Hospital Chicago-Naperville-Elgin, IL-IN

Loretto Hospital

Loretto Hospital in Chicago, IL publishes cash prices for 378 common procedures listed here, from its own machine-readable price file updated Oct 26, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Illinois median for 306 of 377 procedures and above it for 70. By typical cash price it ranks #22 of 117 Illinois hospitals and #18 of 63 hospitals in the Chicago, IL area, cheapest first. Select a procedure to compare it with other hospitals nearby.

645 S. Central Avenue Chicago IL 60644 Collected Nov 8, 2026 Source price file Check a bill from this hospital

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 Loretto Hospital in Chicago, IL:

Nov 28, 2023 Warning notice
Mar 19, 2024 Corrective action plan requested
Jun 7, 2024 Case closed
Jun 9, 2026 Warning notice

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.

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 Illinois	Off list
Abdominal CT scan without and with contrast CPT 74170 CT KIDNEYS W/WO CONTRAST	$3,104.83	$5,174.71	$247.74–$5,174.71	10% above	40%
Abdominal CT scan without and with contrast one side CPT 74170 CT UE ABD RT wo/w con	$2,662.44	$4,437.40	$247.74–$5,174.71	5% below	40%
Abdominal CT scan without and with contrast one side CPT 74170 CT UE ABD LT wo/w con	$2,662.44	$4,437.40	$247.74–$5,174.71	5% below	40%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT KIDNEYS W/WO CONTRAST	$3,104.83	$5,174.71	$247.74–$5,174.71	—	40%
Abdominal CT scan without and with contrast inpatient one side CPT 74170 CT UE ABD LT wo/w con	$2,662.44	$4,437.40	$247.74–$5,174.71	—	40%
Abdominal CT scan without and with contrast inpatient one side CPT 74170 CT UE ABD RT wo/w con	$2,662.44	$4,437.40	$247.74–$5,174.71	—	40%
Abdominal X-ray, 2 views CPT 74019 XR ABDOMEN 2 VIEW	$60.71	$101.18	$18.04–$551.31	82% below	40%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN 2 VIEWS	$330.79	$551.31	$18.04–$551.31	1% below	40%
Abdominal X-ray, 2 views inpatient CPT 74019 XR ABDOMEN 2 VIEW	$60.71	$101.18	$18.04–$551.31	—	40%
Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN 2 VIEWS	$330.79	$551.31	$18.04–$551.31	—	40%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE MIN 3 VIEW RT	$308.64	$514.40	$13.79–$514.40	9% below	40%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE MIN 3 VIEW LT	$308.64	$514.40	$13.79–$514.40	9% below	40%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE MIN 3 VIEW RT	$308.64	$514.40	$13.79–$514.40	—	40%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE MIN 3 VIEW LT	$308.64	$514.40	$13.79–$514.40	—	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$135.59	$225.98	$21.07–$641.32	67% below	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 SEGMENTAL PRESSURE ASSESSMENT	$183.49	$305.81	$21.07–$641.32	56% below	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 tcPO2 MEASUREMENT, 1 OR 2 LVLS	$384.79	$641.32	$21.07–$641.32	7% below	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$135.59	$225.98	$21.07–$641.32	—	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 SEGMENTAL PRESSURE ASSESSMENT	$183.49	$305.81	$21.07–$641.32	—	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 tcPO2 MEASUREMENT, 1 OR 2 LVLS	$384.79	$641.32	$21.07–$641.32	—	40%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTREMITY WO CONT	$1,370.26	$2,283.76	$108.47–$2,283.76	25% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UE LT wo con	$1,370.26	$2,283.76	$108.47–$2,283.76	25% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UE RT wo con	$1,370.26	$2,283.76	$108.47–$2,283.76	25% below	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTREMITY WO CONT	$1,370.26	$2,283.76	$108.47–$2,283.76	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UE RT wo con	$1,370.26	$2,283.76	$108.47–$2,283.76	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UE LT wo con	$1,370.26	$2,283.76	$108.47–$2,283.76	—	40%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS	$284.98	$474.96	$284.98–$474.96	53% below	40%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGUS	$284.98	$474.96	$284.98–$474.96	—	40%
Bone scan, whole body (nuclear medicine) CPT 78306 WHOLE BODY BONE SCAN	$1,253.40	$2,089.00	$65.18–$2,089.00	20% below	40%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 WHOLE BODY BONE SCAN	$1,253.40	$2,089.00	$65.18–$2,089.00	—	40%
Breast ultrasound, complete, one breast CPT 76641 US of breast complete	$57.25	$95.41	$57.25–$95.41	89% below	40%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST UNILAT COMPLETE	$57.25	$95.41	$57.25–$95.41	89% below	40%
Breast ultrasound, complete, one breast inpatient CPT 76641 US of breast complete	$57.25	$95.41	$57.25–$95.41	—	40%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST UNILAT COMPLETE	$57.25	$95.41	$57.25–$95.41	—	40%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US BREAST UNILATERAL OR BILAT	$266.04	$443.40	$53.52–$443.40	—	40%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast unilat ltd w/doc	$53.52	$89.20	$53.52–$443.40	88% below	40%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 US BREAST UNILATERAL OR BILAT	$266.04	$443.40	$53.52–$443.40	—	40%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast unilat ltd w/doc	$53.52	$89.20	$53.52–$443.40	—	40%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD/PEL ANGIO W&WO CON	$3,104.83	$5,174.71	$170.09–$5,174.71	16% below	40%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD/PEL ANGIO W&WO CON	$3,104.83	$5,174.71	$170.09–$5,174.71	—	40%
CT angiography (CTA) of the head CPT 70496 CT ANGIOGRAPHY HEAD	$1,971.70	$3,286.16	$132.80–$3,286.16	22% below	40%
CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIOGRAPHY HEAD	$1,971.70	$3,286.16	$132.80–$3,286.16	—	40%
CT angiography (CTA) of the neck CPT 70498 CT ANGIOGRAPHY NECK	$1,894.66	$3,157.76	$132.80–$3,157.76	26% below	40%
CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIOGRAPHY NECK	$1,894.66	$3,157.76	$132.80–$3,157.76	—	40%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Chest w/Contrast PE Study	$1,851.60	$3,086.00	$138.05–$3,086.00	36% below	40%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Chest w/Contrast PE Study	$1,851.60	$3,086.00	$138.05–$3,086.00	—	40%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIOGRAPHY OF HEART	$2,893.65	$4,822.75	$2,893.65–$4,822.75	63% above	40%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT ANGIOGRAPHY OF HEART	$2,893.65	$4,822.75	$2,893.65–$4,822.75	—	40%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT CALCIUM SCORING	$351.22	$585.36	$104.25–$585.36	59% above	40%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT CALCIUM SCORING	$351.22	$585.36	$104.25–$585.36	—	40%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN & PELVIS WO CONT	$3,394.96	$5,658.26	$170.68–$5,658.26	2% below	40%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN & PELVIS WO CONT	$3,394.96	$5,658.26	$170.68–$5,658.26	—	40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN & PELVIS W CONT	$5,175.05	$8,625.09	$142.02–$8,625.09	17% above	40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN & PELVIS W CONT	$5,175.05	$8,625.09	$142.02–$8,625.09	—	40%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN & PELVIS W WO CONT	$5,309.47	$8,849.11	$155.30–$8,849.11	8% above	40%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN & PELVIS W WO CONT	$5,309.47	$8,849.11	$155.30–$8,849.11	—	40%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST	$2,662.44	$4,437.40	$226.90–$4,437.40	16% above	40%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST	$2,662.44	$4,437.40	$226.90–$4,437.40	—	40%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$1,783.01	$2,971.68	$210.95–$3,299.58	4% below	40%
CT scan of the abdomen without contrast CPT 74150 CT KIDNEYS W/O CONTRAST	$1,979.75	$3,299.58	$210.95–$3,299.58	7% above	40%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$1,783.01	$2,971.68	$210.95–$3,299.58	—	40%
CT scan of the abdomen without contrast inpatient CPT 74150 CT KIDNEYS W/O CONTRAST	$1,979.75	$3,299.58	$210.95–$3,299.58	—	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLO FACIAL W/O CONT	$1,731.56	$2,885.94	$29.39–$2,885.94	2% above	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLO FACIAL W/O CONT	$1,731.56	$2,885.94	$29.39–$2,885.94	—	40%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST	$1,376.00	$2,293.34	$63.02–$2,293.34	24% below	40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST	$1,376.00	$2,293.34	$63.02–$2,293.34	—	40%
CT scan of the head with contrast CPT 70460 CT HEAD W/CONTRAST	$1,459.58	$2,432.63	$201.14–$2,432.63	24% below	40%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/CONTRAST	$1,459.58	$2,432.63	$201.14–$2,432.63	—	40%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/WO CONTRAST	$2,406.07	$4,010.11	$99.10–$4,010.11	1% below	40%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/WO CONTRAST	$2,406.07	$4,010.11	$99.10–$4,010.11	—	40%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$1,549.34	$2,582.24	$108.88–$2,582.24	29% below	40%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$1,549.34	$2,582.24	$108.88–$2,582.24	—	40%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O CONTRAST	$1,574.44	$2,624.06	$76.04–$2,624.06	31% below	40%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O CONTRAST	$1,574.44	$2,624.06	$76.04–$2,624.06	—	40%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 EXTRACRANIAL BILAT STUDY	$314.15	$523.58	$63.45–$1,300.28	—	40%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US DOPPLER CAROTID COMP BIL	$780.17	$1,300.28	$63.45–$1,300.28	10% below	40%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 EXTRACRANIAL BILAT STUDY	$314.15	$523.58	$63.45–$1,300.28	—	40%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US DOPPLER CAROTID COMP BIL	$780.17	$1,300.28	$63.45–$1,300.28	—	40%
Chest CT scan without and with contrast CPT 71270 CT CHEST W/WO	$2,359.66	$3,932.77	$223.21–$3,932.77	16% below	40%
Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST W/WO	$2,359.66	$3,932.77	$223.21–$3,932.77	—	40%
Chest X-ray, 2 views CPT 71046 CHEST(PA & LATERAL)2 VWS	$186.33	$310.55	$16.96–$310.55	38% below	40%
Chest X-ray, 2 views inpatient CPT 71046 CHEST(PA & LATERAL)2 VWS	$186.33	$310.55	$16.96–$310.55	—	40%
Chest X-ray, single view CPT 71045 CHEST-SUPINE 1 VIEW	$186.33	$310.55	$16.00–$310.55	28% below	40%
Chest X-ray, single view inpatient CPT 71045 CHEST-SUPINE 1 VIEW	$186.33	$310.55	$16.00–$310.55	—	40%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE RT	$291.05	$485.09	$13.25–$485.09	3% above	40%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE LT	$291.05	$485.09	$13.25–$485.09	3% above	40%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE RT	$291.05	$485.09	$13.25–$485.09	—	40%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE LT	$291.05	$485.09	$13.25–$485.09	—	40%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL	$580.20	$967.00	$57.23–$967.00	28% below	40%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL	$580.20	$967.00	$57.23–$967.00	—	40%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL	$62.36	$103.93	$15.37–$590.72	87% below	40%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY SPINE	$354.43	$590.72	$15.37–$590.72	25% below	40%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY AXIAL	$62.36	$103.93	$15.37–$590.72	—	40%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY SPINE	$354.43	$590.72	$15.37–$590.72	—	40%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BONE DENSITY FOREARM	$207.08	$345.14	$15.67–$345.14	12% below	40%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BONE DENSITY FOREARM	$207.08	$345.14	$15.67–$345.14	—	40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO CONTRAST	$168.90	$281.50	$168.90–$320.92	91% below	40%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST WO CONTRAST	$168.90	$281.50	$168.90–$320.92	—	40%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST WO CONTRAST	$1,979.75	$3,299.58	$99.58–$3,299.58	17% below	40%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CONTRAST	$1,979.75	$3,299.58	$99.58–$3,299.58	17% below	40%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CONTRAST	$1,979.75	$3,299.58	$99.58–$3,299.58	—	40%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST WO CONTRAST	$1,979.75	$3,299.58	$99.58–$3,299.58	—	40%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMOGRAM DX BILATERAL	$76.04	$126.74	$76.04–$758.76	—	40%
Diagnostic mammogram, both breasts both sides CPT 77066 MM diag mammo wCAD BI	$455.26	$758.76	$76.04–$758.76	—	40%
Diagnostic mammogram, both breasts CPT 77066 DX DIG MAMM W/CAD BIL	$455.26	$758.76	$76.04–$758.76	36% above	40%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMOGRAM DX BILATERAL	$76.04	$126.74	$76.04–$758.76	—	40%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MM diag mammo wCAD BI	$455.26	$758.76	$76.04–$758.76	—	40%
Diagnostic mammogram, both breasts inpatient CPT 77066 DX DIG MAMM W/CAD BIL	$455.26	$758.76	$76.04–$758.76	—	40%
Diagnostic mammogram, one breast CPT 77065 COMPUTER DX MAMMOGRAM CAD UNI	$352.51	$587.51	$47.90–$587.51	15% above	40%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO DX UNILAT	$47.90	$79.83	$47.90–$587.51	84% below	40%
Diagnostic mammogram, one breast one side CPT 77065 MM diag mammo wCAD RT	$162.74	$271.24	$47.90–$587.51	47% below	40%
Diagnostic mammogram, one breast one side CPT 77065 DX DIG MAMM W/CAD UNI RT	$352.51	$587.51	$47.90–$587.51	15% above	40%
Diagnostic mammogram, one breast one side CPT 77065 MM diag mammo wCAD LT	$352.51	$587.51	$47.90–$587.51	15% above	40%
Diagnostic mammogram, one breast one side CPT 77065 DX DIG MAMM W/CAD UNI LT	$352.51	$587.51	$47.90–$587.51	15% above	40%
Diagnostic mammogram, one breast inpatient CPT 77065 COMPUTER DX MAMMOGRAM CAD UNI	$352.51	$587.51	$47.90–$587.51	—	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO DX UNILAT	$47.90	$79.83	$47.90–$587.51	—	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MM diag mammo wCAD RT	$162.74	$271.24	$47.90–$587.51	—	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MM diag mammo wCAD LT	$352.51	$587.51	$47.90–$587.51	—	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 DX DIG MAMM W/CAD UNI LT	$352.51	$587.51	$47.90–$587.51	—	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 DX DIG MAMM W/CAD UNI RT	$352.51	$587.51	$47.90–$587.51	—	40%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 VAS GRAFT LOWER EXT BILATERAL	$573.60	$956.00	$61.35–$956.00	—	40%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US ARTERIAL DOPPLER BIL DUPLEX	$573.60	$956.00	$61.35–$956.00	40% below	40%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 VAS GRAFT LOWER EXT BILATERAL	$573.60	$956.00	$61.35–$956.00	—	40%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US ARTERIAL DOPPLER BIL DUPLEX	$573.60	$956.00	$61.35–$956.00	—	40%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US venous duplex BILATERAL	$436.73	$727.89	$54.73–$1,777.50	—	40%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US DOPPLER EXT BILATERAL	$1,066.50	$1,777.50	$54.73–$1,777.50	—	40%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS LOWER EXTREMITIES BILAT	$1,066.50	$1,777.50	$54.73–$1,777.50	—	40%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US venous duplex BILATERAL	$436.73	$727.89	$54.73–$1,777.50	—	40%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US DOPPLER EXT BILATERAL	$1,066.50	$1,777.50	$54.73–$1,777.50	—	40%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VENOUS LOWER EXTREMITIES BILAT	$1,066.50	$1,777.50	$54.73–$1,777.50	—	40%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO TRANS 2D COMP WO & W CONT	$1,170.55	$1,950.92	$1,170.55–$2,575.64	44% below	40%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO TRANS 2D COMPLETE W/ CONT	$1,545.38	$2,575.64	$1,170.55–$2,575.64	26% below	40%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO TRANS 2D COMPLETE WO CONT	$1,545.38	$2,575.64	$1,170.55–$2,575.64	26% below	40%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO TRANS 2D COMP WO & W CONT	$1,170.55	$1,950.92	$1,170.55–$2,575.64	—	40%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO TRANS 2D COMPLETE WO CONT	$1,545.38	$2,575.64	$1,170.55–$2,575.64	—	40%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO TRANS 2D COMPLETE W/ CONT	$1,545.38	$2,575.64	$1,170.55–$2,575.64	—	40%
Elbow X-ray, 2 views one side CPT 73070 XR ELBOW LT 2V	$369.94	$616.56	$30.68–$616.56	30% above	40%
Elbow X-ray, 2 views one side CPT 73070 XR ELBOW RT 2V	$369.94	$616.56	$30.68–$616.56	30% above	40%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR ELBOW RT 2V	$369.94	$616.56	$30.68–$616.56	—	40%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR ELBOW LT 2V	$369.94	$616.56	$30.68–$616.56	—	40%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW MIN 3 VIEW LT	$279.70	$466.17	$22.24–$466.17	18% below	40%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW MIN 3 VIEW RT	$279.70	$466.17	$22.24–$466.17	18% below	40%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW MIN 3 VIEW LT	$279.70	$466.17	$22.24–$466.17	—	40%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW MIN 3 VIEW RT	$279.70	$466.17	$22.24–$466.17	—	40%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORB/TEMP BONES W/O CONT	$1,823.51	$3,039.18	$100.16–$3,039.18	9% above	40%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORB/TEMP BONES W/O CONT	$1,823.51	$3,039.18	$100.16–$3,039.18	—	40%
Facial bones X-ray, complete, 3 or more views CPT 70150 X-RAY EXAM OF FACIAL BONES	$76.88	$128.13	$20.16–$557.50	81% below	40%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES MIN 3 VIEW	$334.50	$557.50	$20.16–$557.50	19% below	40%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 X-RAY EXAM OF FACIAL BONES	$76.88	$128.13	$20.16–$557.50	—	40%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES MIN 3 VIEW	$334.50	$557.50	$20.16–$557.50	—	40%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM 2 VIEW RT	$269.43	$449.05	$12.72–$449.05	15% below	40%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM 2 VIEW LT	$269.43	$449.05	$12.72–$449.05	15% below	40%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM 2 VIEW LT	$269.43	$449.05	$12.72–$449.05	—	40%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM 2 VIEW RT	$269.43	$449.05	$12.72–$449.05	—	40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY SCAN	$789.16	$1,315.26	$56.69–$1,315.26	46% below	40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY SCAN	$789.16	$1,315.26	$56.69–$1,315.26	—	40%
Hand X-ray, 2 views one side CPT 73120 XR HAND LT 2V	$414.06	$690.10	$30.68–$690.10	45% above	40%
Hand X-ray, 2 views one side CPT 73120 XR HAND RT 2V	$414.06	$690.10	$30.68–$690.10	45% above	40%
Hand X-ray, 2 views inpatient one side CPT 73120 XR HAND LT 2V	$414.06	$690.10	$30.68–$690.10	—	40%
Hand X-ray, 2 views inpatient one side CPT 73120 XR HAND RT 2V	$414.06	$690.10	$30.68–$690.10	—	40%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 X-ray of heel	$274.57	$457.61	$12.72–$457.61	6% above	40%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL MIN 2 VIEW RT	$274.57	$457.61	$12.72–$457.61	6% above	40%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL MIN 2 VIEW LT	$274.57	$457.61	$12.72–$457.61	6% above	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 X-ray of heel	$274.57	$457.61	$12.72–$457.61	—	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL MIN 2 VIEW RT	$274.57	$457.61	$12.72–$457.61	—	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL MIN 2 VIEW LT	$274.57	$457.61	$12.72–$457.61	—	40%
Knee X-ray, 3 views CPT 73562 XR Knee 3 Views	$69.53	$115.88	$34.36–$488.19	80% below	40%
Knee X-ray, 3 views one side CPT 73562 XR knee RT 3V	$292.91	$488.19	$34.36–$488.19	16% below	40%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEW RT	$292.91	$488.19	$34.36–$488.19	16% below	40%
Knee X-ray, 3 views one side CPT 73562 XR knee LT 3V	$292.91	$488.19	$34.36–$488.19	16% below	40%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEW LT	$292.91	$488.19	$34.36–$488.19	16% below	40%
Knee X-ray, 3 views inpatient CPT 73562 XR Knee 3 Views	$69.53	$115.88	$34.36–$488.19	—	40%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEW LT	$292.91	$488.19	$34.36–$488.19	—	40%
Knee X-ray, 3 views inpatient one side CPT 73562 XR knee RT 3V	$292.91	$488.19	$34.36–$488.19	—	40%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEW RT	$292.91	$488.19	$34.36–$488.19	—	40%
Knee X-ray, 3 views inpatient one side CPT 73562 XR knee LT 3V	$292.91	$488.19	$34.36–$488.19	—	40%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE 4+ VIEW RT	$423.60	$706.00	$18.05–$706.00	4% below	40%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE 4+ VIEW LT	$423.60	$706.00	$18.05–$706.00	4% below	40%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE 4+ VIEW LT	$423.60	$706.00	$18.05–$706.00	—	40%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE 4+ VIEW RT	$423.60	$706.00	$18.05–$706.00	—	40%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTREMITY - WO CONT	$1,481.11	$2,468.52	$76.04–$2,468.52	18% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LE RT wo con	$1,481.11	$2,468.52	$76.04–$2,468.52	18% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LE LT wo con	$1,481.11	$2,468.52	$76.04–$2,468.52	18% below	40%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTREMITY - WO CONT	$1,481.11	$2,468.52	$76.04–$2,468.52	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LE LT wo con	$1,481.11	$2,468.52	$76.04–$2,468.52	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LE RT wo con	$1,481.11	$2,468.52	$76.04–$2,468.52	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMINAL LIMITED	$626.29	$1,043.81	$105.47–$1,043.81	9% below	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMINAL LIMITED	$626.29	$1,043.81	$105.47–$1,043.81	—	40%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXTREMITY NON VASCULAR LTD	$53.60	$89.33	$53.60–$604.47	83% below	40%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXTREMITY NON VASCULAR LTD	$53.60	$89.33	$53.60–$604.47	—	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CA W/O CONT	$71.69	$119.48	$71.69–$595.33	87% below	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LOW DOSE CT CHEST	$357.20	$595.33	$71.69–$595.33	37% below	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CA W/O CONT	$71.69	$119.48	$71.69–$595.33	—	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 LOW DOSE CT CHEST	$357.20	$595.33	$71.69–$595.33	—	40%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LOWER LEG TIB & FIB RT	$291.29	$485.49	$12.72–$485.49	10% below	40%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LWR LEG TIB & FIB LT	$291.29	$485.49	$12.72–$485.49	10% below	40%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LOWER LEG TIB & FIB RT	$291.29	$485.49	$12.72–$485.49	—	40%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LWR LEG TIB & FIB LT	$291.29	$485.49	$12.72–$485.49	—	40%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRAST	$369.01	$615.01	$369.01–$615.01	86% below	40%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CONTRAST	$369.01	$615.01	$369.01–$615.01	—	40%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXT JOINT W/O	$2,082.88	$3,471.47	$105.49–$3,471.47	26% below	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR LE joint RT wo con	$369.01	$615.01	$105.49–$3,471.47	87% below	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR LE joint LT wo con	$369.01	$615.01	$105.49–$3,471.47	87% below	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXT JOINT W/O	$2,082.88	$3,471.47	$105.49–$3,471.47	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR LE joint LT wo con	$369.01	$615.01	$105.49–$3,471.47	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR LE joint RT wo con	$369.01	$615.01	$105.49–$3,471.47	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI JOINT LWR EXTR W/O&W/CONT	$1,876.89	$3,128.15	$388.78–$3,128.15	46% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR LE joint RT wo/w con	$1,876.89	$3,128.15	$388.78–$3,128.15	46% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR LE joint LT wo/w con	$1,876.89	$3,128.15	$388.78–$3,128.15	46% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI JOINT LWR EXTR W/O&W/CONT	$1,876.89	$3,128.15	$388.78–$3,128.15	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR LE joint RT wo/w con	$1,876.89	$3,128.15	$388.78–$3,128.15	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR LE joint LT wo/w con	$1,876.89	$3,128.15	$388.78–$3,128.15	—	40%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WITHOUT CONTRAST	$2,183.69	$3,639.49	$260.00–$4,078.64	21% below	40%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$2,447.18	$4,078.64	$260.00–$4,078.64	11% below	40%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN WITHOUT CONTRAST	$2,183.69	$3,639.49	$260.00–$4,078.64	—	40%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST	$2,447.18	$4,078.64	$260.00–$4,078.64	—	40%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/WO CONTRAST	$2,497.80	$4,163.00	$396.13–$4,163.00	33% below	40%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/O & W/CONT	$2,497.80	$4,163.00	$396.13–$4,163.00	33% below	40%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/WO CONTRAST	$2,497.80	$4,163.00	$396.13–$4,163.00	—	40%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/O & W/CONT	$2,497.80	$4,163.00	$396.13–$4,163.00	—	40%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$2,133.17	$3,555.29	$112.93–$3,555.29	24% below	40%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST	$2,133.17	$3,555.29	$112.93–$3,555.29	—	40%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W&W/O CONTRAST	$543.44	$905.73	$178.07–$5,134.09	86% below	40%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO CONTRAST	$3,080.45	$5,134.09	$178.07–$5,134.09	23% below	40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W&W/O CONTRAST	$543.44	$905.73	$178.07–$5,134.09	—	40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO CONTRAST	$3,080.45	$5,134.09	$178.07–$5,134.09	—	40%
MRI of the lower back, no contrast dye CPT 72148 MRI LS SPINE W/O CONTRAST	$2,355.91	$3,926.52	$115.54–$3,926.52	18% below	40%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LS SPINE W/O CONTRAST	$2,355.91	$3,926.52	$115.54–$3,926.52	—	40%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LS SPINE W/WO CONTRAST	$3,289.07	$5,481.79	$178.07–$5,481.79	18% below	40%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LS SPINE W/WO CONTRAST	$3,289.07	$5,481.79	$178.07–$5,481.79	—	40%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI CHEST SPINE W/O DYE	$324.17	$540.29	$115.54–$2,568.00	89% below	40%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O CONTRAS	$1,540.80	$2,568.00	$115.54–$2,568.00	46% below	40%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI CHEST SPINE W/O DYE	$324.17	$540.29	$115.54–$2,568.00	—	40%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE W/O CONTRAS	$1,540.80	$2,568.00	$115.54–$2,568.00	—	40%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI NECK SPINE W/O & W/DYE	$546.14	$910.24	$178.08–$5,738.39	86% below	40%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W/WO CONTRA	$3,443.03	$5,738.39	$178.08–$5,738.39	12% below	40%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI NECK SPINE W/O & W/DYE	$546.14	$910.24	$178.08–$5,738.39	—	40%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE W/WO CONTRA	$3,443.03	$5,738.39	$178.08–$5,738.39	—	40%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE W/O CONTRAS	$2,486.62	$4,144.37	$115.54–$4,144.37	15% below	40%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE W/O CONTRAS	$2,486.62	$4,144.37	$115.54–$4,144.37	—	40%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$369.01	$615.01	$261.24–$615.01	86% below	40%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$369.01	$615.01	$261.24–$615.01	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXT JOINT W/O	$2,529.50	$4,215.83	$106.03–$4,215.83	10% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MR UE joint RT wo con	$2,529.50	$4,215.83	$106.03–$4,215.83	10% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MR UE joint LT wo con	$2,529.50	$4,215.83	$106.03–$4,215.83	10% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXT JOINT W/O	$2,529.50	$4,215.83	$106.03–$4,215.83	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR UE joint RT wo con	$2,529.50	$4,215.83	$106.03–$4,215.83	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR UE joint LT wo con	$2,529.50	$4,215.83	$106.03–$4,215.83	—	40%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR CERVICAL SPINE 4 OR 5 VI	$87.16	$145.26	$21.23–$726.47	84% below	40%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERV SPINE W/OBLIQ 5 VWS	$435.88	$726.47	$21.23–$726.47	20% below	40%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR CERVICAL SPINE 4 OR 5 VI	$87.16	$145.26	$21.23–$726.47	—	40%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERV SPINE W/OBLIQ 5 VWS	$435.88	$726.47	$21.23–$726.47	—	40%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W/CONTRAST	$1,804.33	$3,007.22	$132.29–$3,007.22	14% below	40%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W/CONTRAST	$1,804.33	$3,007.22	$132.29–$3,007.22	—	40%
Neck soft tissue CT scan without contrast CPT 70490 CT NECK W/O CONTRAST	$254.24	$423.74	$100.16–$2,252.76	86% below	40%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O CONT	$1,351.66	$2,252.76	$100.16–$2,252.76	23% below	40%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK W/O CONTRAST	$254.24	$423.74	$100.16–$2,252.76	—	40%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK W/O CONT	$1,351.66	$2,252.76	$100.16–$2,252.76	—	40%
Neck soft tissue X-ray CPT 70360 NECK (SOFT TISSUE)	$256.20	$427.00	$14.30–$427.00	3% below	40%
Neck soft tissue X-ray inpatient CPT 70360 NECK (SOFT TISSUE)	$256.20	$427.00	$14.30–$427.00	—	40%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM-STRESS/REST SESTAMIBI SPECT	$2,294.03	$3,823.39	$186.97–$3,823.39	43% below	40%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM-STRESS/REST SESTAMIBI SPECT	$2,294.03	$3,823.39	$186.97–$3,823.39	—	40%
OCT scan of the retina (optical coherence tomography) CPT 92134 CPTR OPHTH DX IMG POST SEGMT	$53.77	$89.61	$53.77–$89.61	43% below	40%
OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 CPTR OPHTH DX IMG POST SEGMT	$53.77	$89.61	$53.77–$89.61	—	40%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS NON-OB LTD	$38.19	$63.65	$38.18–$959.16	93% below	40%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS NON-OB LTD	$38.19	$63.65	$38.18–$959.16	—	40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM PELVIC COMPLETE	$173.50	$289.17	$54.04–$1,596.67	78% below	40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC NONOBSTETRICAL	$958.00	$1,596.67	$54.04–$1,596.67	21% above	40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US BLADDER	$958.00	$1,596.67	$54.04–$1,596.67	21% above	40%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US EXAM PELVIC COMPLETE	$173.50	$289.17	$54.04–$1,596.67	—	40%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC NONOBSTETRICAL	$958.00	$1,596.67	$54.04–$1,596.67	—	40%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US BLADDER	$958.00	$1,596.67	$54.04–$1,596.67	—	40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB =>14 WKS SNGL FETUS	$637.75	$1,062.92	$76.92–$1,062.92	13% below	40%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB =>14 WKS SNGL FETUS	$637.75	$1,062.92	$76.92–$1,062.92	—	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREGNANCY <14 WEEKS SGL	$131.12	$218.54	$131.12–$1,434.62	80% below	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US FETAL AGE	$860.77	$1,434.62	$131.12–$1,434.62	29% above	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB <14 WKS SINGLE FETUS	$860.77	$1,434.62	$131.12–$1,434.62	29% above	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREGNANCY <14 WEEKS SGL	$131.12	$218.54	$131.12–$1,434.62	—	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US FETAL AGE	$860.77	$1,434.62	$131.12–$1,434.62	—	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB <14 WKS SINGLE FETUS	$860.77	$1,434.62	$131.12–$1,434.62	—	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREG LIMITED >14 WEEKS	$400.69	$667.82	$51.38–$667.82	24% below	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREG LIMITED >14 WEEKS	$400.69	$667.82	$51.38–$667.82	—	40%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS 2 VIEW UNI LT	$249.47	$415.79	$17.50–$690.10	28% below	40%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS 2 VIEW UNI RT	$331.15	$551.91	$17.50–$690.10	4% below	40%
Rib X-ray, one side, 2 views one side CPT 71100 XR RIBS RT 2V	$414.06	$690.10	$17.50–$690.10	20% above	40%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS 2 VIEW UNI LT	$249.47	$415.79	$17.50–$690.10	—	40%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS 2 VIEW UNI RT	$331.15	$551.91	$17.50–$690.10	—	40%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR RIBS RT 2V	$414.06	$690.10	$17.50–$690.10	—	40%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS MIN 3 VIEW UNI RT	$249.47	$415.79	$20.36–$415.79	46% below	40%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS MIN 3 VIEW UNI LT	$249.47	$415.79	$20.36–$415.79	46% below	40%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS MIN 3 VIEW UNI LT	$249.47	$415.79	$20.36–$415.79	—	40%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS MIN 3 VIEW UNI RT	$249.47	$415.79	$20.36–$415.79	—	40%
Screening mammogram, both breasts both sides CPT 77067 MAMMO SCRN BILAT 2V EA BRST	$63.70	$106.17	$59.36–$659.08	—	40%
Screening mammogram, both breasts both sides CPT 77067 MM screen mammo BILAT wCAD	$174.36	$290.60	$59.36–$659.08	—	40%
Screening mammogram, both breasts CPT 77067 PF BREAST CA AWARENESS MNTH W	$59.36	$98.93	$59.36–$659.08	78% below	40%
Screening mammogram, both breasts CPT 77067 SCREENING DIG MAMM W/CAD	$395.45	$659.08	$59.36–$659.08	44% above	40%
Screening mammogram, both breasts CPT 77067 BREAST CA AWARENESS MNTH W CAD	$395.45	$659.08	$59.36–$659.08	44% above	40%
Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO SCRN BILAT 2V EA BRST	$63.70	$106.17	$59.36–$659.08	—	40%
Screening mammogram, both breasts inpatient both sides CPT 77067 MM screen mammo BILAT wCAD	$174.36	$290.60	$59.36–$659.08	—	40%
Screening mammogram, both breasts inpatient CPT 77067 PF BREAST CA AWARENESS MNTH W	$59.36	$98.93	$59.36–$659.08	—	40%
Screening mammogram, both breasts inpatient CPT 77067 SCREENING DIG MAMM W/CAD	$395.45	$659.08	$59.36–$659.08	—	40%
Screening mammogram, both breasts inpatient CPT 77067 BREAST CA AWARENESS MNTH W CAD	$395.45	$659.08	$59.36–$659.08	—	40%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER MIN 2 VIEW LT	$317.65	$529.41	$26.23–$529.41	12% below	40%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER MIN 2 VIEW RT	$317.65	$529.41	$26.23–$529.41	12% below	40%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER MIN 2 VIEW RT	$317.65	$529.41	$26.23–$529.41	—	40%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER MIN 2 VIEW LT	$317.65	$529.41	$26.23–$529.41	—	40%
Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES MIN 3 VIEW	$147.94	$246.57	$16.96–$246.57	60% below	40%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES MIN 3 VIEW	$147.94	$246.57	$16.96–$246.57	—	40%
Skull X-ray, fewer than 4 views CPT 70250 SKULL-AP AND LAT	$168.90	$281.50	$14.30–$281.50	46% below	40%
Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL-AP AND LAT	$168.90	$281.50	$14.30–$281.50	—	40%
Swallow study (modified barium swallow, video X-ray) CPT 74230 SWALLOW STUDY	$403.16	$671.94	$42.35–$671.94	34% below	40%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 SWALLOW STUDY	$403.16	$671.94	$42.35–$671.94	—	40%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR MIN 2 VIEW RT	$193.06	$321.77	$14.30–$321.77	32% below	40%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR MIN 2 VIEW LT	$193.06	$321.77	$14.30–$321.77	32% below	40%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR MIN 2 VIEW RT	$193.06	$321.77	$14.30–$321.77	—	40%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR MIN 2 VIEW LT	$193.06	$321.77	$14.30–$321.77	—	40%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE W/O CONT	$1,084.80	$1,808.00	$92.12–$1,808.00	49% below	40%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE W/O CONT	$1,084.80	$1,808.00	$92.12–$1,808.00	—	40%
Toe X-ray, 2 or more views one side CPT 73660 TOE(S) MIN 2 VIEW RT	$307.02	$511.70	$10.59–$511.70	31% above	40%
Toe X-ray, 2 or more views one side CPT 73660 TOE(S) MIN 2 VIEW LT	$307.02	$511.70	$10.59–$511.70	31% above	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE(S) MIN 2 VIEW LT	$307.02	$511.70	$10.59–$511.70	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE(S) MIN 2 VIEW RT	$307.02	$511.70	$10.59–$511.70	—	40%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$196.99	$328.31	$54.59–$1,027.46	70% below	40%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON-OB	$616.48	$1,027.46	$54.59–$1,027.46	5% below	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$196.99	$328.31	$54.59–$1,027.46	—	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON-OB	$616.48	$1,027.46	$54.59–$1,027.46	—	40%
Transvaginal ultrasound during pregnancy CPT 76817 US TRANSVAGINAL PELVIC	$525.98	$876.63	$58.84–$876.63	1% below	40%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US TRANSVAGINAL PELVIC	$525.98	$876.63	$58.84–$876.63	—	40%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN & RETROPERITONEUM	$779.52	$1,299.20	$69.53–$1,299.20	23% below	40%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN & RETROPERITONEUM	$779.52	$1,299.20	$69.53–$1,299.20	—	40%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$73.06	$121.77	$50.32–$281.50	90% below	40%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM & CONTENTS	$168.90	$281.50	$50.32–$281.50	77% below	40%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$73.06	$121.77	$50.32–$281.50	—	40%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM & CONTENTS	$168.90	$281.50	$50.32–$281.50	—	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID	$594.44	$990.74	$45.02–$990.74	12% below	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US NECK	$594.44	$990.74	$45.02–$990.74	12% below	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US NECK	$594.44	$990.74	$45.02–$990.74	—	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID	$594.44	$990.74	$45.02–$990.74	—	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Upper dig tract (xray)	$62.56	$104.27	$62.56–$534.44	91% below	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI	$320.66	$534.44	$62.56–$534.44	55% below	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Upper dig tract (xray)	$62.56	$104.27	$62.56–$534.44	—	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI	$320.66	$534.44	$62.56–$534.44	—	40%
Upper arm X-ray (humerus), 2 views CPT 73060 X-RAY EXAM OF HUMERUS	$53.21	$88.68	$13.25–$529.41	82% below	40%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS MIN 2 VIEW RT	$317.65	$529.41	$13.25–$529.41	8% above	40%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMEROUS MIN 2 VIEW RT	$317.65	$529.41	$13.25–$529.41	8% above	40%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 X-RAY EXAM OF HUMERUS	$53.21	$88.68	$13.25–$529.41	—	40%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMEROUS MIN 2 VIEW RT	$317.65	$529.41	$13.25–$529.41	—	40%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS MIN 2 VIEW RT	$317.65	$529.41	$13.25–$529.41	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Duplex Venous Extremity Uni	$73.49	$122.49	$35.42–$727.89	89% below	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US venous duplex UNI LT	$436.73	$727.89	$35.42–$727.89	34% below	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DOPPLER-EXT-VEIN UNILAT	$436.73	$727.89	$35.42–$727.89	34% below	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US venous duplex UNI RT	$436.73	$727.89	$35.42–$727.89	34% below	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Duplex Venous Extremity Uni	$73.49	$122.49	$35.42–$727.89	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US venous duplex UNI RT	$436.73	$727.89	$35.42–$727.89	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US venous duplex UNI LT	$436.73	$727.89	$35.42–$727.89	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DOPPLER-EXT-VEIN UNILAT	$436.73	$727.89	$35.42–$727.89	—	40%
Wrist X-ray, 2 views one side CPT 73100 SCAPHOID SERIES RT	$239.50	$399.17	$30.68–$615.43	10% below	40%
Wrist X-ray, 2 views one side CPT 73100 SCAPHOID SERIES LT	$283.58	$472.63	$30.68–$615.43	6% above	40%
Wrist X-ray, 2 views one side CPT 73100 XR WRIST LT 2V	$369.26	$615.43	$30.68–$615.43	38% above	40%
Wrist X-ray, 2 views one side CPT 73100 XR WRIST RT 2V	$369.26	$615.43	$30.68–$615.43	38% above	40%
Wrist X-ray, 2 views inpatient one side CPT 73100 SCAPHOID SERIES RT	$239.50	$399.17	$30.68–$615.43	—	40%
Wrist X-ray, 2 views inpatient one side CPT 73100 SCAPHOID SERIES LT	$283.58	$472.63	$30.68–$615.43	—	40%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST RT 2V	$369.26	$615.43	$30.68–$615.43	—	40%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST LT 2V	$369.26	$615.43	$30.68–$615.43	—	40%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST MIN 3 VIEW LT	$283.58	$472.63	$13.51–$472.63	13% below	40%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST MIN 3 VIEW RT	$283.58	$472.63	$13.51–$472.63	13% below	40%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR wrist RT min 3v	$283.58	$472.63	$13.51–$472.63	13% below	40%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR wrist LT min 3v	$283.58	$472.63	$13.51–$472.63	13% below	40%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST MIN 3 VIEW RT	$283.58	$472.63	$13.51–$472.63	—	40%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR wrist RT min 3v	$283.58	$472.63	$13.51–$472.63	—	40%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST MIN 3 VIEW LT	$283.58	$472.63	$13.51–$472.63	—	40%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR wrist LT min 3v	$283.58	$472.63	$13.51–$472.63	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 PELVIS 2-3 VIEWS UNI LT	$220.27	$367.11	$17.51–$367.11	27% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP 2-3 VIEW UNI RT	$220.27	$367.11	$17.51–$367.11	27% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP 2-3 VIEW UNI LT	$220.27	$367.11	$17.51–$367.11	27% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 PELVIS 2-3 VIEW RT	$220.27	$367.11	$17.51–$367.11	27% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP 2-3 VIEW UNI RT	$220.27	$367.11	$17.51–$367.11	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 PELVIS 2-3 VIEW RT	$220.27	$367.11	$17.51–$367.11	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP 2-3 VIEW UNI LT	$220.27	$367.11	$17.51–$367.11	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 PELVIS 2-3 VIEWS UNI LT	$220.27	$367.11	$17.51–$367.11	—	40%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW	$186.33	$310.55	$14.31–$310.55	30% below	40%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 VIEW	$186.33	$310.55	$14.31–$310.55	—	40%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE RT 2V	$383.78	$639.63	$29.44–$639.63	38% above	40%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE LT 2V	$383.78	$639.63	$29.44–$639.63	38% above	40%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE RT 2V	$383.78	$639.63	$29.44–$639.63	—	40%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE LT 2V	$383.78	$639.63	$29.44–$639.63	—	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER(S) MIN 2 VIEW LT	$280.25	$467.09	$11.13–$467.09	5% above	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER(S) 2 VIEW RT	$280.25	$467.09	$11.13–$467.09	5% above	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER(S) MIN 2 VIEW LT	$280.25	$467.09	$11.13–$467.09	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER(S) 2 VIEW RT	$280.25	$467.09	$11.13–$467.09	—	40%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT LT 2V	$365.67	$609.45	$28.19–$609.45	33% above	40%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT RT 2V	$365.67	$609.45	$28.19–$609.45	33% above	40%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT RT 2V	$365.67	$609.45	$28.19–$609.45	—	40%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT LT 2V	$365.67	$609.45	$28.19–$609.45	—	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR foot RT min 3V	$137.29	$228.81	$13.24–$494.05	60% below	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT MIN 3 VIEW RT	$296.43	$494.05	$13.24–$494.05	14% below	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR foot LT min 3V	$296.43	$494.05	$13.24–$494.05	14% below	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT MIN 3 VIEW LT	$296.43	$494.05	$13.24–$494.05	14% below	40%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR foot RT min 3V	$137.29	$228.81	$13.24–$494.05	—	40%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR foot LT min 3V	$296.43	$494.05	$13.24–$494.05	—	40%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT MIN 3 VIEW LT	$296.43	$494.05	$13.24–$494.05	—	40%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT MIN 3 VIEW RT	$296.43	$494.05	$13.24–$494.05	—	40%
X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 VIEW LT	$285.49	$475.81	$15.41–$475.81	17% below	40%
X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 VIEW RT	$285.49	$475.81	$15.41–$475.81	17% below	40%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 VIEW RT	$285.49	$475.81	$15.41–$475.81	—	40%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 VIEW LT	$285.49	$475.81	$15.41–$475.81	—	40%
X-ray of the knee, 1 or 2 views one side CPT 73560 PATELLA 1/2 VIEW UNI RT	$137.29	$228.81	$13.25–$639.63	52% below	40%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE TUNNEL LEFT	$269.43	$449.05	$13.25–$639.63	7% below	40%
X-ray of the knee, 1 or 2 views one side CPT 73560 PATELLA 1/2 VIEW UNI LT	$269.43	$449.05	$13.25–$639.63	7% below	40%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE RT 2 VIEWS	$269.43	$449.05	$13.25–$639.63	7% below	40%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE LT 2V	$383.78	$639.63	$13.25–$639.63	33% above	40%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PATELLA 1/2 VIEW UNI RT	$137.29	$228.81	$13.25–$639.63	—	40%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PATELLA 1/2 VIEW UNI LT	$269.43	$449.05	$13.25–$639.63	—	40%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE TUNNEL LEFT	$269.43	$449.05	$13.25–$639.63	—	40%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE RT 2 VIEWS	$269.43	$449.05	$13.25–$639.63	—	40%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE LT 2V	$383.78	$639.63	$13.25–$639.63	—	40%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE-AP AND LAT	$371.00	$618.33	$17.18–$618.33	17% below	40%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR SPINE-AP AND LAT	$371.00	$618.33	$17.18–$618.33	—	40%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE 5 VIEWS	$408.30	$680.50	$37.69–$680.50	26% below	40%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPINE 5 VIEWS	$408.30	$680.50	$37.69–$680.50	—	40%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES	$317.65	$529.41	$31.90–$529.41	6% above	40%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES	$317.65	$529.41	$31.90–$529.41	—	40%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVIVAL SPINE- 2/3 VIEWS	$317.73	$529.55	$27.37–$529.55	11% below	40%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVIVAL SPINE- 2/3 VIEWS	$317.73	$529.55	$27.37–$529.55	—	40%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1/2 VIEW	$317.65	$529.41	$13.51–$529.41	9% below	40%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1/2 VIEW	$317.65	$529.41	$13.51–$529.41	—	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 COCCYX	$317.00	$528.34	$13.79–$528.34	8% below	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM	$317.00	$528.34	$13.79–$528.34	8% below	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM	$317.00	$528.34	$13.79–$528.34	—	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 COCCYX	$317.00	$528.34	$13.79–$528.34	—	40%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT (ALT)	$18.54	$30.90	$18.54–$30.90	66% below	40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT (ALT)	$18.54	$30.90	$18.54–$30.90	—	40%
AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT (AST)	$18.54	$30.90	$18.54–$30.90	66% below	40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT (AST)	$18.54	$30.90	$18.54–$30.90	—	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Q-HEPATITIS PANEL, ACUTE W/REF	$29.44	$49.06	$29.44–$578.47	89% below	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$86.52	$144.20	$29.44–$578.47	67% below	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS EXPOSURE PANEL	$114.33	$190.55	$29.44–$578.47	56% below	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PROFILE ACUTE	$347.08	$578.47	$29.44–$578.47	33% above	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Q-HEPATITIS PANEL, ACUTE W/REF	$29.44	$49.06	$29.44–$578.47	—	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$86.52	$144.20	$29.44–$578.47	—	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS EXPOSURE PANEL	$114.33	$190.55	$29.44–$578.47	—	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PROFILE ACUTE	$347.08	$578.47	$29.44–$578.47	—	40%
Albumin blood test CPT 82040 ALBUMIN, SERUM	$44.37	$73.95	$44.37–$73.95	3% above	40%
Albumin blood test inpatient CPT 82040 ALBUMIN, SERUM	$44.37	$73.95	$44.37–$73.95	—	40%
Aldosterone blood test CPT 82088 ALDOSTERONE	$167.40	$279.00	$167.40–$279.00	1% above	40%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE	$167.40	$279.00	$167.40–$279.00	—	40%
Alkaline phosphatase (ALP) blood test CPT 84075 LEUKOCYTE ALKALINE PHOPHATASE	$25.96	$43.26	$25.96–$116.00	53% below	40%
Alkaline phosphatase (ALP) blood test CPT 84075 ALK PHOS ISOENZYMES	$39.74	$66.24	$25.96–$116.00	28% below	40%
Alkaline phosphatase (ALP) blood test CPT 84075 ALKA PHOSPHATOSE, SERUM	$69.60	$116.00	$25.96–$116.00	27% above	40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 LEUKOCYTE ALKALINE PHOPHATASE	$25.96	$43.26	$25.96–$116.00	—	40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALK PHOS ISOENZYMES	$39.74	$66.24	$25.96–$116.00	—	40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKA PHOSPHATOSE, SERUM	$69.60	$116.00	$25.96–$116.00	—	40%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA 1 FETOPROTEIN	$130.50	$217.50	$130.50–$217.50	12% above	40%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA 1 FETOPROTEIN	$130.50	$217.50	$130.50–$217.50	—	40%
Ammonia blood test CPT 82140 AMMONIA (BLOOD)	$95.17	$158.62	$95.17–$158.62	13% below	40%
Ammonia blood test inpatient CPT 82140 AMMONIA (BLOOD)	$95.17	$158.62	$95.17–$158.62	—	40%
Amylase blood test CPT 82150 AMYLASE, URINE	$25.34	$42.23	$25.34–$178.54	69% below	40%
Amylase blood test CPT 82150 AMYLASE PERICARDIAL FLUID	$25.34	$42.23	$25.34–$178.54	69% below	40%
Amylase blood test CPT 82150 AMYLASE-BODY FLUID	$25.34	$42.23	$25.34–$178.54	69% below	40%
Amylase blood test CPT 82150 AMYLASE URINE 24 HR	$25.34	$42.23	$25.34–$178.54	69% below	40%
Amylase blood test CPT 82150 AMYLASE SYNOVIAL FLUID	$25.34	$42.23	$25.34–$178.54	69% below	40%
Amylase blood test CPT 82150 AMYLASE, PERITONEAL FLUID	$107.12	$178.54	$25.34–$178.54	33% above	40%
Amylase blood test CPT 82150 AMYLASE, SERUM	$107.12	$178.54	$25.34–$178.54	33% above	40%
Amylase blood test CPT 82150 AMYLASE,PLEURAL FLUID	$107.12	$178.54	$25.34–$178.54	33% above	40%
Amylase blood test inpatient CPT 82150 AMYLASE-BODY FLUID	$25.34	$42.23	$25.34–$178.54	—	40%
Amylase blood test inpatient CPT 82150 AMYLASE URINE 24 HR	$25.34	$42.23	$25.34–$178.54	—	40%
Amylase blood test inpatient CPT 82150 AMYLASE, URINE	$25.34	$42.23	$25.34–$178.54	—	40%
Amylase blood test inpatient CPT 82150 AMYLASE SYNOVIAL FLUID	$25.34	$42.23	$25.34–$178.54	—	40%
Amylase blood test inpatient CPT 82150 AMYLASE PERICARDIAL FLUID	$25.34	$42.23	$25.34–$178.54	—	40%
Amylase blood test inpatient CPT 82150 AMYLASE,PLEURAL FLUID	$107.12	$178.54	$25.34–$178.54	—	40%
Amylase blood test inpatient CPT 82150 AMYLASE, PERITONEAL FLUID	$107.12	$178.54	$25.34–$178.54	—	40%
Amylase blood test inpatient CPT 82150 AMYLASE, SERUM	$107.12	$178.54	$25.34–$178.54	—	40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULINATED PEPTIDE AB	$90.90	$151.50	$90.90–$151.50	8% above	40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULINATED PEPTIDE AB	$90.90	$151.50	$90.90–$151.50	—	40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA	$204.53	$340.88	$204.53–$340.88	121% above	40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA	$204.53	$340.88	$204.53–$340.88	—	40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-TYPE NATRIURETIC PEPTIDE	$100.12	$166.86	$100.12–$250.86	47% below	40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP ON ISTAT	$150.52	$250.86	$100.12–$250.86	20% below	40%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-TYPE NATRIURETIC PEPTIDE	$100.12	$166.86	$100.12–$250.86	—	40%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP ON ISTAT	$150.52	$250.86	$100.12–$250.86	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, LEGIONELLA	$128.89	$214.82	$128.89–$224.75	45% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, EAR	$134.85	$224.75	$128.89–$224.75	52% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, SPUTUM & GRAM STAIN	$134.85	$224.75	$128.89–$224.75	52% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, BODY FLUID & SMEAR	$134.85	$224.75	$128.89–$224.75	52% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, BRONCHIAL AND SMEAR	$134.85	$224.75	$128.89–$224.75	52% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, CSF AND SMEAR	$134.85	$224.75	$128.89–$224.75	52% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, VARIOUS	$134.85	$224.75	$128.89–$224.75	52% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 THROAT CULTURE	$134.85	$224.75	$128.89–$224.75	52% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, FUNGAL RESPIRATORY	$134.85	$224.75	$128.89–$224.75	52% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, LEGIONELLA	$128.89	$214.82	$128.89–$224.75	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, CSF AND SMEAR	$134.85	$224.75	$128.89–$224.75	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 THROAT CULTURE	$134.85	$224.75	$128.89–$224.75	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, BRONCHIAL AND SMEAR	$134.85	$224.75	$128.89–$224.75	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, VARIOUS	$134.85	$224.75	$128.89–$224.75	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, EAR	$134.85	$224.75	$128.89–$224.75	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, BODY FLUID & SMEAR	$134.85	$224.75	$128.89–$224.75	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, SPUTUM & GRAM STAIN	$134.85	$224.75	$128.89–$224.75	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, FUNGAL RESPIRATORY	$134.85	$224.75	$128.89–$224.75	—	40%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$120.61	$201.01	$120.61–$201.01	6% below	40%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$120.61	$201.01	$120.61–$201.01	—	40%
Bilirubin blood test, total CPT 82247 BILIRUBIN, TOTAL	$21.63	$36.05	$21.63–$36.05	64% below	40%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN, TOTAL	$21.63	$36.05	$21.63–$36.05	—	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 CELL BLOCK	$79.23	$132.05	$79.23–$501.71	68% below	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Surg Path Level IV, Gross	$301.03	$501.71	$79.23–$501.71	23% above	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 CELL BLOCK	$79.23	$132.05	$79.23–$501.71	—	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Surg Path Level IV, Gross	$301.03	$501.71	$79.23–$501.71	—	40%
Blood culture for bacteria CPT 87040 BLOOD CULTURE	$142.28	$237.14	$142.28–$237.14	2% below	40%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE	$142.28	$237.14	$142.28–$237.14	—	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD DRAW (VENIPUNCTURE)	$15.45	$25.75	$15.45–$42.54	34% below	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD DRAW ROUTINE(VENIPNCTRE)	$25.52	$42.54	$15.45–$42.54	9% above	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD DRAW (VENIPUNCTURE)	$15.45	$25.75	$15.45–$42.54	—	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD DRAW ROUTINE(VENIPNCTRE)	$25.52	$42.54	$15.45–$42.54	—	40%
Blood glucose (sugar) test CPT 82947 GLUCOSE SERUM RANDOM QNT	$17.92	$29.87	$17.92–$110.00	55% below	40%
Blood glucose (sugar) test CPT 82947 GLUCOSE SERUM QNT	$66.00	$110.00	$17.92–$110.00	66% above	40%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE SERUM RANDOM QNT	$17.92	$29.87	$17.92–$110.00	—	40%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE SERUM QNT	$66.00	$110.00	$17.92–$110.00	—	40%
Blood lead test CPT 83655 LEAD SCREEN	$18.54	$30.90	$18.54–$30.90	66% below	40%
Blood lead test CPT 83655 LEAD ADULT	$18.54	$30.90	$18.54–$30.90	66% below	40%
Blood lead test CPT 83655 LEAD SCREEN ADULT	$18.54	$30.90	$18.54–$30.90	66% below	40%
Blood lead test inpatient CPT 83655 LEAD SCREEN ADULT	$18.54	$30.90	$18.54–$30.90	—	40%
Blood lead test inpatient CPT 83655 LEAD ADULT	$18.54	$30.90	$18.54–$30.90	—	40%
Blood lead test inpatient CPT 83655 LEAD SCREEN	$18.54	$30.90	$18.54–$30.90	—	40%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY, SERUM TEST	$15.45	$25.75	$15.45–$25.75	83% below	40%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY, SERUM TEST	$15.45	$25.75	$15.45–$25.75	—	40%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO GROUP	$183.49	$305.81	$183.49–$305.81	118% above	40%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO GROUP	$183.49	$305.81	$183.49–$305.81	—	40%
Blood urea nitrogen (BUN) test CPT 84520 BUN SERUM QNT	$27.19	$45.32	$27.19–$45.32	44% below	40%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN SERUM QNT	$27.19	$45.32	$27.19–$45.32	—	40%
C-peptide blood test CPT 84681 C-PEPTIDE	$48.82	$81.37	$48.82–$81.37	53% below	40%
C-peptide blood test inpatient CPT 84681 C-PEPTIDE	$48.82	$81.37	$48.82–$81.37	—	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$57.87	$96.45	$57.87–$96.45	16% below	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$57.87	$96.45	$57.87–$96.45	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 LAB Covid19 Infect Agent Test	$31.71	$52.85	$31.71–$250.00	73% below	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Covid-19 N-CDC SARS-COV LAB TE	$150.00	$250.00	$31.71–$250.00	30% above	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19-CORONAVIRUS	$150.00	$250.00	$31.71–$250.00	30% above	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 LAB Covid19 Infect Agent Test	$31.71	$52.85	$31.71–$250.00	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19-CORONAVIRUS	$150.00	$250.00	$31.71–$250.00	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Covid-19 N-CDC SARS-COV LAB TE	$150.00	$250.00	$31.71–$250.00	—	40%
Calcium blood test, total CPT 82310 CALCIUM SERUM TTL	$23.48	$39.14	$23.48–$39.14	46% below	40%
Calcium blood test, total inpatient CPT 82310 CALCIUM SERUM TTL	$23.48	$39.14	$23.48–$39.14	—	40%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA	$120.60	$201.00	$120.60–$201.00	16% below	40%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA	$120.60	$201.00	$120.60–$201.00	—	40%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER VIRUS IGG ABY	$51.60	$86.00	$51.60–$88.58	29% below	40%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER VIRUS IGG AB	$51.60	$86.00	$51.60–$88.58	29% below	40%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER VIRUS IGM AB	$53.15	$88.58	$51.60–$88.58	27% below	40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER VIRUS IGG AB	$51.60	$86.00	$51.60–$88.58	—	40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER VIRUS IGG ABY	$51.60	$86.00	$51.60–$88.58	—	40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER VIRUS IGM AB	$53.15	$88.58	$51.60–$88.58	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA PROBE, THROAT	$40.17	$66.95	$40.17–$170.00	67% below	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA PCR	$102.00	$170.00	$40.17–$170.00	17% below	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA PROBE, THROAT	$40.17	$66.95	$40.17–$170.00	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA PCR	$102.00	$170.00	$40.17–$170.00	—	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid panel	$91.46	$152.44	$91.46–$326.00	27% below	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$195.60	$326.00	$91.46–$326.00	57% above	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid panel	$91.46	$152.44	$91.46–$326.00	—	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$195.60	$326.00	$91.46–$326.00	—	40%
Complete blood count (CBC) with differential CPT 85025 COMPLETE BLOOD COUNT	$25.96	$43.26	$25.96–$147.86	68% below	40%
Complete blood count (CBC) with differential CPT 85025 CBC	$88.72	$147.86	$25.96–$147.86	11% above	40%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE BLOOD COUNT	$25.96	$43.26	$25.96–$147.86	—	40%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC	$88.72	$147.86	$25.96–$147.86	—	40%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$129.78	$216.30	$129.78–$372.02	17% below	40%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL	$223.21	$372.02	$129.78–$372.02	43% above	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$129.78	$216.30	$129.78–$372.02	—	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL	$223.21	$372.02	$129.78–$372.02	—	40%
Cortisol blood test, total CPT 82533 CORTISOL LEVEL	$99.65	$166.09	$99.65–$166.09	11% below	40%
Cortisol blood test, total inpatient CPT 82533 CORTISOL LEVEL	$99.65	$166.09	$99.65–$166.09	—	40%
Creatine kinase (CK) blood test, total CPT 82550 CPK/CREATINE PHOSPHOKN TTL	$76.80	$128.00	$76.80–$128.00	15% above	40%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK/CREATINE PHOSPHOKN TTL	$76.80	$128.00	$76.80–$128.00	—	40%
Creatinine blood test CPT 82565 CREATININE, SERUM	$22.25	$37.08	$22.25–$37.08	53% below	40%
Creatinine blood test inpatient CPT 82565 CREATININE, SERUM	$22.25	$37.08	$22.25–$37.08	—	40%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV IgG by EIA	$50.89	$84.82	$50.89–$91.67	42% below	40%
Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGALVIRUS IGG	$55.00	$91.67	$50.89–$91.67	37% below	40%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV-IGG ANTIBODY	$55.00	$91.67	$50.89–$91.67	37% below	40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV IgG by EIA	$50.89	$84.82	$50.89–$91.67	—	40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV-IGG ANTIBODY	$55.00	$91.67	$50.89–$91.67	—	40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGALVIRUS IGG	$55.00	$91.67	$50.89–$91.67	—	40%
D-dimer blood test (blood clot marker) CPT 85379 D DIMER QNT	$93.23	$155.39	$93.23–$155.39	22% below	40%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D DIMER QNT	$93.23	$155.39	$93.23–$155.39	—	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE METHADONE	$96.01	$160.01	$96.01–$996.43	4% below	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE PCP	$186.02	$310.03	$96.01–$996.43	87% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE BARBITURATES	$186.02	$310.03	$96.01–$996.43	87% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE OPIATE	$186.02	$310.03	$96.01–$996.43	87% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE AMPHETAMINE	$186.02	$310.03	$96.01–$996.43	87% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ETHYL ALCOHOL	$186.02	$310.03	$96.01–$996.43	87% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Fentanyl w Confirmation	$186.02	$310.03	$96.01–$996.43	87% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 METHADONE URINE	$186.02	$310.03	$96.01–$996.43	87% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE COCAINE	$186.02	$310.03	$96.01–$996.43	87% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 OXYCODONE	$186.02	$310.03	$96.01–$996.43	87% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE BENZO	$186.02	$310.03	$96.01–$996.43	87% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE CANNAB	$186.02	$310.03	$96.01–$996.43	87% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE SUBOXONE (BUPRENORPHINE)	$270.68	$451.14	$96.01–$996.43	172% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HEROIN METABOLITE	$597.86	$996.43	$96.01–$996.43	500% above	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE METHADONE	$96.01	$160.01	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Fentanyl w Confirmation	$186.02	$310.03	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE OPIATE	$186.02	$310.03	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE COCAINE	$186.02	$310.03	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE CANNAB	$186.02	$310.03	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ETHYL ALCOHOL	$186.02	$310.03	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE AMPHETAMINE	$186.02	$310.03	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE PCP	$186.02	$310.03	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 METHADONE URINE	$186.02	$310.03	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE BENZO	$186.02	$310.03	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE BARBITURATES	$186.02	$310.03	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 OXYCODONE	$186.02	$310.03	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE SUBOXONE (BUPRENORPHINE)	$270.68	$451.14	$96.01–$996.43	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HEROIN METABOLITE	$597.86	$996.43	$96.01–$996.43	—	40%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTES BODY FLUID	$60.56	$100.94	$60.56–$208.00	33% below	40%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTES, PANEL	$124.80	$208.00	$60.56–$208.00	37% above	40%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTES BODY FLUID	$60.56	$100.94	$60.56–$208.00	—	40%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTES, PANEL	$124.80	$208.00	$60.56–$208.00	—	40%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTIEN BARR VIRUS	$67.33	$112.22	$67.33–$112.22	37% below	40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTIEN BARR VIRUS	$67.33	$112.22	$67.33–$112.22	—	40%
Estradiol blood test CPT 82670 ESTRADIOL SERUM	$204.53	$340.89	$204.53–$340.89	86% above	40%
Estradiol blood test inpatient CPT 82670 ESTRADIOL SERUM	$204.53	$340.89	$204.53–$340.89	—	40%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$181.44	$302.40	$181.44–$302.40	51% above	40%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$181.44	$302.40	$181.44–$302.40	—	40%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$156.89	$261.48	$156.89–$261.48	20% above	40%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$156.89	$261.48	$156.89–$261.48	—	40%
Folate (folic acid) blood test CPT 82746 FOLIC ACID SERUM	$147.36	$245.60	$147.36–$245.60	29% above	40%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID SERUM	$147.36	$245.60	$147.36–$245.60	—	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE, FREE T4	$153.00	$255.00	$153.00–$255.00	32% above	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE, FREE T4	$153.00	$255.00	$153.00–$255.00	—	40%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$289.36	$482.26	$289.36–$482.26	131% above	40%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$289.36	$482.26	$289.36–$482.26	—	40%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GAMMA GT	$94.04	$156.74	$94.04–$156.74	61% above	40%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GAMMA GT	$94.04	$156.74	$94.04–$156.74	—	40%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 2HRS PP	$22.87	$38.11	$22.87–$38.11	60% below	40%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 2HRS PP	$22.87	$38.11	$22.87–$38.11	—	40%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 3 HRS	$71.07	$118.45	$71.07–$118.45	45% below	40%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 3 HRS	$71.07	$118.45	$71.07–$118.45	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC PROBE, THROAT	$40.17	$66.95	$40.17–$190.00	66% below	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC PCR GENITAL	$114.00	$190.00	$40.17–$190.00	5% below	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC PCR URINE	$114.00	$190.00	$40.17–$190.00	5% below	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC PROBE, THROAT	$40.17	$66.95	$40.17–$190.00	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC PCR GENITAL	$114.00	$190.00	$40.17–$190.00	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC PCR URINE	$114.00	$190.00	$40.17–$190.00	—	40%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI IGG	$35.84	$59.74	$35.84–$153.47	69% below	40%
H. pylori antibody blood test CPT 86677 H.PYLORI IGG ANTIBODIES	$92.08	$153.47	$35.84–$153.47	21% below	40%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI IGG	$35.84	$59.74	$35.84–$153.47	—	40%
H. pylori antibody blood test inpatient CPT 86677 H.PYLORI IGG ANTIBODIES	$92.08	$153.47	$35.84–$153.47	—	40%
H. pylori stool antigen test CPT 87338 Helicobacter Pylori, Stool	$180.69	$301.15	$180.69–$301.15	55% above	40%
H. pylori stool antigen test inpatient CPT 87338 Helicobacter Pylori, Stool	$180.69	$301.15	$180.69–$301.15	—	40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 VIRAL LOAD-HIV	$300.79	$501.32	$300.79–$501.32	12% below	40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV1 RNA	$300.79	$501.32	$300.79–$501.32	12% below	40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 VIRAL LOAD-HIV	$300.79	$501.32	$300.79–$501.32	—	40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV1 RNA	$300.79	$501.32	$300.79–$501.32	—	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1&2 SCREEN	$85.16	$141.93	$85.16–$141.93	26% below	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1&2 SCREEN	$85.16	$141.93	$85.16–$141.93	—	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C	$67.36	$112.27	$67.36–$122.50	24% below	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 A1C HEMOGLOBIN	$73.50	$122.50	$67.36–$122.50	17% below	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C	$67.36	$112.27	$67.36–$122.50	—	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 A1C HEMOGLOBIN	$73.50	$122.50	$67.36–$122.50	—	40%
Hemoglobin blood test CPT 85018 HEMOGLOBIN	$31.96	$53.26	$31.96–$53.26	1% above	40%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN	$31.96	$53.26	$31.96–$53.26	—	40%
Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE AB	$28.43	$47.38	$28.43–$47.38	64% below	40%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE AB	$28.43	$47.38	$28.43–$47.38	—	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURF AB	$114.25	$190.41	$114.25–$190.41	22% above	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURF AB	$114.25	$190.41	$114.25–$190.41	—	40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURF AG	$110.89	$184.82	$110.89–$184.82	25% above	40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURF AG	$110.89	$184.82	$110.89–$184.82	—	40%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C VIRUS AB	$166.64	$277.74	$166.64–$277.74	49% above	40%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB	$166.64	$277.74	$166.64–$277.74	49% above	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C VIRUS AB	$166.64	$277.74	$166.64–$277.74	—	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB	$166.64	$277.74	$166.64–$277.74	—	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 hcv rna pcr	$324.07	$540.12	$324.07–$540.12	22% above	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 hcv rna pcr	$324.07	$540.12	$324.07–$540.12	—	40%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX VIRUS IGG	$59.95	$99.91	$59.95–$135.96	11% below	40%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX T1&2 AB, CSF	$81.58	$135.96	$59.95–$135.96	21% above	40%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IGM ANTIBODIES	$81.58	$135.96	$59.95–$135.96	21% above	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX VIRUS IGG	$59.95	$99.91	$59.95–$135.96	—	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IGM ANTIBODIES	$81.58	$135.96	$59.95–$135.96	—	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX T1&2 AB, CSF	$81.58	$135.96	$59.95–$135.96	—	40%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IGM ANTIBODIES	$53.69	$89.49	$53.69–$89.49	42% below	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IGM ANTIBODIES	$53.69	$89.49	$53.69–$89.49	—	40%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE HIGH SEN	$22.25	$37.08	$22.25–$37.08	76% below	40%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE HIGH SEN	$22.25	$37.08	$22.25–$37.08	—	40%
Homocysteine blood test CPT 83090 HOMOCYSTEINE,TOTAL	$116.80	$194.67	$116.80–$194.67	3% below	40%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE,TOTAL	$116.80	$194.67	$116.80–$194.67	—	40%
Insulin blood test CPT 83525 INSULIN BLOOD TTL	$83.61	$139.35	$83.61–$139.35	13% above	40%
Insulin blood test inpatient CPT 83525 INSULIN BLOOD TTL	$83.61	$139.35	$83.61–$139.35	—	40%
Iron blood test (serum iron) CPT 83540 IRON, TOTAL	$76.54	$127.56	$76.54–$127.56	1% below	40%
Iron blood test (serum iron) inpatient CPT 83540 IRON, TOTAL	$76.54	$127.56	$76.54–$127.56	—	40%
Iron-binding capacity (TIBC) test CPT 83550 TOTAL IRON BINDING CAPACITY	$36.46	$60.77	$36.46–$60.77	54% below	40%
Iron-binding capacity (TIBC) test inpatient CPT 83550 TOTAL IRON BINDING CAPACITY	$36.46	$60.77	$36.46–$60.77	—	40%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$68.60	$114.33	$68.60–$114.33	54% below	40%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$68.60	$114.33	$68.60–$114.33	—	40%
LH (luteinizing hormone) test CPT 83002 LH LUTENIZING HORMONE	$57.47	$95.79	$57.47–$106.61	50% below	40%
LH (luteinizing hormone) test CPT 83002 LH/FSH PANEL SERUM	$63.97	$106.61	$57.47–$106.61	44% below	40%
LH (luteinizing hormone) test inpatient CPT 83002 LH LUTENIZING HORMONE	$57.47	$95.79	$57.47–$106.61	—	40%
LH (luteinizing hormone) test inpatient CPT 83002 LH/FSH PANEL SERUM	$63.97	$106.61	$57.47–$106.61	—	40%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID VENOUS	$77.25	$128.75	$77.25–$145.55	14% below	40%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID PLASMA	$87.33	$145.55	$77.25–$145.55	3% below	40%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID VENOUS	$77.25	$128.75	$77.25–$145.55	—	40%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID PLASMA	$87.33	$145.55	$77.25–$145.55	—	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH SYNOVIAL FLUID	$24.72	$41.20	$24.72–$151.17	53% below	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH PERICARDIAL FLUID	$24.72	$41.20	$24.72–$151.17	53% below	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH	$90.70	$151.17	$24.72–$151.17	72% above	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH,PLEURAL FLUID	$90.70	$151.17	$24.72–$151.17	72% above	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH PERITONEAL FLUID	$90.70	$151.17	$24.72–$151.17	72% above	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH SYNOVIAL FLUID	$24.72	$41.20	$24.72–$151.17	—	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH PERICARDIAL FLUID	$24.72	$41.20	$24.72–$151.17	—	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH PERITONEAL FLUID	$90.70	$151.17	$24.72–$151.17	—	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH	$90.70	$151.17	$24.72–$151.17	—	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH,PLEURAL FLUID	$90.70	$151.17	$24.72–$151.17	—	40%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$93.60	$156.00	$93.60–$156.00	4% above	40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$93.60	$156.00	$93.60–$156.00	—	40%
Liver function blood test panel CPT 80076 HEPATATIC FUNCTION PANEL	$286.80	$478.00	$286.80–$478.00	105% above	40%
Liver function blood test panel inpatient CPT 80076 HEPATATIC FUNCTION PANEL	$286.80	$478.00	$286.80–$478.00	—	40%
Magnesium blood test CPT 83735 MAGNESIUM	$69.46	$115.77	$69.46–$115.77	1% above	40%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$69.46	$115.77	$69.46–$115.77	—	40%
Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY	$57.07	$95.12	$57.07–$95.12	24% below	40%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ANTIBODY	$57.07	$95.12	$57.07–$95.12	—	40%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN	$53.15	$88.58	$53.15–$106.09	31% below	40%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SCREEN	$63.65	$106.09	$53.15–$106.09	17% below	40%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODY SCREEN	$53.15	$88.58	$53.15–$106.09	—	40%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SCREEN	$63.65	$106.09	$53.15–$106.09	—	40%
Mumps immunity blood test CPT 86735 MUMPS VIRUS ANTIBODY IGG/IGM	$65.18	$108.63	$65.18–$108.63	13% below	40%
Mumps immunity blood test inpatient CPT 86735 MUMPS VIRUS ANTIBODY IGG/IGM	$65.18	$108.63	$65.18–$108.63	—	40%
PSA (prostate-specific antigen) blood test, free CPT 84154 FREE PSA	$50.68	$84.46	$50.68–$84.46	48% below	40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 FREE PSA	$50.68	$84.46	$50.68–$84.46	—	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPEC ANTIGEN (PSA)	$142.55	$237.59	$142.55–$237.59	24% above	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SPEC ANTIGEN (PSA)	$142.55	$237.59	$142.55–$237.59	—	40%
Pap test (liquid-based, automated screening with review) CPT 88175 THINPREP TIS PAP W/REFL HPV mR	$41.12	$68.53	$41.12–$68.53	69% below	40%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 THINPREP TIS PAP W/REFL HPV mR	$41.12	$68.53	$41.12–$68.53	—	40%
Parathyroid hormone (PTH) blood test CPT 83970 PTH. INTACT	$274.85	$458.08	$274.85–$458.08	22% above	40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH. INTACT	$274.85	$458.08	$274.85–$458.08	—	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME	$89.57	$149.29	$89.57–$149.29	36% above	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLASTIN TIME	$89.57	$149.29	$89.57–$149.29	—	40%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS, SERUM	$55.97	$93.28	$55.97–$93.28	4% below	40%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS, SERUM	$55.97	$93.28	$55.97–$93.28	—	40%
Potassium blood test CPT 84132 POTASSIUM, SERUM	$51.47	$85.78	$51.47–$85.78	19% above	40%
Potassium blood test inpatient CPT 84132 POTASSIUM, SERUM	$51.47	$85.78	$51.47–$85.78	—	40%
Progesterone blood test CPT 84144 PROGESTERONE	$168.60	$281.00	$168.60–$281.00	20% above	40%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$168.60	$281.00	$168.60–$281.00	—	40%
Prolactin blood test CPT 84146 PROLACTIN	$192.04	$320.06	$192.04–$320.06	48% above	40%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$192.04	$320.06	$192.04–$320.06	—	40%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$78.44	$130.74	$78.44–$162.74	81% above	40%
Prothrombin time (PT/INR) clotting test CPT 85610 DIC SCREEN	$97.64	$162.74	$78.44–$162.74	125% above	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$78.44	$130.74	$78.44–$162.74	—	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 DIC SCREEN	$97.64	$162.74	$78.44–$162.74	—	40%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TOXICOLOGY, URINE	$74.16	$123.60	$74.16–$123.60	9% below	40%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TOXICOLOGY, URINE	$74.16	$123.60	$74.16–$123.60	—	40%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/OPTIC	$22.87	$38.11	$22.87–$83.59	68% below	40%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A RAPID SCREEN	$50.15	$83.59	$22.87–$83.59	30% below	40%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA ASSAY W/OPTIC	$22.87	$38.11	$22.87–$83.59	—	40%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A RAPID SCREEN	$50.15	$83.59	$22.87–$83.59	—	40%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ASSAY W/OPTIC	$61.49	$102.49	$61.49–$120.41	1% above	40%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP SCREEN, THROAT	$72.25	$120.41	$61.49–$120.41	18% above	40%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A ASSAY W/OPTIC	$61.49	$102.49	$61.49–$120.41	—	40%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP SCREEN, THROAT	$72.25	$120.41	$61.49–$120.41	—	40%
Renin blood test CPT 84244 RENIN, PLASHA	$68.60	$114.33	$68.60–$114.33	40% below	40%
Renin blood test inpatient CPT 84244 RENIN, PLASHA	$68.60	$114.33	$68.60–$114.33	—	40%
Rh blood typing CPT 86901 TYPE & SCREEN	$62.77	$104.62	$62.77–$265.86	7% below	40%
Rh blood typing CPT 86901 RH TYPE	$159.52	$265.86	$62.77–$265.86	137% above	40%
Rh blood typing inpatient CPT 86901 TYPE & SCREEN	$62.77	$104.62	$62.77–$265.86	—	40%
Rh blood typing inpatient CPT 86901 RH TYPE	$159.52	$265.86	$62.77–$265.86	—	40%
Rubella antibody test (immunity check) CPT 86762 RUBELLA SCREEN	$66.05	$110.09	$66.05–$110.09	10% below	40%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA SCREEN	$66.05	$110.09	$66.05–$110.09	—	40%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS	$57.08	$95.14	$57.08–$95.14	61% below	40%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANALYSIS	$57.08	$95.14	$57.08–$95.14	—	40%
Sodium blood test CPT 84295 SODIUM, SERUM	$18.54	$30.90	$18.54–$30.90	62% below	40%
Sodium blood test inpatient CPT 84295 SODIUM, SERUM	$18.54	$30.90	$18.54–$30.90	—	40%
Stool ova and parasites exam CPT 87177 OVA & PARASITE STOOL	$105.00	$175.00	$105.00–$175.00	40% above	40%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITE STOOL	$105.00	$175.00	$105.00–$175.00	—	40%
Syphilis antibody test (Treponema pallidum) CPT 86780 FTA-ABS	$39.60	$66.00	$39.60–$66.00	40% below	40%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 FTA-ABS	$39.60	$66.00	$39.60–$66.00	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, CSF	$10.51	$17.51	$10.51–$96.14	79% below	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS VDRL RPR QL	$57.68	$96.14	$10.51–$96.14	13% above	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL, CSF	$10.51	$17.51	$10.51–$96.14	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS VDRL RPR QL	$57.68	$96.14	$10.51–$96.14	—	40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB GOLD TEST	$148.79	$247.99	$148.79–$247.99	33% below	40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB GOLD TEST	$148.79	$247.99	$148.79–$247.99	—	40%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE SERUM TTL	$71.07	$118.45	$71.07–$462.24	44% below	40%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$277.34	$462.24	$71.07–$462.24	119% above	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE SERUM TTL	$71.07	$118.45	$71.07–$462.24	—	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL	$277.34	$462.24	$71.07–$462.24	—	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB	$55.00	$91.67	$55.00–$91.67	31% below	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AB	$55.00	$91.67	$55.00–$91.67	—	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH3	$80.96	$134.93	$80.96–$281.00	27% below	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$168.60	$281.00	$80.96–$281.00	52% above	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH3	$80.96	$134.93	$80.96–$281.00	—	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$168.60	$281.00	$80.96–$281.00	—	40%
Total IgE blood test CPT 82785 IMMUNOGLOBULIN E	$30.90	$51.50	$30.90–$51.50	65% below	40%
Total IgE blood test CPT 82785 ASSAY OF GAMMAGLOBULIN IGE	$30.90	$51.50	$30.90–$51.50	65% below	40%
Total IgE blood test inpatient CPT 82785 ASSAY OF GAMMAGLOBULIN IGE	$30.90	$51.50	$30.90–$51.50	—	40%
Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN E	$30.90	$51.50	$30.90–$51.50	—	40%
Total cholesterol blood test CPT 82465 CHOLESTEROL TOTAL	$18.54	$30.90	$18.54–$102.28	57% below	40%
Total cholesterol blood test CPT 82465 CHOLESTEROL, PLEURAL FLUID	$24.72	$41.20	$18.54–$102.28	42% below	40%
Total cholesterol blood test CPT 82465 CHOLESTEROL,SYNOVIAL FLUID	$24.72	$41.20	$18.54–$102.28	42% below	40%
Total cholesterol blood test CPT 82465 CHOLESTEROL.PERICARDIAL FLUID	$24.72	$41.20	$18.54–$102.28	42% below	40%
Total cholesterol blood test CPT 82465 CHOLESTEROL,PERITONEAL FLUID	$50.55	$84.25	$18.54–$102.28	18% above	40%
Total cholesterol blood test CPT 82465 LIPROPROTEIN ELECTROPHORESIS	$61.37	$102.28	$18.54–$102.28	44% above	40%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL TOTAL	$18.54	$30.90	$18.54–$102.28	—	40%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL,SYNOVIAL FLUID	$24.72	$41.20	$18.54–$102.28	—	40%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL.PERICARDIAL FLUID	$24.72	$41.20	$18.54–$102.28	—	40%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL, PLEURAL FLUID	$24.72	$41.20	$18.54–$102.28	—	40%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL,PERITONEAL FLUID	$50.55	$84.25	$18.54–$102.28	—	40%
Total cholesterol blood test inpatient CPT 82465 LIPROPROTEIN ELECTROPHORESIS	$61.37	$102.28	$18.54–$102.28	—	40%
Total thyroxine (T4) blood test CPT 84436 T4	$132.92	$221.54	$132.92–$221.54	61% above	40%
Total thyroxine (T4) blood test inpatient CPT 84436 T4	$132.92	$221.54	$132.92–$221.54	—	40%
Total triiodothyronine (T3) blood test CPT 84480 T3T	$128.57	$214.28	$128.57–$214.28	34% above	40%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3T	$128.57	$214.28	$128.57–$214.28	—	40%
Transferrin blood test CPT 84466 TRANSFERRIN	$102.32	$170.53	$102.32–$170.53	8% above	40%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$102.32	$170.53	$102.32–$170.53	—	40%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMP	$179.39	$298.99	$179.39–$298.99	44% above	40%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMP	$179.39	$298.99	$179.39–$298.99	—	40%
Triglycerides blood test CPT 84478 TRIGLYCERIDE SYNOVIAL FLUID	$29.66	$49.44	$29.66–$134.02	38% below	40%
Triglycerides blood test CPT 84478 TRIGLYCERIDE PERICARDIAL FLUID	$29.66	$49.44	$29.66–$134.02	38% below	40%
Triglycerides blood test CPT 84478 TRIGLYCERIDE,PLEURAL FLUID	$29.66	$49.44	$29.66–$134.02	38% below	40%
Triglycerides blood test CPT 84478 TRIGLYCERIDES	$80.41	$134.02	$29.66–$134.02	69% above	40%
Triglycerides blood test CPT 84478 TRIGLYCERIDE,PERITONEAL FLUID	$80.41	$134.02	$29.66–$134.02	69% above	40%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDE PERICARDIAL FLUID	$29.66	$49.44	$29.66–$134.02	—	40%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDE,PLEURAL FLUID	$29.66	$49.44	$29.66–$134.02	—	40%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDE SYNOVIAL FLUID	$29.66	$49.44	$29.66–$134.02	—	40%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES	$80.41	$134.02	$29.66–$134.02	—	40%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDE,PERITONEAL FLUID	$80.41	$134.02	$29.66–$134.02	—	40%
Troponin test, quantitative CPT 84484 TROPONIN I QNT	$126.82	$211.37	$126.82–$211.37	15% below	40%
Troponin test, quantitative inpatient CPT 84484 TROPONIN I QNT	$126.82	$211.37	$126.82–$211.37	—	40%
Uric acid blood test CPT 84550 URIC ACID, SERUM	$52.73	$87.89	$52.73–$87.89	25% below	40%
Uric acid blood test inpatient CPT 84550 URIC ACID, SERUM	$52.73	$87.89	$52.73–$87.89	—	40%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS BY DIP	$43.80	$73.00	$43.80–$73.00	95% above	40%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS BY DIP	$43.80	$73.00	$43.80–$73.00	—	40%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE	$29.66	$49.44	$29.66–$49.44	17% above	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O SCOPE	$29.66	$49.44	$29.66–$49.44	—	40%
Urinalysis without microscope exam, manual CPT 81002 OCCULT BLOOD, URINE	$13.60	$22.66	$13.60–$49.44	40% below	40%
Urinalysis without microscope exam, manual CPT 81002 SUGAR QUAL URINE	$13.60	$22.66	$13.60–$49.44	40% below	40%
Urinalysis without microscope exam, manual CPT 81002 PROTEIN QUALITATIVE, URINE	$13.60	$22.66	$13.60–$49.44	40% below	40%
Urinalysis without microscope exam, manual CPT 81002 KETONES, URINE	$13.60	$22.66	$13.60–$49.44	40% below	40%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$29.66	$49.44	$13.60–$49.44	32% above	40%
Urinalysis without microscope exam, manual inpatient CPT 81002 PROTEIN QUALITATIVE, URINE	$13.60	$22.66	$13.60–$49.44	—	40%
Urinalysis without microscope exam, manual inpatient CPT 81002 OCCULT BLOOD, URINE	$13.60	$22.66	$13.60–$49.44	—	40%
Urinalysis without microscope exam, manual inpatient CPT 81002 KETONES, URINE	$13.60	$22.66	$13.60–$49.44	—	40%
Urinalysis without microscope exam, manual inpatient CPT 81002 SUGAR QUAL URINE	$13.60	$22.66	$13.60–$49.44	—	40%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$29.66	$49.44	$13.60–$49.44	—	40%
Urine culture for bacteria, with colony count CPT 87086 CULTURE, URINE	$72.00	$120.00	$72.00–$120.00	21% below	40%
Urine culture for bacteria, with colony count CPT 87086 CULTURE, CATHETER TIP	$72.00	$120.00	$72.00–$120.00	21% below	40%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE, URINE	$72.00	$120.00	$72.00–$120.00	—	40%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE, CATHETER TIP	$72.00	$120.00	$72.00–$120.00	—	40%
Urine microalbumin (albumin) test CPT 82043 URINE ALBUMIN QUANTITATIVE	$88.10	$146.83	$3.57–$146.83	31% above	40%
Urine microalbumin (albumin) test inpatient CPT 82043 URINE ALBUMIN QUANTITATIVE	$88.10	$146.83	$3.57–$146.83	—	40%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$33.59	$55.98	$2.60–$120.03	55% below	40%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST	$72.02	$120.03	$2.60–$120.03	3% below	40%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST	$33.59	$55.98	$2.60–$120.03	—	40%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST	$72.02	$120.03	$2.60–$120.03	—	40%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B 12	$138.16	$230.27	$138.16–$230.27	7% above	40%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B 12	$138.16	$230.27	$138.16–$230.27	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 1,25 DIHYDROXY	$93.32	$155.53	$93.32–$301.00	49% below	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D, 25-HYDROXY	$180.60	$301.00	$93.32–$301.00	1% below	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 1,25 DIHYDROXY	$93.32	$155.53	$93.32–$301.00	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25-HYDROXY	$180.60	$301.00	$93.32–$301.00	—	40%
Zinc blood test CPT 84630 ZINC, SERUM	$38.06	$63.43	$38.06–$63.43	46% below	40%
Zinc blood test CPT 84630 ZINC URINE	$38.06	$63.43	$38.06–$63.43	46% below	40%
Zinc blood test inpatient CPT 84630 ZINC URINE	$38.06	$63.43	$38.06–$63.43	—	40%
Zinc blood test inpatient CPT 84630 ZINC, SERUM	$38.06	$63.43	$38.06–$63.43	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG, QUANTITAVE	$130.80	$218.00	$130.80–$218.00	22% above	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG, QUANTITAVE	$130.80	$218.00	$130.80–$218.00	—	40%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BREAST BX STEREO W/IMG 1ST LES	$2,369.63	$3,949.38	$2,369.63–$3,949.38	23% below	40%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BREAST BX STEREO W/IMG 1ST LES	$2,369.63	$3,949.38	$2,369.63–$3,949.38	—	40%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE EA	$327.13	$545.21	$327.13–$545.21	49% below	40%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 TREAT METATARSAL FRACTURE EA	$327.13	$545.21	$327.13–$545.21	—	40%
Cardiac catheterization with coronary angiogram CPT 93458 L HRT ARTERY/VENTRICLE ANGIO	$4,675.03	$7,791.72	$4,675.03–$7,791.72	54% below	40%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 L HRT ARTERY/VENTRICLE ANGIO	$4,675.03	$7,791.72	$4,675.03–$7,791.72	—	40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION,EXTERNAL LVL4&5	$929.40	$1,549.00	$929.40–$1,549.00	22% below	40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 ELECTIVE CARDIOVERSION	$929.40	$1,549.00	$929.40–$1,549.00	22% below	40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ELECTIVE CARDIOVERSION	$929.40	$1,549.00	$929.40–$1,549.00	—	40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION,EXTERNAL LVL4&5	$929.40	$1,549.00	$929.40–$1,549.00	—	40%
Cataract surgery with lens implant one side CPT 66984 CATARACT REMOVAL W/IOL RT PF	$879.59	$1,465.98	$879.59–$1,465.98	85% below	40%
Cataract surgery with lens implant one side CPT 66984 PF CATARACT REMOVAL LT	$879.59	$1,465.98	$879.59–$1,465.98	85% below	40%
Cataract surgery with lens implant inpatient one side CPT 66984 CATARACT REMOVAL W/IOL RT PF	$879.59	$1,465.98	$879.59–$1,465.98	—	40%
Cataract surgery with lens implant inpatient one side CPT 66984 PF CATARACT REMOVAL LT	$879.59	$1,465.98	$879.59–$1,465.98	—	40%
Cervical biopsy CPT 57500 PF BX/EXC CERVIX LOCAL	$579.56	$965.94	$579.56–$965.94	39% below	40%
Cervical biopsy inpatient CPT 57500 PF BX/EXC CERVIX LOCAL	$579.56	$965.94	$579.56–$965.94	—	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 PF CIRCUM W/CLAMP / OTHER DVC	$158.04	$263.40	$158.04–$263.40	90% below	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUM W/CLAMP / OTHER DVC	$158.04	$263.40	$158.04–$263.40	90% below	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUM W/CLAMP / OTHER DVC	$158.04	$263.40	$158.04–$263.40	—	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 PF CIRCUM W/CLAMP / OTHER DVC	$158.04	$263.40	$158.04–$263.40	—	40%
Colonoscopy with polyp removal CPT 45385 Flexible colonoscopy w/snar PF	$1,673.10	$2,788.50	$1,673.10–$3,141.67	41% below	40%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY FLEX W/REM SNARE	$1,813.28	$3,022.14	$1,673.10–$3,141.67	36% below	40%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY DX	$1,885.00	$3,141.67	$1,673.10–$3,141.67	33% below	40%
Colonoscopy with polyp removal inpatient CPT 45385 Flexible colonoscopy w/snar PF	$1,673.10	$2,788.50	$1,673.10–$3,141.67	—	40%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY FLEX W/REM SNARE	$1,813.28	$3,022.14	$1,673.10–$3,141.67	—	40%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY DX	$1,885.00	$3,141.67	$1,673.10–$3,141.67	—	40%
Colonoscopy with tissue sample CPT 45380 COLORECTAL SCRN; HI RISK IND	$734.61	$1,224.35	$734.61–$3,022.14	73% below	40%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY FLEX W/BIOPSY PF	$1,673.10	$2,788.50	$734.61–$3,022.14	39% below	40%
Colonoscopy with tissue sample CPT 45380 Colonoscopy, flexible; w biops	$1,673.10	$2,788.50	$734.61–$3,022.14	39% below	40%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY FLEX W/BIOPSY	$1,813.28	$3,022.14	$734.61–$3,022.14	34% below	40%
Colonoscopy with tissue sample inpatient CPT 45380 COLORECTAL SCRN; HI RISK IND	$734.61	$1,224.35	$734.61–$3,022.14	—	40%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY FLEX W/BIOPSY PF	$1,673.10	$2,788.50	$734.61–$3,022.14	—	40%
Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy, flexible; w biops	$1,673.10	$2,788.50	$734.61–$3,022.14	—	40%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY FLEX W/BIOPSY	$1,813.28	$3,022.14	$734.61–$3,022.14	—	40%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLEXIBLE PF	$290.23	$483.72	$290.23–$2,188.73	88% below	40%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLEXIBLE	$834.67	$1,391.12	$290.23–$2,188.73	65% below	40%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY > 1 HOUR	$1,313.24	$2,188.73	$290.23–$2,188.73	45% below	40%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLEXIBLE PF	$290.23	$483.72	$290.23–$2,188.73	—	40%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLEXIBLE	$834.67	$1,391.12	$290.23–$2,188.73	—	40%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY > 1 HOUR	$1,313.24	$2,188.73	$290.23–$2,188.73	—	40%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 PF COLPOSCOPY W/BX&CURETTAGE	$228.91	$381.51	$228.91–$381.51	52% below	40%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 PF COLPOSCOPY W/BX&CURETTAGE	$228.91	$381.51	$228.91–$381.51	—	40%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTAGE PF	$376.11	$626.85	$376.11–$626.85	88% below	40%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DILATION AND CURETTAGE PF	$376.11	$626.85	$376.11–$626.85	—	40%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION	$51.91	$86.52	$51.91–$475.60	68% below	40%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION BENIGN LESION, 1ST	$285.36	$475.60	$51.91–$475.60	74% above	40%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION PREMALIG LES,1 WC	$285.36	$475.60	$51.91–$475.60	74% above	40%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALG LESION	$51.91	$86.52	$51.91–$475.60	—	40%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION BENIGN LESION, 1ST	$285.36	$475.60	$51.91–$475.60	—	40%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION PREMALIG LES,1 WC	$285.36	$475.60	$51.91–$475.60	—	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 PF REMOVE CERUMEN IMPACTED IRR	$23.05	$38.42	$23.05–$146.39	80% below	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 EAR IRRIGATION	$25.79	$42.98	$23.05–$146.39	78% below	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 ER REMOVE CERUMEN IMPACTED IRR	$87.83	$146.39	$23.05–$146.39	24% below	40%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 PF REMOVE CERUMEN IMPACTED IRR	$23.05	$38.42	$23.05–$146.39	—	40%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 EAR IRRIGATION	$25.79	$42.98	$23.05–$146.39	—	40%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ER REMOVE CERUMEN IMPACTED IRR	$87.83	$146.39	$23.05–$146.39	—	40%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPCTD CERUMEN 1-2 L4&5	$41.82	$69.70	$41.82–$151.39	67% below	40%
Earwax removal with instruments, one ear CPT 69210 REMVL IMPACTED CERUMEN	$90.83	$151.39	$41.82–$151.39	27% below	40%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPCTD CERUMEN 1-2 L4&5	$41.82	$69.70	$41.82–$151.39	—	40%
Earwax removal with instruments, one ear inpatient CPT 69210 REMVL IMPACTED CERUMEN	$90.83	$151.39	$41.82–$151.39	—	40%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Biopsy of uterus lining PF	$102.53	$170.88	$102.53–$1,681.48	70% below	40%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Endome sampl biopsy w/o cer di	$122.55	$204.25	$102.53–$1,681.48	64% below	40%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL PIPELLE BX	$554.40	$924.00	$102.53–$1,681.48	61% above	40%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Biopsy of uterus lining PF	$102.53	$170.88	$102.53–$1,681.48	—	40%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Endome sampl biopsy w/o cer di	$122.55	$204.25	$102.53–$1,681.48	—	40%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL PIPELLE BX	$554.40	$924.00	$102.53–$1,681.48	—	40%
Eye injection into the vitreous (intravitreal injection) CPT 67028 INJECTION EYE DRUG	$74.16	$123.60	$74.16–$123.60	89% below	40%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 INJECTION EYE DRUG	$74.16	$123.60	$74.16–$123.60	—	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj paravert f jnt l/s 1 lev	$142.05	$236.75	$142.05–$1,282.35	91% below	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj Block lumb/sacr addl	$769.41	$1,282.35	$142.05–$1,282.35	50% below	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Inj paravert f jnt l/s 1 lev	$142.05	$236.75	$142.05–$1,282.35	—	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Inj Block lumb/sacr addl	$769.41	$1,282.35	$142.05–$1,282.35	—	40%
Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE PF	$614.28	$1,023.80	$614.28–$1,023.80	82% below	40%
Hammertoe correction surgery inpatient CPT 28285 REPAIR OF HAMMERTOE PF	$614.28	$1,023.80	$614.28–$1,023.80	—	40%
Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL HYSTERECTOMY PF	$1,650.38	$2,750.63	$1,650.38–$2,750.63	72% below	40%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL HYSTERECTOMY PF	$1,650.38	$2,750.63	$1,650.38–$2,750.63	—	40%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy biopsy PF	$375.51	$625.85	$375.51–$625.85	89% below	40%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 Hysteroscopy biopsy PF	$375.51	$625.85	$375.51–$625.85	—	40%
IUD insertion (the device itself billed separately) CPT 58300 PF INSERT INTRAUTERINE DEVI	$84.63	$141.05	$27.19–$141.05	77% below	40%
IUD insertion (the device itself billed separately) inpatient CPT 58300 PF INSERT INTRAUTERINE DEVI	$84.63	$141.05	$27.19–$141.05	—	40%
Incision and drainage of a simple or single skin abscess CPT 10060 PF I&D ABCESS SIMPLE	$172.20	$287.00	$172.20–$1,649.29	56% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$176.53	$294.22	$172.20–$1,649.29	55% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D ABCESS, SIMPLE/SINGLE	$285.36	$475.60	$172.20–$1,649.29	27% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE LEVEL 4&5	$285.36	$475.60	$172.20–$1,649.29	27% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE / SINGLE	$285.36	$475.60	$172.20–$1,649.29	27% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D OF ABCESS, SIMPLE WC	$340.82	$568.04	$172.20–$1,649.29	13% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 36010060	$989.57	$1,649.29	$172.20–$1,649.29	152% above	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 PF I&D ABCESS SIMPLE	$172.20	$287.00	$172.20–$1,649.29	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$176.53	$294.22	$172.20–$1,649.29	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D ABCESS, SIMPLE/SINGLE	$285.36	$475.60	$172.20–$1,649.29	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE / SINGLE	$285.36	$475.60	$172.20–$1,649.29	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE LEVEL 4&5	$285.36	$475.60	$172.20–$1,649.29	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D OF ABCESS, SIMPLE WC	$340.82	$568.04	$172.20–$1,649.29	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 36010060	$989.57	$1,649.29	$172.20–$1,649.29	—	40%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Prp i/hern init reduc >5 yr PF	$881.09	$1,468.48	$881.09–$1,468.48	79% below	40%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Prp i/hern init reduc >5 yr PF	$881.09	$1,468.48	$881.09–$1,468.48	—	40%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT	$46.35	$77.25	$46.35–$716.09	89% below	40%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECT,TENDON SHEATH,LIGMT/FAS	$46.35	$77.25	$46.35–$716.09	89% below	40%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECT,TENDON SHEATH-LIGMT/FAS	$429.65	$716.09	$46.35–$716.09	at median	40%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT	$46.35	$77.25	$46.35–$716.09	—	40%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECT,TENDON SHEATH,LIGMT/FAS	$46.35	$77.25	$46.35–$716.09	—	40%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECT,TENDON SHEATH-LIGMT/FAS	$429.65	$716.09	$46.35–$716.09	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$61.18	$101.97	$61.18–$716.09	88% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHO/ASPIR/INJ/SHLD/HIP/KNEE	$429.65	$716.09	$61.18–$716.09	13% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 LARGE JOINT ASPIRATION	$429.65	$716.09	$61.18–$716.09	13% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 LARGE JOINT ASPIRATN LEVEL 4&5	$429.65	$716.09	$61.18–$716.09	13% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHO/ASPR/SHLD/HIP/KNEE L4&5	$429.65	$716.09	$61.18–$716.09	13% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION,LG JOINT	$429.65	$716.09	$61.18–$716.09	13% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$61.18	$101.97	$61.18–$716.09	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHO/ASPR/SHLD/HIP/KNEE L4&5	$429.65	$716.09	$61.18–$716.09	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHO/ASPIR/INJ/SHLD/HIP/KNEE	$429.65	$716.09	$61.18–$716.09	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIRATION,LG JOINT	$429.65	$716.09	$61.18–$716.09	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 LARGE JOINT ASPIRATION	$429.65	$716.09	$61.18–$716.09	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 LARGE JOINT ASPIRATN LEVEL 4&5	$429.65	$716.09	$61.18–$716.09	—	40%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 PF INS IMPL DRUG DELIVERY	$108.71	$181.19	$108.71–$181.19	53% below	40%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 PF INS IMPL DRUG DELIVERY	$108.71	$181.19	$108.71–$181.19	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHO/ASPR/INJ WRIST/ELBW L4&5	$429.65	$716.09	$30.90–$716.09	4% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIRATION,MED JOINT-WRST/ANKL	$429.65	$716.09	$30.90–$716.09	4% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHO/ASPIR/INJECT WRIST/ELBOW	$429.65	$716.09	$30.90–$716.09	4% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 MED JOINT ASPIRATION LEVEL 4&5	$429.65	$716.09	$30.90–$716.09	4% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 MEDIUM JOINT ASPIRATION	$429.65	$716.09	$30.90–$716.09	4% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 MED JOINT ASPIRATION LEVEL 4&5	$429.65	$716.09	$30.90–$716.09	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHO/ASPIR/INJECT WRIST/ELBOW	$429.65	$716.09	$30.90–$716.09	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHO/ASPR/INJ WRIST/ELBW L4&5	$429.65	$716.09	$30.90–$716.09	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 MEDIUM JOINT ASPIRATION	$429.65	$716.09	$30.90–$716.09	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASPIRATION,MED JOINT-WRST/ANKL	$429.65	$716.09	$30.90–$716.09	—	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$46.35	$77.25	$46.35–$716.09	85% below	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 SMALL JOINT ASPIRATION/INJ	$429.65	$716.09	$46.35–$716.09	37% above	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 SMALL JOINT ASPIRATION/INJ 4&5	$429.65	$716.09	$46.35–$716.09	37% above	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$46.35	$77.25	$46.35–$716.09	—	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 SMALL JOINT ASPIRATION/INJ	$429.65	$716.09	$46.35–$716.09	—	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 SMALL JOINT ASPIRATION/INJ 4&5	$429.65	$716.09	$46.35–$716.09	—	40%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 PF LAPAROS TOT HYSTR LESS 250G	$1,257.75	$2,096.25	$1,257.75–$2,096.25	92% below	40%
Laparoscopic hysterectomy (uterus 250 g or less) inpatient CPT 58570 PF LAPAROS TOT HYSTR LESS 250G	$1,257.75	$2,096.25	$1,257.75–$2,096.25	—	40%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 PF LAPAR REM TUB/OVAR LESS 250	$1,502.65	$2,504.41	$1,502.65–$2,504.41	87% below	40%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries inpatient CPT 58571 PF LAPAR REM TUB/OVAR LESS 250	$1,502.65	$2,504.41	$1,502.65–$2,504.41	—	40%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy remove adnexa PF	$1,058.74	$1,764.57	$1,058.74–$1,764.57	84% below	40%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 Laparoscopy remove adnexa PF	$1,058.74	$1,764.57	$1,058.74–$1,764.57	—	40%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 PF DISCIS CATARACT SEC LASER	$504.67	$841.11	$504.67–$1,366.74	24% below	40%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 DISCIS CATARACT SEC LASER	$820.04	$1,366.74	$504.67–$1,366.74	23% above	40%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 PF DISCIS CATARACT SEC LASER	$504.67	$841.11	$504.67–$1,366.74	—	40%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 DISCIS CATARACT SEC LASER	$820.04	$1,366.74	$504.67–$1,366.74	—	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 PF ED RPR LAC INT SCLP <2.5CM	$253.33	$422.22	$253.33–$982.57	58% below	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 RPR LAC INT SCLP<2.5CM	$253.33	$422.22	$253.33–$982.57	58% below	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REP INT-S,A,T,E <2.5CM	$589.54	$982.57	$253.33–$982.57	2% below	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REP INT-S,A,T,E<2.5CM LVL4&5	$589.54	$982.57	$253.33–$982.57	2% below	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 PF ED RPR LAC INT SCLP <2.5CM	$253.33	$422.22	$253.33–$982.57	—	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 RPR LAC INT SCLP<2.5CM	$253.33	$422.22	$253.33–$982.57	—	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REP INT-S,A,T,E<2.5CM LVL4&5	$589.54	$982.57	$253.33–$982.57	—	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REP INT-S,A,T,E <2.5CM	$589.54	$982.57	$253.33–$982.57	—	40%
Left heart catheterization, diagnostic one side CPT 93452 LEFT HRT CATH W/VENTRCLGRPHY	$4,675.03	$7,791.72	$4,675.03–$7,791.72	36% below	40%
Left heart catheterization, diagnostic inpatient one side CPT 93452 LEFT HRT CATH W/VENTRCLGRPHY	$4,675.03	$7,791.72	$4,675.03–$7,791.72	—	40%
Lower-back epidural injection, with imaging guidance CPT 62323 Njx interlaminar lmbr/sac	$176.75	$294.58	$176.75–$294.58	88% below	40%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Njx interlaminar lmbr/sac	$176.75	$294.58	$176.75–$294.58	—	40%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 PF	$169.28	$282.14	$169.28–$282.14	88% below	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 PF	$169.28	$282.14	$169.28–$282.14	—	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 PF EXC LESN BGN TRUNK/ARM <0.5	$139.88	$233.13	$139.88–$1,671.10	78% below	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC LESN BGN TRUNK/ARM <0.5CM	$1,002.66	$1,671.10	$139.88–$1,671.10	59% above	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 PF EXC LESN BGN TRUNK/ARM <0.5	$139.88	$233.13	$139.88–$1,671.10	—	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC LESN BGN TRUNK/ARM <0.5CM	$1,002.66	$1,671.10	$139.88–$1,671.10	—	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 PF EXC LESN BGN FACE/EAR <0.5C	$174.91	$291.51	$174.91–$1,740.25	72% below	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC LESN BGN FAC/EAR <0.5CM PF	$174.91	$291.51	$174.91–$1,740.25	72% below	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC LESN BGN FACE/EAR <0.5CM	$1,044.15	$1,740.25	$174.91–$1,740.25	68% above	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 PF EXC LESN BGN FACE/EAR <0.5C	$174.91	$291.51	$174.91–$1,740.25	—	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC LESN BGN FAC/EAR <0.5CM PF	$174.91	$291.51	$174.91–$1,740.25	—	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC LESN BGN FACE/EAR <0.5CM	$1,044.15	$1,740.25	$174.91–$1,740.25	—	40%
Nail removal (partial or complete), one nail CPT 11730 AVULSION OF NAIL PLATE SING PF	$89.45	$149.09	$89.45–$475.60	69% below	40%
Nail removal (partial or complete), one nail CPT 11730 AVIL NAIL PLATE SINGLE-L4&5	$285.36	$475.60	$89.45–$475.60	1% below	40%
Nail removal (partial or complete), one nail CPT 11730 AVIL NAIL PLATE SINGLE/SIMPLE	$285.36	$475.60	$89.45–$475.60	1% below	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION OF NAIL PLATE SING PF	$89.45	$149.09	$89.45–$475.60	—	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVIL NAIL PLATE SINGLE-L4&5	$285.36	$475.60	$89.45–$475.60	—	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVIL NAIL PLATE SINGLE/SIMPLE	$285.36	$475.60	$89.45–$475.60	—	40%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS WITH IMAG	$175.30	$292.16	$164.45–$2,174.15	88% below	40%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS W/IMAGING	$1,304.49	$2,174.15	$164.45–$2,174.15	9% below	40%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS WITH IMAG	$175.30	$292.16	$164.45–$2,174.15	—	40%
Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS W/IMAGING	$1,304.49	$2,174.15	$164.45–$2,174.15	—	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 PF EXC NAIL & MATRIX	$165.45	$275.75	$165.45–$1,415.65	74% below	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL & MATRIX	$165.47	$275.79	$165.45–$1,415.65	74% below	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Removal of the nail plate/matr	$589.54	$982.57	$165.45–$1,415.65	6% below	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL	$589.54	$982.57	$165.45–$1,415.65	6% below	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL BED WC	$849.39	$1,415.65	$165.45–$1,415.65	35% above	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 PF EXC NAIL & MATRIX	$165.45	$275.75	$165.45–$1,415.65	—	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL & MATRIX	$165.47	$275.79	$165.45–$1,415.65	—	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL	$589.54	$982.57	$165.45–$1,415.65	—	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Removal of the nail plate/matr	$589.54	$982.57	$165.45–$1,415.65	—	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL BED WC	$849.39	$1,415.65	$165.45–$1,415.65	—	40%
Prostate biopsy CPT 55700 PF BX PROSTATE NEEDLE	$217.24	$362.07	$217.24–$4,885.22	93% below	40%
Prostate biopsy CPT 55700 BX PROSTATE NEEDLE	$217.25	$362.08	$217.24–$4,885.22	93% below	40%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE SGL/MULT	$2,931.13	$4,885.22	$217.24–$4,885.22	8% below	40%
Prostate biopsy inpatient CPT 55700 PF BX PROSTATE NEEDLE	$217.24	$362.07	$217.24–$4,885.22	—	40%
Prostate biopsy inpatient CPT 55700 BX PROSTATE NEEDLE	$217.25	$362.08	$217.24–$4,885.22	—	40%
Prostate biopsy inpatient CPT 55700 BIOPSY OF PROSTATE SGL/MULT	$2,931.13	$4,885.22	$217.24–$4,885.22	—	40%
Removal of a foreign object under the skin, simple CPT 10120 REMOVAL FOREIGN BODY, SUBQ	$437.54	$729.24	$437.54–$1,620.32	9% below	40%
Removal of a foreign object under the skin, simple CPT 10120 REM FB SUBCU TISSUE SIMPLE	$589.54	$982.57	$437.54–$1,620.32	22% above	40%
Removal of a foreign object under the skin, simple CPT 10120 REMOVAL FB-SUBCU TIS,SIMPLE WC	$972.19	$1,620.32	$437.54–$1,620.32	101% above	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVAL FOREIGN BODY, SUBQ	$437.54	$729.24	$437.54–$1,620.32	—	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REM FB SUBCU TISSUE SIMPLE	$589.54	$982.57	$437.54–$1,620.32	—	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVAL FB-SUBCU TIS,SIMPLE WC	$972.19	$1,620.32	$437.54–$1,620.32	—	40%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 PF COLON CANCER SCR NON-HR	$310.40	$517.33	$310.40–$517.33	88% below	40%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CANCER SCR NON-HR	$1,283.96	$2,139.93	$1,283.96–$2,139.93	49% below	40%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 PF COLON CANCER SCR NON-HR	$310.40	$517.33	$310.40–$517.33	—	40%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLON CANCER SCR NON-HR	$1,283.96	$2,139.93	$1,283.96–$2,139.93	—	40%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL SCRN; HI RISK IND	$734.61	$1,224.35	$734.61–$1,224.35	69% below	40%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLORECTAL SCRN; HI RISK IND	$734.61	$1,224.35	$734.61–$1,224.35	—	40%
Short arm cast (elbow to hand) CPT 29075 Application of forearm cast	$59.33	$98.88	$59.33–$631.85	80% below	40%
Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST	$59.33	$98.88	$59.33–$631.85	80% below	40%
Short arm cast (elbow to hand) CPT 29075 APPLICATION,CAST-ELBOW TO HAND	$379.11	$631.85	$59.33–$631.85	26% above	40%
Short arm cast (elbow to hand) CPT 29075 APPLICATION SHORT ARM CAST	$379.11	$631.85	$59.33–$631.85	26% above	40%
Short arm cast (elbow to hand) CPT 29075 APPL SHORT ARM CAST- LEVEL4&5	$379.11	$631.85	$59.33–$631.85	26% above	40%
Short arm cast (elbow to hand) CPT 29075 HAND TO FOREARM CAST	$379.11	$631.85	$59.33–$631.85	26% above	40%
Short arm cast (elbow to hand) inpatient CPT 29075 Application of forearm cast	$59.33	$98.88	$59.33–$631.85	—	40%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION OF FOREARM CAST	$59.33	$98.88	$59.33–$631.85	—	40%
Short arm cast (elbow to hand) inpatient CPT 29075 HAND TO FOREARM CAST	$379.11	$631.85	$59.33–$631.85	—	40%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION SHORT ARM CAST	$379.11	$631.85	$59.33–$631.85	—	40%
Short arm cast (elbow to hand) inpatient CPT 29075 APPL SHORT ARM CAST- LEVEL4&5	$379.11	$631.85	$59.33–$631.85	—	40%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION,CAST-ELBOW TO HAND	$379.11	$631.85	$59.33–$631.85	—	40%
Short arm splint (forearm and hand) CPT 29125 APPLICTN,SHORTARM SPLNT STATIC	$183.49	$305.81	$183.49–$530.84	26% below	40%
Short arm splint (forearm and hand) CPT 29125 APPLICATION SHORT ARM SPLINT	$183.49	$305.81	$183.49–$530.84	26% below	40%
Short arm splint (forearm and hand) CPT 29125 APPLICAT SHORT ARM SPLINT L4&5	$183.49	$305.81	$183.49–$530.84	26% below	40%
Short arm splint (forearm and hand) CPT 29125 STATIC SHORT ARM SPLINT APPLY	$318.50	$530.84	$183.49–$530.84	28% above	40%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICTN,SHORTARM SPLNT STATIC	$183.49	$305.81	$183.49–$530.84	—	40%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION SHORT ARM SPLINT	$183.49	$305.81	$183.49–$530.84	—	40%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICAT SHORT ARM SPLINT L4&5	$183.49	$305.81	$183.49–$530.84	—	40%
Short arm splint (forearm and hand) inpatient CPT 29125 STATIC SHORT ARM SPLINT APPLY	$318.50	$530.84	$183.49–$530.84	—	40%
Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST	$64.89	$108.15	$64.89–$631.85	82% below	40%
Short leg cast (below the knee) CPT 29405 APPLICATN SHORT LEG CAST L4&5	$379.11	$631.85	$64.89–$631.85	7% above	40%
Short leg cast (below the knee) CPT 29405 APPLICATION OF SHORT LEG CAST	$379.11	$631.85	$64.89–$631.85	7% above	40%
Short leg cast (below the knee) CPT 29405 APPLICATION, SHORT LEG CAST	$379.11	$631.85	$64.89–$631.85	7% above	40%
Short leg cast (below the knee) inpatient CPT 29405 APPLY SHORT LEG CAST	$64.89	$108.15	$64.89–$631.85	—	40%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATION OF SHORT LEG CAST	$379.11	$631.85	$64.89–$631.85	—	40%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATN SHORT LEG CAST L4&5	$379.11	$631.85	$64.89–$631.85	—	40%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATION, SHORT LEG CAST	$379.11	$631.85	$64.89–$631.85	—	40%
Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLINT	$56.24	$93.73	$56.24–$383.88	79% below	40%
Short leg splint (calf to foot) CPT 29515 APPLICATION,SHORT LEG SPLINT	$230.33	$383.88	$56.24–$383.88	15% below	40%
Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT	$230.33	$383.88	$56.24–$383.88	15% below	40%
Short leg splint (calf to foot) CPT 29515 APPLICATN SHORT LEG SPLNT L4&5	$230.33	$383.88	$56.24–$383.88	15% below	40%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION LOWER LEG SPLINT	$56.24	$93.73	$56.24–$383.88	—	40%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATN SHORT LEG SPLNT L4&5	$230.33	$383.88	$56.24–$383.88	—	40%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION,SHORT LEG SPLINT	$230.33	$383.88	$56.24–$383.88	—	40%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION SHORT LEG SPLINT	$230.33	$383.88	$56.24–$383.88	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 PF RPR LAC SMP SCLP <2.5CM	$76.72	$127.87	$76.72–$475.60	79% below	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPR 2.5CM< SCALP,NCK AXIL L45	$285.36	$475.60	$76.72–$475.60	22% below	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REP =<2.5CM EXT HND FT	$285.36	$475.60	$76.72–$475.60	22% below	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPR =<2.5CM EXT HND FT	$285.36	$475.60	$76.72–$475.60	22% below	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPR 2.5CM-LESS,SCALP,NCK,AXIL	$285.36	$475.60	$76.72–$475.60	22% below	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs one side CPT 12001 REP 2.5CM/LESS-RT-EXT,HND,FT	$285.36	$475.60	$76.72–$475.60	22% below	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs one side CPT 12001 REPR 2.5CM-LESS-LT-EXT,HND,FT	$285.36	$475.60	$76.72–$475.60	22% below	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 PF RPR LAC SMP SCLP <2.5CM	$76.72	$127.87	$76.72–$475.60	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPR 2.5CM-LESS,SCALP,NCK,AXIL	$285.36	$475.60	$76.72–$475.60	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REP =<2.5CM EXT HND FT	$285.36	$475.60	$76.72–$475.60	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPR =<2.5CM EXT HND FT	$285.36	$475.60	$76.72–$475.60	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPR 2.5CM< SCALP,NCK AXIL L45	$285.36	$475.60	$76.72–$475.60	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient one side CPT 12001 REP 2.5CM/LESS-RT-EXT,HND,FT	$285.36	$475.60	$76.72–$475.60	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient one side CPT 12001 REPR 2.5CM-LESS-LT-EXT,HND,FT	$285.36	$475.60	$76.72–$475.60	—	40%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION PF	$154.50	$257.50	$154.50–$257.50	58% below	40%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION PF	$154.50	$257.50	$154.50–$257.50	—	40%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS 1-15 PF	$98.88	$164.80	$98.88–$1,738.94	60% below	40%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKIN TAGS, UP TO 16	$285.36	$475.60	$98.88–$1,738.94	15% above	40%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS 1-15	$1,043.36	$1,738.94	$98.88–$1,738.94	321% above	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS 1-15 PF	$98.88	$164.80	$98.88–$1,738.94	—	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKIN TAGS, UP TO 16	$285.36	$475.60	$98.88–$1,738.94	—	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS 1-15	$1,043.36	$1,738.94	$98.88–$1,738.94	—	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE LEVEL 4&5	$1,018.21	$1,697.01	$1,018.21–$1,697.01	5% above	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE LEVEL 4&5	$1,018.21	$1,697.01	$1,018.21–$1,697.01	—	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 PF RPR LAC SMP SCLP 2.6-7.5CM	$101.23	$168.72	$101.23–$554.64	76% below	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SMP RPR S/N/AX/GN/TRNK 2.6-7.5	$332.78	$554.64	$101.23–$554.64	20% below	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 PF RPR LAC SMP SCLP 2.6-7.5CM	$101.23	$168.72	$101.23–$554.64	—	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SMP RPR S/N/AX/GN/TRNK 2.6-7.5	$332.78	$554.64	$101.23–$554.64	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 PF SIMPLE REPAIR F/E/E/N/L/M 2	$66.74	$111.24	$66.74–$475.60	83% below	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR F-E 2.5 CM OR LESS	$285.36	$475.60	$66.74–$475.60	29% below	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REP F-E 2.5CM OR LESS LVL 4&5	$285.36	$475.60	$66.74–$475.60	29% below	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REP CMPLX 1.0 LESS MUC MEM 4&5	$285.36	$475.60	$66.74–$475.60	29% below	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 PF SIMPLE REPAIR F/E/E/N/L/M 2	$66.74	$111.24	$66.74–$475.60	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REP CMPLX 1.0 LESS MUC MEM 4&5	$285.36	$475.60	$66.74–$475.60	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REPAIR F-E 2.5 CM OR LESS	$285.36	$475.60	$66.74–$475.60	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REP F-E 2.5CM OR LESS LVL 4&5	$285.36	$475.60	$66.74–$475.60	—	40%
TURP (transurethral resection of the prostate) CPT 52601 PF PROSTATECTOMY (TURP) PF	$919.80	$1,533.00	$919.80–$1,533.00	84% below	40%
TURP (transurethral resection of the prostate) inpatient CPT 52601 PF PROSTATECTOMY (TURP) PF	$919.80	$1,533.00	$919.80–$1,533.00	—	40%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES PF	$138.32	$230.53	$138.32–$230.53	53% below	40%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES PF	$138.32	$230.53	$138.32–$230.53	—	40%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/CHEST TUBE	$221.24	$368.74	$167.71–$1,680.33	82% below	40%
Thoracentesis with imaging guidance CPT 32555 THORACENTECIS W/ IMAGING	$1,008.20	$1,680.33	$167.71–$1,680.33	19% below	40%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/CHEST TUBE	$221.24	$368.74	$167.71–$1,680.33	—	40%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTECIS W/ IMAGING	$1,008.20	$1,680.33	$167.71–$1,680.33	—	40%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$43.26	$72.10	$43.26–$716.09	92% below	40%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION,TRIGGER POINT 1-2	$43.26	$72.10	$43.26–$716.09	92% below	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION,TRIGGER POINT 1-2	$43.26	$72.10	$43.26–$716.09	—	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$43.26	$72.10	$43.26–$716.09	—	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST DVC US 1ST LESION	$255.90	$426.50	$255.90–$3,949.38	89% below	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST W/DEVICE 1ST LES US	$2,369.63	$3,949.38	$255.90–$3,949.38	2% below	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST DVC US 1ST LESION	$255.90	$426.50	$255.90–$3,949.38	—	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST W/DEVICE 1ST LES US	$2,369.63	$3,949.38	$255.90–$3,949.38	—	40%
Upper endoscopy (EGD) with biopsy CPT 43239 PF EGD FLEX W/BIOPSY	$230.28	$383.80	$230.28–$3,856.45	90% below	40%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD FLEX W/BIOPSY	$230.28	$383.80	$230.28–$3,856.45	90% below	40%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE	$2,313.87	$3,856.45	$230.28–$3,856.45	2% above	40%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PF EGD FLEX W/BIOPSY	$230.28	$383.80	$230.28–$3,856.45	—	40%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD FLEX W/BIOPSY	$230.28	$383.80	$230.28–$3,856.45	—	40%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD BIOPSY SINGLE/MULTIPLE	$2,313.87	$3,856.45	$230.28–$3,856.45	—	40%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD DX W/BRUSHING/WASHING	$2,186.31	$3,643.85	$2,186.31–$3,643.85	8% above	40%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DX W/BRUSHING/WASHING	$2,186.31	$3,643.85	$2,186.31–$3,643.85	—	40%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 Cystouretero w/lithotripsy PF	$612.92	$1,021.53	$612.92–$1,021.53	96% below	40%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 Cystouretero w/lithotripsy PF	$612.92	$1,021.53	$612.92–$1,021.53	—	40%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/PYELOSC INSERT STNT PF	$740.46	$1,234.10	$740.46–$1,234.10	88% below	40%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 CYSTO/PYELOSC INSERT STNT PF	$740.46	$1,234.10	$740.46–$1,234.10	—	40%
Vein ablation, radiofrequency, first vein CPT 36475 PF ABLAT EXTREM RADIOFREQ 1ST	$486.04	$810.06	$486.04–$812.13	90% below	40%
Vein ablation, radiofrequency, first vein CPT 36475 ABLAT EXTREM RADIOFREQ 1ST	$487.28	$812.13	$486.04–$812.13	90% below	40%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 PF ABLAT EXTREM RADIOFREQ 1ST	$486.04	$810.06	$486.04–$812.13	—	40%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 ABLAT EXTREM RADIOFREQ 1ST	$487.28	$812.13	$486.04–$812.13	—	40%
Wart removal, up to 14 warts CPT 17110 PF DESTRUCT BENIGN LESION <15	$110.18	$183.64	$110.18–$475.60	53% below	40%
Wart removal, up to 14 warts CPT 17110 DESTRUCT BENIGN LESION <15	$110.18	$183.64	$110.18–$475.60	53% below	40%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LES UP <14	$285.36	$475.60	$110.18–$475.60	21% above	40%
Wart removal, up to 14 warts inpatient CPT 17110 PF DESTRUCT BENIGN LESION <15	$110.18	$183.64	$110.18–$475.60	—	40%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT BENIGN LESION <15	$110.18	$183.64	$110.18–$475.60	—	40%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION BENIGN LES UP <14	$285.36	$475.60	$110.18–$475.60	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<PF	$79.72	$132.87	$79.72–$1,502.49	88% below	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 PF DBRDMT SUBQ TIS 1ST 20SQCM/	$79.72	$132.87	$79.72–$1,502.49	88% below	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE,SKIN/SUBQ TIS,<20SQ CM	$589.54	$982.57	$79.72–$1,502.49	15% below	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE,SKIN,UPTO 20 SQCM L4&5	$589.54	$982.57	$79.72–$1,502.49	15% below	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE,SKIN, UP TO 20 SQ CM	$589.54	$982.57	$79.72–$1,502.49	15% below	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN,SUBCU TIS,<20SQCM	$901.49	$1,502.49	$79.72–$1,502.49	31% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<PF	$79.72	$132.87	$79.72–$1,502.49	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 PF DBRDMT SUBQ TIS 1ST 20SQCM/	$79.72	$132.87	$79.72–$1,502.49	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE,SKIN, UP TO 20 SQ CM	$589.54	$982.57	$79.72–$1,502.49	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE,SKIN,UPTO 20 SQCM L4&5	$589.54	$982.57	$79.72–$1,502.49	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE,SKIN/SUBQ TIS,<20SQ CM	$589.54	$982.57	$79.72–$1,502.49	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SKIN,SUBCU TIS,<20SQCM	$901.49	$1,502.49	$79.72–$1,502.49	—	40%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLD/BLD COMPNT	$459.17	$765.29	$459.17–$1,073.91	47% below	40%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION LEVEL 4&5	$644.35	$1,073.91	$459.17–$1,073.91	25% below	40%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION	$644.35	$1,073.91	$459.17–$1,073.91	25% below	40%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLD/BLD COMPNT	$459.17	$765.29	$459.17–$1,073.91	—	40%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION	$644.35	$1,073.91	$459.17–$1,073.91	—	40%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION LEVEL 4&5	$644.35	$1,073.91	$459.17–$1,073.91	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$24.11	$40.18	$24.11–$504.37	87% below	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL THERAPY HOURLY	$302.62	$504.37	$24.11–$504.37	57% above	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER TREATMENT ONLY	$302.62	$504.37	$24.11–$504.37	57% above	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER TREATMENT	$302.62	$504.37	$24.11–$504.37	57% above	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM INDUCE	$302.62	$504.37	$24.11–$504.37	57% above	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$24.11	$40.18	$24.11–$504.37	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM INDUCE	$302.62	$504.37	$24.11–$504.37	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER TREATMENT	$302.62	$504.37	$24.11–$504.37	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL THERAPY HOURLY	$302.62	$504.37	$24.11–$504.37	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER TREATMENT ONLY	$302.62	$504.37	$24.11–$504.37	—	40%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION SGL/INIT<1H	$513.90	$856.50	$513.90–$876.02	20% below	40%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION 1ST HOUR	$525.61	$876.02	$513.90–$876.02	18% below	40%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION SGL/INIT<1H	$513.90	$856.50	$513.90–$876.02	—	40%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION 1ST HOUR	$525.61	$876.02	$513.90–$876.02	—	40%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 COMPRE OPH EXAM NEW PT 1/>	$98.56	$164.27	$98.56–$318.32	25% below	40%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 PF EYE EXAM NEW COMPREHENSIVE	$149.43	$249.05	$98.56–$318.32	13% above	40%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 NEW OPTHALOMOLOGY PT-COMPREHEN	$190.99	$318.32	$98.56–$318.32	45% above	40%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 COMPRE OPH EXAM NEW PT 1/>	$98.56	$164.27	$98.56–$318.32	—	40%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 PF EYE EXAM NEW COMPREHENSIVE	$149.43	$249.05	$98.56–$318.32	—	40%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 NEW OPTHALOMOLOGY PT-COMPREHEN	$190.99	$318.32	$98.56–$318.32	—	40%
Comprehensive eye exam, returning patient CPT 92014 COMPRE OPH EXAM EST PT 1/>	$57.20	$95.34	$57.20–$318.32	52% below	40%
Comprehensive eye exam, returning patient CPT 92014 EST OPTHALOMOLOGY PT COMPREHEN	$190.99	$318.32	$57.20–$318.32	60% above	40%
Comprehensive eye exam, returning patient inpatient CPT 92014 COMPRE OPH EXAM EST PT 1/>	$57.20	$95.34	$57.20–$318.32	—	40%
Comprehensive eye exam, returning patient inpatient CPT 92014 EST OPTHALOMOLOGY PT COMPREHEN	$190.99	$318.32	$57.20–$318.32	—	40%
Critical care, first 30 to 74 minutes CPT 99291 CCU/RRT	$355.67	$592.78	$355.67–$2,021.94	83% below	40%
Critical care, first 30 to 74 minutes CPT 99291 PF CRITICAL CARE 30-74 MIN	$355.67	$592.78	$355.67–$2,021.94	83% below	40%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR	$355.67	$592.78	$355.67–$2,021.94	83% below	40%
Critical care, first 30 to 74 minutes CPT 99291 ED LVL 6-CRITICALCARE 30-74MIN	$1,213.16	$2,021.94	$355.67–$2,021.94	42% below	40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 PF CRITICAL CARE 30-74 MIN	$355.67	$592.78	$355.67–$2,021.94	—	40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE FIRST HOUR	$355.67	$592.78	$355.67–$2,021.94	—	40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CCU/RRT	$355.67	$592.78	$355.67–$2,021.94	—	40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ED LVL 6-CRITICALCARE 30-74MIN	$1,213.16	$2,021.94	$355.67–$2,021.94	—	40%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG, AWAKE AND DROWSY	$442.57	$737.61	$442.57–$737.61	49% below	40%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG, AWAKE AND DROWSY	$442.57	$737.61	$442.57–$737.61	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 PF Electrocardiogram, routine	$90.83	$151.39	$90.83–$316.16	61% below	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG ROUTINE 12 LEAD	$189.70	$316.16	$90.83–$316.16	18% below	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 PF Electrocardiogram, routine	$90.83	$151.39	$90.83–$316.16	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG ROUTINE 12 LEAD	$189.70	$316.16	$90.83–$316.16	—	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED LEVEL 1	$118.66	$197.76	$20.53–$197.76	47% below	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED LEVEL 1	$118.66	$197.76	$20.53–$197.76	—	40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 PF ED LEVEL II	$70.67	$117.78	$70.67–$383.16	82% below	40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT SF MDM	$70.67	$117.78	$70.67–$383.16	82% below	40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED LEVEL 2	$229.90	$383.16	$70.67–$383.16	43% below	40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY DEPT VISIT SF MDM	$70.67	$117.78	$70.67–$383.16	—	40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 PF ED LEVEL II	$70.67	$117.78	$70.67–$383.16	—	40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED LEVEL 2	$229.90	$383.16	$70.67–$383.16	—	40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 PF ED LEVEL III	$121.78	$202.97	$121.78–$625.21	83% below	40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LOW MDM	$121.78	$202.97	$121.78–$625.21	83% below	40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED LEVEL 3	$375.13	$625.21	$121.78–$625.21	46% below	40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 PF ED LEVEL III	$121.78	$202.97	$121.78–$625.21	—	40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY DEPT VISIT LOW MDM	$121.78	$202.97	$121.78–$625.21	—	40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED LEVEL 3	$375.13	$625.21	$121.78–$625.21	—	40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 PF ED LEVEL IV	$203.07	$338.45	$203.07–$1,009.40	82% below	40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM	$203.07	$338.45	$203.07–$1,009.40	82% below	40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED LEVEL 4	$605.64	$1,009.40	$203.07–$1,009.40	47% below	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 PF ED LEVEL IV	$203.07	$338.45	$203.07–$1,009.40	—	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPT VISIT MOD MDM	$203.07	$338.45	$203.07–$1,009.40	—	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED LEVEL 4	$605.64	$1,009.40	$203.07–$1,009.40	—	40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT HI MDM	$296.80	$494.67	$296.80–$1,443.58	81% below	40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 PF ED LEVEL V	$296.80	$494.67	$296.80–$1,443.58	81% below	40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED LEVEL 5	$866.15	$1,443.58	$296.80–$1,443.58	46% below	40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY DEPT VISIT HI MDM	$296.80	$494.67	$296.80–$1,443.58	—	40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 PF ED LEVEL V	$296.80	$494.67	$296.80–$1,443.58	—	40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED LEVEL 5	$866.15	$1,443.58	$296.80–$1,443.58	—	40%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST	$367.71	$612.85	$367.71–$1,824.57	62% below	40%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST	$1,094.74	$1,824.57	$367.71–$1,824.57	13% above	40%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVASCULAR STRESS TEST	$367.71	$612.85	$367.71–$1,824.57	—	40%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS TEST	$1,094.74	$1,824.57	$367.71–$1,824.57	—	40%
Eye exam, returning patient, intermediate CPT 92012 INTRM OPH EXAM EST PATIENT	$37.98	$63.30	$37.98–$318.32	67% below	40%
Eye exam, returning patient, intermediate CPT 92012 PF EYE EXAM ESTAB INTERMEDIATE	$81.34	$135.57	$37.98–$318.32	30% below	40%
Eye exam, returning patient, intermediate CPT 92012 EST OPTHALOMOLOGY PT-COMPREHEN	$190.99	$318.32	$37.98–$318.32	64% above	40%
Eye exam, returning patient, intermediate inpatient CPT 92012 INTRM OPH EXAM EST PATIENT	$37.98	$63.30	$37.98–$318.32	—	40%
Eye exam, returning patient, intermediate inpatient CPT 92012 PF EYE EXAM ESTAB INTERMEDIATE	$81.34	$135.57	$37.98–$318.32	—	40%
Eye exam, returning patient, intermediate inpatient CPT 92012 EST OPTHALOMOLOGY PT-COMPREHEN	$190.99	$318.32	$37.98–$318.32	—	40%
Family therapy with the patient, 50 minutes CPT 90847 Family psytx w/patient	$230.24	$383.73	$230.24–$383.73	28% above	40%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Family psytx w/patient	$230.24	$383.73	$230.24–$383.73	—	40%
Family therapy without the patient, 50 minutes CPT 90846 Family psytx w/o patient	$230.24	$383.73	$230.24–$383.73	22% above	40%
Family therapy without the patient, 50 minutes inpatient CPT 90846 Family psytx w/o patient	$230.24	$383.73	$230.24–$383.73	—	40%
Group psychotherapy session CPT 90853 Telehlth Grp Psychotherapy MAT	$21.85	$36.42	$21.85–$50.00	83% below	40%
Group psychotherapy session CPT 90853 Telehlth Grp Psychotherapy	$21.85	$36.42	$21.85–$50.00	83% below	40%
Group psychotherapy session CPT 90853 Group Psychotherapy Tele	$21.85	$36.42	$21.85–$50.00	83% below	40%
Group psychotherapy session CPT 90853 GRP PSYCHOTHERAPY Non MCO/PA	$30.00	$50.00	$21.85–$50.00	77% below	40%
Group psychotherapy session inpatient CPT 90853 Telehlth Grp Psychotherapy	$21.85	$36.42	$21.85–$50.00	—	40%
Group psychotherapy session inpatient CPT 90853 Telehlth Grp Psychotherapy MAT	$21.85	$36.42	$21.85–$50.00	—	40%
Group psychotherapy session inpatient CPT 90853 Group Psychotherapy Tele	$21.85	$36.42	$21.85–$50.00	—	40%
Group psychotherapy session inpatient CPT 90853 GRP PSYCHOTHERAPY Non MCO/PA	$30.00	$50.00	$21.85–$50.00	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION, HYDRATION	$43.26	$72.10	$43.26–$544.05	87% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUS HYD INIT 31MIN-1HR	$319.15	$531.92	$43.26–$544.05	6% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYDRATION, 1ST HR	$326.43	$544.05	$43.26–$544.05	3% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION, HYDRATION 1ST HR	$326.43	$544.05	$43.26–$544.05	3% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT	$326.43	$544.05	$43.26–$544.05	3% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION, HYDRATION	$43.26	$72.10	$43.26–$544.05	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUS HYD INIT 31MIN-1HR	$319.15	$531.92	$43.26–$544.05	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION, HYDRATION 1ST HR	$326.43	$544.05	$43.26–$544.05	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION HYDRATION, 1ST HR	$326.43	$544.05	$43.26–$544.05	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT	$326.43	$544.05	$43.26–$544.05	—	40%
IV infusion of a medicine, first hour CPT 96365 IV INF THPY/PROPH/DX INTL TO 1	$319.15	$531.92	$319.15–$544.05	21% below	40%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION THERAPY 1 HOUR	$326.43	$544.05	$319.15–$544.05	19% below	40%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION THERAPY 1ST HOUR	$326.43	$544.05	$319.15–$544.05	19% below	40%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION THERAPY 1HR LVL4&5	$326.43	$544.05	$319.15–$544.05	19% below	40%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION, 1ST HOUR	$326.43	$544.05	$319.15–$544.05	19% below	40%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF THPY/PROPH/DX INTL TO 1	$319.15	$531.92	$319.15–$544.05	—	40%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION THERAPY 1HR LVL4&5	$326.43	$544.05	$319.15–$544.05	—	40%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION THERAPY 1 HOUR	$326.43	$544.05	$319.15–$544.05	—	40%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION, 1ST HOUR	$326.43	$544.05	$319.15–$544.05	—	40%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION THERAPY 1ST HOUR	$326.43	$544.05	$319.15–$544.05	—	40%
IV push of a medicine, first drug CPT 96374 THERAPYPRO/DX IV PUSH INITIAL	$319.15	$531.92	$319.15–$544.05	48% above	40%
IV push of a medicine, first drug CPT 96374 BUBBLE STUDY IVP	$326.43	$544.05	$319.15–$544.05	52% above	40%
IV push of a medicine, first drug CPT 96374 IVP/IVPB	$326.43	$544.05	$319.15–$544.05	52% above	40%
IV push of a medicine, first drug CPT 96374 IV PUSH, INITIAL DRUG <15 MIN	$326.43	$544.05	$319.15–$544.05	52% above	40%
IV push of a medicine, first drug CPT 96374 IV PUSH, SINGLE/INITIAL	$326.43	$544.05	$319.15–$544.05	52% above	40%
IV push of a medicine, first drug inpatient CPT 96374 THERAPYPRO/DX IV PUSH INITIAL	$319.15	$531.92	$319.15–$544.05	—	40%
IV push of a medicine, first drug inpatient CPT 96374 IV PUSH, SINGLE/INITIAL	$326.43	$544.05	$319.15–$544.05	—	40%
IV push of a medicine, first drug inpatient CPT 96374 IV PUSH, INITIAL DRUG <15 MIN	$326.43	$544.05	$319.15–$544.05	—	40%
IV push of a medicine, first drug inpatient CPT 96374 IVP/IVPB	$326.43	$544.05	$319.15–$544.05	—	40%
IV push of a medicine, first drug inpatient CPT 96374 BUBBLE STUDY IVP	$326.43	$544.05	$319.15–$544.05	—	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM OPMH	$82.81	$138.02	$82.81–$177.71	24% below	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Tele Medication admin visit	$82.81	$138.02	$82.81–$177.71	24% below	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM	$82.81	$138.02	$82.81–$177.71	24% below	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAP/PRO/DX INJ SQ/IM	$104.24	$173.74	$82.81–$177.71	5% below	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SUBQ INJECTION	$106.63	$177.71	$82.81–$177.71	3% below	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 OBS therapeutic injection	$106.63	$177.71	$82.81–$177.71	3% below	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM	$82.81	$138.02	$82.81–$177.71	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Tele Medication admin visit	$82.81	$138.02	$82.81–$177.71	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM OPMH	$82.81	$138.02	$82.81–$177.71	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAP/PRO/DX INJ SQ/IM	$104.24	$173.74	$82.81–$177.71	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 OBS therapeutic injection	$106.63	$177.71	$82.81–$177.71	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SUBQ INJECTION	$106.63	$177.71	$82.81–$177.71	—	40%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psych Diagnostic Evaluation	$230.24	$383.73	$230.24–$421.00	12% below	40%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psych Diagnostic Evaluation	$230.24	$383.73	$230.24–$421.00	—	40%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION, 15M	$43.26	$72.10	$43.26–$162.00	64% below	40%
Neuromuscular re-education, 15 minutes CPT 97112 NEURO RE-EDUCATION, 15 MIN EA	$97.20	$162.00	$43.26–$162.00	18% below	40%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR REEDUCATION, 15M	$43.26	$72.10	$43.26–$162.00	—	40%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEURO RE-EDUCATION, 15 MIN EA	$97.20	$162.00	$43.26–$162.00	—	40%
New patient office visit, about 30 minutes CPT 99203 PF OP VISIT E&M NEW 30-44	$138.61	$231.02	$138.61–$390.00	37% below	40%
New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30 MIN	$139.05	$231.75	$138.61–$390.00	37% below	40%
New patient office visit, about 30 minutes CPT 99203 NEW PT. VISIT LEVEL 3 - 30 MIN	$190.99	$318.32	$138.61–$390.00	14% below	40%
New patient office visit, about 30 minutes CPT 99203 E&M NEW PATIENT,INTERMEDIAT WC	$234.00	$390.00	$138.61–$390.00	6% above	40%
New patient office visit, about 30 minutes inpatient CPT 99203 PF OP VISIT E&M NEW 30-44	$138.61	$231.02	$138.61–$390.00	—	40%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE O/P NEW LOW 30 MIN	$139.05	$231.75	$138.61–$390.00	—	40%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PT. VISIT LEVEL 3 - 30 MIN	$190.99	$318.32	$138.61–$390.00	—	40%
New patient office visit, about 30 minutes inpatient CPT 99203 E&M NEW PATIENT,INTERMEDIAT WC	$234.00	$390.00	$138.61–$390.00	—	40%
New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45 MIN	$154.50	$257.50	$154.50–$498.00	48% below	40%
New patient office visit, about 45 minutes CPT 99204 NEW PT. VISIT LEVEL 4 - 45 MIN	$190.99	$318.32	$154.50–$498.00	35% below	40%
New patient office visit, about 45 minutes CPT 99204 PF OP VISIT E&M NEW 45-59	$220.81	$368.01	$154.50–$498.00	25% below	40%
New patient office visit, about 45 minutes CPT 99204 E&M NEW PATIENT, EXTENDED WC	$298.80	$498.00	$154.50–$498.00	1% above	40%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE O/P NEW MOD 45 MIN	$154.50	$257.50	$154.50–$498.00	—	40%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PT. VISIT LEVEL 4 - 45 MIN	$190.99	$318.32	$154.50–$498.00	—	40%
New patient office visit, about 45 minutes inpatient CPT 99204 PF OP VISIT E&M NEW 45-59	$220.81	$368.01	$154.50–$498.00	—	40%
New patient office visit, about 45 minutes inpatient CPT 99204 E&M NEW PATIENT, EXTENDED WC	$298.80	$498.00	$154.50–$498.00	—	40%
New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60 MIN	$169.95	$283.25	$169.95–$635.00	56% below	40%
New patient office visit, about 60 minutes CPT 99205 NEW PT. VISIT LEVEL 5 -60 MIN	$190.99	$318.32	$169.95–$635.00	51% below	40%
New patient office visit, about 60 minutes CPT 99205 PF OP VISIT E&M NEW 60-74	$299.75	$499.58	$169.95–$635.00	23% below	40%
New patient office visit, about 60 minutes CPT 99205 E&M NEW PATIENT, COMPLEX WC	$381.00	$635.00	$169.95–$635.00	2% below	40%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE O/P NEW HI 60 MIN	$169.95	$283.25	$169.95–$635.00	—	40%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PT. VISIT LEVEL 5 -60 MIN	$190.99	$318.32	$169.95–$635.00	—	40%
New patient office visit, about 60 minutes inpatient CPT 99205 PF OP VISIT E&M NEW 60-74	$299.75	$499.58	$169.95–$635.00	—	40%
New patient office visit, about 60 minutes inpatient CPT 99205 E&M NEW PATIENT, COMPLEX WC	$381.00	$635.00	$169.95–$635.00	—	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 PF OP VISIT E&M NEW 15-29	$79.45	$132.42	$79.45–$321.49	53% below	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE O/P NEW SF 15 MIN	$143.69	$239.48	$79.45–$321.49	14% below	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PT. VISIT LEVEL 2 - 20 MIN	$190.99	$318.32	$79.45–$321.49	14% above	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 E&M NEW PATIENT, LIMITED WC	$192.89	$321.49	$79.45–$321.49	15% above	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 PF OP VISIT E&M NEW 15-29	$79.45	$132.42	$79.45–$321.49	—	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE O/P NEW SF 15 MIN	$143.69	$239.48	$79.45–$321.49	—	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PT. VISIT LEVEL 2 - 20 MIN	$190.99	$318.32	$79.45–$321.49	—	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 E&M NEW PATIENT, LIMITED WC	$192.89	$321.49	$79.45–$321.49	—	40%
Occupational therapy evaluation, low complexity CPT 97165 OCCUPATIONAL THERAPY EVAL	$129.78	$216.30	$129.78–$216.30	49% below	40%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OCCUPATIONAL THERAPY EVAL	$129.78	$216.30	$129.78–$216.30	—	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEX 45 MIN	$140.91	$234.85	$140.91–$234.85	59% below	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEX 45 MIN	$140.91	$234.85	$140.91–$234.85	—	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PHYSICAL THERAPY EVALUATION	$129.78	$216.30	$129.78–$216.30	42% below	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PHYSICAL THERAPY EVALUATION	$129.78	$216.30	$129.78–$216.30	—	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD COMPLEX 30 MIN	$349.03	$581.72	$349.03–$581.72	14% above	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MOD COMPLEX 30 MIN	$349.03	$581.72	$349.03–$581.72	—	40%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY, 15 MIN EACH	$43.26	$72.10	$43.26–$72.10	68% below	40%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY, 15MIN EACH	$43.26	$72.10	$43.26–$72.10	68% below	40%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY, 15MIN EACH	$43.26	$72.10	$43.26–$72.10	—	40%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY, 15 MIN EACH	$43.26	$72.10	$43.26–$72.10	—	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE, EA 15MIN	$43.26	$72.10	$43.26–$72.10	61% below	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE, 15 MIN	$43.26	$72.10	$43.26–$72.10	61% below	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE, 15 MIN	$43.26	$72.10	$43.26–$72.10	—	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE, EA 15MIN	$43.26	$72.10	$43.26–$72.10	—	40%
Preventive checkup, new patient aged 18–39 CPT 99385 PREV VISIT NEW AGE 18-39	$49.44	$82.40	$49.44–$82.40	80% below	40%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREV VISIT NEW AGE 18-39	$49.44	$82.40	$49.44–$82.40	—	40%
Preventive checkup, new patient aged 40–64 CPT 99386 PREV VISIT NEW AGE 40-64	$49.44	$82.40	$49.44–$82.40	80% below	40%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREV VISIT NEW AGE 40-64	$49.44	$82.40	$49.44–$82.40	—	40%
Preventive checkup, new patient aged 65 or older CPT 99387 INIT PM E/M NEW PAT 65+ YRS	$49.44	$82.40	$49.44–$82.40	77% below	40%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 INIT PM E/M NEW PAT 65+ YRS	$49.44	$82.40	$49.44–$82.40	—	40%
Preventive checkup, returning patient aged 18–39 CPT 99395 PELVIC/BREAST EXAM,CANCER SCRN	$29.66	$49.44	$29.66–$82.40	84% below	40%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV VISIT EST AGE 18-39	$49.44	$82.40	$29.66–$82.40	73% below	40%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PELVIC/BREAST EXAM,CANCER SCRN	$29.66	$49.44	$29.66–$82.40	—	40%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREV VISIT EST AGE 18-39	$49.44	$82.40	$29.66–$82.40	—	40%
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV VISIT EST AGE 40-64	$49.44	$82.40	$49.44–$82.40	76% below	40%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PREV VISIT EST AGE 40-64	$49.44	$82.40	$49.44–$82.40	—	40%
Preventive checkup, returning patient aged 65 or older CPT 99397 PER PM REEVAL EST PAT 65+ YR	$49.44	$82.40	$49.44–$82.40	78% below	40%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PER PM REEVAL EST PAT 65+ YR	$49.44	$82.40	$49.44–$82.40	—	40%
Psychiatric evaluation with medical services CPT 90792 Psych Diag eval w/med srvs	$230.24	$383.73	$230.24–$383.73	36% below	40%
Psychiatric evaluation with medical services inpatient CPT 90792 Psych Diag eval w/med srvs	$230.24	$383.73	$230.24–$383.73	—	40%
Psychotherapy for crisis, first 60 minutes CPT 90839 Psytx crisis initial 60 min	$230.24	$383.73	$230.24–$383.73	8% below	40%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 Psytx crisis initial 60 min	$230.24	$383.73	$230.24–$383.73	—	40%
Psychotherapy session, 30 minutes CPT 90832 Psytx pt 30 minutes	$230.24	$383.73	$230.24–$383.73	22% above	40%
Psychotherapy session, 30 minutes CPT 90832 Psytx pt&/family 30 minutes	$230.24	$383.73	$230.24–$383.73	22% above	40%
Psychotherapy session, 30 minutes CPT 90832 Psytx pt 30 minutes PF	$230.24	$383.73	$230.24–$383.73	22% above	40%
Psychotherapy session, 30 minutes inpatient CPT 90832 Psytx pt 30 minutes	$230.24	$383.73	$230.24–$383.73	—	40%
Psychotherapy session, 30 minutes inpatient CPT 90832 Psytx pt&/family 30 minutes	$230.24	$383.73	$230.24–$383.73	—	40%
Psychotherapy session, 30 minutes inpatient CPT 90832 Psytx pt 30 minutes PF	$230.24	$383.73	$230.24–$383.73	—	40%
Psychotherapy session, 45 minutes CPT 90834 Psytx w Pt 45 minutes	$191.58	$319.30	$191.58–$383.73	at median	40%
Psychotherapy session, 45 minutes CPT 90834 Psytx pt&family 45 minutes	$230.24	$383.73	$191.58–$383.73	20% above	40%
Psychotherapy session, 45 minutes inpatient CPT 90834 Psytx w Pt 45 minutes	$191.58	$319.30	$191.58–$383.73	—	40%
Psychotherapy session, 45 minutes inpatient CPT 90834 Psytx pt&family 45 minutes	$230.24	$383.73	$191.58–$383.73	—	40%
Psychotherapy session, 60 minutes CPT 90837 Psytx pt&family 60 min	$230.24	$383.73	$230.24–$383.73	17% below	40%
Psychotherapy session, 60 minutes CPT 90837 Psytx pt 60 min	$230.24	$383.73	$230.24–$383.73	17% below	40%
Psychotherapy session, 60 minutes CPT 90837 PSYCH TX W/PT 60 MIN PF	$230.24	$383.73	$230.24–$383.73	17% below	40%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCH TX W/PT 60 MIN PF	$230.24	$383.73	$230.24–$383.73	—	40%
Psychotherapy session, 60 minutes inpatient CPT 90837 Psytx pt&family 60 min	$230.24	$383.73	$230.24–$383.73	—	40%
Psychotherapy session, 60 minutes inpatient CPT 90837 Psytx pt 60 min	$230.24	$383.73	$230.24–$383.73	—	40%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$15.45	$25.75	$15.45–$78.18	60% below	40%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION 3-8 MIN	$46.91	$78.18	$15.45–$78.18	20% above	40%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$15.45	$25.75	$15.45–$78.18	—	40%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION 3-8 MIN	$46.91	$78.18	$15.45–$78.18	—	40%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40 MIN	$185.40	$309.00	$185.40–$440.00	33% below	40%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST. PT. VISIT LEVEL 5 -45 MIN	$190.99	$318.32	$185.40–$440.00	31% below	40%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PF OP VISIT E&M EST 40-54 MIN	$234.81	$391.35	$185.40–$440.00	15% below	40%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E&M ESTABLISHED PAT,COMPLEX WC	$264.00	$440.00	$185.40–$440.00	4% below	40%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE O/P EST HI 40 MIN	$185.40	$309.00	$185.40–$440.00	—	40%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST. PT. VISIT LEVEL 5 -45 MIN	$190.99	$318.32	$185.40–$440.00	—	40%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PF OP VISIT E&M EST 40-54 MIN	$234.81	$391.35	$185.40–$440.00	—	40%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E&M ESTABLISHED PAT,COMPLEX WC	$264.00	$440.00	$185.40–$440.00	—	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PF OP VISIT E&M EST 20-29 MIN	$108.60	$181.00	$108.60–$318.32	29% below	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20 MIN	$108.60	$181.00	$108.60–$318.32	29% below	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 NON PCP CONSULATION - 40 MIN	$190.99	$318.32	$108.60–$318.32	25% above	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST. PT. VISIT LEVEL 3 -15 MIN	$190.99	$318.32	$108.60–$318.32	25% above	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M ESTABLISHED PAT,INTERMD WC	$190.99	$318.32	$108.60–$318.32	25% above	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PF OP VISIT E&M EST 20-29 MIN	$108.60	$181.00	$108.60–$318.32	—	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE O/P EST LOW 20 MIN	$108.60	$181.00	$108.60–$318.32	—	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST. PT. VISIT LEVEL 3 -15 MIN	$190.99	$318.32	$108.60–$318.32	—	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 NON PCP CONSULATION - 40 MIN	$190.99	$318.32	$108.60–$318.32	—	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E&M ESTABLISHED PAT,INTERMD WC	$190.99	$318.32	$108.60–$318.32	—	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30 MIN	$126.07	$210.12	$126.07–$371.00	32% below	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PF OP VISIT E&M EST 30-39 MIN	$160.03	$266.72	$126.07–$371.00	13% below	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 NON PCP CONSULTATION(60 MIN)	$190.99	$318.32	$126.07–$371.00	3% above	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST. PT. VISIT LEVEL 4 -25 MIN	$190.99	$318.32	$126.07–$371.00	3% above	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E&M ESTABLISHED PAT,EXTEND WC	$222.60	$371.00	$126.07–$371.00	20% above	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE O/P EST MOD 30 MIN	$126.07	$210.12	$126.07–$371.00	—	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PF OP VISIT E&M EST 30-39 MIN	$160.03	$266.72	$126.07–$371.00	—	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 NON PCP CONSULTATION(60 MIN)	$190.99	$318.32	$126.07–$371.00	—	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST. PT. VISIT LEVEL 4 -25 MIN	$190.99	$318.32	$126.07–$371.00	—	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E&M ESTABLISHED PAT,EXTEND WC	$222.60	$371.00	$126.07–$371.00	—	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PF OP VISIT E&M EST 10-19 MIN	$58.77	$97.95	$58.77–$318.32	53% below	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10 MIN	$92.70	$154.50	$58.77–$318.32	26% below	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 NON PCP CONSULTATION	$190.99	$318.32	$58.77–$318.32	53% above	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST. PT. VISIT LEVEL 2 -10 MIN	$190.99	$318.32	$58.77–$318.32	53% above	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M ESTABLISHED PAT, LMTD WC	$190.99	$318.32	$58.77–$318.32	53% above	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PF OP VISIT E&M EST 10-19 MIN	$58.77	$97.95	$58.77–$318.32	—	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE O/P EST SF 10 MIN	$92.70	$154.50	$58.77–$318.32	—	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 NON PCP CONSULTATION	$190.99	$318.32	$58.77–$318.32	—	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST. PT. VISIT LEVEL 2 -10 MIN	$190.99	$318.32	$58.77–$318.32	—	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E&M ESTABLISHED PAT, LMTD WC	$190.99	$318.32	$58.77–$318.32	—	40%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFF/OP CNSLTJ NEW/EST LOW 30	$46.35	$77.25	$46.35–$241.14	67% below	40%
Specialist consultation, low complexity or 30+ minutes CPT 99243 PF OFFICE CONSULT LEVEL III	$144.68	$241.14	$46.35–$241.14	4% above	40%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFF/OP CNSLTJ NEW/EST LOW 30	$46.35	$77.25	$46.35–$241.14	—	40%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PF OFFICE CONSULT LEVEL III	$144.68	$241.14	$46.35–$241.14	—	40%
Speech and language evaluation CPT 92523 SPEECH LANGUAGE EVALUATION	$331.15	$551.91	$331.15–$551.91	5% below	40%
Speech and language evaluation inpatient CPT 92523 SPEECH LANGUAGE EVALUATION	$331.15	$551.91	$331.15–$551.91	—	40%
Speech therapy session, individual CPT 92507 SPEECH LANGUAGE TREATMENT	$219.92	$366.54	$219.92–$366.54	18% above	40%
Speech therapy session, individual inpatient CPT 92507 SPEECH LANGUAGE TREATMENT	$219.92	$366.54	$219.92–$366.54	—	40%
Spirometry (breathing test) CPT 94010 PFT W/VC MMV	$229.82	$383.04	$229.82–$539.72	23% below	40%
Spirometry (breathing test) CPT 94010 SPIROMETRY (PFT 1) - AC	$323.83	$539.72	$229.82–$539.72	9% above	40%
Spirometry (breathing test) inpatient CPT 94010 PFT W/VC MMV	$229.82	$383.04	$229.82–$539.72	—	40%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY (PFT 1) - AC	$323.83	$539.72	$229.82–$539.72	—	40%
Spirometry before and after a bronchodilator CPT 94060 PFT PRE/POST BRONCHODILATOR	$464.14	$773.56	$464.14–$773.56	15% below	40%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT PRE/POST BRONCHODILATOR	$464.14	$773.56	$464.14–$773.56	—	40%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITY, 15 MIN	$43.26	$72.10	$43.26–$72.10	65% below	40%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITY, 15 MIN	$43.26	$72.10	$43.26–$72.10	—	40%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$183.49	$305.81	$183.49–$305.81	15% below	40%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY	$183.49	$305.81	$183.49–$305.81	—	40%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACC SQ	$147.46	$245.77	$147.46–$245.77	47% below	40%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACC SQ	$147.46	$245.77	$147.46–$245.77	—	40%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTaP-IPV VACC PF 4-6 IM	$49.44	$82.40	$49.44–$82.40	51% below	40%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTaP-IPV VACC PF 4-6 IM	$49.44	$82.40	$49.44–$82.40	—	40%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTaP VACC <7 YR IM DOSE	$48.14	$80.24	$48.14–$80.24	24% below	40%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTaP VACC <7 YR IM DOSE	$48.14	$80.24	$48.14–$80.24	—	40%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV NONVALENT IM 3 DOSE	$318.27	$530.45	$318.27–$530.45	35% below	40%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV NONVALENT IM 3 DOSE	$318.27	$530.45	$318.27–$530.45	—	40%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEP B VACCINE/HEP A VACCINE IN	$53.74	$89.56	$53.74–$89.56	74% below	40%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEP B VACCINE/HEP A VACCINE IN	$53.74	$89.56	$53.74–$89.56	—	40%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MEASL/MUMPS/RUB/VARIC VACC	$205.01	$341.68	$205.01–$341.68	48% below	40%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MEASL/MUMPS/RUB/VARIC VACC	$205.01	$341.68	$205.01–$341.68	—	40%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENING CON VACC ACY W135 IM	$145.29	$242.15	$145.29–$242.15	41% below	40%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENING CON VACC ACY W135 IM	$145.29	$242.15	$145.29–$242.15	—	40%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENINGOCOCCAL CONJ POLY TET AC	$235.07	$391.79	$235.07–$570.97	8% below	40%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENING CON VACC ACWY IM	$342.58	$570.97	$235.07–$570.97	34% above	40%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENINGOCOCCAL CONJ POLY TET AC	$235.07	$391.79	$235.07–$570.97	—	40%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENING CON VACC ACWY IM	$342.58	$570.97	$235.07–$570.97	—	40%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 PF Respiratory syncytial virus	$671.50	$1,119.16	$671.50–$1,119.16	22% below	40%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 PF Respiratory syncytial virus	$671.50	$1,119.16	$671.50–$1,119.16	—	40%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSV VACC PREF RECOMB ADJT IM	$212.73	$354.55	$212.73–$354.55	54% below	40%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 RSV VACC PREF RECOMB ADJT IM	$212.73	$354.55	$212.73–$354.55	—	40%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE	$181.44	$302.40	$181.44–$302.40	76% below	40%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE	$181.44	$302.40	$181.44–$302.40	—	40%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HZV VACC RECOMBINANT IM	$192.20	$320.33	$192.20–$320.33	11% below	40%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HZV VACC RECOMBINANT IM	$192.20	$320.33	$192.20–$320.33	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIP/TET/ACE PERT VACC >7YR IM	$111.24	$185.40	$111.24–$185.40	3% above	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIP/TET/ACE PERT VACC >7YR IM	$111.24	$185.40	$111.24–$185.40	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN	$15.45	$25.75	$15.45–$177.71	73% below	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION OF FLU VACCINE	$66.96	$111.60	$15.45–$177.71	17% above	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATN PNEUMONIA VACCINE	$66.96	$111.60	$15.45–$177.71	17% above	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMIN INITIAL	$106.63	$177.71	$15.45–$177.71	86% above	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN VACC/TOXOID	$106.63	$177.71	$15.45–$177.71	86% above	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN	$15.45	$25.75	$15.45–$177.71	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMINISTRATION OF FLU VACCINE	$66.96	$111.60	$15.45–$177.71	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMINISTRATN PNEUMONIA VACCINE	$66.96	$111.60	$15.45–$177.71	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE ADMIN INITIAL	$106.63	$177.71	$15.45–$177.71	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN VACC/TOXOID	$106.63	$177.71	$15.45–$177.71	—	40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD	$15.45	$25.75	$15.45–$77.25	60% below	40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 PF IMMUN ADMIN EA ADD VACC	$23.16	$38.60	$15.45–$77.25	40% below	40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE ADMIN EA ADDL	$46.35	$77.25	$15.45–$77.25	20% above	40%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EACH ADD	$15.45	$25.75	$15.45–$77.25	—	40%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 PF IMMUN ADMIN EA ADD VACC	$23.16	$38.60	$15.45–$77.25	—	40%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 VACCINE ADMIN EA ADDL	$46.35	$77.25	$15.45–$77.25	—	40%

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

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

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

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

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

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

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

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

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

Source file: https://www.lorettohospital.org/documents/362200248_loretto-hospital_standardcharges.csv