Kirby Medical Center
Kirby Medical Center in Monticello, IL publishes cash prices for 315 common procedures listed here, from its own machine-readable price file updated Jun 11, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Illinois median for 281 of 312 procedures and below it for 29. By typical cash price it ranks #83 of 117 Illinois hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.
1000 Medical Center Drive, Monticello, IL 61856 Collected Nov 8, 2026 Source price file Check a bill from this hospital (217) 762-2115
Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 141301 · CMS hospital register NPI 1730179847
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Kirby Medical Center is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.
You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.
Source: IRS, section 501(r) requirements for nonprofit hospitals.
State law
This state limits hospital bills for lower-income patients
Illinois law (Hospital Uninsured Patient Discount Act, 210 ILCS 89): an uninsured Illinois resident with family income up to 600% of the federal poverty level (300% at rural and critical access hospitals) can apply for a discount that brings the bill down to about 135% of the hospital's cost; up to 200% (125% at rural hospitals) medically necessary care is free. A hospital may collect no more than 25% of family income in 12 months. Ask the billing office for the application. Other states' laws.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Illinois | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT ABD W/WO | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 7% above | 40% |
| Abdominal CT scan without and with contrast CPT 74170 CT KIDNEY WO/W CONTRAST | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 7% above | 40% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABD W/WO | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT KIDNEY WO/W CONTRAST | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| Abdominal X-ray, 2 views CPT 74019 KUB WITH OBLIQUE | $450.00 | $750.00 | $232.50–$735.00 | 35% above | 40% |
| Abdominal X-ray, 2 views CPT 74019 KUB 2 VIEWS/SUPINE AND UPRIGHT | $450.00 | $750.00 | $232.50–$735.00 | 35% above | 40% |
| Abdominal X-ray, 2 views inpatient CPT 74019 KUB 2 VIEWS/SUPINE AND UPRIGHT | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Abdominal X-ray, 2 views inpatient CPT 74019 KUB WITH OBLIQUE | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Ankle X-ray, complete, 3 or more views both sides CPT 73610 ORTHO ANKLE BILAT RIGHT FOCUS | $360.00 | $600.00 | $186.00–$588.00 | — | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE RT MIN 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 7% above | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE LT MIN 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 7% above | 40% |
| Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 ORTHO ANKLE BILAT RIGHT FOCUS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE LT MIN 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE RT MIN 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABI | $660.00 | $1,100.00 | $341.00–$1,078.00 | 59% above | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ARTERIAL DPPLR LMTD LWR EXT | $780.00 | $1,300.00 | $403.00–$1,274.00 | 88% above | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ABI | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ARTERIAL DPPLR LMTD LWR EXT | $780.00 | $1,300.00 | $884.00–$1,274.00 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT FOREARM LT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 21% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT ELBOW LT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 21% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT WRIST LT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 21% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT HUMERUS LT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 21% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT HAND LT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 21% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT SHOULDER RT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 21% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT SHOULDER LT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 21% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT HUMERUS RT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 21% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT ELBOW RT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 21% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT WRIST RT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 21% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT HAND RT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 21% above | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT SHOULDER LT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT ELBOW RT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT HUMERUS RT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT SHOULDER RT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT HAND LT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT WRIST LT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT FOREARM LT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT ELBOW LT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT HUMERUS LT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT HAND RT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT WRIST RT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS SINGLE CONTRAST | $720.00 | $1,200.00 | $372.00–$1,176.00 | 18% above | 40% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGUS SINGLE CONTRAST | $720.00 | $1,200.00 | $816.00–$1,176.00 | — | 40% |
| Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE SCAN WHOLE BODY | $1,950.00 | $3,250.00 | $1,007.50–$3,185.00 | 24% above | 40% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE SCAN WHOLE BODY | $1,950.00 | $3,250.00 | $2,210.00–$3,185.00 | — | 40% |
| Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE RT | $660.00 | $1,100.00 | $341.00–$1,078.00 | 28% above | 40% |
| Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE LT | $660.00 | $1,100.00 | $341.00–$1,078.00 | 28% above | 40% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE LT | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE RT | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US BREAST DIAG- LIMITED BILAT | $1,020.00 | $1,700.00 | $527.00–$1,666.00 | — | 40% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED LT | $510.00 | $850.00 | $263.50–$833.00 | 16% above | 40% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED RT | $510.00 | $850.00 | $263.50–$833.00 | 16% above | 40% |
| Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 US BREAST DIAG- LIMITED BILAT | $1,020.00 | $1,700.00 | $1,156.00–$1,666.00 | — | 40% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED RT | $510.00 | $850.00 | $578.00–$833.00 | — | 40% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED LT | $510.00 | $850.00 | $578.00–$833.00 | — | 40% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT CTA ABD/PELV WO/W DYE | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 14% above | 40% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ABD/PELVIS WITH VENOGRAM | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 14% above | 40% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ABD/PELVIS WITH VENOGRAM | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT CTA ABD/PELV WO/W DYE | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| CT angiography (CTA) of the head CPT 70496 CT CTA BRAIN WITH | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 19% above | 40% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT CTA BRAIN WITH | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| CT angiography (CTA) of the neck CPT 70498 CT CTA CAROTID WITH | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 17% above | 40% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CT CTA CAROTID WITH | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT PE CTA CHEST W/DYE | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 3% above | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT CTA CHEST W/DYE | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 3% above | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT PE CTA CHEST W/DYE | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT CTA CHEST W/DYE | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CARDIAC SCORING CT | $360.00 | $600.00 | $186.00–$588.00 | 63% above | 40% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CARDIAC SCORING CT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PELVIS W/O | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 14% below | 40% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT KIDNEY STONE W/O CONTRAST | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 14% below | 40% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PELVIS W/O | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT KIDNEY STONE W/O CONTRAST | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELVIS WITH | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 5% below | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELVIS WITH | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PELVIS W/WO | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 15% below | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD/PELVIS W/WO | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| CT scan of the abdomen with contrast CPT 74160 CT PANCREAS W CONTRAST | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 31% above | 40% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN WITH | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 31% above | 40% |
| CT scan of the abdomen with contrast CPT 74160 CT LIVER W CONTRAST | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 31% above | 40% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN WITH | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT PANCREAS W CONTRAST | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT LIVER W CONTRAST | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 20% above | 40% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT FACIAL BONES WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 31% above | 40% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS W/O | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 31% above | 40% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS W/O | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT FACIAL BONES WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 22% above | 40% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| CT scan of the head with contrast CPT 70460 CT HEAD W | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 56% above | 40% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD W | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD W/WO | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 24% above | 40% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/WO | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 2% above | 40% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C-SPINE WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 2% below | 40% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C-SPINE WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 39% above | 40% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US CAROTID ARTERY EXTRACRANIAL | $1,140.00 | $1,900.00 | $589.00–$1,862.00 | 32% above | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US CAROTID ARTERY EXTRACRANIAL | $1,140.00 | $1,900.00 | $1,292.00–$1,862.00 | — | 40% |
| Chest CT scan without and with contrast CPT 71270 CT THORAX DX C-/C+ | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 6% above | 40% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT THORAX DX C-/C+ | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| Chest X-ray, 2 views CPT 71046 CHEST PA AND LATERAL VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 20% above | 40% |
| Chest X-ray, 2 views CPT 71046 CHEST HIGH/LOW VIEWS 2V | $360.00 | $600.00 | $186.00–$588.00 | 20% above | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST PA AND LATERAL VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST HIGH/LOW VIEWS 2V | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Chest X-ray, single view CPT 71045 CHEST 1 VIEW | $360.00 | $600.00 | $186.00–$588.00 | 38% above | 40% |
| Chest X-ray, single view CPT 71045 CHEST 1V FOR TB | $360.00 | $600.00 | $186.00–$588.00 | 38% above | 40% |
| Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Chest X-ray, single view inpatient CPT 71045 CHEST 1V FOR TB | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE LT | $360.00 | $600.00 | $186.00–$588.00 | 28% above | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE RT | $360.00 | $600.00 | $186.00–$588.00 | 28% above | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE LT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE RT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US COMPLETE RENALS W/BLADDER | $660.00 | $1,100.00 | $341.00–$1,078.00 | 18% below | 40% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US COMPLETE RENALS W/BLADDER | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY DEXA | $480.00 | $800.00 | $248.00–$784.00 | 2% above | 40% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY DEXA | $480.00 | $800.00 | $544.00–$784.00 | — | 40% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DX C- | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 22% above | 40% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX DX C- | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DX C+ | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 25% above | 40% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX DX C+ | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DIAGNOSTIC MAMMO BILATERAL | $459.00 | $765.00 | $237.15–$749.70 | — | 40% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DIAGNOSTIC MAMMO BILATERAL | $459.00 | $765.00 | $520.20–$749.70 | — | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 DIAGNOSTIC MAMMO LT | $381.00 | $635.00 | $196.85–$622.30 | 25% above | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 DIAGNOSTIC MAMMO RT | $381.00 | $635.00 | $196.85–$622.30 | 25% above | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 DIAGNOSTIC MAMMO RT | $381.00 | $635.00 | $431.80–$622.30 | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 DIAGNOSTIC MAMMO LT | $381.00 | $635.00 | $431.80–$622.30 | — | 40% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 LWR EXTR ARTERL DUPLX BILAT | $1,140.00 | $1,900.00 | $589.00–$1,862.00 | — | 40% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 LWR EXTR ARTERL DUPLX BILAT | $1,140.00 | $1,900.00 | $1,292.00–$1,862.00 | — | 40% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS EXTREMITY BILATERAL | $1,140.00 | $1,900.00 | $589.00–$1,862.00 | — | 40% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 US UPPR EXTR VENOUS DUPLX BILA | $1,140.00 | $1,900.00 | $589.00–$1,862.00 | 18% below | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VENOUS EXTREMITY BILATERAL | $1,140.00 | $1,900.00 | $1,292.00–$1,862.00 | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US UPPR EXTR VENOUS DUPLX BILA | $1,140.00 | $1,900.00 | $1,292.00–$1,862.00 | — | 40% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHOCARDIOGRAM W SPECTRAL/C | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 6% above | 40% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHOCARDIOGRAM W SPECTRAL/C | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW LT MIN 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 6% above | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW RT MIN 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 6% above | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW RT MIN 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW LT MIN 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 33% above | 40% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT IAC/TEMPORAL BONE W/O | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 33% above | 40% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT IAC/TEMPORAL BONE W/O | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES COMPLETE MIN 3 VI | $450.00 | $750.00 | $232.50–$735.00 | 9% above | 40% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES COMPLETE MIN 3 VI | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM RT 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 13% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM LT 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 13% above | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM LT 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM RT 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY-GALLBLDR NO CCK | $1,950.00 | $3,250.00 | $1,007.50–$3,185.00 | 35% above | 40% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY-GALLBLDR NO CCK | $1,950.00 | $3,250.00 | $2,210.00–$3,185.00 | — | 40% |
| Hand X-ray, 2 views one side CPT 73120 HAND LT 2 VIEWS | $450.00 | $750.00 | $232.50–$735.00 | 58% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 HAND RT 2 VIEWS | $450.00 | $750.00 | $232.50–$735.00 | 58% above | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HAND RT 2 VIEWS | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HAND LT 2 VIEWS | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL RT OS CALCIS MIN 2V | $360.00 | $600.00 | $186.00–$588.00 | 39% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL LT OS CALCIS MIN 2V | $360.00 | $600.00 | $186.00–$588.00 | 39% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL LT OS CALCIS MIN 2V | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL RT OS CALCIS MIN 2V | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY TEST HOME TYPE3-4 | $661.80 | $1,103.00 | $341.93–$1,080.94 | 6% above | 40% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY TEST HOME TYPE3-4 | $661.80 | $1,103.00 | $750.04–$1,080.94 | — | 40% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY 4+PARAMTRS +CP | $4,328.40 | $7,214.00 | $2,236.34–$7,069.72 | 5% below | 40% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY 4+PARAMTRS +CP | $4,328.40 | $7,214.00 | $4,905.52–$7,069.72 | — | 40% |
| Knee X-ray, 3 views one side CPT 73562 ORTHO RT KNEE POST OP 3 VW | $360.00 | $600.00 | $186.00–$588.00 | 3% above | 40% |
| Knee X-ray, 3 views one side CPT 73562 KNEE RIGHT 3 VIEW MIN | $360.00 | $600.00 | $186.00–$588.00 | 3% above | 40% |
| Knee X-ray, 3 views one side CPT 73562 KNEE LEFT 3 VIEW MIN | $360.00 | $600.00 | $186.00–$588.00 | 3% above | 40% |
| Knee X-ray, 3 views one side CPT 73562 ORTHO LT KNEE POST OP 3 VW | $360.00 | $600.00 | $186.00–$588.00 | 3% above | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 KNEE LEFT 3 VIEW MIN | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 ORTHO RT KNEE POST OP 3 VW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 KNEE RIGHT 3 VIEW MIN | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 ORTHO LT KNEE POST OP 3 VW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Knee X-ray, complete, 4 or more views both sides CPT 73564 ORTHO KNEE BILAT RIGHT FOCUS | $450.00 | $750.00 | $232.50–$735.00 | — | 40% |
| Knee X-ray, complete, 4 or more views both sides CPT 73564 ORTHO KNEE BILAT LEFT FOCUS | $450.00 | $750.00 | $232.50–$735.00 | — | 40% |
| Knee X-ray, complete, 4 or more views CPT 73564 KNEE 4 VIEW MIN | $450.00 | $750.00 | $232.50–$735.00 | 2% above | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE RIGHT 4 VIEW MIN | $459.00 | $765.00 | $237.15–$749.70 | 4% above | 40% |
| Knee X-ray, complete, 4 or more views inpatient both sides CPT 73564 ORTHO KNEE BILAT RIGHT FOCUS | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient both sides CPT 73564 ORTHO KNEE BILAT LEFT FOCUS | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 KNEE 4 VIEW MIN | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE RIGHT 4 VIEW MIN | $459.00 | $765.00 | $520.20–$749.70 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER EXTREM RT WO CONTRAST | $1,797.60 | $2,996.00 | $928.76–$2,936.08 | at median | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT FOOT LT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 23% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT KNEE LT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 23% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LO EXT FEMUR LT WO CONTRAST | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 23% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT HIP LT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 23% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT HIP RT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 23% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT TIB/FIB RT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 23% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT FOOT RT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 23% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT TIB/FIB LT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 23% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT ANKLE RT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 23% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT KNEE RT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 23% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT FEMUR RT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 23% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT ANKLE LT WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 23% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER EXTREM RT WO CONTRAST | $1,797.60 | $2,996.00 | $2,037.28–$2,936.08 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT FOOT LT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LO EXT FEMUR LT WO CONTRAST | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT TIB/FIB LT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT ANKLE LT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT ANKLE RT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT HIP RT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT HIP LT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT KNEE LT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT FEMUR RT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT KNEE RT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT TIB/FIB RT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT FOOT RT WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMINAL REGION S.T. | $660.00 | $1,100.00 | $341.00–$1,078.00 | 5% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US BACK-LOWER S.T. | $660.00 | $1,100.00 | $341.00–$1,078.00 | 5% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED SNGL ORGAN/ | $660.00 | $1,100.00 | $341.00–$1,078.00 | 5% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED SNGL ORGAN/ | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMINAL REGION S.T. | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US BACK-LOWER S.T. | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US GROIN REGION S.T. | $660.00 | $1,100.00 | $341.00–$1,078.00 | 114% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXTREMITY NON VASCULAR LEFT | $660.00 | $1,100.00 | $341.00–$1,078.00 | 114% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US AXILLA RT NONVASCULAR LIMTD | $660.00 | $1,100.00 | $341.00–$1,078.00 | 114% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US AXILLA LT NONVASCULAR LIMTD | $660.00 | $1,100.00 | $341.00–$1,078.00 | 114% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXTREMITY NON VASCULAR RT | $660.00 | $1,100.00 | $341.00–$1,078.00 | 114% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US GROIN REGION S.T. | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US AXILLA LT NONVASCULAR LIMTD | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXTREMITY NON VASCULAR LEFT | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXTREMITY NON VASCULAR RT | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US AXILLA RT NONVASCULAR LIMTD | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR C- | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 293% above | 40% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCR C- | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LEG LOWR LT TIBIA FIBULA 2V | $360.00 | $600.00 | $186.00–$588.00 | 11% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LEG LOWR RT TIBIA & FIBULA 2V | $360.00 | $600.00 | $186.00–$588.00 | 11% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LEG LOWR RT TIBIA & FIBULA 2V | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LEG LOWR LT TIBIA FIBULA 2V | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRV BRAIN WO | $2,700.00 | $4,500.00 | $1,395.00–$4,410.00 | 3% above | 40% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA BRAIN WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 26% above | 40% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV BRAIN WO | $2,700.00 | $4,500.00 | $3,060.00–$4,410.00 | — | 40% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA BRAIN WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST W AND W/O BILATERAL | $4,800.00 | $8,000.00 | $2,480.00–$7,840.00 | — | 40% |
| MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI BREAST W AND W/O BILATERAL | $4,800.00 | $8,000.00 | $5,440.00–$7,840.00 | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LT WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 17% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI JNT OF LWR EXTRE WO RT | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 17% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP RT WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 17% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI JNT OF LWR EXTRE WO LT | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 17% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE LT WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 17% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE RT WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 17% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE LT WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE RT WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP LT WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI JNT OF LWR EXTRE WO RT | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI JNT OF LWR EXTRE WO LT | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP RT WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE LT W/WO | $3,763.80 | $6,273.00 | $1,944.63–$6,147.54 | 9% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI JOINT LWR EXTR W&W/O LT | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 22% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE RT W/WO | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 22% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI JOINT LWR EXTR W&W/O RT | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 22% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP RT W/WO | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 22% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE LT W/WO | $3,763.80 | $6,273.00 | $4,265.64–$6,147.54 | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE RT W/WO | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI JOINT LWR EXTR W&W/O LT | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP RT W/WO | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI JOINT LWR EXTR W&W/O RT | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 20% above | 40% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/WO | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 12% above | 40% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/WO | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 18% above | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 5% above | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO PITUITARY | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 5% above | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO IAC | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 5% above | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO IAC | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO PITUITARY | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 15% above | 40% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/WO | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 4% above | 40% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI SACRUM/COCCYX W & W/O CON | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 4% above | 40% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/WO | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI SACRUM/COCCYX W & W/O CON | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 16% above | 40% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL W/WO | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 7% above | 40% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL W/WO | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 13% above | 40% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/WO | $4,200.00 | $7,000.00 | $2,170.00–$6,860.00 | 18% above | 40% |
| MRI of the pelvis without and with contrast CPT 72197 MRI ABD/PELVIS W/WO | $4,320.00 | $7,200.00 | $2,232.00–$7,056.00 | 21% above | 40% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/WO | $4,200.00 | $7,000.00 | $4,760.00–$6,860.00 | — | 40% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI ABD/PELVIS W/WO | $4,320.00 | $7,200.00 | $4,896.00–$7,056.00 | — | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI SACRUM/COCCYX W/O CONTRAST | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 26% above | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 26% above | 40% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI SACRUM/COCCYX W/O CONTRAST | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST RT WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 17% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER LT W/O | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 17% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW RT WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 17% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER RT WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 17% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW LT WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 17% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST LT WO | $3,300.00 | $5,500.00 | $1,705.00–$5,390.00 | 17% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER LT W/O | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST RT WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER RT WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW RT WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST LT WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW LT WO | $3,300.00 | $5,500.00 | $3,740.00–$5,390.00 | — | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 SPINE CERVICAL OBL4/5VIEWS | $450.00 | $750.00 | $232.50–$735.00 | 17% below | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 SPINE CERVICAL OBL4/5VIEWS | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Neck soft tissue CT scan with contrast CPT 70491 CT S.T. NECK W | $3,000.00 | $5,000.00 | $1,550.00–$4,900.00 | 43% above | 40% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT S.T. NECK W | $3,000.00 | $5,000.00 | $3,400.00–$4,900.00 | — | 40% |
| Neck soft tissue CT scan without contrast CPT 70490 CT S.T. NECK WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 27% above | 40% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT S.T. NECK WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Neck soft tissue X-ray CPT 70360 NECK SOFT TISSUE | $360.00 | $600.00 | $186.00–$588.00 | 37% above | 40% |
| Neck soft tissue X-ray inpatient CPT 70360 NECK SOFT TISSUE | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM STRESS TEST-VASODILATOR | $4,320.00 | $7,200.00 | $2,232.00–$7,056.00 | 8% above | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM STRESS TEST- MULTIPLE STUDY | $4,320.00 | $7,200.00 | $2,232.00–$7,056.00 | 8% above | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM STRESS TEST-VASODILATOR | $4,320.00 | $7,200.00 | $4,896.00–$7,056.00 | — | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM STRESS TEST- MULTIPLE STUDY | $4,320.00 | $7,200.00 | $4,896.00–$7,056.00 | — | 40% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT TUMOR IMAGING SKULLBASE | $5,940.00 | $9,900.00 | $3,069.00–$9,702.00 | 1% above | 40% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT TUMOR IMAGING SKULLBASE | $5,940.00 | $9,900.00 | $6,732.00–$9,702.00 | — | 40% |
| Pelvic CT scan without contrast CPT 72192 CT SACRUM & COCCYX W/O CONTRAS | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 17% above | 40% |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 17% above | 40% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT SACRUM & COCCYX W/O CONTRAS | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BLADDER | $660.00 | $1,100.00 | $341.00–$1,078.00 | 22% above | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BUTTOCKS REGION S.T. | $660.00 | $1,100.00 | $341.00–$1,078.00 | 22% above | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US BUTTOCKS REGION S.T. | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US BLADDER | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS | $660.00 | $1,100.00 | $341.00–$1,078.00 | 16% below | 40% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREGNANT UTERUS TRANSABD>14 | $660.00 | $1,100.00 | $341.00–$1,078.00 | 10% below | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREGNANT UTERUS TRANSABD>14 | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREGNANT UTERUS TRANSABD<14 | $660.00 | $1,100.00 | $341.00–$1,078.00 | 1% below | 40% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREGNANT UTERUS TRANSABD<14 | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIBS LT UNILATERAL 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 4% above | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIBS RT UNILATERAL 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 4% above | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS LT UNILATERAL 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS RT UNILATERAL 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 LT UNILAT RIBS WITH PA CHEST | $450.00 | $750.00 | $232.50–$735.00 | 2% below | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RT UNILAT RIBS WITH PA CHEST | $450.00 | $750.00 | $232.50–$735.00 | 2% below | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 LT UNILAT RIBS WITH PA CHEST | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RT UNILAT RIBS WITH PA CHEST | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Screening mammogram, both breasts both sides CPT 77067 SCREENING MAMMO BILATERAL | $450.00 | $750.00 | $232.50–$735.00 | — | 40% |
| Screening mammogram, both breasts one side CPT 77067 SCREENING MAMMO LT | $444.00 | $740.00 | $229.40–$725.20 | 62% above | 40% |
| Screening mammogram, both breasts one side CPT 77067 SCREENING MAMMO RT | $444.00 | $740.00 | $229.40–$725.20 | 62% above | 40% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCREENING MAMMO BILATERAL | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Screening mammogram, both breasts inpatient one side CPT 77067 SCREENING MAMMO RT | $444.00 | $740.00 | $503.20–$725.20 | — | 40% |
| Screening mammogram, both breasts inpatient one side CPT 77067 SCREENING MAMMO LT | $444.00 | $740.00 | $503.20–$725.20 | — | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER ORTHO POST OP RT | $360.00 | $600.00 | $186.00–$588.00 | at median | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER LT MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | at median | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER RT MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | at median | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER ORTHO POST OP LT | $360.00 | $600.00 | $186.00–$588.00 | at median | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER ORTHO RT | $360.00 | $600.00 | $186.00–$588.00 | at median | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER ORTHO LT | $360.00 | $600.00 | $186.00–$588.00 | at median | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER ORTHO POST OP RT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER ORTHO RT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER ORTHO POST OP LT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER LT MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER RT MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER ORTHO LT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES PARANASAL COMPLETE MIN | $360.00 | $600.00 | $186.00–$588.00 | 2% below | 40% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES PARANASAL COMPLETE MIN | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Skull X-ray, fewer than 4 views CPT 70250 SKULL SURVEY 2 VIEWS | $450.00 | $750.00 | $232.50–$735.00 | 44% above | 40% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL SURVEY 2 VIEWS | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY 4+PARAMETERS S | $3,982.80 | $6,638.00 | $2,057.78–$6,505.24 | 3% above | 40% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY 4+PARAMETERS S | $3,982.80 | $6,638.00 | $4,513.84–$6,505.24 | — | 40% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 CINE/VID X-RAY THROAT/ESOPH | $720.00 | $1,200.00 | $372.00–$1,176.00 | 19% above | 40% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 CINE/VID X-RAY THROAT/ESOPH | $720.00 | $1,200.00 | $816.00–$1,176.00 | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR LT 2 VW | $360.00 | $600.00 | $186.00–$588.00 | 27% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR RT 2 VW | $360.00 | $600.00 | $186.00–$588.00 | 27% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR RT 2 VW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR LT 2 VW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT T-SPINE WO | $2,220.00 | $3,700.00 | $1,147.00–$3,626.00 | 3% above | 40% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT T-SPINE WO | $2,220.00 | $3,700.00 | $2,516.00–$3,626.00 | — | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE LT 5TH DIGIT MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 53% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE LT 3RD DIGIT MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 53% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE LEFT GREAT MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 53% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE LT 2ND DIGIT MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 53% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE RIGHT 5TH DIGIT | $360.00 | $600.00 | $186.00–$588.00 | 53% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE RIGHT 4TH DIGIT MIN 2 VIEW | $360.00 | $600.00 | $186.00–$588.00 | 53% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE RT 2ND DIGIT MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 53% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE RT 3RD DIGIT MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 53% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE RIGHT GREAT MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 53% above | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE LT 4TH DIGIT MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 53% above | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE RIGHT 4TH DIGIT MIN 2 VIEW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE RIGHT 5TH DIGIT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE RT 3RD DIGIT MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE RT 2ND DIGIT MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE RIGHT GREAT MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE LT 5TH DIGIT MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE LT 4TH DIGIT MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE LT 3RD DIGIT MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE LEFT GREAT MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE LT 2ND DIGIT MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $660.00 | $1,100.00 | $341.00–$1,078.00 | 2% above | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Transvaginal ultrasound during pregnancy CPT 76817 US PREGNANT UTERUS TRANSVAGINA | $660.00 | $1,100.00 | $341.00–$1,078.00 | 25% above | 40% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREGNANT UTERUS TRANSVAGINA | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE | $660.00 | $1,100.00 | $341.00–$1,078.00 | 35% below | 40% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Ultrasound of the scrotum and testicles CPT 76870 US TESTICLE | $660.00 | $1,100.00 | $341.00–$1,078.00 | 11% below | 40% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US TESTICLE | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID | $660.00 | $1,100.00 | $341.00–$1,078.00 | 3% below | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE MASS-HEAD 7 NEC | $660.00 | $1,100.00 | $341.00–$1,078.00 | 3% below | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE MASS-HEAD 7 NEC | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI SINGLE CONTRAST | $720.00 | $1,200.00 | $372.00–$1,176.00 | 2% above | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI SINGLE CONTRAST | $720.00 | $1,200.00 | $816.00–$1,176.00 | — | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS RT MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 22% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS LT MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 22% above | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS RT MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS LT MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VENOUS DUPLEX RT UPPR EXT | $660.00 | $1,100.00 | $341.00–$1,078.00 | 1% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VENOUS EXTREMITY LT UNILATE | $660.00 | $1,100.00 | $341.00–$1,078.00 | 1% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VENOUS EXTREMITY RT UNILATE | $660.00 | $1,100.00 | $341.00–$1,078.00 | 1% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VENOUS DUPLX LT UPPR EXT(DPPLR | $660.00 | $1,100.00 | $341.00–$1,078.00 | 1% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VENOUS REFLUX STUDY UNILAT | $660.00 | $1,100.00 | $341.00–$1,078.00 | 1% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 VENOUS DUPLEX RT UPPR EXT | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 VENOUS EXTREMITY LT UNILATE | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 VENOUS DUPLX LT UPPR EXT(DPPLR | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 VENOUS REFLUX STUDY UNILAT | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 VENOUS EXTREMITY RT UNILATE | $660.00 | $1,100.00 | $748.00–$1,078.00 | — | 40% |
| Wrist X-ray, 2 views one side CPT 73100 WRIST RT 2 VIEW | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 WRIST LT 2 VIEW | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST LT 2 VIEW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST RT 2 VIEW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VW WITH NAVICULAR RT | $360.00 | $600.00 | $186.00–$588.00 | 10% above | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST RT 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 10% above | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VW WITH NAVICULAR LT | $360.00 | $600.00 | $186.00–$588.00 | 10% above | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST LT 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 10% above | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3 VW WITH NAVICULAR LT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST LT 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3 VW WITH NAVICULAR RT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST RT 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 ORTHO HIP LEFT | $360.00 | $600.00 | $186.00–$588.00 | 19% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP LT INCLUDE PELVIS | $360.00 | $600.00 | $186.00–$588.00 | 19% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP RT INCLUDE PELVIS | $360.00 | $600.00 | $186.00–$588.00 | 19% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 ORTHO HIP RIGHT | $360.00 | $600.00 | $186.00–$588.00 | 19% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 ORTHO HIP LEFT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP RT INCLUDE PELVIS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP LT INCLUDE PELVIS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 ORTHO HIP RIGHT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the abdomen, 1 view CPT 74018 UPRIGHT KUB | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| X-ray of the abdomen, 1 view CPT 74018 KUB | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 UPRIGHT KUB | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 KUB | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE STRESS VIEW RT | $360.00 | $600.00 | $186.00–$588.00 | 30% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE RT 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 30% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE STRESS VIEW LT | $360.00 | $600.00 | $186.00–$588.00 | 30% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE LT 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 30% above | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE STRESS VIEW RT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE LT 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE RT 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE STRESS VIEW LT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER LEFT THUMB MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER RT 4TH DIGIT MIN 2 VIEW | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER RT 2ND DIGIT MIN 2 VIEW | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER LT 2ND DIGIT MIN 2 VIEW | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER RT 5TH DIGIT MIN 2 VIEW | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER RT 3RD DIGIT MIN 2 VIEW | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER LT 3RD DIGIT MIN 2 VIEW | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER RIGHT THUMB MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER LT 4TH DIGIT MIN 2 VIEW | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER LT 5TH DIGIT MIN 2 VIEW | $360.00 | $600.00 | $186.00–$588.00 | 35% above | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER RIGHT THUMB MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER LT 5TH DIGIT MIN 2 VIEW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER LT 4TH DIGIT MIN 2 VIEW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER LT 3RD DIGIT MIN 2 VIEW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER LT 2ND DIGIT MIN 2 VIEW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER LEFT THUMB MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER RT 5TH DIGIT MIN 2 VIEW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER RT 4TH DIGIT MIN 2 VIEW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER RT 3RD DIGIT MIN 2 VIEW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER RT 2ND DIGIT MIN 2 VIEW | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the foot, 2 views one side CPT 73620 FOOT LT 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 31% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 FOOT RT 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 31% above | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT LT 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT RT 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 ORTHO RIGHT FOOT | $360.00 | $600.00 | $186.00–$588.00 | 4% above | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT RT MIN 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 4% above | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT WEIGHT BEARING RT 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 4% above | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT WEIGHT BEARING LT 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 4% above | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT LT MIN 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 4% above | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 ORTHO LEFT FOOT | $360.00 | $600.00 | $186.00–$588.00 | 4% above | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 ORTHO RIGHT FOOT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 ORTHO LEFT FOOT | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT RT MIN 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT LT MIN 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT WEIGHT BEARING RT 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT WEIGHT BEARING LT 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 HAND RT MIN 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 4% above | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 HAND LT MIN 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 4% above | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND LT MIN 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND RT MIN 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the knee, 1 or 2 views both sides CPT 73560 ORTHO KNEE BILAT 1 OR 2 | $360.00 | $600.00 | $186.00–$588.00 | — | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE RT 1 OR 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 25% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE LT 1 OR 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 25% above | 40% |
| X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 ORTHO KNEE BILAT 1 OR 2 | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE RT 1 OR 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE LT 1 OR 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBAR ROUTINE 2OR 3VIEW | $450.00 | $750.00 | $232.50–$735.00 | 1% above | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE LUMBAR ROUTINE 2OR 3VIEW | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBR W/ OBLQ 4/>VW | $450.00 | $750.00 | $232.50–$735.00 | 19% below | 40% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBR W/ OBLQ 4/>VW | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES COMPLETE MIN 3 VIE | $360.00 | $600.00 | $186.00–$588.00 | 20% above | 40% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES COMPLETE MIN 3 VIE | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE CERVICAL 2 TO 3 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 1% above | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE CERVICAL 2 TO 3 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1-2 VIEWS | $450.00 | $750.00 | $232.50–$735.00 | 29% above | 40% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1-2 VIEWS | $450.00 | $750.00 | $510.00–$735.00 | — | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM & COCCYX MIN 2 VIEWS | $360.00 | $600.00 | $186.00–$588.00 | 5% above | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM & COCCYX MIN 2 VIEWS | $360.00 | $600.00 | $408.00–$588.00 | — | 40% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Illinois | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ACTH QUANT | $296.40 | $494.00 | $153.14–$484.12 | 48% above | 40% |
| ACTH blood test inpatient CPT 82024 ACTH QUANT | $296.40 | $494.00 | $335.92–$484.12 | — | 40% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT SGPT | $115.80 | $193.00 | $59.83–$189.14 | 111% above | 40% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT SGPT | $115.80 | $193.00 | $131.24–$189.14 | — | 40% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 AST SGOT | $109.20 | $182.00 | $56.42–$178.36 | 99% above | 40% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST SGOT | $109.20 | $182.00 | $123.76–$178.36 | — | 40% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PROFILE ACUTE | $595.20 | $992.00 | $307.52–$972.16 | 128% above | 40% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PROFILE ACUTE | $595.20 | $992.00 | $674.56–$972.16 | — | 40% |
| Albumin blood test CPT 82040 ALBUMIN SERUM | $75.00 | $125.00 | $38.75–$122.50 | 74% above | 40% |
| Albumin blood test inpatient CPT 82040 ALBUMIN SERUM | $75.00 | $125.00 | $85.00–$122.50 | — | 40% |
| Aldosterone blood test CPT 82088 ALDOSTERONE | $262.80 | $438.00 | $135.78–$429.24 | 59% above | 40% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE | $262.80 | $438.00 | $297.84–$429.24 | — | 40% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE | $115.20 | $192.00 | $59.52–$188.16 | 109% above | 40% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE | $115.20 | $192.00 | $130.56–$188.16 | — | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CAT DANDER | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 TIMOTHY GRASS(PHLEUM PRATENSE) | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAPLE LEAF SYCAMR,LONDON PLANE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAPLE (BOX ELDER) | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 WALNUT(JUGLANS CALIFORNICA) | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 WHITE ASH(FRAXINUS AMERICANA) | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 BERMUDA GRASS(CYNODON DACTYLON | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS FUMIGATUS | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIUM NOTATUM | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MOUNTAIN CEDAR(JUNIPERUS SABIN | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ROUGH MARSH ELDER | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ROUGH PIGWEED(AMARANTHUS RETRO | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 RUSSIAN THISTLE(SALTWORT SALSO | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MULBERRY | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MOUSE URINE PROTEINS | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 OAK | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 WALNUT IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 TUNA IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SHRIMP IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SESAME SEED IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALTERNARIA ALTERNATA (A MOLD) | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SCALLOP IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SALMON IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ELM | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 PECAN/HICKORY(CARYA SOECUE,PEC | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HAZELNUT IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CODFISH IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CASHEW NUT IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 LOBSTER IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CRAB IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALMOND IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 soybean IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 wheat IgE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 DOG DANDER | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 DERMATOPHAGOIDES PTERONYSSINUS | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 DERMATOPHAGOIDES FARINAE | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 COTTONWOOD(POPULOUS DELTOIDES) | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 COMMON RAGWEED (SHORT) | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 COCKROACH | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MILK ALLERGY TEST, each | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 EGG WHITE ALLERGY TEST, each | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CLADOSPORIUM HERBARUM(HORMODEN | $28.20 | $47.00 | $14.57–$46.06 | 3% above | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ELM | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 wheat IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MILK ALLERGY TEST, each | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 EGG WHITE ALLERGY TEST, each | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALMOND IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CASHEW NUT IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CODFISH IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HAZELNUT IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PEANUT IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SALMON IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SCALLOP IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SESAME SEED IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SHRIMP IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TUNA IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WALNUT IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALTERNARIA ALTERNATA (A MOLD) | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ASPERGILLUS FUMIGATUS | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BERMUDA GRASS(CYNODON DACTYLON | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CAT DANDER | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CLADOSPORIUM HERBARUM(HORMODEN | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COCKROACH | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COMMON RAGWEED (SHORT) | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COTTONWOOD(POPULOUS DELTOIDES) | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DERMATOPHAGOIDES FARINAE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DERMATOPHAGOIDES PTERONYSSINUS | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DOG DANDER | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAPLE (BOX ELDER) | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAPLE LEAF SYCAMR,LONDON PLANE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUNTAIN CEDAR(JUNIPERUS SABIN | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUSE URINE PROTEINS | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MULBERRY | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 OAK | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PECAN/HICKORY(CARYA SOECUE,PEC | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PENICILLIUM NOTATUM | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ROUGH MARSH ELDER | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ROUGH PIGWEED(AMARANTHUS RETRO | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RUSSIAN THISTLE(SALTWORT SALSO | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TIMOTHY GRASS(PHLEUM PRATENSE) | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WALNUT(JUGLANS CALIFORNICA) | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WHITE ASH(FRAXINUS AMERICANA) | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CRAB IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LOBSTER IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLG SPEC IGE CRUDE XTRC EA | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 soybean IgE | $28.20 | $47.00 | $31.96–$46.06 | — | 40% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA FETOPROTEIN SERUM QUANT | $164.40 | $274.00 | $84.94–$268.52 | 41% above | 40% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA FETOPROTEIN SERUM QUANT | $164.40 | $274.00 | $186.32–$268.52 | — | 40% |
| Ammonia blood test CPT 82140 AMMONIA QUANT | $153.00 | $255.00 | $79.05–$249.90 | 41% above | 40% |
| Ammonia blood test inpatient CPT 82140 AMMONIA QUANT | $153.00 | $255.00 | $173.40–$249.90 | — | 40% |
| Amylase blood test CPT 82150 AMYLASE SERUM QUANT | $198.00 | $330.00 | $102.30–$323.40 | 146% above | 40% |
| Amylase blood test inpatient CPT 82150 AMYLASE SERUM QUANT | $198.00 | $330.00 | $224.40–$323.40 | — | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE A | $160.80 | $268.00 | $83.08–$262.64 | 91% above | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE A | $160.80 | $268.00 | $182.24–$262.64 | — | 40% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA | $199.80 | $333.00 | $103.23–$326.34 | 116% above | 40% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA | $199.80 | $333.00 | $226.44–$326.34 | — | 40% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE BRAIN | $244.80 | $408.00 | $126.48–$399.84 | 30% above | 40% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE BRAIN | $244.80 | $408.00 | $277.44–$399.84 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE GENITAL | $160.20 | $267.00 | $82.77–$261.66 | 80% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE NOSE/THROAT COMPREHENS | $160.20 | $267.00 | $82.77–$261.66 | 80% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE WOUND/SPUTUM | $160.20 | $267.00 | $82.77–$261.66 | 80% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CSF, CULTURE | $160.20 | $267.00 | $82.77–$261.66 | 80% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CSF, CULTURE | $160.20 | $267.00 | $181.56–$261.66 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE WOUND/SPUTUM | $160.20 | $267.00 | $181.56–$261.66 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE NOSE/THROAT COMPREHENS | $160.20 | $267.00 | $181.56–$261.66 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE GENITAL | $160.20 | $267.00 | $181.56–$261.66 | — | 40% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL(CALCIUM, | $160.80 | $268.00 | $83.08–$262.64 | 27% above | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL(CALCIUM, | $160.80 | $268.00 | $182.24–$262.64 | — | 40% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL | $149.40 | $249.00 | $77.19–$244.02 | 148% above | 40% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL | $149.40 | $249.00 | $169.32–$244.02 | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL SPECIMEN CLS IV | $385.20 | $642.00 | $199.02–$629.16 | 57% above | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL SPECIMEN CLS IV | $385.20 | $642.00 | $436.56–$629.16 | — | 40% |
| Blood culture for bacteria CPT 87040 CULTURE BLOOD | $220.80 | $368.00 | $114.08–$360.64 | 53% above | 40% |
| Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD | $220.80 | $368.00 | $250.24–$360.64 | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD COLLECTION VENIPUNCTURE | $24.00 | $40.00 | $12.40–$39.20 | 2% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD COLLECTION VENIPUNCTURE | $24.00 | $40.00 | $27.20–$39.20 | — | 40% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE 2 HOUR POST PRANDIAL | $59.40 | $99.00 | $30.69–$97.02 | 49% above | 40% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE QUANTITATIVE | $59.40 | $99.00 | $30.69–$97.02 | 49% above | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANTITATIVE | $59.40 | $99.00 | $67.32–$97.02 | — | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE 2 HOUR POST PRANDIAL | $59.40 | $99.00 | $67.32–$97.02 | — | 40% |
| Blood lead test CPT 83655 LEAD QUANT BLOOD WAIVE TEST | $89.40 | $149.00 | $46.19–$146.02 | 66% above | 40% |
| Blood lead test CPT 83655 LEAD QUANT BLOOD | $91.80 | $153.00 | $47.43–$149.94 | 70% above | 40% |
| Blood lead test inpatient CPT 83655 LEAD QUANT BLOOD WAIVE TEST | $89.40 | $149.00 | $101.32–$146.02 | — | 40% |
| Blood lead test inpatient CPT 83655 LEAD QUANT BLOOD | $91.80 | $153.00 | $104.04–$149.94 | — | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREG SERUM QUAL | $158.40 | $264.00 | $81.84–$258.72 | 78% above | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREG SERUM QUAL | $158.40 | $264.00 | $179.52–$258.72 | — | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB ABO TYPE | $69.00 | $115.00 | $35.65–$112.70 | 18% below | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB ABO TYPE | $69.00 | $115.00 | $78.20–$112.70 | — | 40% |
| Blood urea nitrogen (BUN) test CPT 84520 IMAGING BUN | $75.00 | $125.00 | $38.75–$122.50 | 55% above | 40% |
| Blood urea nitrogen (BUN) test CPT 84520 BUN SERUM QUANT | $75.00 | $125.00 | $38.75–$122.50 | 55% above | 40% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 IMAGING BUN | $75.00 | $125.00 | $85.00–$122.50 | — | 40% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN SERUM QUANT | $75.00 | $125.00 | $85.00–$122.50 | — | 40% |
| C-peptide blood test CPT 84681 C PEPTIDE | $210.60 | $351.00 | $108.81–$343.98 | 103% above | 40% |
| C-peptide blood test inpatient CPT 84681 C PEPTIDE | $210.60 | $351.00 | $238.68–$343.98 | — | 40% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $85.80 | $143.00 | $44.33–$140.14 | 24% above | 40% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN | $85.80 | $143.00 | $97.24–$140.14 | — | 40% |
| C. difficile toxin gene test (stool PCR) CPT 87493 CDIFF-MOL AMP | $217.80 | $363.00 | $112.53–$355.74 | 17% above | 40% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF TOXIN B, QUAL PCR | $217.80 | $363.00 | $112.53–$355.74 | 17% above | 40% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CDIFF-MOL AMP | $217.80 | $363.00 | $246.84–$355.74 | — | 40% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF TOXIN B, QUAL PCR | $217.80 | $363.00 | $246.84–$355.74 | — | 40% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA19-9 | $157.80 | $263.00 | $81.53–$257.74 | 40% above | 40% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA19-9 | $157.80 | $263.00 | $178.84–$257.74 | — | 40% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CANCER ANTIGEN 125 | $235.20 | $392.00 | $121.52–$384.16 | 46% above | 40% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CANCER ANTIGEN 125 | $235.20 | $392.00 | $266.56–$384.16 | — | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 XPERT COV2 | $318.00 | $530.00 | $164.30–$519.40 | 175% above | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CARLE LAB CORONAVIRUS,NOVEL | $318.00 | $530.00 | $164.30–$519.40 | 175% above | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 CARLE LAB CORONAVIRUS,NOVEL | $318.00 | $530.00 | $360.40–$519.40 | — | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 XPERT COV2 | $318.00 | $530.00 | $360.40–$519.40 | — | 40% |
| Calcium blood test, total CPT 82310 CALCIUM SERUM TOTAL | $79.80 | $133.00 | $41.23–$130.34 | 83% above | 40% |
| Calcium blood test, total CPT 82310 CALCIUM, RANDOM URINE | $79.80 | $133.00 | $41.23–$130.34 | 83% above | 40% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM SERUM TOTAL | $79.80 | $133.00 | $90.44–$130.34 | — | 40% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM, RANDOM URINE | $79.80 | $133.00 | $90.44–$130.34 | — | 40% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CEA | $216.60 | $361.00 | $111.91–$353.78 | 51% above | 40% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA | $216.60 | $361.00 | $245.48–$353.78 | — | 40% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER ANT IGM | $166.20 | $277.00 | $85.87–$271.46 | 129% above | 40% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER ANT IGG | $166.20 | $277.00 | $85.87–$271.46 | 129% above | 40% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER ANT IGG | $166.20 | $277.00 | $188.36–$271.46 | — | 40% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER ANT IGM | $166.20 | $277.00 | $188.36–$271.46 | — | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACH, PCR | $270.00 | $450.00 | $139.50–$441.00 | 119% above | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACH, PCR | $270.00 | $450.00 | $306.00–$441.00 | — | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $177.00 | $295.00 | $91.45–$289.10 | 42% above | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $177.00 | $295.00 | $200.60–$289.10 | — | 40% |
| Complete blood count (CBC) with differential CPT 85025 CBC HEMOGRAM W/AUTOMATED DIFF | $112.20 | $187.00 | $57.97–$183.26 | 40% above | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC HEMOGRAM W/AUTOMATED DIFF | $112.20 | $187.00 | $127.16–$183.26 | — | 40% |
| Complete blood count (CBC), no differential CPT 85027 HEMOGRAM WITH PLATELETS AUTOMA | $91.80 | $153.00 | $47.43–$149.94 | 41% above | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM WITH PLATELETS AUTOMA | $91.80 | $153.00 | $104.04–$149.94 | — | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $223.20 | $372.00 | $115.32–$364.56 | 46% above | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $223.20 | $372.00 | $252.96–$364.56 | — | 40% |
| Cortisol blood test, total CPT 82533 CORTISOL TOTAL | $211.20 | $352.00 | $109.12–$344.96 | 88% above | 40% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL | $211.20 | $352.00 | $239.36–$344.96 | — | 40% |
| Creatine kinase (CK) blood test, total CPT 82550 CPK TOTAL SERUM | $112.80 | $188.00 | $58.28–$184.24 | 69% above | 40% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK TOTAL SERUM | $112.80 | $188.00 | $127.84–$184.24 | — | 40% |
| Creatinine blood test CPT 82565 IMAGING CREATININE W/GFR | $82.80 | $138.00 | $42.78–$135.24 | 74% above | 40% |
| Creatinine blood test CPT 82565 CREATININE SERUM | $82.80 | $138.00 | $42.78–$135.24 | 74% above | 40% |
| Creatinine blood test inpatient CPT 82565 CREATININE SERUM | $82.80 | $138.00 | $93.84–$135.24 | — | 40% |
| Creatinine blood test inpatient CPT 82565 IMAGING CREATININE W/GFR | $82.80 | $138.00 | $93.84–$135.24 | — | 40% |
| Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGALOVIRUS IGG | $132.60 | $221.00 | $68.51–$216.58 | 52% above | 40% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGALOVIRUS IGG | $132.60 | $221.00 | $150.28–$216.58 | — | 40% |
| D-dimer blood test (blood clot marker) CPT 85379 D DIMER QUANT | $177.00 | $295.00 | $91.45–$289.10 | 49% above | 40% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 D DIMER QUANT | $177.00 | $295.00 | $200.60–$289.10 | — | 40% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE | $270.00 | $450.00 | $139.50–$441.00 | 145% above | 40% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE | $270.00 | $450.00 | $306.00–$441.00 | — | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 ALCOHOL METABOLITES URINE | $132.00 | $220.00 | $68.20–$215.60 | 32% above | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ALCOHOL METABOLITES URINE | $132.00 | $220.00 | $149.60–$215.60 | — | 40% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EBV IGM QUANT | $236.40 | $394.00 | $122.14–$386.12 | 120% above | 40% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN-BARR CAPSID VCA | $236.40 | $394.00 | $122.14–$386.12 | 120% above | 40% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN-BARR CAPSID VCA | $236.40 | $394.00 | $267.92–$386.12 | — | 40% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV IGM QUANT | $236.40 | $394.00 | $267.92–$386.12 | — | 40% |
| Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL | $267.60 | $446.00 | $138.26–$437.08 | 143% above | 40% |
| Estradiol blood test inpatient CPT 82670 ASSAY OF TOTAL ESTRADIOL | $267.60 | $446.00 | $303.28–$437.08 | — | 40% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH | $238.20 | $397.00 | $123.07–$389.06 | 98% above | 40% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH | $238.20 | $397.00 | $269.96–$389.06 | — | 40% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, STOOL | $303.00 | $505.00 | $156.55–$494.90 | 73% above | 40% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, STOOL | $303.00 | $505.00 | $343.40–$494.90 | — | 40% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $184.20 | $307.00 | $95.17–$300.86 | 40% above | 40% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN | $184.20 | $307.00 | $208.76–$300.86 | — | 40% |
| Fibrinogen blood test CPT 85384 FIBRINOGEN ACTIVITY | $136.80 | $228.00 | $70.68–$223.44 | 63% above | 40% |
| Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN ACTIVITY | $136.80 | $228.00 | $155.04–$223.44 | — | 40% |
| Folate (folic acid) blood test CPT 82746 FOLIC ACID SERUM | $148.80 | $248.00 | $76.88–$243.04 | 31% above | 40% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID SERUM | $148.80 | $248.00 | $168.64–$243.04 | — | 40% |
| Free T3 thyroid hormone test CPT 84481 T3 FREE | $236.40 | $394.00 | $122.14–$386.12 | 95% above | 40% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE | $236.40 | $394.00 | $267.92–$386.12 | — | 40% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE, DIRECT DIALYSIS | $163.20 | $272.00 | $84.32–$266.56 | 41% above | 40% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE | $163.20 | $272.00 | $84.32–$266.56 | 41% above | 40% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE | $163.20 | $272.00 | $184.96–$266.56 | — | 40% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE, DIRECT DIALYSIS | $163.20 | $272.00 | $184.96–$266.56 | — | 40% |
| Free testosterone test CPT 84402 TESTOSTERONE FREE | $153.60 | $256.00 | $79.36–$250.88 | 23% above | 40% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE | $153.60 | $256.00 | $174.08–$250.88 | — | 40% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 GAMMA GT SERUM | $85.80 | $143.00 | $44.33–$140.14 | 47% above | 40% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GAMMA GT SERUM | $85.80 | $143.00 | $97.24–$140.14 | — | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST GLUCOSE DOSE | $78.60 | $131.00 | $40.61–$128.38 | 36% above | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST GLUCOSE DOSE | $78.60 | $131.00 | $89.08–$128.38 | — | 40% |
| Glucose tolerance test, 3 samples CPT 82951 GTT - FASTING GLUCOSE | $114.60 | $191.00 | $59.21–$187.18 | 12% below | 40% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GTT - FASTING GLUCOSE | $114.60 | $191.00 | $129.88–$187.18 | — | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE, PCR | $270.00 | $450.00 | $139.50–$441.00 | 126% above | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE, PCR | $270.00 | $450.00 | $306.00–$441.00 | — | 40% |
| H. pylori stool antigen test CPT 87338 H PYLORI AG, EIA, STOOL | $171.60 | $286.00 | $88.66–$280.28 | 48% above | 40% |
| H. pylori stool antigen test inpatient CPT 87338 H PYLORI AG, EIA, STOOL | $171.60 | $286.00 | $194.48–$280.28 | — | 40% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 QUANT PCR | $405.60 | $676.00 | $209.56–$662.48 | 19% above | 40% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 QUANT PCR | $405.60 | $676.00 | $459.68–$662.48 | — | 40% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV, AMPLIFIED PROBE TECHNQUE | $167.40 | $279.00 | $86.49–$273.42 | 14% above | 40% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV, AMPLIFIED PROBE TECHNQUE | $167.40 | $279.00 | $189.72–$273.42 | — | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 POC A1C HEMOGLOBIN GLYCOSYLATD | $49.20 | $82.00 | $25.42–$80.36 | 44% below | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C GLYCOSYLATED | $148.20 | $247.00 | $76.57–$242.06 | 67% above | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 POC A1C HEMOGLOBIN GLYCOSYLATD | $49.20 | $82.00 | $55.76–$80.36 | — | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C GLYCOSYLATED | $148.20 | $247.00 | $167.96–$242.06 | — | 40% |
| Hemoglobin blood test CPT 85018 HEMOGLOBIN | $40.80 | $68.00 | $21.08–$66.64 | 30% above | 40% |
| Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN | $40.80 | $68.00 | $46.24–$66.64 | — | 40% |
| Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE ANTIBODY TOTA | $190.20 | $317.00 | $98.27–$310.66 | 138% above | 40% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE ANTIBODY TOTA | $190.20 | $317.00 | $215.56–$310.66 | — | 40% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY | $123.60 | $206.00 | $63.86–$201.88 | 32% above | 40% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY | $123.60 | $206.00 | $140.08–$201.88 | — | 40% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE (HBsAG) | $176.40 | $294.00 | $91.14–$288.12 | 99% above | 40% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE (HBsAG) | $176.40 | $294.00 | $199.92–$288.12 | — | 40% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE I | $118.80 | $198.00 | $61.38–$194.04 | 76% above | 40% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE I | $118.80 | $198.00 | $134.64–$194.04 | — | 40% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE II | $126.60 | $211.00 | $65.41–$206.78 | 37% above | 40% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE II | $126.60 | $211.00 | $143.48–$206.78 | — | 40% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS | $150.00 | $250.00 | $77.50–$245.00 | 62% above | 40% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HS | $150.00 | $250.00 | $170.00–$245.00 | — | 40% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE | $174.60 | $291.00 | $90.21–$285.18 | 46% above | 40% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE | $174.60 | $291.00 | $197.88–$285.18 | — | 40% |
| Insulin blood test CPT 83525 INSULIN RIA TOTAL | $114.00 | $190.00 | $58.90–$186.20 | 54% above | 40% |
| Insulin blood test inpatient CPT 83525 INSULIN RIA TOTAL | $114.00 | $190.00 | $129.20–$186.20 | — | 40% |
| Iron blood test (serum iron) CPT 83540 IRON | $133.20 | $222.00 | $68.82–$217.56 | 73% above | 40% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON | $133.20 | $222.00 | $150.96–$217.56 | — | 40% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $311.40 | $519.00 | $160.89–$508.62 | 110% above | 40% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $311.40 | $519.00 | $352.92–$508.62 | — | 40% |
| LH (luteinizing hormone) test CPT 83002 LH LUTEINIZING HORMONE | $232.80 | $388.00 | $120.28–$380.24 | 103% above | 40% |
| LH (luteinizing hormone) test inpatient CPT 83002 LH LUTEINIZING HORMONE | $232.80 | $388.00 | $263.84–$380.24 | — | 40% |
| Lactate (lactic acid) blood test CPT 83605 LACTIC ACID | $144.00 | $240.00 | $74.40–$235.20 | 60% above | 40% |
| Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID | $144.00 | $240.00 | $163.20–$235.20 | — | 40% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH | $90.00 | $150.00 | $46.50–$147.00 | 71% above | 40% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH | $90.00 | $150.00 | $102.00–$147.00 | — | 40% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE SERUM | $141.00 | $235.00 | $72.85–$230.30 | 57% above | 40% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE SERUM | $141.00 | $235.00 | $159.80–$230.30 | — | 40% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $199.20 | $332.00 | $102.92–$325.36 | 42% above | 40% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $199.20 | $332.00 | $225.76–$325.36 | — | 40% |
| Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY | $200.40 | $334.00 | $103.54–$327.32 | 170% above | 40% |
| Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY | $200.40 | $334.00 | $227.12–$327.32 | — | 40% |
| Magnesium blood test CPT 83735 MAGNESIUM SERUM | $176.40 | $294.00 | $91.14–$288.12 | 157% above | 40% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM SERUM | $176.40 | $294.00 | $199.92–$288.12 | — | 40% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA IMMUNITY SCREEN | $154.80 | $258.00 | $79.98–$252.84 | 106% above | 40% |
| Measles (rubeola) antibody test CPT 86765 MEASLES ANTIBODY IgM | $154.80 | $258.00 | $79.98–$252.84 | 106% above | 40% |
| Measles (rubeola) antibody test inpatient CPT 86765 MEASLES ANTIBODY IgM | $154.80 | $258.00 | $175.44–$252.84 | — | 40% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA IMMUNITY SCREEN | $154.80 | $258.00 | $175.44–$252.84 | — | 40% |
| Mono test (heterophile antibody, Monospot) CPT 86308 MONOSPOT | $102.60 | $171.00 | $53.01–$167.58 | 33% above | 40% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSPOT | $102.60 | $171.00 | $116.28–$167.58 | — | 40% |
| Mumps immunity blood test CPT 86735 MUMPS TITER IgG | $183.60 | $306.00 | $94.86–$299.88 | 145% above | 40% |
| Mumps immunity blood test CPT 86735 MUMPS TITER IgM | $183.60 | $306.00 | $94.86–$299.88 | 145% above | 40% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS TITER IgG | $183.60 | $306.00 | $208.08–$299.88 | — | 40% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS TITER IgM | $183.60 | $306.00 | $208.08–$299.88 | — | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PSA FREE | $129.00 | $215.00 | $66.65–$210.70 | 32% above | 40% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 ASSAY OF PSA FREE | $129.00 | $215.00 | $146.20–$210.70 | — | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE HEALTH INDEX | $183.60 | $306.00 | $94.86–$299.88 | 60% above | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA DIAGNOSTIC TOTAL | $194.40 | $324.00 | $100.44–$317.52 | 69% above | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA SCREENING | $194.40 | $324.00 | $100.44–$317.52 | 69% above | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE HEALTH INDEX | $183.60 | $306.00 | $208.08–$299.88 | — | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA SCREENING | $194.40 | $324.00 | $220.32–$317.52 | — | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA DIAGNOSTIC TOTAL | $194.40 | $324.00 | $220.32–$317.52 | — | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAPSMEAR CYTOPATHOLOGY CERV/VA | $160.80 | $268.00 | $83.08–$262.64 | 43% above | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAPSMEAR CYTOPATHOLOGY CERV/VA | $160.80 | $268.00 | $182.24–$262.64 | — | 40% |
| Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT & CALCIUM | $318.00 | $530.00 | $164.30–$519.40 | 41% above | 40% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT & CALCIUM | $318.00 | $530.00 | $360.40–$519.40 | — | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $102.60 | $171.00 | $53.01–$167.58 | 56% above | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL | $102.60 | $171.00 | $116.28–$167.58 | — | 40% |
| Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS INORGANIC SERUM | $88.20 | $147.00 | $45.57–$144.06 | 51% above | 40% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS INORGANIC SERUM | $88.20 | $147.00 | $99.96–$144.06 | — | 40% |
| Potassium blood test CPT 84132 POTASSIUM; SERUM, PLASMA OR WH | $63.00 | $105.00 | $32.55–$102.90 | 45% above | 40% |
| Potassium blood test inpatient CPT 84132 POTASSIUM; SERUM, PLASMA OR WH | $63.00 | $105.00 | $71.40–$102.90 | — | 40% |
| Progesterone blood test CPT 84144 PROGESTERONE SERUM | $210.00 | $350.00 | $108.50–$343.00 | 50% above | 40% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE SERUM | $210.00 | $350.00 | $238.00–$343.00 | — | 40% |
| Prolactin blood test CPT 84146 PROLACTIN RIA | $242.40 | $404.00 | $125.24–$395.92 | 87% above | 40% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN RIA | $242.40 | $404.00 | $274.72–$395.92 | — | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 AMS INR | $78.00 | $130.00 | $40.30–$127.40 | 80% above | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR | $78.00 | $130.00 | $40.30–$127.40 | 80% above | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR | $78.00 | $130.00 | $88.40–$127.40 | — | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 AMS INR | $78.00 | $130.00 | $88.40–$127.40 | — | 40% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRSMV DIR OPT OBS | $156.00 | $260.00 | $80.60–$254.80 | 90% above | 40% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 CLIENT 4 PANEL DRUG SCREEN | $156.00 | $260.00 | $80.60–$254.80 | 90% above | 40% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 COTININE, URINE | $156.00 | $260.00 | $80.60–$254.80 | 90% above | 40% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 CLIENT 4 PANEL DRUG SCREEN | $156.00 | $260.00 | $176.80–$254.80 | — | 40% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 COTININE, URINE | $156.00 | $260.00 | $176.80–$254.80 | — | 40% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TEST PRSMV DIR OPT OBS | $156.00 | $260.00 | $176.80–$254.80 | — | 40% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A VIRUS | $148.80 | $248.00 | $76.88–$243.04 | 108% above | 40% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA B VIRUS | $148.80 | $248.00 | $76.88–$243.04 | 108% above | 40% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A VIRUS | $148.80 | $248.00 | $168.64–$243.04 | — | 40% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA B VIRUS | $148.80 | $248.00 | $168.64–$243.04 | — | 40% |
| Renin blood test CPT 84244 RENIN PLASMA LEVEL | $178.20 | $297.00 | $92.07–$291.06 | 55% above | 40% |
| Renin blood test inpatient CPT 84244 RENIN PLASMA LEVEL | $178.20 | $297.00 | $201.96–$291.06 | — | 40% |
| Rh blood typing CPT 86901 BB RH FACTOR | $66.60 | $111.00 | $34.41–$108.78 | 1% below | 40% |
| Rh blood typing inpatient CPT 86901 BB RH FACTOR | $66.60 | $111.00 | $75.48–$108.78 | — | 40% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIVE | $96.00 | $160.00 | $49.60–$156.80 | 53% above | 40% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTITATIVE | $96.00 | $160.00 | $108.80–$156.80 | — | 40% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM | $110.40 | $184.00 | $57.04–$180.32 | 51% above | 40% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA TITER AB | $110.40 | $184.00 | $57.04–$180.32 | 51% above | 40% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGM | $110.40 | $184.00 | $125.12–$180.32 | — | 40% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA TITER AB | $110.40 | $184.00 | $125.12–$180.32 | — | 40% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE AUTOMATED | $79.80 | $133.00 | $41.23–$130.34 | 65% above | 40% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE AUTOMATED | $79.80 | $133.00 | $90.44–$130.34 | — | 40% |
| Sodium blood test CPT 84295 SODIUM; SERUM,PLASMA OR WHOLE | $60.00 | $100.00 | $31.00–$98.00 | 22% above | 40% |
| Sodium blood test inpatient CPT 84295 SODIUM; SERUM,PLASMA OR WHOLE | $60.00 | $100.00 | $68.00–$98.00 | — | 40% |
| Stool ova and parasites exam CPT 87177 OVA & PARASITES STOOL | $183.60 | $306.00 | $94.86–$299.88 | 145% above | 40% |
| Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES STOOL | $183.60 | $306.00 | $208.08–$299.88 | — | 40% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD COLORECTAL CA SCR | $51.00 | $85.00 | $26.35–$83.30 | 77% above | 40% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD COLORECTAL CA SCR | $51.00 | $85.00 | $57.80–$83.30 | — | 40% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 IFOB TEST | $83.40 | $139.00 | $43.09–$136.22 | 12% above | 40% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 IFOB TEST | $83.40 | $139.00 | $94.52–$136.22 | — | 40% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 FTA-ABS | $96.00 | $160.00 | $49.60–$156.80 | 45% above | 40% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 FTA-ABS | $96.00 | $160.00 | $108.80–$156.80 | — | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR VDRL QUAL(SYPHILIS TEST) | $79.80 | $133.00 | $41.23–$130.34 | 56% above | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL serum | $79.80 | $133.00 | $41.23–$130.34 | 56% above | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL serum | $79.80 | $133.00 | $90.44–$130.34 | — | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR VDRL QUAL(SYPHILIS TEST) | $79.80 | $133.00 | $90.44–$130.34 | — | 40% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB GOLD | $248.40 | $414.00 | $128.34–$405.72 | 12% above | 40% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB GOLD | $248.40 | $414.00 | $281.52–$405.72 | — | 40% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL | $202.80 | $338.00 | $104.78–$331.24 | 60% above | 40% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL | $202.80 | $338.00 | $229.84–$331.24 | — | 40% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE ANTIBODIES | $136.80 | $228.00 | $70.68–$223.44 | 72% above | 40% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 LKM-1 LIVER KIDNEY MICROSOME | $136.80 | $228.00 | $70.68–$223.44 | 72% above | 40% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LKM-1 LIVER KIDNEY MICROSOME | $136.80 | $228.00 | $155.04–$223.44 | — | 40% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE ANTIBODIES | $136.80 | $228.00 | $155.04–$223.44 | — | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $184.20 | $307.00 | $95.17–$300.86 | 66% above | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $184.20 | $307.00 | $208.76–$300.86 | — | 40% |
| Total IgE blood test CPT 82785 IMMUNOGLOBULIN E (IGE) | $188.40 | $314.00 | $97.34–$307.72 | 115% above | 40% |
| Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN E (IGE) | $188.40 | $314.00 | $213.52–$307.72 | — | 40% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL SERUM TOTAL | $135.00 | $225.00 | $69.75–$220.50 | 216% above | 40% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL SERUM TOTAL | $135.00 | $225.00 | $153.00–$220.50 | — | 40% |
| Total thyroxine (T4) blood test CPT 84436 T4 TOTAL | $111.00 | $185.00 | $57.35–$181.30 | 34% above | 40% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4 TOTAL | $111.00 | $185.00 | $125.80–$181.30 | — | 40% |
| Total triiodothyronine (T3) blood test CPT 84480 T3 TOTAL | $174.60 | $291.00 | $90.21–$285.18 | 82% above | 40% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 TOTAL | $174.60 | $291.00 | $197.88–$285.18 | — | 40% |
| Transferrin blood test CPT 84466 TRANSFERRIN | $126.60 | $211.00 | $65.41–$206.78 | 33% above | 40% |
| Transferrin blood test inpatient CPT 84466 TRANSFERRIN | $126.60 | $211.00 | $143.48–$206.78 | — | 40% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $150.00 | $250.00 | $77.50–$245.00 | 20% above | 40% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS RNA,QUAL | $150.00 | $250.00 | $77.50–$245.00 | 20% above | 40% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS RNA,MALE | $150.00 | $250.00 | $77.50–$245.00 | 20% above | 40% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS RNA,QUAL | $150.00 | $250.00 | $170.00–$245.00 | — | 40% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $150.00 | $250.00 | $170.00–$245.00 | — | 40% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS RNA,MALE | $150.00 | $250.00 | $170.00–$245.00 | — | 40% |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES SERUM | $182.40 | $304.00 | $94.24–$297.92 | 284% above | 40% |
| Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES SERUM | $182.40 | $304.00 | $206.72–$297.92 | — | 40% |
| Troponin test, quantitative CPT 84484 TROPONIN ISTAT | $186.60 | $311.00 | $96.41–$304.78 | 24% above | 40% |
| Troponin test, quantitative CPT 84484 TROPONIN I QUANT | $186.60 | $311.00 | $96.41–$304.78 | 24% above | 40% |
| Troponin test, quantitative inpatient CPT 84484 TROPONIN ISTAT | $186.60 | $311.00 | $211.48–$304.78 | — | 40% |
| Troponin test, quantitative inpatient CPT 84484 TROPONIN I QUANT | $186.60 | $311.00 | $211.48–$304.78 | — | 40% |
| Uric acid blood test CPT 84550 URIC ACID SERUM | $70.20 | $117.00 | $36.27–$114.66 | at median | 40% |
| Uric acid blood test inpatient CPT 84550 URIC ACID SERUM | $70.20 | $117.00 | $79.56–$114.66 | — | 40% |
| Urinalysis with microscope exam, automated CPT 81001 UA WITH MICRO | $114.00 | $190.00 | $58.90–$186.20 | 78% above | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA WITH MICRO | $114.00 | $190.00 | $129.20–$186.20 | — | 40% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE | $65.40 | $109.00 | $33.79–$106.82 | 158% above | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O SCOPE | $65.40 | $109.00 | $74.12–$106.82 | — | 40% |
| Urine culture for bacteria, with colony count CPT 87086 URINE PATHOGEN SCREEN | $171.60 | $286.00 | $88.66–$280.28 | 87% above | 40% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 URINE PATHOGEN SCREEN | $171.60 | $286.00 | $194.48–$280.28 | — | 40% |
| Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN URINE QUANT | $112.80 | $188.00 | $58.28–$184.24 | 68% above | 40% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN URINE QUANT | $112.80 | $188.00 | $127.84–$184.24 | — | 40% |
| Urine pregnancy test, read by color change CPT 81025 URINE, PREGNANCY | $121.20 | $202.00 | $62.62–$197.96 | 64% above | 40% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE, PREGNANCY | $121.20 | $202.00 | $137.36–$197.96 | — | 40% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 | $160.80 | $268.00 | $83.08–$262.64 | 24% above | 40% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 | $160.80 | $268.00 | $182.24–$262.64 | — | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 OH | $272.40 | $454.00 | $140.74–$444.92 | 50% above | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 OH | $272.40 | $454.00 | $308.72–$444.92 | — | 40% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D 1, 25 OH, LC/MS/MS | $250.80 | $418.00 | $129.58–$409.64 | 28% above | 40% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D 1, 25 OH, LC/MS/MS | $250.80 | $418.00 | $284.24–$409.64 | — | 40% |
| Zinc blood test CPT 84630 ZINC | $102.60 | $171.00 | $53.01–$167.58 | 44% above | 40% |
| Zinc blood test inpatient CPT 84630 ZINC | $102.60 | $171.00 | $116.28–$167.58 | — | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG TUMOR MARKER | $202.20 | $337.00 | $104.47–$330.26 | 88% above | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUANTITATIVE | $202.20 | $337.00 | $104.47–$330.26 | 88% above | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG TUMOR MARKER | $202.20 | $337.00 | $229.16–$330.26 | — | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QUANTITATIVE | $202.20 | $337.00 | $229.16–$330.26 | — | 40% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Illinois | Off list |
|---|---|---|---|---|---|
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 F TREATMENT OF ANKLE FRACTURE | $555.60 | $926.00 | $287.06–$907.48 | 26% above | 40% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 F TREATMENT OF ANKLE FRACTURE | $555.60 | $926.00 | $629.68–$907.48 | — | 40% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT | $1,366.20 | $2,277.00 | $705.87–$2,231.46 | 15% above | 40% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTRIC EXT | $1,366.20 | $2,277.00 | $1,548.36–$2,231.46 | — | 40% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLOSED TX DISTAL RADIAL FX WO | $555.60 | $926.00 | $287.06–$907.48 | 7% above | 40% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLOSED TX DISTAL RADIAL FX WO | $555.60 | $926.00 | $629.68–$907.48 | — | 40% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI | $137.40 | $229.00 | $70.99–$224.42 | 19% above | 40% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI | $137.40 | $229.00 | $155.72–$224.42 | — | 40% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED CERUMEN | $295.20 | $492.00 | $152.52–$482.16 | 136% above | 40% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED CERUMEN | $295.20 | $492.00 | $334.56–$482.16 | — | 40% |
| Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS | $471.60 | $786.00 | $243.66–$770.28 | 20% above | 40% |
| Incision and drainage of a simple or single skin abscess CPT 10060 F I&D ABSCESS SIMP/SINGLE | $1,306.20 | $2,177.00 | $674.87–$2,133.46 | 233% above | 40% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS | $471.60 | $786.00 | $534.48–$770.28 | — | 40% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 F I&D ABSCESS SIMP/SINGLE | $1,306.20 | $2,177.00 | $1,480.36–$2,133.46 | — | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT | $697.80 | $1,163.00 | $360.53–$1,139.74 | 62% above | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT | $697.80 | $1,163.00 | $790.84–$1,139.74 | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASP/INJECT JOINT/BURSA MAJOR S | $867.60 | $1,446.00 | $448.26–$1,417.08 | 76% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 DRAIN/INJ JOINT/BRSA W/O US RT | $720.00 | $1,200.00 | $372.00–$1,176.00 | 46% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 DRAIN/INJ JOINT/BRSA W/O US LT | $817.80 | $1,363.00 | $422.53–$1,335.74 | 66% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASP/INJECT JOINT/BURSA MAJOR S | $867.60 | $1,446.00 | $983.28–$1,417.08 | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 DRAIN/INJ JOINT/BRSA W/O US RT | $720.00 | $1,200.00 | $816.00–$1,176.00 | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 DRAIN/INJ JOINT/BRSA W/O US LT | $817.80 | $1,363.00 | $926.84–$1,335.74 | — | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US | $697.80 | $1,163.00 | $360.53–$1,139.74 | 68% above | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ JOINT/BURSA W/O US | $697.80 | $1,163.00 | $790.84–$1,139.74 | — | 40% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $600.00 | $1,000.00 | $310.00–$980.00 | 92% above | 40% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $600.00 | $1,000.00 | $680.00–$980.00 | — | 40% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 F REPAIR INTERM WND SCLP,AX,TR | $939.60 | $1,566.00 | $485.46–$1,534.68 | 56% above | 40% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 F REPAIR INTERM WND SCLP,AX,TR | $939.60 | $1,566.00 | $1,064.88–$1,534.68 | — | 40% |
| Nail removal (partial or complete), one nail CPT 11730 F AVULSION NAIL PLATE PART/COM | $471.60 | $786.00 | $243.66–$770.28 | 64% above | 40% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 F AVULSION NAIL PLATE PART/COM | $471.60 | $786.00 | $534.48–$770.28 | — | 40% |
| Occipital nerve block (injection for headaches) CPT 64405 F NERVE BLOCK GREATER OCCIPITA | $697.80 | $1,163.00 | $360.53–$1,139.74 | 34% above | 40% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 F NERVE BLOCK GREATER OCCIPITA | $697.80 | $1,163.00 | $790.84–$1,139.74 | — | 40% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 F EXCISION NAIL&MATRIX PARTIAL | $837.00 | $1,395.00 | $432.45–$1,367.10 | 33% above | 40% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 F EXCISION NAIL&MATRIX PARTIAL | $837.00 | $1,395.00 | $948.60–$1,367.10 | — | 40% |
| Removal of a foreign object under the skin, simple CPT 10120 F INCISE&REMOVE FB SQ/SIMPLE | $939.60 | $1,566.00 | $485.46–$1,534.68 | 95% above | 40% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 F INCISE&REMOVE FB SQ/SIMPLE | $939.60 | $1,566.00 | $1,064.88–$1,534.68 | — | 40% |
| Short arm splint (forearm and hand) CPT 29125 SPLINT APPLCTN SHORT ARM FOREA | $301.20 | $502.00 | $155.62–$491.96 | 21% above | 40% |
| Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT APPLCTN SHORT ARM FOREA | $301.20 | $502.00 | $341.36–$491.96 | — | 40% |
| Short leg splint (calf to foot) CPT 29515 SPLINT APPLICATION SHORT LEG | $371.40 | $619.00 | $191.89–$606.62 | 37% above | 40% |
| Short leg splint (calf to foot) inpatient CPT 29515 SPLINT APPLICATION SHORT LEG | $371.40 | $619.00 | $420.92–$606.62 | — | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 F RPR S/N/AX/GEN/TRNK 2.5CM/< | $471.60 | $786.00 | $243.66–$770.28 | 28% above | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 F RPR S/N/AX/GEN/TRNK 2.5CM/< | $471.60 | $786.00 | $534.48–$770.28 | — | 40% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 F SPINAL/LUMBAR PUNCTURE | $1,629.00 | $2,715.00 | $841.65–$2,660.70 | 68% above | 40% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 F SPINAL/LUMBAR PUNCTURE | $1,629.00 | $2,715.00 | $1,846.20–$2,660.70 | — | 40% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 F REPAIR SPRFCL WND SCLP,NCK,T | $471.60 | $786.00 | $243.66–$770.28 | 13% above | 40% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 F REPAIR SPRFCL WND SCLP,NCK,T | $471.60 | $786.00 | $534.48–$770.28 | — | 40% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 F REPAIR SPRFCL WND FACE,EAR,E | $471.60 | $786.00 | $243.66–$770.28 | 17% above | 40% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 F REPAIR SPRFCL WND FACE,EAR,E | $471.60 | $786.00 | $534.48–$770.28 | — | 40% |
| Thoracentesis with imaging guidance CPT 32555 F THORACENTESIS NEEDLE/CATH | $2,400.00 | $4,000.00 | $1,240.00–$3,920.00 | 92% above | 40% |
| Thoracentesis with imaging guidance inpatient CPT 32555 F THORACENTESIS NEEDLE/CATH | $2,400.00 | $4,000.00 | $2,720.00–$3,920.00 | — | 40% |
| Trigger point injections, 1 or 2 muscles CPT 20552 F INJ TRIGGER POINT 1/2 MUSCL | $697.80 | $1,163.00 | $360.53–$1,139.74 | 34% above | 40% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 F INJ TRIGGER POINT 1/2 MUSCL | $697.80 | $1,163.00 | $790.84–$1,139.74 | — | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE,SUBQ TISSUE 1ST 20SQCM | $939.60 | $1,566.00 | $485.46–$1,534.68 | 36% above | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE,SUBQ TISSUE 1ST 20SQCM | $939.60 | $1,566.00 | $1,064.88–$1,534.68 | — | 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 BLOOD TRANSFUSION SERVICE | $1,026.60 | $1,711.00 | $530.41–$1,676.78 | 19% above | 40% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION SERVICE | $1,026.60 | $1,711.00 | $1,163.48–$1,676.78 | — | 40% |
| Critical care, first 30 to 74 minutes CPT 99291 F ER CRITICAL CARE 30-74 MIN | $2,617.80 | $4,363.00 | $1,352.53–$4,275.74 | 26% above | 40% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 F ER CRITICAL CARE 30-74 MIN | $2,617.80 | $4,363.00 | $2,966.84–$4,275.74 | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG FAA | $276.00 | $460.00 | $142.60–$450.80 | 19% above | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG/EKG TRACING | $276.00 | $460.00 | $142.60–$450.80 | 19% above | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG FAA | $276.00 | $460.00 | $312.80–$450.80 | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG/EKG TRACING | $276.00 | $460.00 | $312.80–$450.80 | — | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 FCLTY ER LEV 1 MINIMAL | $285.60 | $476.00 | $147.56–$466.48 | 28% above | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 FCLTY ER LEV 1 MINIMAL | $285.60 | $476.00 | $323.68–$466.48 | — | 40% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 FCLTY ER LEV 2 BRIEF | $516.00 | $860.00 | $266.60–$842.80 | 29% above | 40% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 FCLTY ER LEV 2 BRIEF | $516.00 | $860.00 | $584.80–$842.80 | — | 40% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 FCLTY ER LEV 3 LIMITED | $873.60 | $1,456.00 | $451.36–$1,426.88 | 25% above | 40% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 FCLTY ER LEV 3 LIMITED | $873.60 | $1,456.00 | $990.08–$1,426.88 | — | 40% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 FCLTY ER LEV 4 INTERMEDIATE | $1,397.40 | $2,329.00 | $721.99–$2,282.42 | 22% above | 40% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 FCLTY ER LEV 4 INTERMEDIATE | $1,397.40 | $2,329.00 | $1,583.72–$2,282.42 | — | 40% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 FCLTY ER LEV 5 INTENSIVE | $1,773.00 | $2,955.00 | $916.05–$2,895.90 | 11% above | 40% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 FCLTY ER LEV 5 INTENSIVE | $1,773.00 | $2,955.00 | $2,009.40–$2,895.90 | — | 40% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 TREADMILL STRESS TEST NON IMAG | $1,020.00 | $1,700.00 | $527.00–$1,666.00 | 6% above | 40% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 NM STRESS TEST TECHNCL CHRG | $1,020.00 | $1,700.00 | $527.00–$1,666.00 | 6% above | 40% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TREADMILL STRESS TEST NON IMAG | $1,020.00 | $1,700.00 | $1,156.00–$1,666.00 | — | 40% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 NM STRESS TEST TECHNCL CHRG | $1,020.00 | $1,700.00 | $1,156.00–$1,666.00 | — | 40% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY | $318.00 | $530.00 | $164.30–$519.40 | 148% above | 40% |
| Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY | $318.00 | $530.00 | $360.40–$519.40 | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 TP IV HYDRATION INT 31M TO 90M | $456.60 | $761.00 | $235.91–$745.78 | 35% above | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 F IV HYDRATION INT 31M TO 90M | $456.60 | $761.00 | $235.91–$745.78 | 35% above | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 TP IV HYDRATION INT 31M TO 90M | $456.60 | $761.00 | $517.48–$745.78 | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 F IV HYDRATION INT 31M TO 90M | $456.60 | $761.00 | $517.48–$745.78 | — | 40% |
| IV infusion of a medicine, first hour CPT 96365 TP IV INF THER/PROPH/DX 15-90 | $505.20 | $842.00 | $261.02–$825.16 | 25% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 F IVINF THER/PROP/DX INI 15-90 | $505.20 | $842.00 | $261.02–$825.16 | 25% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 F IV INFSN INT I5M TO 90M | $505.20 | $842.00 | $261.02–$825.16 | 25% above | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 F IVINF THER/PROP/DX INI 15-90 | $505.20 | $842.00 | $572.56–$825.16 | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 F IV INFSN INT I5M TO 90M | $505.20 | $842.00 | $572.56–$825.16 | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 TP IV INF THER/PROPH/DX 15-90 | $505.20 | $842.00 | $572.56–$825.16 | — | 40% |
| IV push of a medicine, first drug CPT 96374 F INJ IVPUSH *INITIAL* SUBS/ | $505.20 | $842.00 | $261.02–$825.16 | 135% above | 40% |
| IV push of a medicine, first drug CPT 96374 INJ IVPUSH SNGL/INITIAL SUBS/ | $505.20 | $842.00 | $261.02–$825.16 | 135% above | 40% |
| IV push of a medicine, first drug CPT 96374 TP INJECTION IVPUSH SNGL/INIT | $505.20 | $842.00 | $261.02–$825.16 | 135% above | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 TP INJECTION IVPUSH SNGL/INIT | $505.20 | $842.00 | $572.56–$825.16 | — | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 INJ IVPUSH SNGL/INITIAL SUBS/ | $505.20 | $842.00 | $572.56–$825.16 | — | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 F INJ IVPUSH *INITIAL* SUBS/ | $505.20 | $842.00 | $572.56–$825.16 | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM SUBQ EA SUBSTANCE | $334.20 | $557.00 | $172.67–$545.86 | 205% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM SUBQ THER/DIAG/PR | $334.20 | $557.00 | $172.67–$545.86 | 205% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 F IMMUN ADMIN INJ TETANUS TOXO | $334.20 | $557.00 | $172.67–$545.86 | 205% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 TP INJECTION IM SUBQ THER/DIAG | $334.20 | $557.00 | $172.67–$545.86 | 205% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 TP INJECTION IM SUBQ THER/DIAG | $334.20 | $557.00 | $378.76–$545.86 | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM SUBQ EA SUBSTANCE | $334.20 | $557.00 | $378.76–$545.86 | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 F IMMUN ADMIN INJ TETANUS TOXO | $334.20 | $557.00 | $378.76–$545.86 | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM SUBQ THER/DIAG/PR | $334.20 | $557.00 | $378.76–$545.86 | — | 40% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUAT | $384.00 | $640.00 | $198.40–$627.20 | 46% above | 40% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUAT | $384.00 | $640.00 | $435.20–$627.20 | — | 40% |
| Neuromuscular re-education, 15 minutes CPT 97112 OT NEUROMUSCULAR RE-ED EA 15M | $136.20 | $227.00 | $70.37–$222.46 | 15% above | 40% |
| Neuromuscular re-education, 15 minutes CPT 97112 PT NEUROMSCLR RE-EDUCAT EA 15M | $136.20 | $227.00 | $70.37–$222.46 | 15% above | 40% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT NEUROMSCLR RE-EDUCAT EA 15M | $136.20 | $227.00 | $154.36–$222.46 | — | 40% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT NEUROMUSCULAR RE-ED EA 15M | $136.20 | $227.00 | $154.36–$222.46 | — | 40% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30-44 MIN | $256.20 | $427.00 | $132.37–$418.46 | 16% above | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE O/P NEW LOW 30-44 MIN | $256.20 | $427.00 | $290.36–$418.46 | — | 40% |
| Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEX 30 MIN | $321.60 | $536.00 | $166.16–$525.28 | 26% above | 40% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEX 30 MIN | $321.60 | $536.00 | $364.48–$525.28 | — | 40% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEX 45 MIN | $312.00 | $520.00 | $161.20–$509.60 | 9% below | 40% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEX 45 MIN | $312.00 | $520.00 | $353.60–$509.60 | — | 40% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEX 20 MIN | $240.00 | $400.00 | $124.00–$392.00 | 6% above | 40% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEX 20 MIN | $240.00 | $400.00 | $272.00–$392.00 | — | 40% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD COMPLEX 30 MIN | $300.00 | $500.00 | $155.00–$490.00 | 2% below | 40% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MOD COMPLEX 30 MIN | $300.00 | $500.00 | $340.00–$490.00 | — | 40% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MYOFASCIAL RLS SFT TSS MOBIL E | $164.40 | $274.00 | $84.94–$268.52 | 23% above | 40% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MYOFASCIAL RLS SFT TSS MOBIL E | $164.40 | $274.00 | $186.32–$268.52 | — | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXERC EA 15 MIN | $128.40 | $214.00 | $66.34–$209.72 | 15% above | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAPEUTIC EXER EA 15 MIN | $128.40 | $214.00 | $66.34–$209.72 | 15% above | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES 15 MINS | $128.40 | $214.00 | $66.34–$209.72 | 15% above | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAPEUTIC EXER EA 15 MIN | $128.40 | $214.00 | $145.52–$209.72 | — | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPEUTIC EXERC EA 15 MIN | $128.40 | $214.00 | $145.52–$209.72 | — | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES 15 MINS | $128.40 | $214.00 | $145.52–$209.72 | — | 40% |
| Psychiatric evaluation with medical services CPT 90792 PSYCHIATRIC DIAGNOSTIC EVAL 2/ | $396.00 | $660.00 | $204.60–$646.80 | 11% above | 40% |
| Psychiatric evaluation with medical services inpatient CPT 90792 PSYCHIATRIC DIAGNOSTIC EVAL 2/ | $396.00 | $660.00 | $448.80–$646.80 | — | 40% |
| Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHRPY W/PATIENT 16-37MIN | $318.00 | $530.00 | $164.30–$519.40 | 68% above | 40% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHRPY W/PATIENT 16-37MIN | $318.00 | $530.00 | $360.40–$519.40 | — | 40% |
| Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHRPY W/PATIENT 38-52MIN | $318.00 | $530.00 | $164.30–$519.40 | 66% above | 40% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHRPY W/PATIENT 38-52MIN | $318.00 | $530.00 | $360.40–$519.40 | — | 40% |
| Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHRPY W/PATIENT 53-67MIN | $318.00 | $530.00 | $164.30–$519.40 | 15% above | 40% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHRPY W/PATIENT 53-67MIN | $318.00 | $530.00 | $360.40–$519.40 | — | 40% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20 MIN | $264.00 | $440.00 | $136.40–$431.20 | 73% above | 40% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE O/P EST LOW 20 MIN | $264.00 | $440.00 | $299.20–$431.20 | — | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30 MIN | $264.00 | $440.00 | $136.40–$431.20 | 43% above | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE O/P EST MOD 30 MIN | $264.00 | $440.00 | $299.20–$431.20 | — | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10-19 MIN | $264.00 | $440.00 | $136.40–$431.20 | 111% above | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE O/P EST SF 10-19 MIN | $264.00 | $440.00 | $299.20–$431.20 | — | 40% |
| Speech and language evaluation CPT 92523 SPEECH SOUND LANG COMPREHEN | $477.60 | $796.00 | $246.76–$780.08 | 38% above | 40% |
| Speech and language evaluation inpatient CPT 92523 SPEECH SOUND LANG COMPREHEN | $477.60 | $796.00 | $541.28–$780.08 | — | 40% |
| Speech therapy session, individual CPT 92507 TX SPEECH,LANG,VOICE,COMM | $333.00 | $555.00 | $172.05–$543.90 | 79% above | 40% |
| Speech therapy session, individual inpatient CPT 92507 TX SPEECH,LANG,VOICE,COMM | $333.00 | $555.00 | $377.40–$543.90 | — | 40% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY | $186.00 | $310.00 | $96.10–$303.80 | 37% below | 40% |
| Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST | $240.00 | $400.00 | $124.00–$392.00 | 19% below | 40% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY | $186.00 | $310.00 | $210.80–$303.80 | — | 40% |
| Spirometry (breathing test) inpatient CPT 94010 BREATHING CAPACITY TEST | $240.00 | $400.00 | $272.00–$392.00 | — | 40% |
| Spirometry before and after a bronchodilator CPT 94060 BRONCHODILATION RESP,SPIROMETR | $570.00 | $950.00 | $294.50–$931.00 | 5% above | 40% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHODILATION RESP,SPIROMETR | $570.00 | $950.00 | $646.00–$931.00 | — | 40% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 OT ACTIVITIES DYNAMIC EA 15M | $128.40 | $214.00 | $66.34–$209.72 | 3% above | 40% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 PT THERAPEUTIC ACTIVIT EA 15MN | $128.40 | $214.00 | $66.34–$209.72 | 3% above | 40% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES 15 MINS | $128.40 | $214.00 | $66.34–$209.72 | 3% above | 40% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT ACTIVITIES DYNAMIC EA 15M | $128.40 | $214.00 | $145.52–$209.72 | — | 40% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITIES 15 MINS | $128.40 | $214.00 | $145.52–$209.72 | — | 40% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THERAPEUTIC ACTIVIT EA 15MN | $128.40 | $214.00 | $145.52–$209.72 | — | 40% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Illinois | Off list |
|---|---|---|---|---|---|
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 IIV ADJUVANT VACCINE IM | $120.00 | $200.00 | $62.00–$196.00 | at median | 40% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 IIV ADJUVANT VACCINE IM | $120.00 | $200.00 | $136.00–$196.00 | — | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 IIV3 VACC NO PRSV 0.5 ML IM | $18.00 | $30.00 | $9.30–$29.40 | 49% below | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 IIV3 VACC NO PRSV 0.5 ML IM | $18.00 | $30.00 | $20.40–$29.40 | — | 40% |
| Rabies vaccine, one dose CPT 90675 RABAVERT RABIES VACCINE 2.5UNT | $772.80 | $1,288.00 | $399.28–$1,262.24 | 2% above | 40% |
| Rabies vaccine, one dose CPT 90675 Imovax Rabies Vaccine 2.5unit | $901.80 | $1,503.00 | $465.93–$1,472.94 | 19% above | 40% |
| Rabies vaccine, one dose inpatient CPT 90675 RABAVERT RABIES VACCINE 2.5UNT | $772.80 | $1,288.00 | $875.84–$1,262.24 | — | 40% |
| Rabies vaccine, one dose inpatient CPT 90675 Imovax Rabies Vaccine 2.5unit | $901.80 | $1,503.00 | $1,022.04–$1,472.94 | — | 40% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 DIPTHERIA TETANUS TOXOID IM >7 | $160.80 | $268.00 | $83.08–$262.64 | 109% above | 40% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 DIPTHERIA TETANUS TOXOID IM >7 | $160.80 | $268.00 | $182.24–$262.64 | — | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX(Tdap) 0.5ml VACCINE | $171.60 | $286.00 | $88.66–$280.28 | 60% above | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 BOOSTRIX(Tdap) 0.5ml VACCINE | $171.60 | $286.00 | $194.48–$280.28 | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMM. ADM. ONE VACCINE | $60.00 | $100.00 | $31.00–$98.00 | 5% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IM ADM PRQ ID SUBQ/IM 1VACCINE | $165.60 | $276.00 | $85.56–$270.48 | 189% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMM. ADM. ONE VACCINE | $60.00 | $100.00 | $68.00–$98.00 | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IM ADM PRQ ID SUBQ/IM 1VACCINE | $165.60 | $276.00 | $187.68–$270.48 | — | 40% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 EACH ADDITIONAL VACCINE | $36.00 | $60.00 | $18.60–$58.80 | 7% below | 40% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 EACH ADDITIONAL VACCINE | $36.00 | $60.00 | $40.80–$58.80 | — | 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.