPV Charge	$44.10	$147.00	$74.91–$140.65	—	70%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP-IPV Vacc 4-6 YR IM 90696	$49.80	$166.00	$84.59–$158.83	—	70%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Non-State Supplied - DTap Charge	$19.20	$64.00	$18.64–$61.24	54% below	70%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP Vaccine, <7 Yrs, IM 90700	$31.50	$105.00	$30.58–$100.46	24% below	70%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Non-State Supplied - DTap Charge	$19.20	$64.00	$32.61–$61.24	—	70%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP Vaccine, <7 Yrs, IM 90700	$31.50	$105.00	$53.51–$100.46	—	70%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP-HEP B-IPV Vaccine, IM 90723	$63.90	$213.00	$62.03–$203.80	54% below	70%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 Non-State Supplied - Dtap-Hep B-IPV Charge	$64.80	$216.00	$62.90–$206.67	53% below	70%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 Administered - Dtap-Hep B-IPV Charge	$66.00	$220.00	$64.06–$210.50	52% below	70%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP-HEP B-IPV Vaccine, IM 90723	$63.90	$213.00	$108.54–$203.80	—	70%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 Non-State Supplied - Dtap-Hep B-IPV Charge	$64.80	$216.00	$110.07–$206.67	—	70%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 Administered - Dtap-Hep B-IPV Charge	$66.00	$220.00	$112.11–$210.50	—	70%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 diphth/haemophilus/pertussis/tetanus/polio	$85.50	$285.00	$82.99–$272.69	27% below	70%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-HIB-IP Vaccine, IM 90698	$85.50	$285.00	$82.99–$272.69	27% below	70%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 Non-State Supplied - Pentacel Charge	$99.00	$330.00	$96.10–$315.74	15% below	70%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 diphth/haemophilus/pertussis/tetanus/polio	$85.50	$285.00	$145.24–$272.69	—	70%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP-HIB-IP Vaccine, IM 90698	$85.50	$285.00	$145.24–$272.69	—	70%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 Non-State Supplied - Pentacel Charge	$99.00	$330.00	$168.17–$315.74	—	70%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 Vaxelis Charge - Vaxelis Charge	$82.20	$274.00	$79.79–$262.16	56% below	70%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 Vaxelis (Dtap-IPV-HibHepB) Vaccine 90697	$85.50	$285.00	$82.99–$272.69	54% below	70%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 Vaxelis Charge - Vaxelis Charge	$82.20	$274.00	$139.63–$262.16	—	70%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 Vaxelis (Dtap-IPV-HibHepB) Vaccine 90697	$85.50	$285.00	$145.24–$272.69	—	70%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Flu Vaccine Medicare	$6.30	$21.00	$6.12–$96.60	80% below	70%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Flu Virus 3 and up Preservative Free 90656	$10.80	$36.00	$10.48–$96.60	66% below	70%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Flu Virus 3 and up 90656	$10.80	$36.00	$10.48–$96.60	66% below	70%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Flu Vaccine Non Medicare	$10.80	$36.00	$10.48–$96.60	66% below	70%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Flu Vaccine Medicare	$6.30	$21.00	$10.70–$20.09	—	70%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Flu Virus 3 and up Preservative Free 90656	$10.80	$36.00	$18.35–$34.44	—	70%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Flu Virus 3 and up 90656	$10.80	$36.00	$18.35–$34.44	—	70%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Flu Vaccine Non Medicare	$10.80	$36.00	$18.35–$34.44	—	70%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 9VHPV VACC 2/3 DOSE SCHED IM USE - 90651	$170.40	$568.00	$165.40–$543.46	47% below	70%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 9VHPV VACC 2/3 DOSE SCHED IM USE - 90651	$170.40	$568.00	$289.45–$543.46	—	70%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Administered - Hep A/B Charge	$84.30	$281.00	$81.83–$268.86	56% below	70%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Hep A/Hep B Vacc, Adult IM 90636	$115.20	$384.00	$111.82–$367.41	40% below	70%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 Administered - Hep A/B Charge	$84.30	$281.00	$143.20–$268.86	—	70%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 Hep A/Hep B Vacc, Adult IM 90636	$115.20	$384.00	$195.69–$367.41	—	70%
Hepatitis A vaccine, adult dose CPT 90632 Administered - Hep A Adult Charge	$58.20	$194.00	$56.49–$315.08	56% below	70%
Hepatitis A vaccine, adult dose CPT 90632 Hep A Vaccine, Adult IM 90632	$60.30	$201.00	$58.53–$315.08	54% below	70%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Administered - Hep A Adult Charge	$58.20	$194.00	$98.86–$185.62	—	70%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hep A Vaccine, Adult IM 90632	$60.30	$201.00	$102.43–$192.32	—	70%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Non-State Supplied - Hep A Pediatric Charge	$26.10	$87.00	$25.33–$83.24	50% below	70%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Hep A Vacc, Ped/Addl, 2 Dose 90633	$41.70	$139.00	$40.48–$133.00	20% below	70%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Non-State Supplied - Hep A Pediatric Charge	$26.10	$87.00	$44.34–$83.24	—	70%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Hep A Vacc, Ped/Addl, 2 Dose 90633	$41.70	$139.00	$70.83–$133.00	—	70%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Administered - Hep B Adult Charge	$44.40	$148.00	$43.10–$312.62	62% below	70%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hep B Vaccine, Adult, IM 90746	$45.30	$151.00	$43.97–$312.62	61% below	70%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Administered - Hep B Adult Charge	$44.40	$148.00	$75.42–$141.61	—	70%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hep B Vaccine, Adult, IM 90746	$45.30	$151.00	$76.95–$144.48	—	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Non-State Supplied - Hep B Ped/Adol Charge	$14.40	$48.00	$13.98–$138.20	74% below	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPB Vacc Ped/Adol 3 Dose IM 90744	$43.80	$146.00	$42.34–$139.69	22% below	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Non-State Supplied - Hep B Ped/Adol Charge	$14.40	$48.00	$24.46–$45.93	—	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPB Vacc Ped/Adol 3 Dose IM 90744	$43.80	$146.00	$74.40–$139.69	—	70%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 Hib PRP-OMP 90647	$36.90	$123.00	$35.82–$117.69	27% below	70%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 Non-State Supplied - HIB Vaccine, PRP-OPM Charge	$36.90	$123.00	$35.82–$117.69	27% below	70%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 Non-State Supplied - HIB Vaccine, PRP-OPM Charge	$36.90	$123.00	$62.68–$117.69	—	70%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 Hib PRP-OMP 90647	$36.90	$123.00	$62.68–$117.69	—	70%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE 90648 - VFC	$6.25	$20.83	$6.07–$19.93	85% below	70%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 State Supplied - HIB Charge	$6.60	$22.00	$6.41–$21.05	84% below	70%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIB Vaccine, PRP-T, IM 90648	$32.40	$108.00	$31.45–$103.33	22% below	70%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Non-State Supplied - HIB Charge	$48.60	$162.00	$47.17–$155.00	16% above	70%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE 90648 - VFC	$6.25	$20.83	$10.61–$19.93	—	70%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 State Supplied - HIB Charge	$6.60	$22.00	$11.21–$21.05	—	70%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HIB Vaccine, PRP-T, IM 90648	$32.40	$108.00	$55.04–$103.33	—	70%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 Non-State Supplied - HIB Charge	$48.60	$162.00	$82.56–$155.00	—	70%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Flu Vaccine High	$14.10	$47.00	$13.69–$408.35	82% below	70%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Flu Vaccine High Dose	$14.10	$47.00	$13.69–$408.35	82% below	70%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Flu Virus Fluzone High Dose 90662	$14.40	$48.00	$13.98–$408.35	82% below	70%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High Dose 90662 Medicare	$15.30	$51.00	$14.85–$408.35	81% below	70%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High Dose (0.7ml) (Dialysis) 90662	$18.00	$60.00	$17.47–$408.35	77% below	70%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High Dose (0.7ml) (Peritoneal) 90662	$18.00	$60.00	$17.47–$408.35	77% below	70%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High Dose (0.7ml) - Flu Virus, Inactivated Charge	$18.00	$60.00	$17.47–$408.35	77% below	70%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone high Dose 90662	$19.80	$66.00	$19.22–$408.35	75% below	70%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Flu Vaccine High	$14.10	$47.00	$23.95–$44.97	—	70%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Flu Vaccine High Dose	$14.10	$47.00	$23.95–$44.97	—	70%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Flu Virus Fluzone High Dose 90662	$14.40	$48.00	$24.46–$45.93	—	70%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone High Dose 90662 Medicare	$15.30	$51.00	$25.99–$48.80	—	70%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone High Dose (0.7ml) - Flu Virus, Inactivated Charge	$18.00	$60.00	$30.58–$57.41	—	70%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone High Dose (0.7ml) (Dialysis) 90662	$18.00	$60.00	$30.58–$57.41	—	70%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone High Dose (0.7ml) (Peritoneal) 90662	$18.00	$60.00	$30.58–$57.41	—	70%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone high Dose 90662	$19.80	$66.00	$33.63–$63.15	—	70%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Non-State Supplied - MMR Charge	$61.80	$206.00	$59.99–$197.10	60% below	70%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR Vaccine, SC 90707	$62.70	$209.00	$60.86–$199.97	59% below	70%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Non-State Supplied - MMR Charge	$61.80	$206.00	$104.98–$197.10	—	70%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR Vaccine, SC 90707	$62.70	$209.00	$106.51–$199.97	—	70%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 Non-State Supplied - MMR-Varicella Charge	$116.10	$387.00	$112.69–$370.28	54% below	70%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MMRV Vaccine, SC 90710	$118.20	$394.00	$114.73–$376.98	53% below	70%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 Non-State Supplied - MMR-Varicella Charge	$116.10	$387.00	$197.22–$370.28	—	70%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MMRV Vaccine, SC 90710	$118.20	$394.00	$200.78–$376.98	—	70%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Non-State Supplied - Menveo Charge	$108.30	$361.00	$105.12–$345.40	53% below	70%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Non-State Supplied - Menactra Charge	$119.40	$398.00	$115.90–$380.81	48% below	70%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal Vaccine, IM 90734	$121.80	$406.00	$118.23–$388.46	47% below	70%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Menveo Vaccine 90734	$121.80	$406.00	$118.23–$388.46	47% below	70%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Non-State Supplied - Menveo Charge	$108.30	$361.00	$183.97–$345.40	—	70%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Non-State Supplied - Menactra Charge	$119.40	$398.00	$202.82–$380.81	—	70%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Menveo Vaccine 90734	$121.80	$406.00	$206.90–$388.46	—	70%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Meningococcal Vaccine, IM 90734	$121.80	$406.00	$206.90–$388.46	—	70%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Non-State Supplied - Bexsero Charge	$114.90	$383.00	$111.53–$366.45	50% below	70%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Bexsero Charge 90620	$116.70	$389.00	$113.28–$372.20	50% below	70%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Non-State Supplied - Bexsero Charge	$114.90	$383.00	$195.18–$366.45	—	70%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Bexsero Charge 90620	$116.70	$389.00	$198.23–$372.20	—	70%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Non-State Supplied - Prevnar13 Charge	$114.60	$382.00	$111.24–$670.77	61% below	70%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal Vacc, Ped <5 13 Valent 90670	$116.40	$388.00	$112.99–$670.77	60% below	70%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal valent13	$137.10	$457.00	$133.08–$670.77	53% below	70%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal valent 13	$137.10	$457.00	$133.08–$670.77	53% below	70%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Non-State Supplied - Prevnar13 Charge	$114.60	$382.00	$194.67–$365.50	—	70%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Pneumococcal Vacc, Ped <5 13 Valent 90670	$116.40	$388.00	$197.72–$371.24	—	70%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Pneumococcal valent 13	$137.10	$457.00	$232.89–$437.26	—	70%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Pneumococcal valent13	$137.10	$457.00	$232.89–$437.26	—	70%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Non-State Supplied - Prevnar 20 Charge	$72.30	$241.00	$70.18–$1,418.56	75% below	70%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal valent 20	$159.90	$533.00	$155.21–$1,418.56	45% below	70%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal valent 20	$159.90	$533.00	$155.21–$1,418.56	45% below	70%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Non-State Supplied - Prevnar 20 Charge	$72.30	$241.00	$122.81–$230.59	—	70%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumococcal valent 20	$159.90	$533.00	$271.62–$509.97	—	70%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumococcal valent 20	$159.90	$533.00	$271.62–$509.97	—	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal vaccine	$30.00	$100.00	$29.12–$555.24	79% below	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal Vaccine	$30.00	$100.00	$29.12–$555.24	79% below	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Non-State Supplied - Pneumococcal 23 Charge	$54.60	$182.00	$53.00–$555.24	61% below	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal Vaccine 90732 man	$55.80	$186.00	$54.16–$555.24	60% below	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal Vaccine	$30.00	$100.00	$50.96–$95.68	—	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal vaccine	$30.00	$100.00	$50.96–$95.68	—	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Non-State Supplied - Pneumococcal 23 Charge	$54.60	$182.00	$92.75–$174.14	—	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal Vaccine 90732 man	$55.80	$186.00	$94.79–$177.96	—	70%
Polio vaccine, inactivated (IPV) CPT 90713 Poliovirus, IPV, SC/IM 90713	$35.40	$118.00	$34.36–$112.90	41% below	70%
Polio vaccine, inactivated (IPV) CPT 90713 Non-State Supplied - Polio Charge	$47.40	$158.00	$46.01–$151.17	21% below	70%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 Poliovirus, IPV, SC/IM 90713	$35.40	$118.00	$60.13–$112.90	—	70%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 Non-State Supplied - Polio Charge	$47.40	$158.00	$80.52–$151.17	—	70%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Beyfortus 100mg/mL - Beyfortus Charge	$939.60	$3,132.00	$912.04–$2,996.70	8% below	70%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Beyfortus 100mg/mL - Beyfortus Charge	$939.60	$3,132.00	$1,596.07–$2,996.70	—	70%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Beyfortus 50mg/0.5mL - Beyfortus Charge	$939.60	$3,132.00	$912.04–$2,996.70	8% below	70%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 Beyfortus 50mg/0.5mL - Beyfortus Charge	$939.60	$3,132.00	$1,596.07–$2,996.70	—	70%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 Abrysvo RSV vaccine preF A-preF B, recombinant 90678	$101.40	$338.00	$98.43–$323.40	82% below	70%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 Abrysvo RSV 0.5 mL Inj - Abrysvo Med Charge	$106.20	$354.00	$103.08–$338.71	81% below	70%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 Abrysvo RSV vaccine preF A-preF B, recombinant 90678	$101.40	$338.00	$172.24–$323.40	—	70%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 Abrysvo RSV 0.5 mL Inj - Abrysvo Med Charge	$106.20	$354.00	$180.40–$338.71	—	70%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 Arexvy RSV vaccine preF3, recombinant 90679	$185.70	$619.00	$180.25–$592.26	66% below	70%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 Arexvy RSV 0.5 mL Inj - Arexvy Med Charge	$185.70	$619.00	$180.25–$592.26	66% below	70%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 Arexvy RSV vaccine preF3, recombinant 90679	$185.70	$619.00	$315.44–$592.26	—	70%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 Arexvy RSV 0.5 mL Inj - Arexvy Med Charge	$185.70	$619.00	$315.44–$592.26	—	70%
Rabies vaccine, one dose CPT 90675 Administered - Rabies Charge	$192.90	$643.00	$320.99–$1,381.04	67% below	70%
Rabies vaccine, one dose inpatient CPT 90675 Administered - Rabies Charge	$192.90	$643.00	$327.67–$615.22	—	70%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 Non-State Supplied - Rotarix Charge	$97.80	$326.00	$94.93–$311.92	36% below	70%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 Non-State Supplied - Rotarix Charge	$97.80	$326.00	$166.13–$311.92	—	70%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Non-State Supplied - Rotateq Charge	$33.30	$111.00	$32.32–$106.20	71% below	70%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Rotovirus Vacc 3 Dose, Oral 90680	$64.20	$214.00	$62.32–$204.76	45% below	70%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 Non-State Supplied - Rotateq Charge	$33.30	$111.00	$56.57–$106.20	—	70%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 Rotovirus Vacc 3 Dose, Oral 90680	$64.20	$214.00	$109.05–$204.76	—	70%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Administered - Shingrix Charge	$102.00	$340.00	$99.01–$325.31	48% below	70%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Shingrix Vaccine 90750	$102.00	$340.00	$99.01–$325.31	48% below	70%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Administered - Shingrix Charge	$102.00	$340.00	$173.26–$325.31	—	70%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Shingrix Vaccine 90750	$102.00	$340.00	$173.26–$325.31	—	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Non-State Supplied - Td Charge	$17.40	$58.00	$16.89–$169.15	58% below	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD Vaccine No Prsrv >/= 7 IM 90714	$31.80	$106.00	$25.91–$169.15	23% below	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Non-State Supplied - Td Charge	$17.40	$58.00	$29.56–$55.49	—	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD Vaccine No Prsrv >/= 7 IM 90714	$31.80	$106.00	$54.02–$101.42	—	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP Vaccine > 7 IM 90715	$27.90	$93.00	$27.08–$167.61	66% below	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Non-State Supplied - TDaP Charge	$29.40	$98.00	$28.54–$167.61	64% below	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP Vaccine > 7 IM 90715	$27.90	$93.00	$47.39–$88.98	—	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Non-State Supplied - TDaP Charge	$29.40	$98.00	$49.94–$93.77	—	70%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Administered - Typhoid Charge	$58.20	$194.00	$56.49–$185.62	53% below	70%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 Administered - Typhoid Charge	$58.20	$194.00	$98.86–$185.62	—	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Pneum Vaccine (Dialysis Com Ins)	$15.60	$52.00	$25.96–$303.10	60% below	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Pneumo Vaccine (Per Dialysis Com Ins)	$15.60	$52.00	$25.96–$303.10	60% below	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 First Vaccine 90471 - Pnuemococcal 23, 2 years+	$29.10	$97.00	$48.42–$303.10	25% below	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin 90471 man	$29.10	$97.00	$48.42–$303.10	25% below	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 First Vaccine 90471 - Admin Hep B Charge	$30.60	$102.00	$50.92–$303.10	21% below	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 First Vaccine 90471 - Admin Immunization Charge	$30.60	$102.00	$50.92–$303.10	21% below	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine/Toxoid Injection	$35.40	$118.00	$58.91–$303.10	9% below	70%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Admin Pneum Vaccine (Dialysis Com Ins)	$15.60	$52.00	$26.50–$49.75	—	70%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Admin Pneumo Vaccine (Per Dialysis Com Ins)	$15.60	$52.00	$26.50–$49.75	—	70%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin 90471 man	$29.10	$97.00	$49.43–$92.81	—	70%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 First Vaccine 90471 - Pnuemococcal 23, 2 years+	$29.10	$97.00	$49.43–$92.81	—	70%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 First Vaccine 90471 - Admin Immunization Charge	$30.60	$102.00	$51.98–$97.59	—	70%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 First Vaccine 90471 - Admin Hep B Charge	$30.60	$102.00	$51.98–$97.59	—	70%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine/Toxoid Injection	$35.40	$118.00	$60.13–$112.90	—	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin, Each Add 90472	$16.20	$54.00	$15.72–$63.86	50% below	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Each Additional 90472 - Pnuemococcal 23, 2 years+	$16.20	$54.00	$15.72–$63.86	50% below	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Each Additional 90472 - Admin Flu ages 3 and up	$16.20	$54.00	$15.72–$63.86	50% below	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Each Additional 90472 - Admin Hep B Charge	$16.80	$56.00	$16.31–$63.86	48% below	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin, Each Addl	$16.80	$56.00	$16.31–$63.86	48% below	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Each Additional 90472 - Admin Immunization Charge	$16.80	$56.00	$16.31–$63.86	48% below	70%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Each Additional 90472 - Pnuemococcal 23, 2 years+	$16.20	$54.00	$27.52–$51.67	—	70%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Each Additional 90472 - Admin Flu ages 3 and up	$16.20	$54.00	$27.52–$51.67	—	70%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Admin, Each Add 90472	$16.20	$54.00	$27.52–$51.67	—	70%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Each Additional 90472 - Admin Hep B Charge	$16.80	$56.00	$28.54–$53.58	—	70%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Each Additional 90472 - Admin Immunization Charge	$16.80	$56.00	$28.54–$53.58	—	70%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Admin, Each Addl	$16.80	$56.00	$28.54–$53.58	—	70%

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://pricetransparency.healthcare/beloit-memorial-hospital/charges/export