Opelousas General Main Campus
Opelousas General Main Campus in Opelousas, LA publishes cash prices for 327 common procedures listed here, from its own machine-readable price file updated Mar 5, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Louisiana median for 286 of 324 procedures and below it for 36. By typical cash price it ranks #51 of 67 Louisiana hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.
539 E Prudhomme St, Opelousas, LA 70570 Collected Nov 10, 2026 Source price file Check a bill from this hospital (337) 948-3011
Acute care hospital Government-owned hospital Emergency department CMS star rating 2 of 5 CCN 190017 · CMS hospital register NPI 1447230388
Financial assistance
Public hospital: ask for its charity care or sliding-scale discount
Opelousas General Main Campus is government-owned (CMS register). The federal financial assistance rules for nonprofit hospitals do not always apply to public ones, but many public hospitals run charity care or sliding-scale discounts for uninsured and low-income patients. Ask the billing office for its financial assistance or charity care policy and application before you pay. Letters you can copy.
CMS price transparency record
The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 5 actions for a hospital named Opelousas General Main Campus in Opelousas, LA:
- May 31, 2023 Warning notice
- Sep 13, 2023 Corrective action plan requested
- Jan 2, 2024 Case closed
- Sep 25, 2025 Warning notice
- Nov 25, 2025 Case closed
Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems.
A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Louisiana | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT Abdomen w/ + w/o Contrast | $1,461.00 | $2,922.00 | $161.60–$2,045.40 | 43% above | 50% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen w/ + w/o Contrast | $1,461.00 | $2,922.00 | $161.60–$2,045.40 | — | 50% |
| Abdominal X-ray, 2 views CPT 74019 XR Abdomen 2 Views | $149.00 | $298.00 | $96.32–$673.00 | 14% below | 50% |
| Abdominal X-ray, 2 views CPT 74019 XR Abdomen Complete w Decub and/or Erect | $149.00 | $298.00 | $96.32–$673.00 | 14% below | 50% |
| Abdominal X-ray, 2 views inpatient CPT 74019 XR Abdomen 2 Views | $149.00 | $298.00 | $96.32–$673.00 | — | 50% |
| Abdominal X-ray, 2 views inpatient CPT 74019 XR Abdomen Complete w Decub and/or Erect | $149.00 | $298.00 | $96.32–$673.00 | — | 50% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete 3 Plus Views Right | $132.50 | $265.00 | — | 6% above | 50% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete 3 Plus Views Left | $132.50 | $265.00 | — | 6% above | 50% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete 3 Plus Views Right | $132.50 | $265.00 | — | — | 50% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete 3 Plus Views Left | $132.50 | $265.00 | — | — | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US Ankle Brachial Index | $176.00 | $352.00 | $122.58–$539.00 | at median | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US Ankle Brachial Index | $176.00 | $352.00 | $122.58–$539.00 | — | 50% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Upper Extremity w/o Contrast Right | $751.50 | $1,503.00 | — | 16% above | 50% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Upper Extremity w/o Contrast Left | $751.50 | $1,503.00 | — | 16% above | 50% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Upper Extremity w/o Contrast Left | $751.50 | $1,503.00 | — | — | 50% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Upper Extremity w/o Contrast Right | $751.50 | $1,503.00 | — | — | 50% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus | $169.00 | $338.00 | $161.60–$673.00 | 22% below | 50% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus | $169.00 | $338.00 | $161.60–$673.00 | — | 50% |
| Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Imaging Whole Body Injection | $590.00 | $1,180.00 | $368.31–$2,419.00 | 7% above | 50% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Imaging Whole Body Injection | $590.00 | $1,180.00 | $368.31–$2,419.00 | — | 50% |
| Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Right. | $177.00 | $354.00 | — | 5% above | 50% |
| Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Left. | $177.00 | $354.00 | — | 5% above | 50% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Right. | $177.00 | $354.00 | — | — | 50% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Left. | $177.00 | $354.00 | — | — | 50% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Left. | $148.00 | $296.00 | — | 12% below | 50% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Right. | $148.00 | $296.00 | — | 12% below | 50% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Right. | $148.00 | $296.00 | — | — | 50% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Left. | $148.00 | $296.00 | — | — | 50% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Angio Abdomen and Pelvis | $1,760.50 | $3,521.00 | $321.41–$2,464.70 | 92% above | 50% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Angio Abdomen and Pelvis | $1,760.50 | $3,521.00 | $321.41–$2,464.70 | — | 50% |
| CT angiography (CTA) of the head CPT 70496 CT Angio Brain/Head | $1,188.00 | $2,376.00 | $161.60–$1,663.20 | 72% above | 50% |
| CT angiography (CTA) of the head CPT 70496 CT Angio Head/Neck | $1,225.00 | $2,450.00 | $161.60–$1,715.00 | 77% above | 50% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Brain/Head | $1,188.00 | $2,376.00 | $161.60–$1,663.20 | — | 50% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Head/Neck | $1,225.00 | $2,450.00 | $161.60–$1,715.00 | — | 50% |
| CT angiography (CTA) of the neck CPT 70498 CT Angio Neck | $1,584.50 | $3,169.00 | $161.60–$2,218.30 | 129% above | 50% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CT Angio Neck | $1,584.50 | $3,169.00 | $161.60–$2,218.30 | — | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest PE w/ Contrast | $1,412.00 | $2,824.00 | $161.60–$1,976.80 | 74% above | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest | $1,412.00 | $2,824.00 | $161.60–$1,976.80 | 74% above | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest PE w/ Contrast | $1,412.00 | $2,824.00 | $161.60–$1,976.80 | — | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest | $1,412.00 | $2,824.00 | $161.60–$1,976.80 | — | 50% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Coronary Calcium Screening | $31.50 | $63.00 | $31.50–$1,207.00 | 62% below | 50% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Heart Calcium Scoring | $31.50 | $63.00 | $31.50–$1,207.00 | 62% below | 50% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Coronary Calcium Screening | $31.50 | $63.00 | $31.50–$1,207.00 | — | 50% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Heart Calcium Scoring | $31.50 | $63.00 | $31.50–$1,207.00 | — | 50% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen and Pelvis w/o Contrast | $1,195.50 | $2,391.00 | $219.82–$1,673.70 | 6% above | 50% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen and Pelvis w/o Contrast | $1,195.50 | $2,391.00 | $219.82–$1,673.70 | — | 50% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen and Pelvis w/ Contrast | $1,328.50 | $2,657.00 | $321.41–$1,859.90 | 3% above | 50% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen and Pelvis w/ Contrast | $1,328.50 | $2,657.00 | $321.41–$1,859.90 | — | 50% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast | $1,661.00 | $3,322.00 | $321.41–$2,325.40 | 15% above | 50% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast | $1,661.00 | $3,322.00 | $321.41–$2,325.40 | — | 50% |
| CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast | $1,176.00 | $2,352.00 | $161.60–$1,646.40 | 37% above | 50% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Contrast | $1,176.00 | $2,352.00 | $161.60–$1,646.40 | — | 50% |
| CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast | $1,093.00 | $2,186.00 | $96.32–$1,530.20 | 43% above | 50% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Contrast | $1,093.00 | $2,186.00 | $96.32–$1,530.20 | — | 50% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Contrast | $883.00 | $1,766.00 | $96.32–$1,236.20 | 42% above | 50% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus w/o Contrast | $883.00 | $1,766.00 | $96.32–$1,236.20 | 42% above | 50% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Contrast | $883.00 | $1,766.00 | $96.32–$1,236.20 | — | 50% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus w/o Contrast | $883.00 | $1,766.00 | $96.32–$1,236.20 | — | 50% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head w/o Contrast | $883.00 | $1,766.00 | $96.32–$1,236.20 | 35% above | 50% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain/Head Stroke Alert | $883.00 | $1,766.00 | $96.32–$1,236.20 | 35% above | 50% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head w/o Contrast | $883.00 | $1,766.00 | $96.32–$1,236.20 | — | 50% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain/Head Stroke Alert | $883.00 | $1,766.00 | $96.32–$1,236.20 | — | 50% |
| CT scan of the head with contrast CPT 70460 CT Head w/ Contrast | $562.00 | $1,124.00 | $161.60–$1,207.00 | 22% below | 50% |
| CT scan of the head with contrast inpatient CPT 70460 CT Head w/ Contrast | $562.00 | $1,124.00 | $161.60–$1,207.00 | — | 50% |
| CT scan of the head without and with contrast CPT 70470 CT Head w/ + w/o Contrast | $1,127.00 | $2,254.00 | $161.60–$1,577.80 | 23% above | 50% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT Head w/ + w/o Contrast | $1,127.00 | $2,254.00 | $161.60–$1,577.80 | — | 50% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar Robotic w/o Contrast | $867.00 | $1,734.00 | $96.32–$1,213.80 | 15% above | 50% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Contrast | $974.50 | $1,949.00 | $96.32–$1,364.30 | 29% above | 50% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Discogram w/o Contrast | $974.50 | $1,949.00 | $96.32–$1,364.30 | 29% above | 50% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar Robotic w/o Contrast | $867.00 | $1,734.00 | $96.32–$1,213.80 | — | 50% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Contrast | $974.50 | $1,949.00 | $96.32–$1,364.30 | — | 50% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Discogram w/o Contrast | $974.50 | $1,949.00 | $96.32–$1,364.30 | — | 50% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Contrast | $974.50 | $1,949.00 | $96.32–$1,364.30 | 32% above | 50% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Contrast | $974.50 | $1,949.00 | $96.32–$1,364.30 | — | 50% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast | $1,176.00 | $2,352.00 | $161.60–$1,646.40 | 41% above | 50% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast | $1,176.00 | $2,352.00 | $161.60–$1,646.40 | — | 50% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Bilateral | $506.50 | $1,013.00 | $219.82–$709.10 | — | 50% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Carotid Ultrasound, Bilateral | $506.50 | $1,013.00 | $219.82–$709.10 | — | 50% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Duplex Bilateral | $506.50 | $1,013.00 | $219.82–$709.10 | — | 50% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Carotid Ultrasound, Bilateral | $506.50 | $1,013.00 | $219.82–$709.10 | — | 50% |
| Chest CT scan without and with contrast CPT 71270 CT Thorax w/ + w/o Contrast | $1,218.50 | $2,437.00 | $161.60–$1,705.90 | 16% above | 50% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT Thorax w/ + w/o Contrast | $1,218.50 | $2,437.00 | $161.60–$1,705.90 | — | 50% |
| Chest X-ray, 2 views CPT 71046 XR Chest 2 Views | $132.50 | $265.00 | $80.18–$673.00 | at median | 50% |
| Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views | $132.50 | $265.00 | $80.18–$673.00 | — | 50% |
| Chest X-ray, single view CPT 71045 XR Chest Apical Lordotic | $112.50 | $225.00 | $80.18–$673.00 | 2% above | 50% |
| Chest X-ray, single view CPT 71045 XR Chest 1 View Portable | $112.50 | $225.00 | $80.18–$673.00 | 2% above | 50% |
| Chest X-ray, single view CPT 71045 XR Chest 1 View | $112.50 | $225.00 | $80.18–$673.00 | 2% above | 50% |
| Chest X-ray, single view one side CPT 71045 XR Chest Decubitus Left | $112.50 | $225.00 | — | 2% above | 50% |
| Chest X-ray, single view one side CPT 71045 XR Chest Decubitus Right | $112.50 | $225.00 | — | 2% above | 50% |
| Chest X-ray, single view inpatient CPT 71045 XR Chest Apical Lordotic | $112.50 | $225.00 | $80.18–$673.00 | — | 50% |
| Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View | $112.50 | $225.00 | $80.18–$673.00 | — | 50% |
| Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View Portable | $112.50 | $225.00 | $80.18–$673.00 | — | 50% |
| Chest X-ray, single view inpatient one side CPT 71045 XR Chest Decubitus Left | $112.50 | $225.00 | — | — | 50% |
| Chest X-ray, single view inpatient one side CPT 71045 XR Chest Decubitus Right | $112.50 | $225.00 | — | — | 50% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Right | $132.50 | $265.00 | — | 13% above | 50% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Left | $132.50 | $265.00 | — | 13% above | 50% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Left | $132.50 | $265.00 | — | — | 50% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Right | $132.50 | $265.00 | — | — | 50% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete | $592.00 | $1,184.00 | $96.32–$828.80 | 105% above | 50% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Abdomen Complete w/ Contrast | $592.00 | $1,184.00 | $96.32–$828.80 | 105% above | 50% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete | $592.00 | $1,184.00 | $96.32–$828.80 | — | 50% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Abdomen Complete w/ Contrast | $592.00 | $1,184.00 | $96.32–$828.80 | — | 50% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton | $97.50 | $195.00 | $96.32–$673.00 | 33% below | 50% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Density DEXA Axial Skeleton | $97.50 | $195.00 | $96.32–$673.00 | — | 50% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD Bone Density DEXA App Skeleton | $173.00 | $346.00 | $80.18–$673.00 | 110% above | 50% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD Bone Density DEXA App Skeleton | $173.00 | $346.00 | $80.18–$673.00 | — | 50% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB Detailed Complete First Gest | $310.00 | $620.00 | $219.82–$434.00 | 17% above | 50% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB Detailed Complete First Gest | $310.00 | $620.00 | $219.82–$434.00 | — | 50% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Thorax w/o Contrast | $909.50 | $1,819.00 | $96.32–$1,273.30 | 27% above | 50% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Thorax w/o Contrast | $909.50 | $1,819.00 | $96.32–$1,273.30 | — | 50% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Thorax w/ Contrast | $1,176.00 | $2,352.00 | $161.60–$1,646.40 | 37% above | 50% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Thorax w/ Contrast | $1,176.00 | $2,352.00 | $161.60–$1,646.40 | — | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Digital Diagnostic Bilat. | $187.00 | $374.00 | $74.80–$261.80 | — | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Implant Digital Diag Bilateral. | $187.00 | $374.00 | $74.80–$261.80 | — | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Diagnostic Bilateral w/ Tomo. | $187.00 | $374.00 | $74.80–$261.80 | — | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Implant Digital Diag Bilateral. | $187.00 | $374.00 | $74.80–$261.80 | — | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Diagnostic Bilateral w/ Tomo. | $187.00 | $374.00 | $74.80–$261.80 | — | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Digital Diagnostic Bilat. | $187.00 | $374.00 | $74.80–$261.80 | — | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Diagnostic Left w/ Tomo. | $187.00 | $374.00 | — | 54% above | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Digital Diagnostic Right. | $187.00 | $374.00 | — | 54% above | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Implant Digital Diag Right. | $187.00 | $374.00 | — | 54% above | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Digital Diagnostic Left. | $187.00 | $374.00 | — | 54% above | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Diagnostic Right w/ Tomo. | $187.00 | $374.00 | — | 54% above | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Digital Diagnostic Right. | $187.00 | $374.00 | — | — | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Diagnostic Right w/ Tomo. | $187.00 | $374.00 | — | — | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Digital Diagnostic Left. | $187.00 | $374.00 | — | — | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Diagnostic Left w/ Tomo. | $187.00 | $374.00 | — | — | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Implant Digital Diag Right. | $187.00 | $374.00 | — | — | 50% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral | $695.50 | $1,391.00 | $219.82–$973.70 | — | 50% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Lower Extremity Arteries Ultrasound, Bilateral | $695.50 | $1,391.00 | $219.82–$973.70 | — | 50% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 US Art/Vein Abd/Pelvis/Scrotal Complete | $695.50 | $1,391.00 | $219.82–$973.70 | 53% above | 50% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 Lower Extremity Arteries Ultrasound, Bilateral | $695.50 | $1,391.00 | $219.82–$973.70 | — | 50% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral | $695.50 | $1,391.00 | $219.82–$973.70 | — | 50% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US Art/Vein Abd/Pelvis/Scrotal Complete | $695.50 | $1,391.00 | $219.82–$973.70 | — | 50% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Lower Extremity Venous Ultrasound Insufficiency, Bilateral | $585.00 | $1,170.00 | $219.82–$819.00 | — | 50% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Upper Extremity Venous Ultrasound, Bilateral | $585.00 | $1,170.00 | $219.82–$819.00 | — | 50% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Lower Extremity Venous Ultrasound DVT Bilateral | $585.00 | $1,170.00 | $219.82–$819.00 | — | 50% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Lower Ext Venous Duplex Bilateral | $630.00 | $1,260.00 | $219.82–$882.00 | — | 50% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Upper Ext Venous Duplex Bilateral | $630.00 | $1,260.00 | $219.82–$882.00 | — | 50% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Lower Extremity Venous Ultrasound Insufficiency, Bilateral | $585.00 | $1,170.00 | $219.82–$819.00 | — | 50% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Upper Extremity Venous Ultrasound, Bilateral | $585.00 | $1,170.00 | $219.82–$819.00 | — | 50% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Lower Extremity Venous Ultrasound DVT Bilateral | $585.00 | $1,170.00 | $219.82–$819.00 | — | 50% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Upper Ext Venous Duplex Bilateral | $630.00 | $1,260.00 | $219.82–$882.00 | — | 50% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Lower Ext Venous Duplex Bilateral | $630.00 | $1,260.00 | $219.82–$882.00 | — | 50% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echocardiogram Complete | $1,104.50 | $2,209.00 | $503.41–$1,546.30 | 45% above | 50% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echocardiogram Complete w/ Agitated Saline | $1,104.50 | $2,209.00 | $503.41–$1,546.30 | 45% above | 50% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echocardiogram Complete w/ Image Enhancement Agent | $1,622.50 | $3,245.00 | $503.41–$2,271.50 | 113% above | 50% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Echocardiogram Complete | $1,104.50 | $2,209.00 | $503.41–$1,546.30 | — | 50% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Echocardiogram Complete w/ Agitated Saline | $1,104.50 | $2,209.00 | $503.41–$1,546.30 | — | 50% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Echocardiogram Complete w/ Image Enhancement Agent | $1,622.50 | $3,245.00 | $503.41–$2,271.50 | — | 50% |
| Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Right | $132.50 | $265.00 | — | 2% above | 50% |
| Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Left | $132.50 | $265.00 | — | 2% above | 50% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Right | $132.50 | $265.00 | — | — | 50% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Left | $132.50 | $265.00 | — | — | 50% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete 3+ Views Left | $190.00 | $380.00 | — | 43% above | 50% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete 3+ Views Right | $190.00 | $380.00 | — | 43% above | 50% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Complete 3+ Views Left | $190.00 | $380.00 | — | — | 50% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Complete 3+ Views Right | $190.00 | $380.00 | — | — | 50% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT Orbit Sella etc. or IAC w/o Cont | $883.00 | $1,766.00 | $96.32–$1,236.20 | 45% above | 50% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Orbit Sella etc. or IAC w/o Cont | $883.00 | $1,766.00 | $96.32–$1,236.20 | — | 50% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 XR Facial Bones 3+ Views | $189.00 | $378.00 | $96.32–$673.00 | 21% above | 50% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR Facial Bones 3+ Views | $189.00 | $378.00 | $96.32–$673.00 | — | 50% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Left | $132.50 | $265.00 | — | 15% above | 50% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Right | $132.50 | $265.00 | — | 15% above | 50% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Right | $132.50 | $265.00 | — | — | 50% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Left | $132.50 | $265.00 | — | — | 50% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary Imaging | $758.00 | $1,516.00 | $368.31–$2,419.00 | 30% above | 50% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary Imaging | $758.00 | $1,516.00 | $368.31–$2,419.00 | — | 50% |
| Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Left | $89.00 | $178.00 | — | 16% below | 50% |
| Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Right | $89.00 | $178.00 | — | 16% below | 50% |
| Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Left | $89.00 | $178.00 | — | — | 50% |
| Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Right | $89.00 | $178.00 | — | — | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneus Right | $132.50 | $265.00 | — | 20% above | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneus Left | $132.50 | $265.00 | — | 20% above | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneus Right | $132.50 | $265.00 | — | — | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneus Left | $132.50 | $265.00 | — | — | 50% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Home Sleep Test CHARGE | $258.00 | $516.00 | $198.93–$803.00 | 10% above | 50% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Home Sleep Test CHARGE | $258.00 | $516.00 | $198.93–$803.00 | — | 50% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Sleep Study | $2,440.50 | $4,881.00 | $791.16–$3,416.70 | 66% above | 50% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Sleep Study With CPAP CHARGE | $2,440.50 | $4,881.00 | $791.16–$3,416.70 | 66% above | 50% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Sleep Study With CPAP CHARGE | $2,440.50 | $4,881.00 | $791.16–$3,416.70 | — | 50% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Sleep Study | $2,440.50 | $4,881.00 | $791.16–$3,416.70 | — | 50% |
| Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Right | $87.50 | $175.00 | — | 36% below | 50% |
| Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Left | $87.50 | $175.00 | — | 36% below | 50% |
| Knee X-ray, 3 views one side CPT 73562 XR Patella Right | $90.00 | $180.00 | $80.18–$673.00 | 34% below | 50% |
| Knee X-ray, 3 views one side CPT 73562 XR Patella Left | $90.00 | $180.00 | — | 34% below | 50% |
| Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Left | $87.50 | $175.00 | — | — | 50% |
| Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Right | $87.50 | $175.00 | — | — | 50% |
| Knee X-ray, 3 views inpatient one side CPT 73562 XR Patella Left | $90.00 | $180.00 | — | — | 50% |
| Knee X-ray, 3 views inpatient one side CPT 73562 XR Patella Right | $90.00 | $180.00 | $80.18–$673.00 | — | 50% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Complete 4 Plus Views Right | $169.00 | $338.00 | — | 7% above | 50% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Complete 4 Plus Views Left | $169.00 | $338.00 | — | 7% above | 50% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Complete 4 Plus Views Left | $169.00 | $338.00 | — | — | 50% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Complete 4 Plus Views Right | $169.00 | $338.00 | — | — | 50% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity w/o Contrast Left | $1,646.00 | $3,292.00 | — | 175% above | 50% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity w/o Contrast Right | $1,646.00 | $3,292.00 | — | 175% above | 50% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity Robotic w/o Cont Rt | $1,646.00 | $3,292.00 | — | 175% above | 50% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity Robotic w/o Cont Lt | $1,646.00 | $3,292.00 | — | 175% above | 50% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity Robotic w/o Cont Lt | $1,646.00 | $3,292.00 | — | — | 50% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity w/o Contrast Right | $1,646.00 | $3,292.00 | — | — | 50% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity Robotic w/o Cont Rt | $1,646.00 | $3,292.00 | — | — | 50% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity w/o Contrast Left | $1,646.00 | $3,292.00 | — | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdominal Limited | $379.00 | $758.00 | $96.32–$530.60 | 46% above | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited | $379.00 | $758.00 | $96.32–$530.60 | 46% above | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Pyloric Stenosis Infant | $379.00 | $758.00 | $96.32–$530.60 | 46% above | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Soft Tissue Abd/Pel | $379.00 | $758.00 | $96.32–$530.60 | 46% above | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Pyloric Stenosis | $379.00 | $758.00 | $96.32–$530.60 | 46% above | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Pyloric Stenosis | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Limited | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdominal Limited | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Soft Tissue Abd/Pel | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Pyloric Stenosis Infant | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Knee Limited Rt | $251.00 | $502.00 | — | 44% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Knee Limited Lt | $251.00 | $502.00 | — | 44% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Hip Limited Lt | $251.00 | $502.00 | — | 44% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Hand/Wrist Limited Rt | $251.00 | $502.00 | — | 44% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Elbow Limited Lt | $251.00 | $502.00 | — | 44% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Hand/Wrist Limited Lt | $251.00 | $502.00 | — | 44% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Hip Limited Rt | $251.00 | $502.00 | — | 44% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Shoulder Limited Rt | $251.00 | $502.00 | — | 44% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Shoulder Limited Lt | $251.00 | $502.00 | — | 44% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Elbow Limited Rt | $251.00 | $502.00 | — | 44% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Ankle/Foot Limited Rt | $257.50 | $515.00 | — | 48% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Ankle/Foot Limited Lt | $257.50 | $515.00 | — | 48% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Nonvascular Limited Right | $348.00 | $696.00 | $96.32–$487.20 | 100% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Nonvascular Limited Left | $348.00 | $696.00 | $96.32–$487.20 | 100% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Hip Limited Rt | $251.00 | $502.00 | — | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Knee Limited Lt | $251.00 | $502.00 | — | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Knee Limited Rt | $251.00 | $502.00 | — | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Shoulder Limited Lt | $251.00 | $502.00 | — | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Shoulder Limited Rt | $251.00 | $502.00 | — | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Elbow Limited Rt | $251.00 | $502.00 | — | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Hand/Wrist Limited Rt | $251.00 | $502.00 | — | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Hand/Wrist Limited Lt | $251.00 | $502.00 | — | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Elbow Limited Lt | $251.00 | $502.00 | — | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Hip Limited Lt | $251.00 | $502.00 | — | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Ankle/Foot Limited Rt | $257.50 | $515.00 | — | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Ankle/Foot Limited Lt | $257.50 | $515.00 | — | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Nonvascular Limited Right | $348.00 | $696.00 | $96.32–$487.20 | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Nonvascular Limited Left | $348.00 | $696.00 | $96.32–$487.20 | — | 50% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Low Dose Lung Screening | $62.50 | $125.00 | $62.50–$1,207.00 | 58% below | 50% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Low Dose Lung Screening Follow Up | $62.50 | $125.00 | $62.50–$1,207.00 | 58% below | 50% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Low Dose Lung Screening | $62.50 | $125.00 | $62.50–$1,207.00 | — | 50% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Low Dose Lung Screening Follow Up | $62.50 | $125.00 | $62.50–$1,207.00 | — | 50% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia/Fibula Right | $132.50 | $265.00 | — | 10% above | 50% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia/Fibula Left | $132.50 | $265.00 | — | 10% above | 50% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia/Fibula Right | $132.50 | $265.00 | — | — | 50% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia/Fibula Left | $132.50 | $265.00 | — | — | 50% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRV Head w/o Contrast | $1,172.00 | $2,344.00 | $219.82–$2,351.00 | 39% above | 50% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA Brain/Head w/o Contrast | $1,172.00 | $2,344.00 | $219.82–$2,351.00 | 39% above | 50% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA Brain/Head w/o Contrast | $1,172.00 | $2,344.00 | $219.82–$2,351.00 | — | 50% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV Head w/o Contrast | $1,172.00 | $2,344.00 | $219.82–$2,351.00 | — | 50% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE Joint w/o Contrast Right | $1,287.00 | $2,574.00 | — | 48% above | 50% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE Joint w/o Contrast Left | $1,287.00 | $2,574.00 | — | 48% above | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE Joint w/o Contrast Right | $1,287.00 | $2,574.00 | — | — | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE Joint w/o Contrast Left | $1,287.00 | $2,574.00 | — | — | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE Joint w/ + w/o Contrast Left | $1,931.00 | $3,862.00 | — | 55% above | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE Joint w/ + w/o Contrast Right | $1,931.00 | $3,862.00 | — | 55% above | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE Joint w/ + w/o Contrast Right | $1,931.00 | $3,862.00 | — | — | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE Joint w/ + w/o Contrast Left | $1,931.00 | $3,862.00 | — | — | 50% |
| MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Contrast | $1,094.50 | $2,189.00 | $219.82–$2,351.00 | 20% above | 50% |
| MRI of the abdomen without contrast CPT 74181 MRI MRCP w/o Contrast | $1,094.50 | $2,189.00 | $219.82–$2,351.00 | 20% above | 50% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP w/o Contrast | $1,094.50 | $2,189.00 | $219.82–$2,351.00 | — | 50% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Contrast | $1,094.50 | $2,189.00 | $219.82–$2,351.00 | — | 50% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Enterography | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | 27% above | 50% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Contrast | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | 27% above | 50% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Enterography | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | — | 50% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Contrast | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | — | 50% |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast | $1,089.00 | $2,178.00 | $219.82–$2,351.00 | 4% above | 50% |
| MRI of the brain, no contrast dye CPT 70551 MRI Pituitary w/o Contrast | $1,094.50 | $2,189.00 | $219.82–$2,351.00 | 4% above | 50% |
| MRI of the brain, no contrast dye CPT 70551 MRI IAC w/o Contrast | $1,094.50 | $2,189.00 | $219.82–$2,351.00 | 4% above | 50% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast | $1,089.00 | $2,178.00 | $219.82–$2,351.00 | — | 50% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI IAC w/o Contrast | $1,094.50 | $2,189.00 | $219.82–$2,351.00 | — | 50% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Pituitary w/o Contrast | $1,094.50 | $2,189.00 | $219.82–$2,351.00 | — | 50% |
| MRI of the brain, with and without contrast dye both sides CPT 70553 MRA Upper Extremity w/ + w/o Cnt Bilat | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | — | 50% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI IAC w/ + w/o Contrast | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | 16% above | 50% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | 16% above | 50% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Pituitary w/ + w/o Contrast | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | 16% above | 50% |
| MRI of the brain, with and without contrast dye one side CPT 70553 MRA Upper Extremity w/ + w/o Cnt Right | $1,599.50 | $3,199.00 | — | 16% above | 50% |
| MRI of the brain, with and without contrast dye one side CPT 70553 MRA Upper Extremity w/ + w/o Cnt Left | $1,599.50 | $3,199.00 | — | 16% above | 50% |
| MRI of the brain, with and without contrast dye inpatient both sides CPT 70553 MRA Upper Extremity w/ + w/o Cnt Bilat | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | — | 50% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Pituitary w/ + w/o Contrast | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | — | 50% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI IAC w/ + w/o Contrast | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | — | 50% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | — | 50% |
| MRI of the brain, with and without contrast dye inpatient one side CPT 70553 MRA Upper Extremity w/ + w/o Cnt Right | $1,599.50 | $3,199.00 | — | — | 50% |
| MRI of the brain, with and without contrast dye inpatient one side CPT 70553 MRA Upper Extremity w/ + w/o Cnt Left | $1,599.50 | $3,199.00 | — | — | 50% |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast | $1,160.50 | $2,321.00 | $219.82–$2,351.00 | 12% above | 50% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast | $1,160.50 | $2,321.00 | $219.82–$2,351.00 | — | 50% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Contrast | $1,667.50 | $3,335.00 | $321.41–$2,351.00 | 21% above | 50% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Contrast | $1,667.50 | $3,335.00 | $321.41–$2,351.00 | — | 50% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast | $1,160.50 | $2,321.00 | $219.82–$2,351.00 | 21% above | 50% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Contrast | $1,160.50 | $2,321.00 | $219.82–$2,351.00 | — | 50% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Contrast | $1,667.50 | $3,335.00 | $321.41–$2,351.00 | 21% above | 50% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Contrast | $1,667.50 | $3,335.00 | $321.41–$2,351.00 | — | 50% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast | $1,160.50 | $2,321.00 | $219.82–$2,351.00 | 22% above | 50% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Contrast | $1,160.50 | $2,321.00 | $219.82–$2,351.00 | — | 50% |
| MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Contrast | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | 56% above | 50% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Contrast | $1,599.50 | $3,199.00 | $321.41–$2,351.00 | — | 50% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast | $1,094.50 | $2,189.00 | $219.82–$2,351.00 | 33% above | 50% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Contrast | $1,094.50 | $2,189.00 | $219.82–$2,351.00 | — | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE Joint w/o Contrast Right | $1,287.00 | $2,574.00 | — | 50% above | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE Joint w/o Contrast Left | $1,287.00 | $2,574.00 | — | 50% above | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE Joint w/o Contrast Left | $1,287.00 | $2,574.00 | — | — | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE Joint w/o Contrast Right | $1,287.00 | $2,574.00 | — | — | 50% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR Spine Cervical 4 or 5 Views | $220.00 | $440.00 | $96.32–$673.00 | 8% above | 50% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR Spine Cervical 4 or 5 Views | $220.00 | $440.00 | $96.32–$673.00 | — | 50% |
| Neck soft tissue CT scan with contrast CPT 70491 CT Neck Soft Tissue w/ Contrast | $1,545.50 | $3,091.00 | $161.60–$2,163.70 | 123% above | 50% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Neck Soft Tissue w/ Contrast | $1,545.50 | $3,091.00 | $161.60–$2,163.70 | — | 50% |
| Neck soft tissue CT scan without contrast CPT 70490 CT Neck Soft Tissue w/o Contrast | $1,176.00 | $2,352.00 | $96.32–$1,646.40 | 74% above | 50% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Neck Soft Tissue w/o Contrast | $1,176.00 | $2,352.00 | $96.32–$1,646.40 | — | 50% |
| Neck soft tissue X-ray CPT 70360 XR Neck Soft Tissue | $132.50 | $265.00 | $80.18–$673.00 | 7% above | 50% |
| Neck soft tissue X-ray inpatient CPT 70360 XR Neck Soft Tissue | $132.50 | $265.00 | $80.18–$673.00 | — | 50% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial SPECT Rest and Stress | $1,527.50 | $3,055.00 | $1,192.75–$2,304.44 | 29% above | 50% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Thallium Spect | $1,527.50 | $3,055.00 | $1,192.75–$2,304.44 | 29% above | 50% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial SPECT Rest and Stress | $1,527.50 | $3,055.00 | $1,192.75–$2,304.44 | — | 50% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial Thallium Spect | $1,527.50 | $3,055.00 | $1,192.75–$2,304.44 | — | 50% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET CT Skull to Midthigh w/ Ga68 | $3,668.00 | $7,336.00 | $1,317.41–$5,135.20 | 88% above | 50% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET CT Skull Base to Midthigh | $3,668.00 | $7,336.00 | $1,317.41–$5,135.20 | 88% above | 50% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET CT Skull Base to Midthigh | $3,668.00 | $7,336.00 | $1,317.41–$5,135.20 | — | 50% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET CT Skull to Midthigh w/ Ga68 | $3,668.00 | $7,336.00 | $1,317.41–$5,135.20 | — | 50% |
| Pelvic CT scan without contrast CPT 72192 CT Pelvis w/o Contrast | $1,093.00 | $2,186.00 | $96.32–$1,530.20 | 58% above | 50% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis w/o Contrast | $1,093.00 | $2,186.00 | $96.32–$1,530.20 | — | 50% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Soft Tissue Pelvic | $379.00 | $758.00 | $96.32–$530.60 | 126% above | 50% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Bladder Scan | $379.00 | $758.00 | $96.32–$530.60 | 126% above | 50% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic Ltd | $379.00 | $758.00 | $96.32–$530.60 | 126% above | 50% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic Ltd | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Soft Tissue Pelvic | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Bladder Scan | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Comp | $379.00 | $758.00 | $96.32–$530.60 | 35% above | 50% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Comp | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Greater Than 14 Weeks | $379.00 | $758.00 | $96.32–$530.60 | 49% above | 50% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Greater Than 14 Weeks | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB Less Than 14 Weeks | $379.00 | $758.00 | $96.32–$530.60 | 66% above | 50% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB Less Than 14 Weeks | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited | $254.00 | $508.00 | $96.32–$355.60 | 47% above | 50% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited | $254.00 | $508.00 | $96.32–$355.60 | — | 50% |
| Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 Views Left | $169.00 | $338.00 | — | 20% above | 50% |
| Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 Views Right | $169.00 | $338.00 | — | 20% above | 50% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 Views Right | $169.00 | $338.00 | — | — | 50% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 Views Left | $169.00 | $338.00 | — | — | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w/ PA Chest Left | $169.00 | $338.00 | — | 14% above | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w/ PA Chest Right | $169.00 | $338.00 | — | 14% above | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs w/ PA Chest Left | $169.00 | $338.00 | — | — | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs w/ PA Chest Right | $169.00 | $338.00 | — | — | 50% |
| Screening mammogram, both breasts both sides CPT 77067 MG Mammo Screening Bilateral w/ Tomo. | $106.50 | $213.00 | $42.60–$160.00 | — | 50% |
| Screening mammogram, both breasts both sides CPT 77067 MG Mammo Digital Screening Bilateral. | $106.50 | $213.00 | $42.60–$160.00 | — | 50% |
| Screening mammogram, both breasts CPT 77067 MG Breast Tomo 3D Digital Screening. | $47.50 | $95.00 | $19.00–$160.00 | 63% below | 50% |
| Screening mammogram, both breasts CPT 77067 MG Mammo Implant Screening Bil w/ Tomo. | $106.50 | $213.00 | $42.60–$160.00 | 17% below | 50% |
| Screening mammogram, both breasts CPT 77067 MG Mammo Implant Digital Screening Bil. | $106.50 | $213.00 | $42.60–$160.00 | 17% below | 50% |
| Screening mammogram, both breasts one side CPT 77067 MG Mammo Screening Left w/ Tomo. | $106.50 | $213.00 | $42.60–$160.00 | 17% below | 50% |
| Screening mammogram, both breasts one side CPT 77067 MG Mammo Implant Screening Rt w/ Tomo. | $106.50 | $213.00 | $42.60–$160.00 | 17% below | 50% |
| Screening mammogram, both breasts one side CPT 77067 MG Mammo Screening Right w/ Tomo. | $106.50 | $213.00 | $42.60–$160.00 | 17% below | 50% |
| Screening mammogram, both breasts one side CPT 77067 MG Mammo Screening Right w/ Tomo. | $106.50 | $213.00 | — | 17% below | 50% |
| Screening mammogram, both breasts one side CPT 77067 MG Mammo Implant Screening Lt w/ Tomo. | $106.50 | $213.00 | $42.60–$160.00 | 17% below | 50% |
| Screening mammogram, both breasts one side CPT 77067 MG Mammo Screening Left w/ Tomo. | $106.50 | $213.00 | — | 17% below | 50% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Digital Screening Bilateral. | $106.50 | $213.00 | $42.60–$160.00 | — | 50% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Screening Bilateral w/ Tomo. | $106.50 | $213.00 | $42.60–$160.00 | — | 50% |
| Screening mammogram, both breasts inpatient CPT 77067 MG Breast Tomo 3D Digital Screening. | $47.50 | $95.00 | $19.00–$160.00 | — | 50% |
| Screening mammogram, both breasts inpatient CPT 77067 MG Mammo Implant Screening Bil w/ Tomo. | $106.50 | $213.00 | $42.60–$160.00 | — | 50% |
| Screening mammogram, both breasts inpatient CPT 77067 MG Mammo Implant Digital Screening Bil. | $106.50 | $213.00 | $42.60–$160.00 | — | 50% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Screening Right w/ Tomo. | $106.50 | $213.00 | — | — | 50% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Implant Screening Rt w/ Tomo. | $106.50 | $213.00 | $42.60–$160.00 | — | 50% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Screening Left w/ Tomo. | $106.50 | $213.00 | — | — | 50% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Implant Screening Lt w/ Tomo. | $106.50 | $213.00 | $42.60–$160.00 | — | 50% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Screening Left w/ Tomo. | $106.50 | $213.00 | $42.60–$160.00 | — | 50% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Screening Right w/ Tomo. | $106.50 | $213.00 | $42.60–$160.00 | — | 50% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete 2 Plus Views Left | $90.00 | $180.00 | — | 32% below | 50% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete 2 Plus Views Right | $90.00 | $180.00 | — | 32% below | 50% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete 2 Plus Views Right | $90.00 | $180.00 | — | — | 50% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete 2 Plus Views Left | $90.00 | $180.00 | — | — | 50% |
| Sinus X-ray, complete, 3 or more views CPT 70220 XR Sinuses Paranasal Complete | $211.00 | $422.00 | $80.18–$673.00 | 29% above | 50% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR Sinuses Paranasal Complete | $211.00 | $422.00 | $80.18–$673.00 | — | 50% |
| Skull X-ray, fewer than 4 views CPT 70250 XR Skull < 4 Views | $132.50 | $265.00 | $96.32–$673.00 | at median | 50% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 XR Skull < 4 Views | $132.50 | $265.00 | $96.32–$673.00 | — | 50% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnography CHARGE | $1,584.50 | $3,169.00 | $791.16–$2,218.30 | 6% above | 50% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnography CHARGE | $1,584.50 | $3,169.00 | $791.16–$2,218.30 | — | 50% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Swallowing Function w/ Speech | $211.00 | $422.00 | $161.60–$673.00 | 13% below | 50% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Swallowing Function w/ Speech | $211.00 | $422.00 | $161.60–$673.00 | — | 50% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur 2 Views Left | $178.00 | $356.00 | — | 49% above | 50% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur 2 Views Right | $178.00 | $356.00 | — | 49% above | 50% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur 2 Views Left | $178.00 | $356.00 | — | — | 50% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur 2 Views Right | $178.00 | $356.00 | — | — | 50% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Spine Thoracic Robotic w/o Contrast | $864.50 | $1,729.00 | $96.32–$1,210.30 | 14% above | 50% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Spine Thoracic w/o Contrast | $974.50 | $1,949.00 | $96.32–$1,364.30 | 29% above | 50% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Spine Thoracic Robotic w/o Contrast | $864.50 | $1,729.00 | $96.32–$1,210.30 | — | 50% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Spine Thoracic w/o Contrast | $974.50 | $1,949.00 | $96.32–$1,364.30 | — | 50% |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB | $437.50 | $875.00 | $96.32–$612.50 | 105% above | 50% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB | $437.50 | $875.00 | $96.32–$612.50 | — | 50% |
| Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal | $317.50 | $635.00 | $96.32–$444.50 | 75% above | 50% |
| Transvaginal ultrasound during pregnancy CPT 76817 Transvaginal OB Add On | $317.50 | $635.00 | $96.32–$444.50 | 75% above | 50% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 Transvaginal OB Add On | $317.50 | $635.00 | $96.32–$444.50 | — | 50% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal | $317.50 | $635.00 | $96.32–$444.50 | — | 50% |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete | $590.00 | $1,180.00 | $96.32–$826.00 | 96% above | 50% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete | $590.00 | $1,180.00 | $96.32–$826.00 | — | 50% |
| Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents) w/ Doppler if ind | $379.00 | $758.00 | $96.32–$530.60 | 76% above | 50% |
| Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents) | $379.00 | $758.00 | $96.32–$530.60 | 76% above | 50% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents) w/ Doppler if ind | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents) | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head/Neck Soft Tissue | $257.50 | $515.00 | $96.32–$360.50 | 2% above | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Soft Tissue | $257.50 | $515.00 | $96.32–$360.50 | 2% above | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid | $379.00 | $758.00 | $96.32–$530.60 | 50% above | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Soft Tissue | $257.50 | $515.00 | $96.32–$360.50 | — | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head/Neck Soft Tissue | $257.50 | $515.00 | $96.32–$360.50 | — | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid | $379.00 | $758.00 | $96.32–$530.60 | — | 50% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI + KUB | $287.50 | $575.00 | $161.60–$673.00 | 13% above | 50% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI | $287.50 | $575.00 | $161.60–$673.00 | 13% above | 50% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI + KUB | $287.50 | $575.00 | $161.60–$673.00 | — | 50% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI | $287.50 | $575.00 | $161.60–$673.00 | — | 50% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Left | $132.50 | $265.00 | — | 4% above | 50% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Right | $132.50 | $265.00 | — | 4% above | 50% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Left | $132.50 | $265.00 | — | — | 50% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Right | $132.50 | $265.00 | — | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Insufficiency Right | $389.50 | $779.00 | — | 51% above | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Lower Extremity Venous Ultrasound DVT, Left | $407.50 | $815.00 | $96.32–$570.50 | 58% above | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Insufficiency Left | $407.50 | $815.00 | — | 58% above | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Upper Extremity Venous Ultrasound, Left | $407.50 | $815.00 | $96.32–$570.50 | 58% above | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Lower Extremity Venous Ultrasound Insufficiency, Left | $407.50 | $815.00 | $96.32–$570.50 | 58% above | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Upper Extremity Venous Ultrasound, Right | $407.50 | $815.00 | $96.32–$570.50 | 58% above | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Lower Extremity Venous Ultrasound Insufficiency, Right | $407.50 | $815.00 | $96.32–$570.50 | 58% above | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Lower Extremity Venous Ultrasound DVT, Right | $407.50 | $815.00 | $96.32–$570.50 | 58% above | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Ext Venous Duplex Right | $438.50 | $877.00 | — | 70% above | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Ext Venous Duplex Left | $438.50 | $877.00 | — | 70% above | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Venous Duplex Left | $438.50 | $877.00 | — | 70% above | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Venous Duplex Right | $438.50 | $877.00 | — | 70% above | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Insufficiency Right | $389.50 | $779.00 | — | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Lower Extremity Venous Ultrasound Insufficiency, Right | $407.50 | $815.00 | $96.32–$570.50 | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Insufficiency Left | $407.50 | $815.00 | — | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Lower Extremity Venous Ultrasound DVT, Right | $407.50 | $815.00 | $96.32–$570.50 | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Lower Extremity Venous Ultrasound DVT, Left | $407.50 | $815.00 | $96.32–$570.50 | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Upper Extremity Venous Ultrasound, Left | $407.50 | $815.00 | $96.32–$570.50 | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Lower Extremity Venous Ultrasound Insufficiency, Left | $407.50 | $815.00 | $96.32–$570.50 | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Upper Extremity Venous Ultrasound, Right | $407.50 | $815.00 | $96.32–$570.50 | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Venous Duplex Left | $438.50 | $877.00 | — | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Ext Venous Duplex Right | $438.50 | $877.00 | — | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Ext Venous Duplex Left | $438.50 | $877.00 | — | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Venous Duplex Right | $438.50 | $877.00 | — | — | 50% |
| Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Right | $89.00 | $178.00 | — | 18% below | 50% |
| Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Left | $89.00 | $178.00 | — | 18% below | 50% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Right | $89.00 | $178.00 | — | — | 50% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Left | $89.00 | $178.00 | — | — | 50% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete 3+ Views Left | $132.50 | $265.00 | — | 11% above | 50% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete 3 Plus Views Right | $132.50 | $265.00 | — | 11% above | 50% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete 3 Plus Views Right | $132.50 | $265.00 | — | — | 50% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete 3+ Views Left | $132.50 | $265.00 | — | — | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Right | $134.50 | $269.00 | — | 6% above | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Left | $134.50 | $269.00 | — | 6% above | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Right | $134.50 | $269.00 | — | — | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Left | $134.50 | $269.00 | — | — | 50% |
| X-ray of the abdomen, 1 view CPT 74018 XR Abdomen KUB 1 View | $131.00 | $262.00 | $40.79–$673.00 | 8% above | 50% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen KUB 1 View | $131.00 | $262.00 | $40.79–$673.00 | — | 50% |
| X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Left | $89.00 | $178.00 | — | 18% below | 50% |
| X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Right | $89.00 | $178.00 | — | 18% below | 50% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Left | $89.00 | $178.00 | — | — | 50% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Right | $89.00 | $178.00 | — | — | 50% |
| X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Right | $89.00 | $178.00 | — | 17% below | 50% |
| X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Left | $89.00 | $178.00 | — | 17% below | 50% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Left | $89.00 | $178.00 | — | — | 50% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Right | $89.00 | $178.00 | — | — | 50% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete 3 plus Views Right | $132.50 | $265.00 | — | 7% above | 50% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete 3 Plus Views Left | $132.50 | $265.00 | — | 7% above | 50% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete 3 Plus Views Left | $132.50 | $265.00 | — | — | 50% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete 3 plus Views Right | $132.50 | $265.00 | — | — | 50% |
| X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete 3 Views Left | $132.50 | $265.00 | — | 4% above | 50% |
| X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete 3 Plus Views Right | $132.50 | $265.00 | — | 4% above | 50% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete 3 Plus Views Right | $132.50 | $265.00 | — | — | 50% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete 3 Views Left | $132.50 | $265.00 | — | — | 50% |
| X-ray of the knee, 1 or 2 views both sides CPT 73560 XR Knee 1 View Standing AP Bilateral | $130.50 | $261.00 | $80.18–$673.00 | — | 50% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Right | $130.50 | $261.00 | — | 15% above | 50% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee in OR Right | $130.50 | $261.00 | — | 15% above | 50% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Left | $130.50 | $261.00 | — | 15% above | 50% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee in OR Left | $130.50 | $261.00 | — | 15% above | 50% |
| X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 XR Knee 1 View Standing AP Bilateral | $130.50 | $261.00 | $80.18–$673.00 | — | 50% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee in OR Right | $130.50 | $261.00 | — | — | 50% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Right | $130.50 | $261.00 | — | — | 50% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Left | $130.50 | $261.00 | — | — | 50% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee in OR Left | $130.50 | $261.00 | — | — | 50% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views | $111.00 | $222.00 | $96.32–$673.00 | 27% below | 50% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views | $111.00 | $222.00 | $96.32–$673.00 | — | 50% |
| X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral 4 Plus Views | $269.00 | $538.00 | $96.32–$673.00 | 24% above | 50% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral 4 Plus Views | $269.00 | $538.00 | $96.32–$673.00 | — | 50% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views | $132.50 | $265.00 | $96.32–$673.00 | 14% below | 50% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views | $132.50 | $265.00 | $96.32–$673.00 | — | 50% |
| X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones 3+ Views | $161.50 | $323.00 | $80.18–$673.00 | 37% above | 50% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones 3+ Views | $161.50 | $323.00 | $80.18–$673.00 | — | 50% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 Views | $156.50 | $313.00 | $80.18–$673.00 | 9% above | 50% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical 2 or 3 Views | $156.50 | $313.00 | $80.18–$673.00 | — | 50% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views | $110.50 | $221.00 | $96.32–$673.00 | 16% below | 50% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views | $110.50 | $221.00 | $96.32–$673.00 | — | 50% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx 2+ Views | $161.50 | $323.00 | $80.18–$673.00 | 15% above | 50% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum/Coccyx 2+ Views | $161.50 | $323.00 | $80.18–$673.00 | — | 50% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Louisiana | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ACTH, Plasma QST | $214.00 | $428.00 | $38.62–$299.60 | 98% above | 50% |
| ACTH blood test inpatient CPT 82024 ACTH, Plasma QST | $214.00 | $428.00 | $38.62–$299.60 | — | 50% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine aminotransferase | $87.50 | $175.00 | $5.30–$122.50 | 335% above | 50% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Transferase; alanine amino (ALT) (SGPT) OGH | $87.50 | $175.00 | $5.30–$122.50 | 335% above | 50% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine aminotransferase | $87.50 | $175.00 | $5.30–$122.50 | — | 50% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Transferase; alanine amino (ALT) (SGPT) OGH | $87.50 | $175.00 | $5.30–$122.50 | — | 50% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate aminotransferase | $87.50 | $175.00 | $5.18–$122.50 | 348% above | 50% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Aspartate aminotransferase | $87.50 | $175.00 | $5.18–$122.50 | — | 50% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hep Acute Pnl | $80.00 | $160.00 | $47.63–$112.00 | 28% below | 50% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hep Acute Pnl | $80.00 | $160.00 | $47.63–$112.00 | — | 50% |
| Albumin blood test CPT 82040 Albumin Level 24 Hour Urine | $30.50 | $61.00 | $4.95–$42.70 | 95% above | 50% |
| Albumin blood test CPT 82040 Albumin Level | $30.50 | $61.00 | $4.95–$42.70 | 95% above | 50% |
| Albumin blood test CPT 82040 IgG Synthesis Rate/Index, CSF QST | $30.50 | $61.00 | $4.95–$42.70 | 95% above | 50% |
| Albumin blood test CPT 82040 Albumin QST | $30.50 | $61.00 | $4.95–$42.70 | 95% above | 50% |
| Albumin blood test CPT 82040 Albumin; serum, plasma or whole blood OGH | $30.50 | $61.00 | $4.95–$42.70 | 95% above | 50% |
| Albumin blood test CPT 82040 Albumin Level Urine | $30.50 | $61.00 | $4.95–$42.70 | 95% above | 50% |
| Albumin blood test inpatient CPT 82040 Albumin Level Urine | $30.50 | $61.00 | $4.95–$42.70 | — | 50% |
| Albumin blood test inpatient CPT 82040 Albumin Level 24 Hour Urine | $30.50 | $61.00 | $4.95–$42.70 | — | 50% |
| Albumin blood test inpatient CPT 82040 IgG Synthesis Rate/Index, CSF QST | $30.50 | $61.00 | $4.95–$42.70 | — | 50% |
| Albumin blood test inpatient CPT 82040 Albumin Level | $30.50 | $61.00 | $4.95–$42.70 | — | 50% |
| Albumin blood test inpatient CPT 82040 Albumin QST | $30.50 | $61.00 | $4.95–$42.70 | — | 50% |
| Albumin blood test inpatient CPT 82040 Albumin; serum, plasma or whole blood OGH | $30.50 | $61.00 | $4.95–$42.70 | — | 50% |
| Aldosterone blood test CPT 82088 Aldosterone, LC/MS QST | $110.00 | $220.00 | $40.75–$154.00 | 14% above | 50% |
| Aldosterone blood test CPT 82088 ALDOSTERONE, LC/MS OGH | $110.00 | $220.00 | $40.75–$154.00 | 14% above | 50% |
| Aldosterone blood test CPT 82088 Aldosterone/Plasma Renin Activ Ratio QST | $110.00 | $220.00 | $40.75–$154.00 | 14% above | 50% |
| Aldosterone blood test inpatient CPT 82088 Aldosterone, LC/MS QST | $110.00 | $220.00 | $40.75–$154.00 | — | 50% |
| Aldosterone blood test inpatient CPT 82088 Aldosterone/Plasma Renin Activ Ratio QST | $110.00 | $220.00 | $40.75–$154.00 | — | 50% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE, LC/MS OGH | $110.00 | $220.00 | $40.75–$154.00 | — | 50% |
| Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase, Bone Specific QST | $7.75 | $15.50 | $5.18–$10.85 | 59% below | 50% |
| Alkaline phosphatase (ALP) blood test CPT 84075 Phosphatase, alkaline; OGH | $69.50 | $139.00 | $5.18–$97.30 | 271% above | 50% |
| Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase | $69.50 | $139.00 | $5.18–$97.30 | 271% above | 50% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase, Bone Specific QST | $7.75 | $15.50 | $5.18–$10.85 | — | 50% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase | $69.50 | $139.00 | $5.18–$97.30 | — | 50% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Phosphatase, alkaline; OGH | $69.50 | $139.00 | $5.18–$97.30 | — | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Phoma Betae (M13) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Epicoccum Purpurascens (M14) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Willow (T12) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen IGE Rhodotorula QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen IGE Mulberry Red Tree QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen IGE Epiderm Floc. QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Botrytis Cinerea (M7) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 #NAME? | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Trichophyton Rubrum (M205) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cocklebur (W13) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel 11, Mold Group QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Corn Smut, Till Trit (M201) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel, Region 6, Grasses-QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Rhizopus Nigricans (M11) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Dog Fennel (W46) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Birch (T3) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Alder (T2) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | 23% below | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria tenuis/alternata IgG4 QST | $11.67 | $23.33 | $5.22–$16.33 | 12% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Egg Mix (Yolk & White) (f245) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Aureobasidium Pullulans (m12) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Pine (t213) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 BASS BLACK(SEA Bass) (CENTROPRISTIS) IgE | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Privet (t210) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Bahia Grass (g17) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Red Cedar (T57) IGE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Barley (F6) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Beef (F27) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda Grass (g2) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Rough Marsh Elder (W16) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Rough Pigweed (w14) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Sesame Seed (F10) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Sheep Sorrel w18) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp (F24) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Horse Dander (e3) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Hickory/Pecan Tree (t22) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Soybean (f14) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Sycamore (t11) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass (g6) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Turkey Feathers (e89) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Virginia Live Oak (rt218) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Walnut (f256) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Wheat (f4) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 White Ash (t15) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 White Pine (t16) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Yeast (f45) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Helminthosporium Halodes (m8) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Hackberry (rt44) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Yellow Dock Weed (rw23) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Goose Feathers (e70) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Gluten (F79) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 A. Kiliense C. Acremonium m202 IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Lamb's Quarter (Goose Foot) w10 IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGY PANEL REGION VI WITH REFLEXES, QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Maize/Corn (f8) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Giant Ragweed (Tall) (W3) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Fusarium Moniliforme (m9) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Feather Mix IgE (Poultry) QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Spec IgE Curvularia Spicifera QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 English Plantain (w9) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Egg White (F2) IgE w/Rflx to Panel QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Johnson Grass (g10) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Spec IgE Red Oak(Q.Rubra) QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Maple (Box Elder) (t1) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific IgE A. Flavus QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Milk Component Panel QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen specific IgE quantitative or semiquantitative cru add on | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Mountain Cedar (t6) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen specific IgE; quantitative or semiquantitative, crude al OGH | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Mucor Racemosus (m4) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen(IGE) ConvRast HelmSativum QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Oak (T7) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Mold Pan, Complete QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Peanut (F13) Ige QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Dog Dander (e5) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophagoides Farinae (d2) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 D. Pteronyssinus (d1) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Crayfish (rf320) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 American Cockroach (I206) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium Notatum (m1) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus Fumigatus (m3) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Crab (f23) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus niger (M207) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cow'S Milk (F2) IgE w/Rflx to Panel QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cow'S Milk (F2) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cow Dander (e4) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cottonwood (t14) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Common Ragweed (Short) (w1) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach (i6) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium Herbarum (m2) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Chicken Feathers (e85) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cedar (Rt212) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cat Dander (e1) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Careless Weed (A. Palmeri) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Candida Albicans (m5) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Curvularia Lunata (m16) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria Alternata (m6) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Pecan Nut (f201) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | 72% above | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cocklebur (W13) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel 11, Mold Group QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dog Fennel (W46) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Phoma Betae (M13) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Epicoccum Purpurascens (M14) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen IGE Rhodotorula QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen IGE Mulberry Red Tree QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen IGE Epiderm Floc. QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 #NAME? | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Willow (T12) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Corn Smut, Till Trit (M201) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Alder (T2) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Trichophyton Rubrum (M205) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel, Region 6, Grasses-QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rhizopus Nigricans (M11) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Birch (T3) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Botrytis Cinerea (M7) IGE QST | $8.00 | $16.00 | $5.22–$11.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Alternaria tenuis/alternata IgG4 QST | $11.67 | $23.33 | $5.22–$16.33 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Horse Dander (e3) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Johnson Grass (g10) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lamb's Quarter (Goose Foot) w10 IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 A. Kiliense C. Acremonium m202 IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGY PANEL REGION VI WITH REFLEXES, QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Spec IgE Curvularia Spicifera QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Spec IgE Red Oak(Q.Rubra) QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Specific IgE A. Flavus QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen specific IgE quantitative or semiquantitative cru add on | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen specific IgE; quantitative or semiquantitative, crude al OGH | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen(IGE) ConvRast HelmSativum QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Mold Pan, Complete QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Alternaria Alternata (m6) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 American Cockroach (I206) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus Fumigatus (m3) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus niger (M207) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aureobasidium Pullulans (m12) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BASS BLACK(SEA Bass) (CENTROPRISTIS) IgE | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bahia Grass (g17) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Barley (F6) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Beef (F27) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bermuda Grass (g2) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Candida Albicans (m5) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Careless Weed (A. Palmeri) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cat Dander (e1) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cedar (Rt212) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Chicken Feathers (e85) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cladosporium Herbarum (m2) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cockroach (i6) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Common Ragweed (Short) (w1) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cottonwood (t14) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cow Dander (e4) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cow'S Milk (F2) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cow'S Milk (F2) IgE w/Rflx to Panel QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Crab (f23) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Crayfish (rf320) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Curvularia Lunata (m16) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 D. Pteronyssinus (d1) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dermatophagoides Farinae (d2) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dog Dander (e5) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg Mix (Yolk & White) (f245) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg White (F2) IgE w/Rflx to Panel QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 English Plantain (w9) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Feather Mix IgE (Poultry) QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Fusarium Moniliforme (m9) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Giant Ragweed (Tall) (W3) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Gluten (F79) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Yellow Dock Weed (rw23) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Yeast (f45) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Goose Feathers (e70) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hackberry (rt44) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Pine (t16) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Ash (t15) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Wheat (f4) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut (f256) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Virginia Live Oak (rt218) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Turkey Feathers (e89) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Timothy Grass (g6) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sycamore (t11) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Soybean (f14) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Shrimp (F24) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Helminthosporium Halodes (m8) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hickory/Pecan Tree (t22) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sheep Sorrel w18) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sesame Seed (F10) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough Pigweed (w14) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough Marsh Elder (W16) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Red Cedar (T57) IGE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Privet (t210) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pine (t213) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillium Notatum (m1) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pecan Nut (f201) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peanut (F13) Ige QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oak (T7) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mucor Racemosus (m4) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mountain Cedar (t6) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Milk Component Panel QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Maple (Box Elder) (t1) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Maize/Corn (f8) IgE QST | $18.00 | $36.00 | $5.22–$25.20 | — | 50% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-fetoprotein (AFP); serum OGH | $191.50 | $383.00 | $16.77–$268.10 | 255% above | 50% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 Maternal Serum AFP QST | $191.50 | $383.00 | $16.77–$268.10 | 255% above | 50% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein, Tumor Marker QST | $191.50 | $383.00 | $16.77–$268.10 | 255% above | 50% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein Tumor Marker | $191.50 | $383.00 | $16.77–$268.10 | 255% above | 50% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Maternal Serum AFP QST | $191.50 | $383.00 | $16.77–$268.10 | — | 50% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha Fetoprotein, Tumor Marker QST | $191.50 | $383.00 | $16.77–$268.10 | — | 50% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha-fetoprotein (AFP); serum OGH | $191.50 | $383.00 | $16.77–$268.10 | — | 50% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha Fetoprotein Tumor Marker | $191.50 | $383.00 | $16.77–$268.10 | — | 50% |
| Ammonia blood test CPT 82140 Ammonia Level | $83.00 | $166.00 | $14.57–$116.20 | 66% above | 50% |
| Ammonia blood test CPT 82140 Ammonia, Plasma | $83.00 | $166.00 | $14.57–$116.20 | 66% above | 50% |
| Ammonia blood test inpatient CPT 82140 Ammonia, Plasma | $83.00 | $166.00 | $14.57–$116.20 | — | 50% |
| Ammonia blood test inpatient CPT 82140 Ammonia Level | $83.00 | $166.00 | $14.57–$116.20 | — | 50% |
| Amylase blood test CPT 82150 Amylase Level Body Fluid | $92.50 | $185.00 | $6.48–$129.50 | 314% above | 50% |
| Amylase blood test CPT 82150 Amylase Level | $92.50 | $185.00 | $6.48–$129.50 | 314% above | 50% |
| Amylase blood test CPT 82150 Amylase Level 24 Hour Urine | $92.50 | $185.00 | $6.48–$129.50 | 314% above | 50% |
| Amylase blood test CPT 82150 Amylase Level Urine | $92.50 | $185.00 | $6.48–$129.50 | 314% above | 50% |
| Amylase blood test inpatient CPT 82150 Amylase Level Body Fluid | $92.50 | $185.00 | $6.48–$129.50 | — | 50% |
| Amylase blood test inpatient CPT 82150 Amylase Level 24 Hour Urine | $92.50 | $185.00 | $6.48–$129.50 | — | 50% |
| Amylase blood test inpatient CPT 82150 Amylase Level | $92.50 | $185.00 | $6.48–$129.50 | — | 50% |
| Amylase blood test inpatient CPT 82150 Amylase Level Urine | $92.50 | $185.00 | $6.48–$129.50 | — | 50% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic citrullinated peptide (CCP), antibody OGH | $131.00 | $262.00 | $12.95–$183.40 | 187% above | 50% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 ANALYZER ANA,IFA W/REFLEX TITER /PATTERN,SYSTEMIC AUTOIMMUNE | $131.00 | $262.00 | $12.95–$183.40 | 187% above | 50% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Ab (IgG) QST | $131.00 | $262.00 | $12.95–$183.40 | 187% above | 50% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP Ab (IgG) QST | $131.00 | $262.00 | $12.95–$183.40 | — | 50% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic citrullinated peptide (CCP), antibody OGH | $131.00 | $262.00 | $12.95–$183.40 | — | 50% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 ANALYZER ANA,IFA W/REFLEX TITER /PATTERN,SYSTEMIC AUTOIMMUNE | $131.00 | $262.00 | $12.95–$183.40 | — | 50% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Scrn, IFA, w/Refl Titer/Pattern QST | $71.00 | $142.00 | $12.09–$99.40 | 59% above | 50% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear antibodies (ANA); OGH | $71.00 | $142.00 | $12.09–$99.40 | 59% above | 50% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANALYZER ANA,IFA W/REFLEX TITER /PATTERN,SYSTEMIC AUTOIMMUNE | $71.00 | $142.00 | $12.09–$99.40 | 59% above | 50% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Scr,IFA rfx Titer/Ptrn/MPX Ab QST | $71.00 | $142.00 | $12.09–$99.40 | 59% above | 50% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Scr IFA w/Rfx/Titer/Pat/Sjogren QST | $71.00 | $142.00 | $12.09–$99.40 | 59% above | 50% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Scr IFA Titer/Ptrn/Lupus Pnl 4 QST | $71.00 | $142.00 | $12.09–$99.40 | 59% above | 50% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Multiplex w/Reflex 11 AB Cascade QST | $71.00 | $142.00 | $12.09–$99.40 | 59% above | 50% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Scr IFA Titer/Ptrn/Lupus Pnl 4 QST | $71.00 | $142.00 | $12.09–$99.40 | — | 50% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Scr IFA w/Rfx/Titer/Pat/Sjogren QST | $71.00 | $142.00 | $12.09–$99.40 | — | 50% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Scr,IFA rfx Titer/Ptrn/MPX Ab QST | $71.00 | $142.00 | $12.09–$99.40 | — | 50% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Scrn, IFA, w/Refl Titer/Pattern QST | $71.00 | $142.00 | $12.09–$99.40 | — | 50% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANALYZER ANA,IFA W/REFLEX TITER /PATTERN,SYSTEMIC AUTOIMMUNE | $71.00 | $142.00 | $12.09–$99.40 | — | 50% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear antibodies (ANA); OGH | $71.00 | $142.00 | $12.09–$99.40 | — | 50% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Multiplex w/Reflex 11 AB Cascade QST | $71.00 | $142.00 | $12.09–$99.40 | — | 50% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-Type Natriuretic Peptide | $81.00 | $162.00 | $39.26–$113.40 | 22% above | 50% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 N-Terminal Pro B-Type Natriuretic Peptide | $81.00 | $162.00 | $39.26–$113.40 | 22% above | 50% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-Type Natriuretic Peptide | $81.00 | $162.00 | $39.26–$113.40 | — | 50% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 N-Terminal Pro B-Type Natriuretic Peptide | $81.00 | $162.00 | $39.26–$113.40 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Ear Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Catheter Tip Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Tissue Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Sterility Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Renal Washing Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Sputum Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bone Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Eye Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Respiratory Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Body Fluid Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Nasal Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Throat Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Synovial Fluid Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 IV Catheter Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Medical Device Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Environmental Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bronchial Wash Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 GC Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Cerebrospinal Fluid Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Wound Culture | $93.50 | $187.00 | $8.62–$130.90 | 220% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Medical Device Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Synovial Fluid Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Ear Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Environmental Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Renal Washing Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Sterility Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Eye Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Respiratory Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Throat Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Wound Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Cerebrospinal Fluid Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Nasal Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Tissue Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Catheter Tip Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 GC Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Sputum Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 IV Catheter Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Body Fluid Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bone Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bronchial Wash Culture | $93.50 | $187.00 | $8.62–$130.90 | — | 50% |
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $81.00 | $162.00 | $8.46–$113.40 | 131% above | 50% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel | $81.00 | $162.00 | $8.46–$113.40 | — | 50% |
| Bilirubin blood test, total CPT 82247 Bilirubin, Fractionated QST | $44.00 | $88.00 | $5.02–$61.60 | 160% above | 50% |
| Bilirubin blood test, total CPT 82247 Bilirubin Indirect | $44.00 | $88.00 | $5.02–$61.60 | 160% above | 50% |
| Bilirubin blood test, total CPT 82247 Bilirubin Total and Direct | $44.00 | $88.00 | $5.02–$61.60 | 160% above | 50% |
| Bilirubin blood test, total CPT 82247 Bilirubin Total | $44.00 | $88.00 | $5.02–$61.60 | 160% above | 50% |
| Bilirubin blood test, total CPT 82247 Bilirubin; total OGH | $44.00 | $88.00 | $5.02–$61.60 | 160% above | 50% |
| Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total and Direct | $44.00 | $88.00 | $5.02–$61.60 | — | 50% |
| Bilirubin blood test, total inpatient CPT 82247 Bilirubin; total OGH | $44.00 | $88.00 | $5.02–$61.60 | — | 50% |
| Bilirubin blood test, total inpatient CPT 82247 Bilirubin Indirect | $44.00 | $88.00 | $5.02–$61.60 | — | 50% |
| Bilirubin blood test, total inpatient CPT 82247 Bilirubin, Fractionated QST | $44.00 | $88.00 | $5.02–$61.60 | — | 50% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 AP Bill Surgical Pathology Level IV Complexity | $122.00 | $244.00 | $48.01–$170.80 | 44% above | 50% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 AP Bill Surgical Pathology Level IV Complexity | $122.00 | $244.00 | $48.01–$170.80 | — | 50% |
| Blood culture for bacteria CPT 87040 Blood Culture | $130.00 | $260.00 | $10.32–$182.00 | 189% above | 50% |
| Blood culture for bacteria inpatient CPT 87040 Blood Culture | $130.00 | $260.00 | $10.32–$182.00 | — | 50% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture Routine Charge | $14.00 | $28.00 | $3.00–$19.60 | 69% above | 50% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw | $14.00 | $28.00 | $3.00–$19.60 | 69% above | 50% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture Routine Charge | $14.00 | $28.00 | $3.00–$19.60 | — | 50% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw | $14.00 | $28.00 | $3.00–$19.60 | — | 50% |
| Blood glucose (sugar) test CPT 82947 Glucose Tolerance Test OB 3Hr | $66.00 | $132.00 | $3.93–$92.40 | 370% above | 50% |
| Blood glucose (sugar) test CPT 82947 Glucose Body Fluid | $66.00 | $132.00 | $3.93–$92.40 | 370% above | 50% |
| Blood glucose (sugar) test CPT 82947 Glucose Fasting Urine | $66.00 | $132.00 | $3.93–$92.40 | 370% above | 50% |
| Blood glucose (sugar) test CPT 82947 Glucose Level | $66.00 | $132.00 | $3.93–$92.40 | 370% above | 50% |
| Blood glucose (sugar) test CPT 82947 Glucose Tolerance 1 Hr w/Urine | $66.00 | $132.00 | $3.93–$92.40 | 370% above | 50% |
| Blood glucose (sugar) test CPT 82947 Glucose Fasting | $66.00 | $132.00 | $3.93–$92.40 | 370% above | 50% |
| Blood glucose (sugar) test CPT 82947 Glucose; quantitative, blood (except reagent strip) OGH | $66.00 | $132.00 | $3.93–$92.40 | 370% above | 50% |
| Blood glucose (sugar) test inpatient CPT 82947 Glucose Fasting | $66.00 | $132.00 | $3.93–$92.40 | — | 50% |
| Blood glucose (sugar) test inpatient CPT 82947 Glucose Body Fluid | $66.00 | $132.00 | $3.93–$92.40 | — | 50% |
| Blood glucose (sugar) test inpatient CPT 82947 Glucose Level | $66.00 | $132.00 | $3.93–$92.40 | — | 50% |
| Blood glucose (sugar) test inpatient CPT 82947 Glucose; quantitative, blood (except reagent strip) OGH | $66.00 | $132.00 | $3.93–$92.40 | — | 50% |
| Blood glucose (sugar) test inpatient CPT 82947 Glucose Tolerance 1 Hr w/Urine | $66.00 | $132.00 | $3.93–$92.40 | — | 50% |
| Blood glucose (sugar) test inpatient CPT 82947 Glucose Tolerance Test OB 3Hr | $66.00 | $132.00 | $3.93–$92.40 | — | 50% |
| Blood glucose (sugar) test inpatient CPT 82947 Glucose Fasting Urine | $66.00 | $132.00 | $3.93–$92.40 | — | 50% |
| Blood lead test CPT 83655 Lead (Venous), OSHA and Zinc Protoporphyrin Evaluation QST | $71.50 | $143.00 | $12.11–$100.10 | 153% above | 50% |
| Blood lead test CPT 83655 Lead, Blood QST | $71.50 | $143.00 | $12.11–$100.10 | 153% above | 50% |
| Blood lead test CPT 83655 Lead (Venous), OSHA QST | $71.50 | $143.00 | $12.11–$100.10 | 153% above | 50% |
| Blood lead test CPT 83655 Lead OGH | $71.50 | $143.00 | $12.11–$100.10 | 153% above | 50% |
| Blood lead test inpatient CPT 83655 Lead (Venous), OSHA QST | $71.50 | $143.00 | $12.11–$100.10 | — | 50% |
| Blood lead test inpatient CPT 83655 Lead, Blood QST | $71.50 | $143.00 | $12.11–$100.10 | — | 50% |
| Blood lead test inpatient CPT 83655 Lead OGH | $71.50 | $143.00 | $12.11–$100.10 | — | 50% |
| Blood lead test inpatient CPT 83655 Lead (Venous), OSHA and Zinc Protoporphyrin Evaluation QST | $71.50 | $143.00 | $12.11–$100.10 | — | 50% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 hCG, Total, Qual w Reflex to Quant QST | $44.00 | $88.00 | $7.52–$61.60 | 37% above | 50% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Serum Pregnancy Test Qualitative | $44.00 | $88.00 | $7.52–$61.60 | 37% above | 50% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 hCG, Total, Qual w Reflex to Quant QST | $44.00 | $88.00 | $7.52–$61.60 | — | 50% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Serum Pregnancy Test Qualitative | $44.00 | $88.00 | $7.52–$61.60 | — | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Type ABO/Rh Typing | $104.50 | $209.00 | $5.20–$146.30 | 129% above | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord ABO/Rh | $104.50 | $209.00 | $5.20–$146.30 | 129% above | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh Echo | $104.50 | $209.00 | $5.20–$146.30 | 129% above | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 REF ABO/Rh | $104.50 | $209.00 | $5.20–$146.30 | 129% above | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood typing, serologic; ABO OGH | $157.00 | $314.00 | $5.20–$219.80 | 244% above | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh Echo | $104.50 | $209.00 | $5.20–$146.30 | — | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Cord ABO/Rh | $104.50 | $209.00 | $5.20–$146.30 | — | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood Type ABO/Rh Typing | $104.50 | $209.00 | $5.20–$146.30 | — | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 REF ABO/Rh | $104.50 | $209.00 | $5.20–$146.30 | — | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood typing, serologic; ABO OGH | $157.00 | $314.00 | $5.20–$219.80 | — | 50% |
| Blood urea nitrogen (BUN) test CPT 84520 Blood Urea Nitrogen | $66.00 | $132.00 | $3.95–$92.40 | 293% above | 50% |
| Blood urea nitrogen (BUN) test CPT 84520 Urea Nitrogen Urine | $66.00 | $132.00 | $3.95–$92.40 | 293% above | 50% |
| Blood urea nitrogen (BUN) test CPT 84520 Urea nitrogen; quantitative OGH | $66.00 | $132.00 | $3.95–$92.40 | 293% above | 50% |
| Blood urea nitrogen (BUN) test CPT 84520 Urea Nitrogen Level 24 Hour Urine | $66.00 | $132.00 | $3.95–$92.40 | 293% above | 50% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea nitrogen; quantitative OGH | $66.00 | $132.00 | $3.95–$92.40 | — | 50% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 Blood Urea Nitrogen | $66.00 | $132.00 | $3.95–$92.40 | — | 50% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea Nitrogen Level 24 Hour Urine | $66.00 | $132.00 | $3.95–$92.40 | — | 50% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea Nitrogen Urine | $66.00 | $132.00 | $3.95–$92.40 | — | 50% |
| C-peptide blood test CPT 84681 C-Peptide QST | $55.50 | $111.00 | $20.81–$77.70 | at median | 50% |
| C-peptide blood test inpatient CPT 84681 C-Peptide QST | $55.50 | $111.00 | $20.81–$77.70 | — | 50% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein | $75.00 | $150.00 | $5.18–$105.00 | 222% above | 50% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein | $75.00 | $150.00 | $5.18–$105.00 | — | 50% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C difficile (GeneXpert) | $110.50 | $221.00 | $37.27–$154.70 | 48% above | 50% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C difficile/Epi (GeneXpert) | $110.50 | $221.00 | $37.27–$154.70 | 48% above | 50% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C difficile/Epi (GeneXpert) | $110.50 | $221.00 | $37.27–$154.70 | — | 50% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C difficile (GeneXpert) | $110.50 | $221.00 | $37.27–$154.70 | — | 50% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 QST | $90.00 | $180.00 | $20.81–$126.00 | 83% above | 50% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 QST | $90.00 | $180.00 | $20.81–$126.00 | — | 50% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Immunoassay for tumor antigen, quantitative; CA 125 OGH | $262.50 | $525.00 | $20.81–$367.50 | 392% above | 50% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 QST | $262.50 | $525.00 | $20.81–$367.50 | 392% above | 50% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 QST | $262.50 | $525.00 | $20.81–$367.50 | — | 50% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Immunoassay for tumor antigen, quantitative; CA 125 OGH | $262.50 | $525.00 | $20.81–$367.50 | — | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) Total Abs (no Ratio) | $80.50 | $161.00 | $51.31–$112.70 | 9% above | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 RNA (COVID-19), Qualitative NAAT QST | $80.50 | $161.00 | $51.31–$112.70 | 9% above | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 - Diatherix | $80.50 | $161.00 | $51.31–$112.70 | 9% above | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) by PCR | $80.50 | $161.00 | $51.31–$112.70 | 9% above | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Cov-19 amp PRB HGH thruput OGH | $80.50 | $161.00 | $51.31–$112.70 | 9% above | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert) | $80.50 | $161.00 | $51.31–$112.70 | 9% above | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert) | $80.50 | $161.00 | $51.31–$112.70 | — | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) by PCR | $80.50 | $161.00 | $51.31–$112.70 | — | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 - Diatherix | $80.50 | $161.00 | $51.31–$112.70 | — | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Cov-19 amp PRB HGH thruput OGH | $80.50 | $161.00 | $51.31–$112.70 | — | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) Total Abs (no Ratio) | $80.50 | $161.00 | $51.31–$112.70 | — | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 RNA (COVID-19), Qualitative NAAT QST | $80.50 | $161.00 | $51.31–$112.70 | — | 50% |
| Calcium blood test, total CPT 82310 Calcium; total OGH | $52.00 | $104.00 | $5.16–$72.80 | 162% above | 50% |
| Calcium blood test, total CPT 82310 Calcium Level Total | $52.00 | $104.00 | $5.16–$72.80 | 162% above | 50% |
| Calcium blood test, total inpatient CPT 82310 Calcium Level Total | $52.00 | $104.00 | $5.16–$72.80 | — | 50% |
| Calcium blood test, total inpatient CPT 82310 Calcium; total OGH | $52.00 | $104.00 | $5.16–$72.80 | — | 50% |
| Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen | $153.00 | $306.00 | $18.96–$214.20 | 158% above | 50% |
| Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Virus Antibody IgG QST | $137.50 | $275.00 | $12.88–$192.50 | 256% above | 50% |
| Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Virus Ab (IgM) QST | $137.50 | $275.00 | $12.88–$192.50 | 256% above | 50% |
| Chickenpox (varicella) immunity blood test CPT 86787 Antibody; varicella-zoster OGH | $137.50 | $275.00 | $12.88–$192.50 | 256% above | 50% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 Antibody; varicella-zoster OGH | $137.50 | $275.00 | $12.88–$192.50 | — | 50% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Virus Antibody IgG QST | $137.50 | $275.00 | $12.88–$192.50 | — | 50% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Virus Ab (IgM) QST | $137.50 | $275.00 | $12.88–$192.50 | — | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydi OGH | $134.50 | $269.00 | $35.09–$188.30 | 121% above | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 SURESWAB(R) ADVANCED VAGINITIS PLUS, TMA | $134.50 | $269.00 | $35.09–$188.30 | 121% above | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia trach- Diatherix | $134.50 | $269.00 | $35.09–$188.30 | 121% above | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Neisseria gonorrhoeae - Diatherix | $134.50 | $269.00 | $35.09–$188.30 | 121% above | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/N. Gonorrhoeae RNA, Tma QST | $134.50 | $269.00 | $35.09–$188.30 | 121% above | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/N. Gonorrhoeae RNA, Tma QST | $134.50 | $269.00 | $35.09–$188.30 | — | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Neisseria gonorrhoeae - Diatherix | $134.50 | $269.00 | $35.09–$188.30 | — | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 SURESWAB(R) ADVANCED VAGINITIS PLUS, TMA | $134.50 | $269.00 | $35.09–$188.30 | — | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydi OGH | $134.50 | $269.00 | $35.09–$188.30 | — | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia trach- Diatherix | $134.50 | $269.00 | $35.09–$188.30 | — | 50% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Pnl | $88.50 | $177.00 | $13.39–$123.90 | 77% above | 50% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid panel This panel must include the following: Cholesterol, s OGH | $88.50 | $177.00 | $13.39–$123.90 | 77% above | 50% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipo FN, NMR w Lipid PNL (Trig/HDL-C)QST add-on | $88.50 | $177.00 | $13.39–$123.90 | 77% above | 50% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Pnl | $88.50 | $177.00 | $13.39–$123.90 | — | 50% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid panel This panel must include the following: Cholesterol, s OGH | $88.50 | $177.00 | $13.39–$123.90 | — | 50% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipo FN, NMR w Lipid PNL (Trig/HDL-C)QST add-on | $88.50 | $177.00 | $13.39–$123.90 | — | 50% |
| Complete blood count (CBC) with differential CPT 85025 CBC w/ Differential | $50.50 | $101.00 | $7.77–$70.70 | 88% above | 50% |
| Complete blood count (CBC) with differential CPT 85025 Automated Differential | $50.50 | $101.00 | $7.77–$70.70 | 88% above | 50% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Automated Differential | $50.50 | $101.00 | $7.77–$70.70 | — | 50% |
| Complete blood count (CBC), no differential CPT 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and pl OGH | $62.50 | $125.00 | $6.47–$87.50 | 123% above | 50% |
| Complete blood count (CBC), no differential CPT 85027 CBC without Differential | $62.50 | $125.00 | $6.47–$87.50 | 123% above | 50% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and pl OGH | $62.50 | $125.00 | $6.47–$87.50 | — | 50% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC without Differential | $62.50 | $125.00 | $6.47–$87.50 | — | 50% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $125.00 | $250.00 | $10.56–$175.00 | 63% above | 50% |
| Cortisol blood test, total CPT 82533 Cortisol, Total, LC/MS QST | $110.50 | $221.00 | $16.30–$154.70 | 190% above | 50% |
| Cortisol blood test, total CPT 82533 Cortisol; total OGH | $110.50 | $221.00 | $16.30–$154.70 | 190% above | 50% |
| Cortisol blood test, total CPT 82533 Cortisol 30 Min | $110.50 | $221.00 | $16.30–$154.70 | 190% above | 50% |
| Cortisol blood test, total CPT 82533 Cortisol, A.M. QST | $110.50 | $221.00 | $16.30–$154.70 | 190% above | 50% |
| Cortisol blood test, total CPT 82533 Cortisol PM | $110.50 | $221.00 | $16.30–$154.70 | 190% above | 50% |
| Cortisol blood test, total CPT 82533 Cortisol Baseline | $110.50 | $221.00 | $16.30–$154.70 | 190% above | 50% |
| Cortisol blood test, total CPT 82533 Cortisol AM | $110.50 | $221.00 | $16.30–$154.70 | 190% above | 50% |
| Cortisol blood test, total CPT 82533 Cortisol 60 Min | $110.50 | $221.00 | $16.30–$154.70 | 190% above | 50% |
| Cortisol blood test, total CPT 82533 Cortisol | $110.50 | $221.00 | $16.30–$154.70 | 190% above | 50% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol AM | $110.50 | $221.00 | $16.30–$154.70 | — | 50% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol, A.M. QST | $110.50 | $221.00 | $16.30–$154.70 | — | 50% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol 60 Min | $110.50 | $221.00 | $16.30–$154.70 | — | 50% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol; total OGH | $110.50 | $221.00 | $16.30–$154.70 | — | 50% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol | $110.50 | $221.00 | $16.30–$154.70 | — | 50% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol PM | $110.50 | $221.00 | $16.30–$154.70 | — | 50% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol 30 Min | $110.50 | $221.00 | $16.30–$154.70 | — | 50% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol Baseline | $110.50 | $221.00 | $16.30–$154.70 | — | 50% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol, Total, LC/MS QST | $110.50 | $221.00 | $16.30–$154.70 | — | 50% |
| Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase | $72.50 | $145.00 | $6.51–$101.50 | 225% above | 50% |
| Creatine kinase (CK) blood test, total CPT 82550 Creatine kinase (CK), (CPK); total OGH | $72.50 | $145.00 | $6.51–$101.50 | 225% above | 50% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine kinase (CK), (CPK); total OGH | $72.50 | $145.00 | $6.51–$101.50 | — | 50% |
| Creatinine blood test CPT 82565 Creatinine | $67.00 | $134.00 | $5.12–$93.80 | 282% above | 50% |
| Creatinine blood test inpatient CPT 82565 Creatinine | $67.00 | $134.00 | $5.12–$93.80 | — | 50% |
| Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus Antibody (IgG) QST | $85.50 | $171.00 | $14.39–$119.70 | 117% above | 50% |
| Cytomegalovirus (CMV) antibody test CPT 86644 Antibody; cytomegalovirus (CMV) OGH | $85.50 | $171.00 | $14.39–$119.70 | 117% above | 50% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Antibody; cytomegalovirus (CMV) OGH | $85.50 | $171.00 | $14.39–$119.70 | — | 50% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus Antibody (IgG) QST | $85.50 | $171.00 | $14.39–$119.70 | — | 50% |
| D-dimer blood test (blood clot marker) CPT 85379 Fibrinolysis Comprehensive Panel QST add-on | $107.00 | $214.00 | $10.18–$149.80 | 114% above | 50% |
| D-dimer blood test (blood clot marker) CPT 85379 D-Dimer | $107.00 | $214.00 | $10.18–$149.80 | 114% above | 50% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 Fibrinolysis Comprehensive Panel QST add-on | $107.00 | $214.00 | $10.18–$149.80 | — | 50% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer | $107.00 | $214.00 | $10.18–$149.80 | — | 50% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA Sulfate QST | $179.00 | $358.00 | $22.23–$250.60 | 208% above | 50% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA Sulfate QST | $179.00 | $358.00 | $22.23–$250.60 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Panel 5, Meconium QST | $136.00 | $272.00 | $62.14–$190.40 | 332% above | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug test(s), presumptive, any number of drug classes, any number OGH | $136.00 | $272.00 | $62.14–$190.40 | 332% above | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Urine Drug Screen | $136.00 | $272.00 | $62.14–$190.40 | 332% above | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Acetone Serum | $136.00 | $272.00 | $62.14–$190.40 | 332% above | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Amphetamine Screen Urine | $136.00 | $272.00 | $62.14–$190.40 | 332% above | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Amphetamine Screen Urine | $136.00 | $272.00 | $62.14–$190.40 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Acetone Serum | $136.00 | $272.00 | $62.14–$190.40 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen Panel 5, Meconium QST | $136.00 | $272.00 | $62.14–$190.40 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug test(s), presumptive, any number of drug classes, any number OGH | $136.00 | $272.00 | $62.14–$190.40 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Urine Drug Screen | $136.00 | $272.00 | $62.14–$190.40 | — | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ABG wCOOX and Lytes | $50.50 | $101.00 | $7.01–$70.70 | 32% above | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte Panel | $50.50 | $101.00 | $7.01–$70.70 | 32% above | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolytre Panel OGH | $50.50 | $101.00 | $7.01–$70.70 | 32% above | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ABG wCOOX and Lytes | $50.50 | $101.00 | $7.01–$70.70 | — | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolytre Panel OGH | $50.50 | $101.00 | $7.01–$70.70 | — | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte Panel | $50.50 | $101.00 | $7.01–$70.70 | — | 50% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 Antibody; Epstein-Barr (EB) virus, viral capsid (VCA) OGH | $49.00 | $98.00 | $18.14–$68.60 | 3% below | 50% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein Barr Virus Ab Panel QST | $49.00 | $98.00 | $18.14–$68.60 | 3% below | 50% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Antibody; Epstein-Barr (EB) virus, viral capsid (VCA) OGH | $49.00 | $98.00 | $18.14–$68.60 | — | 50% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein Barr Virus Ab Panel QST | $49.00 | $98.00 | $18.14–$68.60 | — | 50% |
| Estradiol blood test CPT 82670 Estradiol,Ultrasensitive, LC/MS QST | $173.00 | $346.00 | $27.94–$242.20 | 180% above | 50% |
| Estradiol blood test CPT 82670 Estradiol, Free QST | $173.00 | $346.00 | $27.94–$242.20 | 180% above | 50% |
| Estradiol blood test CPT 82670 Estradiol Lvl | $173.00 | $346.00 | $27.94–$242.20 | 180% above | 50% |
| Estradiol blood test inpatient CPT 82670 Estradiol,Ultrasensitive, LC/MS QST | $173.00 | $346.00 | $27.94–$242.20 | — | 50% |
| Estradiol blood test inpatient CPT 82670 Estradiol, Free QST | $173.00 | $346.00 | $27.94–$242.20 | — | 50% |
| Estradiol blood test inpatient CPT 82670 Estradiol Lvl | $173.00 | $346.00 | $27.94–$242.20 | — | 50% |
| FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone Level | $98.00 | $196.00 | $18.58–$137.20 | 71% above | 50% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stimulating Hormone Level | $98.00 | $196.00 | $18.58–$137.20 | — | 50% |
| Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Stool QST | $168.00 | $336.00 | $19.63–$235.20 | 61% above | 50% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Stool QST | $168.00 | $336.00 | $19.63–$235.20 | — | 50% |
| Ferritin blood test (iron stores) CPT 82728 Ferritin | $122.00 | $244.00 | $13.63–$170.80 | 165% above | 50% |
| Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin | $122.00 | $244.00 | $13.63–$170.80 | — | 50% |
| Fibrinogen blood test CPT 85384 Fibrinogen Activity, Clauss QST | $78.50 | $157.00 | $9.72–$109.90 | 152% above | 50% |
| Fibrinogen blood test CPT 85384 Fibrinogen Level | $78.50 | $157.00 | $9.72–$109.90 | 152% above | 50% |
| Fibrinogen blood test inpatient CPT 85384 Fibrinogen Activity, Clauss QST | $78.50 | $157.00 | $9.72–$109.90 | — | 50% |
| Folate (folic acid) blood test CPT 82746 Folate Level | $122.00 | $244.00 | $14.70–$170.80 | 207% above | 50% |
| Folate (folic acid) blood test inpatient CPT 82746 Folate Level | $122.00 | $244.00 | $14.70–$170.80 | — | 50% |
| Free T3 thyroid hormone test CPT 84481 T3, Free QST | $185.00 | $370.00 | $16.94–$259.00 | 309% above | 50% |
| Free T3 thyroid hormone test CPT 84481 T3 Free | $185.00 | $370.00 | $16.94–$259.00 | 309% above | 50% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3 Free | $185.00 | $370.00 | $16.94–$259.00 | — | 50% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3, Free QST | $185.00 | $370.00 | $16.94–$259.00 | — | 50% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4, Free QST | $133.50 | $267.00 | $9.02–$186.90 | 282% above | 50% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 Level | $133.50 | $267.00 | $9.02–$186.90 | 282% above | 50% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4 Level | $133.50 | $267.00 | $9.02–$186.90 | — | 50% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4, Free QST | $133.50 | $267.00 | $9.02–$186.90 | — | 50% |
| Free testosterone test CPT 84402 Testosterone; free OGH | $67.00 | $134.00 | $25.47–$93.80 | 7% above | 50% |
| Free testosterone test CPT 84402 Testosterone, Free QST | $67.00 | $134.00 | $25.47–$93.80 | 7% above | 50% |
| Free testosterone test inpatient CPT 84402 Testosterone, Free QST | $67.00 | $134.00 | $25.47–$93.80 | — | 50% |
| Free testosterone test inpatient CPT 84402 Testosterone; free OGH | $67.00 | $134.00 | $25.47–$93.80 | — | 50% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 Glutamyltransferase, gamma (GGT) OGH | $86.00 | $172.00 | $7.20–$120.40 | 245% above | 50% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase | $86.00 | $172.00 | $7.20–$120.40 | 245% above | 50% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Gamma Glutamyl Transferase | $86.00 | $172.00 | $7.20–$120.40 | — | 50% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Glutamyltransferase, gamma (GGT) OGH | $86.00 | $172.00 | $7.20–$120.40 | — | 50% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 2 Hour | $69.50 | $139.00 | $4.75–$97.30 | 326% above | 50% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 2 Hour Post Prandial | $69.50 | $139.00 | $4.75–$97.30 | 326% above | 50% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 1 Hour | $69.50 | $139.00 | $4.75–$97.30 | 326% above | 50% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose; post glucose dose (includes glucose) OGH | $69.50 | $139.00 | $4.75–$97.30 | 326% above | 50% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose; post glucose dose (includes glucose) OGH | $69.50 | $139.00 | $4.75–$97.30 | — | 50% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 2 Hour Post Prandial | $69.50 | $139.00 | $4.75–$97.30 | — | 50% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 2 Hour | $69.50 | $139.00 | $4.75–$97.30 | — | 50% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 1 Hour | $69.50 | $139.00 | $4.75–$97.30 | — | 50% |
| Glucose tolerance test, 3 samples CPT 82951 Glucose 3 Hour | $166.00 | $332.00 | $12.87–$232.40 | 269% above | 50% |
| Glucose tolerance test, 3 samples CPT 82951 Glucose; tolerance test (GTT), 3 specimens (includes glucose) OGH | $166.00 | $332.00 | $12.87–$232.40 | 269% above | 50% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose; tolerance test (GTT), 3 specimens (includes glucose) OGH | $166.00 | $332.00 | $12.87–$232.40 | — | 50% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose 3 Hour | $166.00 | $332.00 | $12.87–$232.40 | — | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Chlamydia and Gonorrhea (GeneXpert) | $134.50 | $269.00 | $35.09–$188.30 | 121% above | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 SURESWAB(R) ADVANCED VAGINITIS PLUS, TMA | $134.50 | $269.00 | $35.09–$188.30 | 121% above | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 SURESWAB(R) ADVANCED VAGINITIS PLUS, TMA QST | $134.50 | $269.00 | $35.09–$188.30 | 121% above | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC by Amplified Probe add on | $134.50 | $269.00 | $35.09–$188.30 | 121% above | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Infectious agent detection by nucleic acid (DNA or RNA); Neisseri OGH | $134.50 | $269.00 | $35.09–$188.30 | 121% above | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 SURESWAB(R) ADVANCED VAGINITIS PLUS, TMA | $134.50 | $269.00 | $35.09–$188.30 | — | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 SURESWAB(R) ADVANCED VAGINITIS PLUS, TMA QST | $134.50 | $269.00 | $35.09–$188.30 | — | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Infectious agent detection by nucleic acid (DNA or RNA); Neisseri OGH | $134.50 | $269.00 | $35.09–$188.30 | — | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC by Amplified Probe add on | $134.50 | $269.00 | $35.09–$188.30 | — | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Chlamydia and Gonorrhea (GeneXpert) | $134.50 | $269.00 | $35.09–$188.30 | — | 50% |
| H. pylori stool antigen test CPT 87338 Helicobacter pylori Antigen Stool | $140.00 | $280.00 | $14.38–$196.00 | 130% above | 50% |
| H. pylori stool antigen test inpatient CPT 87338 Helicobacter pylori Antigen Stool | $140.00 | $280.00 | $14.38–$196.00 | — | 50% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 Rna, Qn PCR W/Rfx To Genotype QST | $371.00 | $742.00 | $85.10–$519.40 | 110% above | 50% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA, Quant Real Time PCR QST | $371.00 | $742.00 | $85.10–$519.40 | 110% above | 50% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA, Quant Real Time PCR QST | $371.00 | $742.00 | $85.10–$519.40 | — | 50% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 Rna, Qn PCR W/Rfx To Genotype QST | $371.00 | $742.00 | $85.10–$519.40 | — | 50% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV Ag/Ab Combo 1/2 Screen | $56.50 | $113.00 | $13.71–$79.10 | 66% above | 50% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/2 Antibody Screen | $56.50 | $113.00 | $13.71–$79.10 | 66% above | 50% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV Ag/Ab Combo 1/2 Screen | $56.50 | $113.00 | $13.71–$79.10 | — | 50% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1/2 Antibody Screen | $56.50 | $113.00 | $13.71–$79.10 | — | 50% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 Ag/Ab, Fourth Gen w/Rfl QST | $56.00 | $112.00 | $24.08–$78.40 | 13% above | 50% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 Ag/Ab, Fourth Gen w/Rfl QST | $56.00 | $112.00 | $24.08–$78.40 | — | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Total Glycohemoglobin QST | $92.50 | $185.00 | $9.71–$129.50 | 179% above | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c | $92.50 | $185.00 | $9.71–$129.50 | 179% above | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C QST | $92.50 | $185.00 | $9.71–$129.50 | 179% above | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c | $92.50 | $185.00 | $9.71–$129.50 | — | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C QST | $92.50 | $185.00 | $9.71–$129.50 | — | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Total Glycohemoglobin QST | $92.50 | $185.00 | $9.71–$129.50 | — | 50% |
| Hemoglobin blood test CPT 85018 Blood count; hemoglobin (Hgb) OGH | $13.00 | $26.00 | $2.37–$18.20 | 19% above | 50% |
| Hemoglobin blood test CPT 85018 Hemoglobin | $13.00 | $26.00 | $2.37–$18.20 | 19% above | 50% |
| Hemoglobin blood test inpatient CPT 85018 Blood count; hemoglobin (Hgb) OGH | $13.00 | $26.00 | $2.37–$18.20 | — | 50% |
| Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Ab Total w/Rfx IgM QST | $33.00 | $66.00 | $12.05–$46.20 | 14% above | 50% |
| Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Antibody Total IgG and IgM | $33.00 | $66.00 | $12.05–$46.20 | 14% above | 50% |
| Hepatitis B core antibody test (total) CPT 86704 Hep B Core Ab Total QST | $33.00 | $66.00 | $12.05–$46.20 | 14% above | 50% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Ab Total w/Rfx IgM QST | $33.00 | $66.00 | $12.05–$46.20 | — | 50% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Antibody Total IgG and IgM | $33.00 | $66.00 | $12.05–$46.20 | — | 50% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 Hep B Core Ab Total QST | $33.00 | $66.00 | $12.05–$46.20 | — | 50% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B S Ab | $29.50 | $59.00 | $10.74–$41.30 | 1% above | 50% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Surface Ab Ql QST | $29.50 | $59.00 | $10.74–$41.30 | 1% above | 50% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B S Ab | $29.50 | $59.00 | $10.74–$41.30 | — | 50% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hep B Surface Ab Ql QST | $29.50 | $59.00 | $10.74–$41.30 | — | 50% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Hep B Surface Ag w/Refl Confrm QST | $28.50 | $57.00 | $10.33–$39.90 | 22% below | 50% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen | $28.50 | $57.00 | $10.33–$39.90 | 22% below | 50% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hep B Surface Ag w/Refl Confrm QST | $28.50 | $57.00 | $10.33–$39.90 | — | 50% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab | $38.50 | $77.00 | $14.27–$53.90 | 14% below | 50% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hep C Ab w/Refl HCV RNA Qn PCR Rfx QST | $38.50 | $77.00 | $14.27–$53.90 | 14% below | 50% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hep C Ab w/Refl To HCV RNA, Qn, PCR QST | $38.50 | $77.00 | $14.27–$53.90 | 14% below | 50% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hep C Ab w/Refl To HCV RNA, Qn, PCR QST | $38.50 | $77.00 | $14.27–$53.90 | — | 50% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hep C Ab w/Refl HCV RNA Qn PCR Rfx QST | $38.50 | $77.00 | $14.27–$53.90 | — | 50% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Ab | $38.50 | $77.00 | $14.27–$53.90 | — | 50% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Hep C Viral RNA Qn Real Time PCR rfx QST | $491.00 | $982.00 | $42.84–$687.40 | 299% above | 50% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA Qn PCR Rfx Genotype LiPA(R) QST | $491.00 | $982.00 | $42.84–$687.40 | 299% above | 50% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA, Quant Real Time PCR QST | $491.00 | $982.00 | $42.84–$687.40 | 299% above | 50% |
| Hepatitis C viral load (HCV RNA) test one side CPT 87522 .HCV RNA, Quant RT-PCR Rfx QST | $491.00 | $982.00 | $42.84–$687.40 | 299% above | 50% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hep C Viral RNA Qn Real Time PCR rfx QST | $491.00 | $982.00 | $42.84–$687.40 | — | 50% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA Qn PCR Rfx Genotype LiPA(R) QST | $491.00 | $982.00 | $42.84–$687.40 | — | 50% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA, Quant Real Time PCR QST | $491.00 | $982.00 | $42.84–$687.40 | — | 50% |
| Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 .HCV RNA, Quant RT-PCR Rfx QST | $491.00 | $982.00 | $42.84–$687.40 | — | 50% |
| Herpes blood test, HSV-1 antibody CPT 86695 Antibody; herpes simplex, type 1 OGH | $37.00 | $74.00 | $13.19–$51.80 | 26% above | 50% |
| Herpes blood test, HSV-1 antibody CPT 86695 HSV 1/2 Ab (IgM), IFA Rfx Titer CSF QST | $37.00 | $74.00 | $13.19–$51.80 | 26% above | 50% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1/2 Ab (IgM), IFA Rfx Titer CSF QST | $37.00 | $74.00 | $13.19–$51.80 | — | 50% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 Antibody; herpes simplex, type 1 OGH | $37.00 | $74.00 | $13.19–$51.80 | — | 50% |
| Herpes blood test, HSV-2 antibody CPT 86696 .HSV 2 IgG Inhibition, IA QST | $83.00 | $166.00 | $19.35–$116.20 | 87% above | 50% |
| Herpes blood test, HSV-2 antibody CPT 86696 Antibody; herpes simplex, type 2 OGH | $83.00 | $166.00 | $19.35–$116.20 | 87% above | 50% |
| Herpes blood test, HSV-2 antibody CPT 86696 HSV 1/2 IgG,Type Specific Ab QST | $83.00 | $166.00 | $19.35–$116.20 | 87% above | 50% |
| Herpes blood test, HSV-2 antibody CPT 86696 HSV 1/2 IgG, W/Refl HSV2 Inhibition QST | $83.00 | $166.00 | $19.35–$116.20 | 87% above | 50% |
| Herpes blood test, HSV-2 antibody CPT 86696 HSV 1/2 Ab (IgM), IFA w/Rfl To Titer QST | $83.00 | $166.00 | $19.35–$116.20 | 87% above | 50% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 Antibody; herpes simplex, type 2 OGH | $83.00 | $166.00 | $19.35–$116.20 | — | 50% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 1/2 Ab (IgM), IFA w/Rfl To Titer QST | $83.00 | $166.00 | $19.35–$116.20 | — | 50% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 1/2 IgG, W/Refl HSV2 Inhibition QST | $83.00 | $166.00 | $19.35–$116.20 | — | 50% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 1/2 IgG,Type Specific Ab QST | $83.00 | $166.00 | $19.35–$116.20 | — | 50% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 .HSV 2 IgG Inhibition, IA QST | $83.00 | $166.00 | $19.35–$116.20 | — | 50% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein High Sensitivity | $82.00 | $164.00 | $12.95–$114.80 | 88% above | 50% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein High Sensitivity | $82.00 | $164.00 | $12.95–$114.80 | — | 50% |
| Homocysteine blood test CPT 83090 Homocysteine Total | $150.00 | $300.00 | $17.92–$210.00 | 162% above | 50% |
| Homocysteine blood test inpatient CPT 83090 Homocysteine Total | $150.00 | $300.00 | $17.92–$210.00 | — | 50% |
| Insulin blood test CPT 83525 Insulin; total OGH | $251.50 | $503.00 | $11.43–$352.10 | 619% above | 50% |
| Insulin blood test CPT 83525 Insulin QST | $251.50 | $503.00 | $11.43–$352.10 | 619% above | 50% |
| Insulin blood test inpatient CPT 83525 Insulin QST | $251.50 | $503.00 | $11.43–$352.10 | — | 50% |
| Insulin blood test inpatient CPT 83525 Insulin; total OGH | $251.50 | $503.00 | $11.43–$352.10 | — | 50% |
| Iron blood test (serum iron) CPT 83540 Iron Level | $56.00 | $112.00 | $6.47–$78.40 | 158% above | 50% |
| Iron blood test (serum iron) CPT 83540 Iron OGH | $56.00 | $112.00 | $6.47–$78.40 | 158% above | 50% |
| Iron blood test (serum iron) CPT 83540 Iron, 24-Hour Urine QST | $56.00 | $112.00 | $6.47–$78.40 | 158% above | 50% |
| Iron blood test (serum iron) inpatient CPT 83540 Iron Level | $56.00 | $112.00 | $6.47–$78.40 | — | 50% |
| Iron blood test (serum iron) inpatient CPT 83540 Iron, 24-Hour Urine QST | $56.00 | $112.00 | $6.47–$78.40 | — | 50% |
| Iron blood test (serum iron) inpatient CPT 83540 Iron OGH | $56.00 | $112.00 | $6.47–$78.40 | — | 50% |
| Iron-binding capacity (TIBC) test CPT 83550 Iron Panel | $56.00 | $112.00 | $8.74–$78.40 | 71% above | 50% |
| Iron-binding capacity (TIBC) test CPT 83550 Iron binding capacity OGH | $56.00 | $112.00 | $8.74–$78.40 | 71% above | 50% |
| Iron-binding capacity (TIBC) test CPT 83550 Total Iron Binding Capacity | $56.00 | $112.00 | $8.74–$78.40 | 71% above | 50% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Panel | $56.00 | $112.00 | $8.74–$78.40 | — | 50% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 Total Iron Binding Capacity | $56.00 | $112.00 | $8.74–$78.40 | — | 50% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron binding capacity OGH | $56.00 | $112.00 | $8.74–$78.40 | — | 50% |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $104.00 | $208.00 | $8.68–$145.60 | 77% above | 50% |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $104.00 | $208.00 | $8.68–$145.60 | — | 50% |
| LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone | $68.00 | $136.00 | $18.52–$95.20 | 26% above | 50% |
| LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone | $68.00 | $136.00 | $18.52–$95.20 | — | 50% |
| Lactate (lactic acid) blood test CPT 83605 Lactic Acid (Arterial) | $67.00 | $134.00 | $11.57–$93.80 | 137% above | 50% |
| Lactate (lactic acid) blood test CPT 83605 Lactic Acid (Venous) | $67.00 | $134.00 | $11.57–$93.80 | 137% above | 50% |
| Lactate (lactic acid) blood test CPT 83605 Lactic Acid Arterial (RT) | $67.00 | $134.00 | $11.57–$93.80 | 137% above | 50% |
| Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid (Arterial) | $67.00 | $134.00 | $11.57–$93.80 | — | 50% |
| Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid Arterial (RT) | $67.00 | $134.00 | $11.57–$93.80 | — | 50% |
| Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid (Venous) | $67.00 | $134.00 | $11.57–$93.80 | — | 50% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase | $72.50 | $145.00 | $6.04–$101.50 | 247% above | 50% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase Isoenzyme Panel QST | $72.50 | $145.00 | $6.04–$101.50 | 247% above | 50% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase Body Fluid | $72.50 | $145.00 | $6.04–$101.50 | 247% above | 50% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase | $72.50 | $145.00 | $6.04–$101.50 | — | 50% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase Body Fluid | $72.50 | $145.00 | $6.04–$101.50 | — | 50% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase Isoenzyme Panel QST | $72.50 | $145.00 | $6.04–$101.50 | — | 50% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level | $101.00 | $202.00 | $6.89–$141.40 | 272% above | 50% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level | $101.00 | $202.00 | $6.89–$141.40 | — | 50% |
| Liver function blood test panel CPT 80076 Hepatic Function Panel | $122.00 | $244.00 | $8.17–$170.80 | 138% above | 50% |
| Lyme disease antibody test CPT 86618 Lyme Disease Ab w/Rfl Blot (IgG,IgM) QST | $47.50 | $95.00 | $17.03–$66.50 | 6% below | 50% |
| Lyme disease antibody test inpatient CPT 86618 Lyme Disease Ab w/Rfl Blot (IgG,IgM) QST | $47.50 | $95.00 | $17.03–$66.50 | — | 50% |
| Magnesium blood test CPT 83735 Magnesium Level | $70.50 | $141.00 | $6.70–$98.70 | 215% above | 50% |
| Magnesium blood test CPT 83735 Magnesium Level Urine | $70.50 | $141.00 | $6.70–$98.70 | 215% above | 50% |
| Magnesium blood test CPT 83735 Magnesium Level 24 Hour Urine | $70.50 | $141.00 | $6.70–$98.70 | 215% above | 50% |
| Magnesium blood test inpatient CPT 83735 Magnesium Level 24 Hour Urine | $70.50 | $141.00 | $6.70–$98.70 | — | 50% |
| Magnesium blood test inpatient CPT 83735 Magnesium Level Urine | $70.50 | $141.00 | $6.70–$98.70 | — | 50% |
| Magnesium blood test inpatient CPT 83735 Magnesium Level | $70.50 | $141.00 | $6.70–$98.70 | — | 50% |
| Measles (rubeola) antibody test CPT 86765 Measles Ab (IgG) QST | $69.00 | $138.00 | $12.88–$96.60 | 113% above | 50% |
| Measles (rubeola) antibody test CPT 86765 MMR (IgG) Pnl QST | $69.00 | $138.00 | $12.88–$96.60 | 113% above | 50% |
| Measles (rubeola) antibody test inpatient CPT 86765 MMR (IgG) Pnl QST | $69.00 | $138.00 | $12.88–$96.60 | — | 50% |
| Measles (rubeola) antibody test inpatient CPT 86765 Measles Ab (IgG) QST | $69.00 | $138.00 | $12.88–$96.60 | — | 50% |
| Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen | $49.00 | $98.00 | $5.18–$68.60 | 113% above | 50% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen | $49.00 | $98.00 | $5.18–$68.60 | — | 50% |
| Mumps immunity blood test CPT 86735 Antibody; mumps OGH | $51.50 | $103.00 | $13.05–$72.10 | 67% above | 50% |
| Mumps immunity blood test CPT 86735 MMR (IgG) Pnl QST | $51.50 | $103.00 | $13.05–$72.10 | 67% above | 50% |
| Mumps immunity blood test CPT 86735 Mumps Virus Ab (IgG) QST | $51.50 | $103.00 | $13.05–$72.10 | 67% above | 50% |
| Mumps immunity blood test CPT 86735 Mumps Virus Ab (IgM) QST | $51.50 | $103.00 | $13.05–$72.10 | 67% above | 50% |
| Mumps immunity blood test inpatient CPT 86735 Mumps Virus Ab (IgM) QST | $51.50 | $103.00 | $13.05–$72.10 | — | 50% |
| Mumps immunity blood test inpatient CPT 86735 Antibody; mumps OGH | $51.50 | $103.00 | $13.05–$72.10 | — | 50% |
| Mumps immunity blood test inpatient CPT 86735 MMR (IgG) Pnl QST | $51.50 | $103.00 | $13.05–$72.10 | — | 50% |
| Mumps immunity blood test inpatient CPT 86735 Mumps Virus Ab (IgG) QST | $51.50 | $103.00 | $13.05–$72.10 | — | 50% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate specific antigen (PSA); free OGH | $83.00 | $166.00 | $18.39–$116.20 | 70% above | 50% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (Free and Total) QST | $83.00 | $166.00 | $18.39–$116.20 | 70% above | 50% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA (Free and Total) QST | $83.00 | $166.00 | $18.39–$116.20 | — | 50% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Prostate specific antigen (PSA); free OGH | $83.00 | $166.00 | $18.39–$116.20 | — | 50% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Total With Reflex To PSA, Free QST | $41.14 | $82.28 | $18.39–$57.59 | 7% below | 50% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Post-Prostatectomy QST | $41.14 | $82.28 | $18.39–$57.59 | 7% below | 50% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate specific antigen (PSA); total OGH | $101.00 | $202.00 | $18.39–$141.40 | 129% above | 50% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic | $101.00 | $202.00 | $18.39–$141.40 | 129% above | 50% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Total With Reflex To PSA, Free QST | $41.14 | $82.28 | $18.39–$57.59 | — | 50% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Post-Prostatectomy QST | $41.14 | $82.28 | $18.39–$57.59 | — | 50% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate specific antigen (PSA); total OGH | $101.00 | $202.00 | $18.39–$141.40 | — | 50% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic | $101.00 | $202.00 | $18.39–$141.40 | — | 50% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathormone (parathyroid hormone) OGH | $144.00 | $288.00 | $41.28–$201.60 | 57% above | 50% |
| Parathyroid hormone (PTH) blood test CPT 83970 PTH, Intact and Calcium QST | $144.00 | $288.00 | $41.28–$201.60 | 57% above | 50% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Intact | $144.00 | $288.00 | $41.28–$201.60 | 57% above | 50% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathormone (parathyroid hormone) OGH | $144.00 | $288.00 | $41.28–$201.60 | — | 50% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, Intact and Calcium QST | $144.00 | $288.00 | $41.28–$201.60 | — | 50% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone Intact | $144.00 | $288.00 | $41.28–$201.60 | — | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT, Activated QST | $64.00 | $128.00 | $6.01–$89.60 | 208% above | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Lupus Anticoagulant Evaluation w Rfx QST | $64.00 | $128.00 | $6.01–$89.60 | 208% above | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Mixing Study QST add-on | $64.00 | $128.00 | $6.01–$89.60 | 208% above | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Von Willebrand Screen QST add-on | $64.00 | $128.00 | $6.01–$89.60 | 208% above | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplastin time, partial (PTT); plasma or whole blood OGH | $64.00 | $128.00 | $6.01–$89.60 | 208% above | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $64.00 | $128.00 | $6.01–$89.60 | 208% above | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Antiphospholipid Syndrome Diag Panel QST add-on | $256.59 | $513.18 | $6.01–$359.22 | 1134% above | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Mixing Study QST add-on | $64.00 | $128.00 | $6.01–$89.60 | — | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $64.00 | $128.00 | $6.01–$89.60 | — | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Lupus Anticoagulant Evaluation w Rfx QST | $64.00 | $128.00 | $6.01–$89.60 | — | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT, Activated QST | $64.00 | $128.00 | $6.01–$89.60 | — | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thromboplastin time, partial (PTT); plasma or whole blood OGH | $64.00 | $128.00 | $6.01–$89.60 | — | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Von Willebrand Screen QST add-on | $64.00 | $128.00 | $6.01–$89.60 | — | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Antiphospholipid Syndrome Diag Panel QST add-on | $256.59 | $513.18 | $6.01–$359.22 | — | 50% |
| Phosphorus (phosphate) blood test CPT 84100 Phosphorus Level | $59.00 | $118.00 | $4.74–$82.60 | 250% above | 50% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Level | $59.00 | $118.00 | $4.74–$82.60 | — | 50% |
| Potassium blood test CPT 84132 Potassium, Plasma QST | $49.00 | $98.00 | $4.76–$68.60 | 177% above | 50% |
| Potassium blood test CPT 84132 Potassium Level | $49.00 | $98.00 | $4.76–$68.60 | 177% above | 50% |
| Potassium blood test inpatient CPT 84132 Potassium Level | $49.00 | $98.00 | $4.76–$68.60 | — | 50% |
| Potassium blood test inpatient CPT 84132 Potassium, Plasma QST | $49.00 | $98.00 | $4.76–$68.60 | — | 50% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 QNATAL(R) Advanced QST | $1,322.50 | $2,645.00 | $759.05–$1,851.50 | 193% above | 50% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 QNATAL(R) Advanced QST | $1,322.50 | $2,645.00 | $759.05–$1,851.50 | — | 50% |
| Progesterone blood test CPT 84144 Progesterone Level | $110.50 | $221.00 | $20.86–$154.70 | 99% above | 50% |
| Progesterone blood test inpatient CPT 84144 Progesterone Level | $110.50 | $221.00 | $20.86–$154.70 | — | 50% |
| Prolactin blood test CPT 84146 Prolactin Level | $104.00 | $208.00 | $19.38–$145.60 | 59% above | 50% |
| Prolactin blood test inpatient CPT 84146 Prolactin Level | $104.00 | $208.00 | $19.38–$145.60 | — | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time and INR | $56.00 | $112.00 | $4.29–$78.40 | 287% above | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Mixing Study QST | $56.00 | $112.00 | $4.29–$78.40 | 287% above | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT/PTT | $56.00 | $112.00 | $4.29–$78.40 | 287% above | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Mixing Study QST | $56.00 | $112.00 | $4.29–$78.40 | — | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/PTT | $56.00 | $112.00 | $4.29–$78.40 | — | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time and INR | $56.00 | $112.00 | $4.29–$78.40 | — | 50% |
| Rapid flu test (influenza antigen) CPT 87804 Infectious agent antigen detection by immunoassay with direc OGH | $41.00 | $82.00 | $16.55–$57.40 | 77% above | 50% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 Infectious agent antigen detection by immunoassay with direc OGH | $41.00 | $82.00 | $16.55–$57.40 | — | 50% |
| Renin blood test CPT 84244 PLASMA RENIN ACTIVITY, LC/MS/MS | $110.50 | $221.00 | $21.99–$154.70 | 83% above | 50% |
| Renin blood test CPT 84244 Renin OGH | $110.50 | $221.00 | $21.99–$154.70 | 83% above | 50% |
| Renin blood test CPT 84244 PLASMA RENIN ACTIVITY, LC/MS/MS OGH | $110.50 | $221.00 | $21.99–$154.70 | 83% above | 50% |
| Renin blood test CPT 84244 Plasma Renin Activity, LC/MS/MS QST | $110.50 | $221.00 | $21.99–$154.70 | 83% above | 50% |
| Renin blood test inpatient CPT 84244 PLASMA RENIN ACTIVITY, LC/MS/MS | $110.50 | $221.00 | $21.99–$154.70 | — | 50% |
| Renin blood test inpatient CPT 84244 PLASMA RENIN ACTIVITY, LC/MS/MS OGH | $110.50 | $221.00 | $21.99–$154.70 | — | 50% |
| Renin blood test inpatient CPT 84244 Plasma Renin Activity, LC/MS/MS QST | $110.50 | $221.00 | $21.99–$154.70 | — | 50% |
| Renin blood test inpatient CPT 84244 Renin OGH | $110.50 | $221.00 | $21.99–$154.70 | — | 50% |
| Rh blood typing CPT 86901 Blood typing, serologic; Rh (D) OGH | $53.50 | $107.00 | $5.20–$74.90 | 150% above | 50% |
| Rh blood typing inpatient CPT 86901 Blood typing, serologic; Rh (D) OGH | $53.50 | $107.00 | $5.20–$74.90 | — | 50% |
| Rheumatoid factor (RF) test CPT 86431 Cryoglobulin Scrn w/Reflex Cryo PNL QST add-on | $44.00 | $88.00 | $5.67–$61.60 | 87% above | 50% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor QST | $44.00 | $88.00 | $5.67–$61.60 | 87% above | 50% |
| Rheumatoid factor (RF) test CPT 86431 ANA Scr IFA w Titer/Ptrn/Lupus Pnl 5 QST | $44.00 | $88.00 | $5.67–$61.60 | 87% above | 50% |
| Rheumatoid factor (RF) test CPT 86431 ANA Scr IFA Titer/Ptrn/Lupus Pnl 4 QST | $44.00 | $88.00 | $5.67–$61.60 | 87% above | 50% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Quantitative | $44.00 | $88.00 | $5.67–$61.60 | 87% above | 50% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid factor; quantitative OGH | $44.00 | $88.00 | $5.67–$61.60 | 87% above | 50% |
| Rheumatoid factor (RF) test inpatient CPT 86431 Cryoglobulin Scrn w/Reflex Cryo PNL QST add-on | $44.00 | $88.00 | $5.67–$61.60 | — | 50% |
| Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor QST | $44.00 | $88.00 | $5.67–$61.60 | — | 50% |
| Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor Quantitative | $44.00 | $88.00 | $5.67–$61.60 | — | 50% |
| Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid factor; quantitative OGH | $44.00 | $88.00 | $5.67–$61.60 | — | 50% |
| Rheumatoid factor (RF) test inpatient CPT 86431 ANA Scr IFA w Titer/Ptrn/Lupus Pnl 5 QST | $44.00 | $88.00 | $5.67–$61.60 | — | 50% |
| Rheumatoid factor (RF) test inpatient CPT 86431 ANA Scr IFA Titer/Ptrn/Lupus Pnl 4 QST | $44.00 | $88.00 | $5.67–$61.60 | — | 50% |
| Rubella antibody test (immunity check) CPT 86762 MMR (IgG) Pnl QST | $58.00 | $116.00 | $14.39–$81.20 | 73% above | 50% |
| Rubella antibody test (immunity check) CPT 86762 Rubella Immune Status QST | $58.00 | $116.00 | $14.39–$81.20 | 73% above | 50% |
| Rubella antibody test (immunity check) CPT 86762 Rubella IgG Antibody | $58.00 | $116.00 | $14.39–$81.20 | 73% above | 50% |
| Rubella antibody test (immunity check) CPT 86762 Antibody; rubella OGH | $58.00 | $116.00 | $14.39–$81.20 | 73% above | 50% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Rubella IgG Antibody | $58.00 | $116.00 | $14.39–$81.20 | — | 50% |
| Rubella antibody test (immunity check) inpatient CPT 86762 MMR (IgG) Pnl QST | $58.00 | $116.00 | $14.39–$81.20 | — | 50% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Antibody; rubella OGH | $58.00 | $116.00 | $14.39–$81.20 | — | 50% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Immune Status QST | $58.00 | $116.00 | $14.39–$81.20 | — | 50% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Sample Analysis | $35.50 | $71.00 | $12.31–$49.70 | 31% above | 50% |
| Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen Sample Analysis | $35.50 | $71.00 | $12.31–$49.70 | — | 50% |
| Sodium blood test CPT 84295 Sodium Level | $39.00 | $78.00 | $4.81–$54.60 | 118% above | 50% |
| Sodium blood test inpatient CPT 84295 Sodium Level | $39.00 | $78.00 | $4.81–$54.60 | — | 50% |
| Stool ova and parasites exam CPT 87177 Ova And Parasites, Conc And Perm Smr QST | $52.00 | $104.00 | $8.90–$72.80 | 72% above | 50% |
| Stool ova and parasites exam CPT 87177 Ova and parasites, direct smears, concentration and identificatio OGH | $52.00 | $104.00 | $8.90–$72.80 | 72% above | 50% |
| Stool ova and parasites exam inpatient CPT 87177 Ova And Parasites, Conc And Perm Smr QST | $52.00 | $104.00 | $8.90–$72.80 | — | 50% |
| Stool ova and parasites exam inpatient CPT 87177 Ova and parasites, direct smears, concentration and identificatio OGH | $52.00 | $104.00 | $8.90–$72.80 | — | 50% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Stool I | $23.00 | $46.00 | $4.38–$32.20 | 60% above | 50% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Stool I | $23.00 | $46.00 | $4.38–$32.20 | — | 50% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 Immunological Fecal Occult Blood | $42.50 | $85.00 | $15.92–$59.50 | 67% above | 50% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Immunological Fecal Occult Blood | $42.50 | $85.00 | $15.92–$59.50 | — | 50% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema Pallidum Ab Prticle Agglut QST | $52.00 | $104.00 | $13.24–$72.80 | 83% above | 50% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema Pallidum Ab | $52.00 | $104.00 | $13.24–$72.80 | 83% above | 50% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 FTA-Abs QST | $52.00 | $104.00 | $13.24–$72.80 | 83% above | 50% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema Pallidum Ab | $52.00 | $104.00 | $13.24–$72.80 | — | 50% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema Pallidum Ab Prticle Agglut QST | $52.00 | $104.00 | $13.24–$72.80 | — | 50% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 FTA-Abs QST | $52.00 | $104.00 | $13.24–$72.80 | — | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR (Monitor) w/Refl Titer QST | $44.00 | $88.00 | $4.27–$61.60 | 223% above | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR (Dx) w/Refl Titer/Confrm Testing QST | $44.00 | $88.00 | $4.27–$61.60 | 223% above | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, CSF QST | $44.00 | $88.00 | $4.27–$61.60 | 223% above | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, Serum QST | $44.00 | $88.00 | $4.27–$61.60 | 223% above | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin | $44.00 | $88.00 | $4.27–$61.60 | 223% above | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR (Monitor) w/Refl Titer QST | $44.00 | $88.00 | $4.27–$61.60 | — | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL, Serum QST | $44.00 | $88.00 | $4.27–$61.60 | — | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagin | $44.00 | $88.00 | $4.27–$61.60 | — | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL, CSF QST | $44.00 | $88.00 | $4.27–$61.60 | — | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR (Dx) w/Refl Titer/Confrm Testing QST | $44.00 | $88.00 | $4.27–$61.60 | — | 50% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon(R)-TB Gold Plus, 1 Tube QST | $130.50 | $261.00 | $61.98–$182.70 | 4% above | 50% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon(R)-TB Gold Plus, 1 Tube QST | $130.50 | $261.00 | $61.98–$182.70 | — | 50% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Free Dialysis & Totl MS QST | $97.00 | $194.00 | $25.81–$135.80 | 62% above | 50% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone; total OGH | $97.00 | $194.00 | $25.81–$135.80 | 62% above | 50% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Level Total | $97.00 | $194.00 | $25.81–$135.80 | 62% above | 50% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total Males (Adult), QST | $97.00 | $194.00 | $25.81–$135.80 | 62% above | 50% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total Males (Adult), QST | $97.00 | $194.00 | $25.81–$135.80 | — | 50% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Level Total | $97.00 | $194.00 | $25.81–$135.80 | — | 50% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Free Dialysis & Totl MS QST | $97.00 | $194.00 | $25.81–$135.80 | — | 50% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone; total OGH | $97.00 | $194.00 | $25.81–$135.80 | — | 50% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 ANALYZER ANA,IFA W/REFLEX TITER /PATTERN,SYSTEMIC AUTOIMMUNE | $62.00 | $124.00 | $14.55–$86.80 | 60% above | 50% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Liver Kidney Microsome LKM-1 Ab IgG QST | $62.00 | $124.00 | $14.55–$86.80 | 60% above | 50% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibodies QST | $62.00 | $124.00 | $14.55–$86.80 | 60% above | 50% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 ANA Scr IFA Titer/Ptrn/Lupus Pnl 4 QST | $62.00 | $124.00 | $14.55–$86.80 | 60% above | 50% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibodies (eg, thyroid or liver-kidney), each OGH | $62.00 | $124.00 | $14.55–$86.80 | 60% above | 50% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Liver Kidney Microsome LKM-1 Ab IgG QST | $62.00 | $124.00 | $14.55–$86.80 | — | 50% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Antibodies QST | $62.00 | $124.00 | $14.55–$86.80 | — | 50% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANA Scr IFA Titer/Ptrn/Lupus Pnl 4 QST | $62.00 | $124.00 | $14.55–$86.80 | — | 50% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Microsomal antibodies (eg, thyroid or liver-kidney), each OGH | $62.00 | $124.00 | $14.55–$86.80 | — | 50% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANALYZER ANA,IFA W/REFLEX TITER /PATTERN,SYSTEMIC AUTOIMMUNE | $62.00 | $124.00 | $14.55–$86.80 | — | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $58.00 | $116.00 | $16.80–$81.20 | 41% above | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Cascading Reflex QST | $58.00 | $116.00 | $16.80–$81.20 | 41% above | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH QST | $58.00 | $116.00 | $16.80–$81.20 | 41% above | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH QST | $58.00 | $116.00 | $16.80–$81.20 | — | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Cascading Reflex QST | $58.00 | $116.00 | $16.80–$81.20 | — | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $58.00 | $116.00 | $16.80–$81.20 | — | 50% |
| Total IgE blood test CPT 82785 RESPIRATORY ALLERGY PANEL REGION VI WITH REFLEXES, QST | $25.00 | $50.00 | $16.46–$35.00 | 35% below | 50% |
| Total IgE blood test CPT 82785 Gammaglobulin (immunoglobulin); IgE OGH | $45.00 | $90.00 | $16.46–$63.00 | 17% above | 50% |
| Total IgE blood test CPT 82785 Immunoglobulin E | $45.00 | $90.00 | $16.46–$63.00 | 17% above | 50% |
| Total IgE blood test CPT 82785 Immunoglobulin E QST | $45.00 | $90.00 | $16.46–$63.00 | 17% above | 50% |
| Total IgE blood test inpatient CPT 82785 RESPIRATORY ALLERGY PANEL REGION VI WITH REFLEXES, QST | $25.00 | $50.00 | $16.46–$35.00 | — | 50% |
| Total IgE blood test inpatient CPT 82785 Immunoglobulin E QST | $45.00 | $90.00 | $16.46–$63.00 | — | 50% |
| Total IgE blood test inpatient CPT 82785 Immunoglobulin E | $45.00 | $90.00 | $16.46–$63.00 | — | 50% |
| Total IgE blood test inpatient CPT 82785 Gammaglobulin (immunoglobulin); IgE OGH | $45.00 | $90.00 | $16.46–$63.00 | — | 50% |
| Total cholesterol blood test CPT 82465 Cholesterol Total | $59.00 | $118.00 | $4.35–$82.60 | 283% above | 50% |
| Total thyroxine (T4) blood test CPT 84436 T4 Total | $55.00 | $110.00 | $6.87–$77.00 | 113% above | 50% |
| Total thyroxine (T4) blood test CPT 84436 Thyroxine; total OGH | $55.00 | $110.00 | $6.87–$77.00 | 113% above | 50% |
| Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine; total OGH | $55.00 | $110.00 | $6.87–$77.00 | — | 50% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4 Total | $55.00 | $110.00 | $6.87–$77.00 | — | 50% |
| Total triiodothyronine (T3) blood test CPT 84480 T3, Total QST | $84.00 | $168.00 | $14.18–$117.60 | 91% above | 50% |
| Total triiodothyronine (T3) blood test CPT 84480 T3 Total | $84.00 | $168.00 | $14.18–$117.60 | 91% above | 50% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 Total | $84.00 | $168.00 | $14.18–$117.60 | — | 50% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3, Total QST | $84.00 | $168.00 | $14.18–$117.60 | — | 50% |
| Transferrin blood test CPT 84466 Transferrin | $88.50 | $177.00 | $12.76–$123.90 | 118% above | 50% |
| Transferrin blood test inpatient CPT 84466 Transferrin | $88.50 | $177.00 | $12.76–$123.90 | — | 50% |
| Trichomonas test (NAAT) CPT 87661 SURESWAB(R) ADVANCED VAGINITIS PLUS, TMA | $78.49 | $156.98 | $35.09–$109.88 | 42% above | 50% |
| Trichomonas test (NAAT) CPT 87661 SURESWAB(R) ADVANCED CV/TV, TMA QST | $78.49 | $156.98 | $35.09–$109.88 | 42% above | 50% |
| Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis RNA Qual, Male QST | $78.49 | $156.98 | $35.09–$109.88 | 42% above | 50% |
| Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis RNA, Ql, TMA QST | $78.49 | $156.98 | $35.09–$109.88 | 42% above | 50% |
| Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginalis RNA Qual, Male QST | $78.49 | $156.98 | $35.09–$109.88 | — | 50% |
| Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginalis RNA, Ql, TMA QST | $78.49 | $156.98 | $35.09–$109.88 | — | 50% |
| Trichomonas test (NAAT) inpatient CPT 87661 SURESWAB(R) ADVANCED CV/TV, TMA QST | $78.49 | $156.98 | $35.09–$109.88 | — | 50% |
| Trichomonas test (NAAT) inpatient CPT 87661 SURESWAB(R) ADVANCED VAGINITIS PLUS, TMA | $78.49 | $156.98 | $35.09–$109.88 | — | 50% |
| Triglycerides blood test CPT 84478 Triglyceride | $64.00 | $128.00 | $5.74–$89.60 | 167% above | 50% |
| Triglycerides blood test CPT 84478 Cardio IQ(R) Triglycerides QST | $64.00 | $128.00 | $5.74–$89.60 | 167% above | 50% |
| Triglycerides blood test CPT 84478 Triglycerides, Pleural Fluid QST | $64.00 | $128.00 | $5.74–$89.60 | 167% above | 50% |
| Triglycerides blood test inpatient CPT 84478 Triglycerides, Pleural Fluid QST | $64.00 | $128.00 | $5.74–$89.60 | — | 50% |
| Triglycerides blood test inpatient CPT 84478 Cardio IQ(R) Triglycerides QST | $64.00 | $128.00 | $5.74–$89.60 | — | 50% |
| Triglycerides blood test inpatient CPT 84478 Triglyceride | $64.00 | $128.00 | $5.74–$89.60 | — | 50% |
| Troponin test, quantitative CPT 84484 Troponin T QST | $45.50 | $91.00 | $12.47–$63.70 | 8% above | 50% |
| Troponin test, quantitative CPT 84484 Troponin-I | $45.50 | $91.00 | $12.47–$63.70 | 8% above | 50% |
| Troponin test, quantitative CPT 84484 High Sensitivity Troponin I | $45.50 | $91.00 | $12.47–$63.70 | 8% above | 50% |
| Troponin test, quantitative inpatient CPT 84484 Troponin-I | $45.50 | $91.00 | $12.47–$63.70 | — | 50% |
| Troponin test, quantitative inpatient CPT 84484 Troponin T QST | $45.50 | $91.00 | $12.47–$63.70 | — | 50% |
| Troponin test, quantitative inpatient CPT 84484 High Sensitivity Troponin I | $45.50 | $91.00 | $12.47–$63.70 | — | 50% |
| Uric acid blood test CPT 84550 Uric Acid | $52.00 | $104.00 | $4.52–$72.80 | 197% above | 50% |
| Uric acid blood test inpatient CPT 84550 Uric Acid | $52.00 | $104.00 | $4.52–$72.80 | — | 50% |
| Urinalysis with microscope exam, automated CPT 81001 UA Complete w Cult if Ind | $56.00 | $112.00 | $3.17–$78.40 | 130% above | 50% |
| Urinalysis with microscope exam, automated CPT 81001 UA w Micro if Ind & Cult if Ind | $56.00 | $112.00 | $3.17–$78.40 | 130% above | 50% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA w Micro if Ind & Cult if Ind | $56.00 | $112.00 | $3.17–$78.40 | — | 50% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA Complete w Cult if Ind | $56.00 | $112.00 | $3.17–$78.40 | — | 50% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Macroscopic | $54.50 | $109.00 | $2.25–$76.30 | 517% above | 50% |
| Urinalysis without microscope exam, automated CPT 81003 POCT Urinalysis Dipstick | $54.50 | $109.00 | $2.25–$76.30 | 517% above | 50% |
| Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick OB POC | $54.50 | $109.00 | $2.25–$76.30 | 517% above | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Macroscopic | $54.50 | $109.00 | $2.25–$76.30 | — | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Dipstick OB POC | $54.50 | $109.00 | $2.25–$76.30 | — | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 POCT Urinalysis Dipstick | $54.50 | $109.00 | $2.25–$76.30 | — | 50% |
| Urinalysis without microscope exam, manual CPT 81002 UA Microscopic | $54.50 | $109.00 | $3.48–$76.30 | 673% above | 50% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 UA Microscopic | $54.50 | $109.00 | $3.48–$76.30 | — | 50% |
| Urine microalbumin (albumin) test CPT 82043 Microalbumin Random Ur w/Creatinine QST | $84.00 | $168.00 | $5.78–$117.60 | 327% above | 50% |
| Urine microalbumin (albumin) test CPT 82043 Microalbumin Level Urine | $84.00 | $168.00 | $5.78–$117.60 | 327% above | 50% |
| Urine microalbumin (albumin) test CPT 82043 Microalbumin Level 24 Hour Urine | $84.00 | $168.00 | $5.78–$117.60 | 327% above | 50% |
| Urine microalbumin (albumin) test CPT 82043 Urine Albumin | $84.00 | $168.00 | $5.78–$117.60 | 327% above | 50% |
| Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Random Ur w/Creatinine QST | $84.00 | $168.00 | $5.78–$117.60 | — | 50% |
| Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Level 24 Hour Urine | $84.00 | $168.00 | $5.78–$117.60 | — | 50% |
| Urine microalbumin (albumin) test inpatient CPT 82043 Urine Albumin | $84.00 | $168.00 | $5.78–$117.60 | — | 50% |
| Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Level Urine | $84.00 | $168.00 | $5.78–$117.60 | — | 50% |
| Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test Qualitative | $44.00 | $88.00 | $8.61–$61.60 | 116% above | 50% |
| Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Test Qualitative | $44.00 | $88.00 | $8.61–$61.60 | — | 50% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 QST | $148.00 | $296.00 | $15.08–$207.20 | 270% above | 50% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level | $148.00 | $296.00 | $15.08–$207.20 | 270% above | 50% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level | $148.00 | $296.00 | $15.08–$207.20 | — | 50% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 QST | $148.00 | $296.00 | $15.08–$207.20 | — | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Questassured 25-OH Vit D, (D2,D3) QST | $172.50 | $345.00 | $29.60–$241.50 | 123% above | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25-OH & 1,25 Dihydroxyvitamin D QST | $172.50 | $345.00 | $29.60–$241.50 | 123% above | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy Level | $172.50 | $345.00 | $29.60–$241.50 | 123% above | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed OGH | $172.50 | $345.00 | $29.60–$241.50 | 123% above | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25-OH & 1,25 Dihydroxyvitamin D QST | $172.50 | $345.00 | $29.60–$241.50 | — | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy Level | $172.50 | $345.00 | $29.60–$241.50 | — | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed OGH | $172.50 | $345.00 | $29.60–$241.50 | — | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Questassured 25-OH Vit D, (D2,D3) QST | $172.50 | $345.00 | $29.60–$241.50 | — | 50% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vitamin D, 1,25 Dihydroxy QST | $152.50 | $305.00 | $38.50–$213.50 | 49% above | 50% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed OGH | $152.50 | $305.00 | $38.50–$213.50 | 49% above | 50% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed OGH | $152.50 | $305.00 | $38.50–$213.50 | — | 50% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Vitamin D, 1,25 Dihydroxy QST | $152.50 | $305.00 | $38.50–$213.50 | — | 50% |
| Zinc blood test CPT 84630 Zinc, 24-Hour Urine QST | $25.50 | $51.00 | $11.39–$35.70 | 22% below | 50% |
| Zinc blood test CPT 84630 Zinc QST | $25.50 | $51.00 | $11.39–$35.70 | 22% below | 50% |
| Zinc blood test CPT 84630 Zinc, Random Urine QST add-on | $25.50 | $51.00 | $11.39–$35.70 | 22% below | 50% |
| Zinc blood test inpatient CPT 84630 Zinc, Random Urine QST add-on | $25.50 | $51.00 | $11.39–$35.70 | — | 50% |
| Zinc blood test inpatient CPT 84630 Zinc QST | $25.50 | $51.00 | $11.39–$35.70 | — | 50% |
| Zinc blood test inpatient CPT 84630 Zinc, 24-Hour Urine QST | $25.50 | $51.00 | $11.39–$35.70 | — | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 hCG, Total, Qual w Reflex to Quant QST add-on | $37.50 | $75.00 | $15.05–$52.50 | 25% below | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 hCG, Total, Qn QST | $37.50 | $75.00 | $15.05–$52.50 | 25% below | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Total hCG Quantitative | $37.50 | $75.00 | $15.05–$52.50 | 25% below | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin, chorionic (hCG); quantitative OGH | $37.50 | $75.00 | $15.05–$52.50 | 25% below | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta hCG Quantitative | $37.50 | $75.00 | $15.05–$52.50 | 25% below | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Gonadotropin, chorionic (hCG); quantitative OGH | $37.50 | $75.00 | $15.05–$52.50 | — | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Total hCG Quantitative | $37.50 | $75.00 | $15.05–$52.50 | — | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 hCG, Total, Qual w Reflex to Quant QST add-on | $37.50 | $75.00 | $15.05–$52.50 | — | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 hCG, Total, Qn QST | $37.50 | $75.00 | $15.05–$52.50 | — | 50% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Louisiana | Off list |
|---|---|---|---|---|---|
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MG Breast Biopsy w/ Stereo Guide Right. | $1,170.00 | $2,340.00 | — | 54% above | 50% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MG Breast Biopsy w/ Stereo Guide Left. | $1,170.00 | $2,340.00 | — | 54% above | 50% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MG Breast Biopsy w/ Stereo Guide Right | $1,170.00 | $2,340.00 | — | 54% above | 50% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MG Breast Biopsy w/ Stereo Guide Left | $1,170.00 | $2,340.00 | — | 54% above | 50% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MG Breast Biopsy w/ Stereo Guide Left | $1,170.00 | $2,340.00 | — | — | 50% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MG Breast Biopsy w/ Stereo Guide Right. | $1,170.00 | $2,340.00 | — | — | 50% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MG Breast Biopsy w/ Stereo Guide Right | $1,170.00 | $2,340.00 | — | — | 50% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MG Breast Biopsy w/ Stereo Guide Left. | $1,170.00 | $2,340.00 | — | — | 50% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Distal Fibular w/o Manipulation | $312.00 | $624.00 | $227.25–$436.80 | 49% above | 50% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Distal Fibular w/o Manipulation | $312.00 | $624.00 | $227.25–$436.80 | — | 50% |
| Cardiac catheterization with coronary angiogram one side CPT 93458 Left Heart Cath W/Cor Angio Ventriculography | $7,319.00 | $14,638.00 | $2,986.78–$10,246.60 | 56% above | 50% |
| Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 Left Heart Cath W/Cor Angio Ventriculography | $7,319.00 | $14,638.00 | $2,986.78–$10,246.60 | — | 50% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion CL CL | $784.50 | $1,569.00 | $608.93–$1,098.30 | 30% above | 50% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion CL | $784.50 | $1,569.00 | $608.93–$1,098.30 | 30% above | 50% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion | $981.50 | $1,963.00 | $608.93–$1,374.10 | 63% above | 50% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Cath Lab | $981.50 | $1,963.00 | $608.93–$1,374.10 | 63% above | 50% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion; Elective | $981.50 | $1,963.00 | $608.93–$1,374.10 | 63% above | 50% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion CL CL | $784.50 | $1,569.00 | $608.93–$1,098.30 | — | 50% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion CL | $784.50 | $1,569.00 | $608.93–$1,098.30 | — | 50% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion; Elective | $981.50 | $1,963.00 | $608.93–$1,374.10 | — | 50% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion | $981.50 | $1,963.00 | $608.93–$1,374.10 | — | 50% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Cath Lab | $981.50 | $1,963.00 | $608.93–$1,374.10 | — | 50% |
| Catheter ablation for atrial fibrillation CPT 93656 PERQ STENT/ANGIO SINGLE VESSEL --LC | $26,222.50 | $52,445.00 | $10,040.00–$37,016.45 | 62% above | 50% |
| Catheter ablation for atrial fibrillation inpatient CPT 93656 PERQ STENT/ANGIO SINGLE VESSEL --LC | $26,222.50 | $52,445.00 | $10,040.00–$37,016.45 | — | 50% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Distal Radial w/o Manipulation | $614.00 | $1,228.00 | $227.25–$859.60 | 116% above | 50% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Distal Radial w/o Manipulation | $614.00 | $1,228.00 | $227.25–$859.60 | — | 50% |
| Coronary stent placement, one artery CPT 92928 Intracoronary Stent Placement 1St Vessel | $10,394.50 | $20,789.00 | $6,034.00–$17,948.22 | 17% above | 50% |
| Coronary stent placement, one artery inpatient CPT 92928 Intracoronary Stent Placement 1St Vessel | $10,394.50 | $20,789.00 | $6,034.00–$17,948.22 | — | 50% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 Cerumen Irrigation/Lavage | $168.00 | $336.00 | $54.35–$235.20 | 119% above | 50% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Cerumen Irrigation/Lavage | $168.00 | $336.00 | $54.35–$235.20 | — | 50% |
| Earwax removal with instruments, one ear CPT 69210 Cerumen w/ Instrumentation | $110.50 | $221.00 | $54.35–$154.70 | 70% above | 50% |
| Earwax removal with instruments, one ear inpatient CPT 69210 Cerumen w/ Instrumentation | $110.50 | $221.00 | $54.35–$154.70 | — | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 CT Aspiration Abscess/Hematoma/Cyst | $635.50 | $1,271.00 | $184.84–$889.70 | 191% above | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Incision and Drainage - Procedure Performed. | $635.50 | $1,271.00 | $184.84–$889.70 | 191% above | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Incision and Debridement of Skin Abscess Simple-Singular-Hyperbaric | $635.50 | $1,271.00 | $184.84–$889.70 | 191% above | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D Abscess/Cyst/Hematoma Simple | $635.50 | $1,271.00 | $184.84–$889.70 | 191% above | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Abscess Drainage | $635.50 | $1,271.00 | $184.84–$889.70 | 191% above | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Incision and Drainage - Procedure Performed. | $635.50 | $1,271.00 | $184.84–$889.70 | — | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Incision and Debridement of Skin Abscess Simple-Singular-Hyperbaric | $635.50 | $1,271.00 | $184.84–$889.70 | — | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Abscess Drainage | $635.50 | $1,271.00 | $184.84–$889.70 | — | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Abscess/Cyst/Hematoma Simple | $635.50 | $1,271.00 | $184.84–$889.70 | — | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 CT Aspiration Abscess/Hematoma/Cyst | $635.50 | $1,271.00 | $184.84–$889.70 | — | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Major Joint Aspirate/Inject w/o US | $1,130.50 | $2,261.00 | $282.80–$1,582.70 | 338% above | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 CT Joint/Bursa Major Arthr/Asp/Inj Left | $1,130.50 | $2,261.00 | — | 338% above | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Left | $1,130.50 | $2,261.00 | — | 338% above | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Right | $1,130.50 | $2,261.00 | $282.80–$1,582.70 | 338% above | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 CT Joint/Bursa Major Arthr/Asp/Inj Right | $1,130.50 | $2,261.00 | — | 338% above | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Major Joint Aspirate/Inject w/o US | $1,130.50 | $2,261.00 | $282.80–$1,582.70 | — | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 CT Joint/Bursa Major Arthr/Asp/Inj Left | $1,130.50 | $2,261.00 | — | — | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Left | $1,130.50 | $2,261.00 | — | — | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Right | $1,130.50 | $2,261.00 | $282.80–$1,582.70 | — | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 CT Joint/Bursa Major Arthr/Asp/Inj Right | $1,130.50 | $2,261.00 | — | — | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Intermediate Aspiration/Inj w/o US | $463.50 | $927.00 | $282.80–$648.90 | 79% above | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 XR Joint/Bursa Intmd Arthr/Asp/Inj Left | $1,130.50 | $2,261.00 | — | 338% above | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 CT Joint/Bursa Intmd Arthr/Asp/Inj Left | $1,130.50 | $2,261.00 | — | 338% above | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 CT Joint/Bursa Intmd Arthr/Asp/Inj Right | $1,130.50 | $2,261.00 | — | 338% above | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 XR Joint/Bursa Intmd Arthr/Asp/Inj Right | $1,130.50 | $2,261.00 | $282.80–$1,582.70 | 338% above | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Intermediate Aspiration/Inj w/o US | $463.50 | $927.00 | $282.80–$648.90 | — | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 CT Joint/Bursa Intmd Arthr/Asp/Inj Left | $1,130.50 | $2,261.00 | — | — | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 XR Joint/Bursa Intmd Arthr/Asp/Inj Right | $1,130.50 | $2,261.00 | $282.80–$1,582.70 | — | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 XR Joint/Bursa Intmd Arthr/Asp/Inj Left | $1,130.50 | $2,261.00 | — | — | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 CT Joint/Bursa Intmd Arthr/Asp/Inj Right | $1,130.50 | $2,261.00 | — | — | 50% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Small Joint Aspirate/Inject w/o US | $1,130.50 | $2,261.00 | $282.80–$1,582.70 | 338% above | 50% |
| Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 CT Joint/Bursa Small Arthr/Asp/Inj Right | $1,130.50 | $2,261.00 | — | 338% above | 50% |
| Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 XR Joint/Bursa Small Arthr/Asp/Inj Left | $1,130.50 | $2,261.00 | — | 338% above | 50% |
| Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 CT Joint/Bursa Small Arthr/Asp/Inj Left | $1,130.50 | $2,261.00 | — | 338% above | 50% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Small Joint Aspirate/Inject w/o US | $1,130.50 | $2,261.00 | $282.80–$1,582.70 | — | 50% |
| Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 XR Joint/Bursa Small Arthr/Asp/Inj Left | $1,130.50 | $2,261.00 | — | — | 50% |
| Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 CT Joint/Bursa Small Arthr/Asp/Inj Left | $1,130.50 | $2,261.00 | — | — | 50% |
| Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 CT Joint/Bursa Small Arthr/Asp/Inj Right | $1,130.50 | $2,261.00 | — | — | 50% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm | $753.50 | $1,507.00 | $374.52–$1,054.90 | 116% above | 50% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm | $753.50 | $1,507.00 | $374.52–$1,054.90 | — | 50% |
| Left heart catheterization, diagnostic one side CPT 93452 Left Heart Cath | $6,371.00 | $12,742.00 | $2,986.78–$8,919.40 | 67% above | 50% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 Left Heart Cath | $6,371.00 | $12,742.00 | $2,986.78–$8,919.40 | — | 50% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Exc, Benign Lesion, <=0.5 cm | $840.50 | $1,681.00 | $652.40–$1,337.00 | 70% above | 50% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Excise Lesion Benign Face Less Than/Equal to 0.5 cm | $841.00 | $1,682.00 | $652.40–$1,177.40 | 70% above | 50% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Exc, Benign Lesion, <=0.5 cm | $840.50 | $1,681.00 | $652.40–$1,337.00 | — | 50% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Excise Lesion Benign Face Less Than/Equal to 0.5 cm | $841.00 | $1,682.00 | $652.40–$1,177.40 | — | 50% |
| Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate Single | $240.50 | $481.00 | $184.84–$336.70 | 60% above | 50% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion Nail Plate Single | $240.50 | $481.00 | $184.84–$336.70 | — | 50% |
| Pacemaker implant (dual chamber) CPT 33208 Insert or Replace Perm Atr and Ven | $14,908.00 | $29,816.00 | $9,629.40–$20,871.20 | 41% above | 50% |
| Pacemaker implant (dual chamber) inpatient CPT 33208 Insert or Replace Perm Atr and Ven | $14,908.00 | $29,816.00 | $9,629.40–$20,871.20 | — | 50% |
| Paracentesis with imaging guidance CPT 49083 US Guided Paracentesis | $2,079.00 | $4,158.00 | $835.60–$2,910.60 | 253% above | 50% |
| Paracentesis with imaging guidance CPT 49083 Abdominal Paracentesis Diagnostic/Therapeutic W/Imaging | $2,079.00 | $4,158.00 | $835.60–$2,910.60 | 253% above | 50% |
| Paracentesis with imaging guidance CPT 49083 Paracentesis - Procedure Performed. | $2,079.00 | $4,158.00 | $835.60–$2,910.60 | 253% above | 50% |
| Paracentesis with imaging guidance CPT 49083 Abdominal Paracentesis w/ Imaging Guide | $2,079.00 | $4,158.00 | $835.60–$2,910.60 | 253% above | 50% |
| Paracentesis with imaging guidance CPT 49083 Paracentesis | $2,079.00 | $4,158.00 | $835.60–$2,910.60 | 253% above | 50% |
| Paracentesis with imaging guidance inpatient CPT 49083 US Guided Paracentesis | $2,079.00 | $4,158.00 | $835.60–$2,910.60 | — | 50% |
| Paracentesis with imaging guidance inpatient CPT 49083 Abdominal Paracentesis Diagnostic/Therapeutic W/Imaging | $2,079.00 | $4,158.00 | $835.60–$2,910.60 | — | 50% |
| Paracentesis with imaging guidance inpatient CPT 49083 Abdominal Paracentesis w/ Imaging Guide | $2,079.00 | $4,158.00 | $835.60–$2,910.60 | — | 50% |
| Paracentesis with imaging guidance inpatient CPT 49083 Paracentesis | $2,079.00 | $4,158.00 | $835.60–$2,910.60 | — | 50% |
| Paracentesis with imaging guidance inpatient CPT 49083 Paracentesis - Procedure Performed. | $2,079.00 | $4,158.00 | $835.60–$2,910.60 | — | 50% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision Nail & Matrix | $740.50 | $1,481.00 | $374.52–$1,036.70 | 79% above | 50% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excision Nail & Matrix | $740.50 | $1,481.00 | $374.52–$1,036.70 | — | 50% |
| Removal of a foreign object under the skin, simple CPT 10120 Subcutaneous Tissue Simple | $677.50 | $1,355.00 | $374.52–$948.50 | 143% above | 50% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 Subcutaneous Tissue Simple | $677.50 | $1,355.00 | $374.52–$948.50 | — | 50% |
| Short arm cast (elbow to hand) CPT 29075 APPLICATION CAST ELBOW FINGER SHORT ARM | $146.50 | $293.00 | $146.50–$416.30 | 18% below | 50% |
| Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION CAST ELBOW FINGER SHORT ARM | $146.50 | $293.00 | $146.50–$416.30 | — | 50% |
| Short arm splint (forearm and hand) CPT 29125 Short Arm | $146.50 | $293.00 | $122.58–$205.10 | 11% above | 50% |
| Short arm splint (forearm and hand) CPT 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee | $146.50 | $293.00 | $122.58–$205.10 | 11% above | 50% |
| Short arm splint (forearm and hand) inpatient CPT 29125 Short Arm | $146.50 | $293.00 | $122.58–$205.10 | — | 50% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee | $146.50 | $293.00 | $122.58–$205.10 | — | 50% |
| Short leg splint (calf to foot) CPT 29515 Application lower leg splint | $146.50 | $293.00 | $146.50–$242.26 | 5% below | 50% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee | $146.50 | $293.00 | $146.50–$242.26 | 5% below | 50% |
| Short leg splint (calf to foot) CPT 29515 Short Leg | $146.50 | $293.00 | $146.50–$242.26 | 5% below | 50% |
| Short leg splint (calf to foot) inpatient CPT 29515 Short Leg | $146.50 | $293.00 | $146.50–$242.26 | — | 50% |
| Short leg splint (calf to foot) inpatient CPT 29515 Application lower leg splint | $146.50 | $293.00 | $146.50–$242.26 | — | 50% |
| Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee | $146.50 | $293.00 | $146.50–$242.26 | — | 50% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm | $258.50 | $517.00 | $184.84–$361.90 | 30% above | 50% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm | $258.50 | $517.00 | $184.84–$361.90 | — | 50% |
| Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy | $313.50 | $627.00 | $222.00–$438.90 | 1% above | 50% |
| Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy-Hyperbaric | $313.50 | $627.00 | $222.00–$438.90 | 1% above | 50% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Biopsy | $313.50 | $627.00 | $222.00–$438.90 | — | 50% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Biopsy-Hyperbaric | $313.50 | $627.00 | $222.00–$438.90 | — | 50% |
| Skin tag removal, up to 15 tags CPT 11200 Remove Skin Tag | $240.50 | $481.00 | $184.84–$336.70 | 80% above | 50% |
| Skin tag removal, up to 15 tags CPT 11200 Removal Skin Tag up to 15 | $240.50 | $481.00 | $184.84–$336.70 | 80% above | 50% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 Remove Skin Tag | $240.50 | $481.00 | $184.84–$336.70 | — | 50% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 Removal Skin Tag up to 15 | $240.50 | $481.00 | $184.84–$336.70 | — | 50% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar Puncture Diagnostic | $1,170.00 | $2,340.00 | $650.32–$1,638.00 | 155% above | 50% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 XR Spinal Puncture Diagnostic | $1,170.00 | $2,340.00 | $650.32–$1,638.00 | 155% above | 50% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar Puncture without Guidance | $1,170.00 | $2,340.00 | $650.32–$1,638.00 | 155% above | 50% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar puncture adult 20 G - Procedure Performed. | $1,170.00 | $2,340.00 | $650.32–$1,638.00 | 155% above | 50% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Lumbar Puncture without Guidance | $1,170.00 | $2,340.00 | $650.32–$1,638.00 | — | 50% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Lumbar puncture adult 20 G - Procedure Performed. | $1,170.00 | $2,340.00 | $650.32–$1,638.00 | — | 50% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Lumbar Puncture Diagnostic | $1,170.00 | $2,340.00 | $650.32–$1,638.00 | — | 50% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 XR Spinal Puncture Diagnostic | $1,170.00 | $2,340.00 | $650.32–$1,638.00 | — | 50% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm | $258.50 | $517.00 | $184.84–$361.90 | 32% above | 50% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm | $258.50 | $517.00 | $184.84–$361.90 | — | 50% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm | $258.50 | $517.00 | $184.84–$361.90 | 33% above | 50% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm | $258.50 | $517.00 | $184.84–$361.90 | — | 50% |
| Thoracentesis with imaging guidance CPT 32555 Thoracentesis CL | $2,180.50 | $4,361.00 | $577.93–$3,052.70 | 237% above | 50% |
| Thoracentesis with imaging guidance CPT 32555 US Guided Thoracentesis | $2,279.00 | $4,558.00 | $577.93–$3,190.60 | 252% above | 50% |
| Thoracentesis with imaging guidance CPT 32555 Thorocentesis W/ Imaging | $2,279.00 | $4,558.00 | $577.93–$3,190.60 | 252% above | 50% |
| Thoracentesis with imaging guidance CPT 32555 Thoracentesis w/ Imaging Guidance | $2,279.00 | $4,558.00 | $577.93–$3,190.60 | 252% above | 50% |
| Thoracentesis with imaging guidance CPT 32555 CT Thoracentesis w/ CT Guidance | $2,279.00 | $4,558.00 | $577.93–$3,190.60 | 252% above | 50% |
| Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis CL | $2,180.50 | $4,361.00 | $577.93–$3,052.70 | — | 50% |
| Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis w/ Imaging Guidance | $2,279.00 | $4,558.00 | $577.93–$3,190.60 | — | 50% |
| Thoracentesis with imaging guidance inpatient CPT 32555 Thorocentesis W/ Imaging | $2,279.00 | $4,558.00 | $577.93–$3,190.60 | — | 50% |
| Thoracentesis with imaging guidance inpatient CPT 32555 CT Thoracentesis w/ CT Guidance | $2,279.00 | $4,558.00 | $577.93–$3,190.60 | — | 50% |
| Thoracentesis with imaging guidance inpatient CPT 32555 US Guided Thoracentesis | $2,279.00 | $4,558.00 | $577.93–$3,190.60 | — | 50% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Inject Trigger Point 1-2 Muscles | $360.50 | $721.00 | $282.80–$504.70 | 117% above | 50% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inject Trigger Point 1-2 Muscles | $360.50 | $721.00 | $282.80–$504.70 | — | 50% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy w/ US Guide Right. | $1,170.00 | $2,340.00 | — | 5% above | 50% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy w/ US Guide Right | $1,170.00 | $2,340.00 | — | 5% above | 50% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy w/ US Guide Left | $1,170.00 | $2,340.00 | — | 5% above | 50% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy w/ US Guide Left. | $1,170.00 | $2,340.00 | — | 5% above | 50% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy w/ US Guide Left | $1,170.00 | $2,340.00 | — | — | 50% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy w/ US Guide Right | $1,170.00 | $2,340.00 | — | — | 50% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy w/ US Guide Left. | $1,170.00 | $2,340.00 | — | — | 50% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy w/ US Guide Right. | $1,170.00 | $2,340.00 | — | — | 50% |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD | $1,150.00 | $2,300.00 | $835.60–$1,717.00 | 39% above | 50% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD | $1,150.00 | $2,300.00 | $835.60–$1,717.00 | — | 50% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCT BENIGN LESION OTHER THAN SKIN TAG UP TO 14 LESION TechFee | $234.50 | $469.00 | $184.84–$328.30 | 67% above | 50% |
| Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT BENIGN LESION OTHER THAN SKIN TAG UP TO 14 LESION TechFee | $234.50 | $469.00 | $184.84–$328.30 | — | 50% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 SQ Tissue Less Than/Equal to 1st 20 sq cm | $629.00 | $1,258.00 | $374.52–$880.60 | 51% above | 50% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Skin-Subcutaneous Tissue 20cm or less-Hyperb | $629.00 | $1,258.00 | $374.52–$3,176.00 | 51% above | 50% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride Skin-Subcutaneous Tissue 20cm or less-Hyperb | $629.00 | $1,258.00 | $374.52–$3,176.00 | — | 50% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 SQ Tissue Less Than/Equal to 1st 20 sq cm | $629.00 | $1,258.00 | $374.52–$880.60 | — | 50% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Louisiana | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Clinic- transfusion/blood components CHARGE | $401.00 | $802.00 | $401.00–$702.90 | 16% below | 50% |
| Blood transfusion (giving blood or blood components) CPT 36430 Blood Product Administration OGH | $550.00 | $1,100.00 | $406.46–$770.00 | 16% above | 50% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 Clinic- transfusion/blood components CHARGE | $401.00 | $802.00 | $401.00–$702.90 | — | 50% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Product Administration OGH | $550.00 | $1,100.00 | $406.46–$770.00 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Continuous Neb Initial CHARGE | $353.00 | $706.00 | $201.74–$494.20 | 276% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT Tech Fee | $353.00 | $706.00 | $201.74–$494.20 | 276% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPV - Aerosol Delivery Device | $353.00 | $706.00 | $201.74–$494.20 | 276% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 IPPB Treatment - RT CHARGE IPPB | $353.00 | $706.00 | $201.74–$494.20 | 276% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 Subsequent - RT CHARGE Aerosol Therapy | $353.00 | $706.00 | $201.74–$494.20 | 276% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 Initial - RT CHARGE MDI | $353.00 | $706.00 | $201.74–$494.20 | 276% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 Initial - RT CHARGE Aerosol Therapy | $353.00 | $706.00 | $201.74–$494.20 | 276% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 Subsequent - RT CHARGE MDI | $353.00 | $706.00 | $201.74–$494.20 | 276% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT Tech Fee | $353.00 | $706.00 | $201.74–$494.20 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPV - Aerosol Delivery Device | $353.00 | $706.00 | $201.74–$494.20 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Continuous Neb Initial CHARGE | $353.00 | $706.00 | $201.74–$494.20 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient one side CPT 94640 Subsequent - RT CHARGE Aerosol Therapy | $353.00 | $706.00 | $201.74–$494.20 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient one side CPT 94640 Subsequent - RT CHARGE MDI | $353.00 | $706.00 | $201.74–$494.20 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient one side CPT 94640 Initial - RT CHARGE MDI | $353.00 | $706.00 | $201.74–$494.20 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient one side CPT 94640 Initial - RT CHARGE Aerosol Therapy | $353.00 | $706.00 | $201.74–$494.20 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient one side CPT 94640 IPPB Treatment - RT CHARGE IPPB | $353.00 | $706.00 | $201.74–$494.20 | — | 50% |
| Chemotherapy IV infusion, first hour CPT 96413 Chemo Infusion Initial Hour Charge | $250.50 | $501.00 | $250.50–$560.81 | 14% below | 50% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemo Infusion Initial Hour Charge | $250.50 | $501.00 | $250.50–$560.81 | — | 50% |
| Critical care, first 30 to 74 minutes CPT 99291 Critical Care Ill/Injured Patient Init 30-74 Min | $1,177.00 | $2,354.00 | $761.02–$2,019.00 | 40% above | 50% |
| Critical care, first 30 to 74 minutes CPT 99291 TRAUMA ALERT CLASS 1 | $1,177.00 | $2,354.00 | $761.02–$2,019.00 | 40% above | 50% |
| Critical care, first 30 to 74 minutes CPT 99291 Critical Care, First Hour | $1,177.00 | $2,354.00 | $761.02–$2,019.00 | 40% above | 50% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 TRAUMA ALERT CLASS 1 | $1,177.00 | $2,354.00 | $761.02–$2,019.00 | — | 50% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care, First Hour | $1,177.00 | $2,354.00 | $761.02–$2,019.00 | — | 50% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care Ill/Injured Patient Init 30-74 Min | $1,177.00 | $2,354.00 | $761.02–$2,019.00 | — | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG Pediatric | $100.00 | $200.00 | $54.35–$183.00 | 22% above | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG | $100.00 | $200.00 | $54.35–$183.00 | 22% above | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram 12 Lead | $100.00 | $200.00 | $54.35–$183.00 | 22% above | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG | $100.00 | $200.00 | $54.35–$183.00 | — | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram 12 Lead | $100.00 | $200.00 | $54.35–$183.00 | — | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG Pediatric | $100.00 | $200.00 | $54.35–$183.00 | — | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency Department Visit. Level 1 | $165.00 | $330.00 | $77.69–$634.00 | 24% above | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency Department Visit. Level 1 | $165.00 | $330.00 | $77.69–$634.00 | — | 50% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Level 2 | $300.00 | $600.00 | $141.46–$724.00 | 76% above | 50% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Level 2 | $300.00 | $600.00 | $141.46–$724.00 | — | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Level 3 | $475.00 | $950.00 | $251.49–$937.00 | 76% above | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Level 3 | $475.00 | $950.00 | $251.49–$937.00 | — | 50% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Level 4 | $610.00 | $1,220.00 | $384.43–$1,243.00 | 43% above | 50% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Level 4 | $610.00 | $1,220.00 | $384.43–$1,243.00 | — | 50% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Level 5 | $990.00 | $1,980.00 | $548.66–$1,571.00 | 86% above | 50% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Level 5 | $990.00 | $1,980.00 | $548.66–$1,571.00 | — | 50% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOLITE STRESS TEST CHARGE | $304.00 | $608.00 | $198.93–$458.47 | 11% below | 50% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Treadmill Stress Test | $304.00 | $608.00 | $198.93–$458.47 | 11% below | 50% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Treadmill Stress Test | $304.00 | $608.00 | $198.93–$458.47 | — | 50% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOLITE STRESS TEST CHARGE | $304.00 | $608.00 | $198.93–$458.47 | — | 50% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY (WITH PATIENT PRESENT), 50 MINUTES CHARGE | $177.00 | $354.00 | $163.52–$247.80 | 42% above | 50% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY (WITH PATIENT PRESENT), 50 MINUTES CHARGE | $177.00 | $354.00 | $163.52–$247.80 | — | 50% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT), 50 MINUTES CHARGE | $177.00 | $354.00 | $163.52–$247.80 | 34% above | 50% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT), 50 MINUTES CHARGE | $177.00 | $354.00 | $163.52–$247.80 | — | 50% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY | $150.50 | $301.00 | $93.59–$210.70 | 54% above | 50% |
| Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY | $150.50 | $301.00 | $93.59–$210.70 | — | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hydration, first hour | $282.00 | $564.00 | $195.97–$394.80 | 67% above | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Initial Hydration Infusion First Hour Charge | $282.00 | $564.00 | $195.97–$394.80 | 67% above | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration Initial 31 min - 1 hr | $282.00 | $564.00 | $195.97–$394.80 | 67% above | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 AMB INF HYDRATION THERAPY 1ST HR CHARGE | $282.00 | $564.00 | $195.97–$394.80 | 67% above | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration Initial 31 min - 1 hr | $282.00 | $564.00 | $195.97–$394.80 | — | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Initial Hydration Infusion First Hour Charge | $282.00 | $564.00 | $195.97–$394.80 | — | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 AMB INF HYDRATION THERAPY 1ST HR CHARGE | $282.00 | $564.00 | $195.97–$394.80 | — | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hydration, first hour | $282.00 | $564.00 | $195.97–$394.80 | — | 50% |
| IV infusion of a medicine, first hour CPT 96365 Infusion Therapy Ist Hour Charge | $362.00 | $724.00 | $195.97–$506.80 | 72% above | 50% |
| IV infusion of a medicine, first hour CPT 96365 Infusion Drug Initial up to 1 hr Greater Than 15 mins | $362.00 | $724.00 | $195.97–$506.80 | 72% above | 50% |
| IV infusion of a medicine, first hour CPT 96365 IV tx, first hour | $362.00 | $724.00 | $195.97–$506.80 | 72% above | 50% |
| IV infusion of a medicine, first hour CPT 96365 IV Therapy - LTAC/SNF | $362.00 | $724.00 | $195.97–$506.80 | 72% above | 50% |
| IV infusion of a medicine, first hour CPT 96365 IV Infusion Initial Hr. | $362.00 | $724.00 | $195.97–$506.80 | 72% above | 50% |
| IV infusion of a medicine, first hour CPT 96365 TH NONCHEMO INFUSION 1HR CHARGE | $362.00 | $724.00 | $195.97–$506.80 | 72% above | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV tx, first hour | $362.00 | $724.00 | $195.97–$506.80 | — | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV Infusion Initial Hr. | $362.00 | $724.00 | $195.97–$506.80 | — | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV Therapy - LTAC/SNF | $362.00 | $724.00 | $195.97–$506.80 | — | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 Infusion Drug Initial up to 1 hr Greater Than 15 mins | $362.00 | $724.00 | $195.97–$506.80 | — | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 Infusion Therapy Ist Hour Charge | $362.00 | $724.00 | $195.97–$506.80 | — | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 TH NONCHEMO INFUSION 1HR CHARGE | $362.00 | $724.00 | $195.97–$506.80 | — | 50% |
| IV push of a medicine, first drug CPT 96374 IV Push/Inj Initial | $362.00 | $724.00 | $195.97–$506.80 | 229% above | 50% |
| IV push of a medicine, first drug CPT 96374 IV Push Initial Drug | $362.00 | $724.00 | $195.97–$506.80 | 229% above | 50% |
| IV push of a medicine, first drug CPT 96374 Initial IVP Charge | $362.00 | $724.00 | $195.97–$506.80 | 229% above | 50% |
| IV push of a medicine, first drug CPT 96374 IV Injection, single/initial | $362.00 | $724.00 | $195.97–$506.80 | 229% above | 50% |
| IV push of a medicine, first drug CPT 96374 INJ IV PUSH INITIAL CHARGE | $362.00 | $724.00 | $195.97–$506.80 | 229% above | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 INJ IV PUSH INITIAL CHARGE | $362.00 | $724.00 | $195.97–$506.80 | — | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 IV Push Initial Drug | $362.00 | $724.00 | $195.97–$506.80 | — | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 IV Push/Inj Initial | $362.00 | $724.00 | $195.97–$506.80 | — | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 Initial IVP Charge | $362.00 | $724.00 | $195.97–$506.80 | — | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 IV Injection, single/initial | $362.00 | $724.00 | $195.97–$506.80 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ ADMINISTRATION CHARGE | $84.00 | $168.00 | $66.34–$266.00 | 49% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapy Inj. SQ or IM | $84.00 | $168.00 | $66.34–$266.00 | 49% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Subq/IM Injection | $84.00 | $168.00 | $66.34–$266.00 | 49% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Pediatric Outpatient Injection CHARGE | $84.00 | $168.00 | $66.34–$266.00 | 49% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection/SQ/IM | $84.00 | $168.00 | $66.34–$266.00 | 49% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection SQ/IM Charge | $84.00 | $168.00 | $66.34–$266.00 | 49% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ ADMINISTRATION CHARGE | $84.00 | $168.00 | $66.34–$266.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Pediatric Outpatient Injection CHARGE | $84.00 | $168.00 | $66.34–$266.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection/SQ/IM | $84.00 | $168.00 | $66.34–$266.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection SQ/IM Charge | $84.00 | $168.00 | $66.34–$266.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapy Inj. SQ or IM | $84.00 | $168.00 | $66.34–$266.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Subq/IM Injection | $84.00 | $168.00 | $66.34–$266.00 | — | 50% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAGNOSTIC EVALUATION CHARGE | $185.00 | $370.00 | $163.52–$259.00 | 56% above | 50% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psychosocial complete - BH psychosocial complete Charge | $190.00 | $380.00 | $163.52–$266.00 | 60% above | 50% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAGNOSTIC EVALUATION CHARGE | $185.00 | $370.00 | $163.52–$259.00 | — | 50% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psychosocial complete - BH psychosocial complete Charge | $190.00 | $380.00 | $163.52–$266.00 | — | 50% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 Nerve Conduction Studies, 7-8 Studies CHARGE | $471.00 | $942.00 | $343.79–$659.40 | 160% above | 50% |
| Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 Nerve Conduction Studies, 7-8 Studies CHARGE | $471.00 | $942.00 | $343.79–$659.40 | — | 50% |
| New patient office visit, about 30 minutes CPT 99203 NEW PATIENT VISIT-LEVEL - 3 | $105.50 | $211.00 | $42.20–$147.70 | 39% above | 50% |
| New patient office visit, about 30 minutes CPT 99203 NEW PATIENT EVAL LEVEL 3 CHARGE | $118.00 | $236.00 | $47.20–$165.20 | 55% above | 50% |
| New patient office visit, about 30 minutes CPT 99203 Office Visit Level 3 New | $118.00 | $236.00 | $47.20–$165.20 | 55% above | 50% |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT VISIT-LEVEL - 3 | $105.50 | $211.00 | $42.20–$147.70 | — | 50% |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT EVAL LEVEL 3 CHARGE | $118.00 | $236.00 | $47.20–$165.20 | — | 50% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office Visit Level 3 New | $118.00 | $236.00 | $47.20–$165.20 | — | 50% |
| New patient office visit, about 45 minutes CPT 99204 NEW PATIENT VISIT-LEVEL - 4 | $131.50 | $263.00 | $52.60–$184.10 | 42% above | 50% |
| New patient office visit, about 45 minutes CPT 99204 Office Visit Level 4 New | $169.00 | $338.00 | $53.53–$236.60 | 83% above | 50% |
| New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT VISIT-LEVEL - 4 | $131.50 | $263.00 | $52.60–$184.10 | — | 50% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office Visit Level 4 New | $169.00 | $338.00 | $53.53–$236.60 | — | 50% |
| New patient office visit, about 60 minutes CPT 99205 NEW PATIENT VISIT-LEVEL - 5 | $156.00 | $312.00 | $59.04–$218.40 | 36% above | 50% |
| New patient office visit, about 60 minutes CPT 99205 NEW PATIENT EVAL LEVEL 5 CHARGE | $254.50 | $509.00 | $59.04–$356.30 | 122% above | 50% |
| New patient office visit, about 60 minutes CPT 99205 Office Visit Level 5 New | $254.50 | $509.00 | $59.04–$356.30 | 122% above | 50% |
| New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT VISIT-LEVEL - 5 | $156.00 | $312.00 | $59.04–$218.40 | — | 50% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office Visit Level 5 New | $254.50 | $509.00 | $59.04–$356.30 | — | 50% |
| New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT EVAL LEVEL 5 CHARGE | $254.50 | $509.00 | $59.04–$356.30 | — | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT VISIT-LEVEL - 2 | $79.00 | $158.00 | $31.60–$110.60 | 33% above | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT EVAL LEVEL 2 CHARGE | $100.00 | $200.00 | $39.18–$140.00 | 68% above | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office Visit Level 2 New | $100.00 | $200.00 | $39.18–$140.00 | 68% above | 50% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT VISIT-LEVEL - 2 | $79.00 | $158.00 | $31.60–$110.60 | — | 50% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office Visit Level 2 New | $100.00 | $200.00 | $39.18–$140.00 | — | 50% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT EVAL LEVEL 2 CHARGE | $100.00 | $200.00 | $39.18–$140.00 | — | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Medical Nutrition Therapy Initial Assessment 15 min Charge | $9.50 | $19.00 | $3.80–$208.00 | 69% below | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Nutrition Counseling Level 1 | $15.50 | $31.00 | $6.20–$65.59 | 50% below | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 NS Outpatient Nutrition Education Charge | $21.00 | $42.00 | $8.40–$208.00 | 32% below | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Nutrition Counseling Level 2 | $28.00 | $56.00 | $11.20–$65.59 | 9% below | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Nutrition Counseling Level 3 | $83.50 | $167.00 | $33.40–$116.90 | 170% above | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Medical Nutrition Therapy Initial Assessment 15 min Charge | $9.50 | $19.00 | $3.80–$208.00 | — | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Nutrition Counseling Level 1 | $15.50 | $31.00 | $6.20–$65.59 | — | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 NS Outpatient Nutrition Education Charge | $21.00 | $42.00 | $8.40–$208.00 | — | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Nutrition Counseling Level 2 | $28.00 | $56.00 | $11.20–$65.59 | — | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Nutrition Counseling Level 3 | $83.50 | $167.00 | $33.40–$116.90 | — | 50% |
| Psychotherapy session, 30 minutes CPT 90832 20 - 30 minutes - OGH BH Time Spent in Therapy Charge | $140.50 | $281.00 | $140.50–$237.95 | 48% above | 50% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 20 - 30 minutes - OGH BH Time Spent in Therapy Charge | $140.50 | $281.00 | $140.50–$237.95 | — | 50% |
| Psychotherapy session, 45 minutes CPT 90834 40 - 50 minutes - OGH BH Time Spent in Therapy Charge | $190.00 | $380.00 | $163.52–$266.00 | 44% above | 50% |
| Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT CHARGE | $190.00 | $380.00 | $163.52–$266.00 | 44% above | 50% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 40 - 50 minutes - OGH BH Time Spent in Therapy Charge | $190.00 | $380.00 | $163.52–$266.00 | — | 50% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT CHARGE | $190.00 | $380.00 | $163.52–$266.00 | — | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PATIENT VISIT-LEVEL - 5 | $185.50 | $371.00 | $52.97–$259.70 | 145% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office Visit Level 5 Est | $216.50 | $433.00 | $52.97–$303.10 | 186% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PATIENT EVAL LEVEL 5 CHARGE | $216.50 | $433.00 | $52.97–$303.10 | 186% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PATIENT VISIT-LEVEL - 5 | $185.50 | $371.00 | $52.97–$259.70 | — | 50% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office Visit Level 5 Est | $216.50 | $433.00 | $52.97–$303.10 | — | 50% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PATIENT EVAL LEVEL 5 CHARGE | $216.50 | $433.00 | $52.97–$303.10 | — | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Wound Care - LTAC/SNF | $125.50 | $251.00 | $36.43–$175.70 | 121% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PATIENT EVAL LEVEL 3 CHARGE | $125.50 | $251.00 | $36.43–$175.70 | 121% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PATIENT VISIT-LEVEL - 3 | $125.50 | $251.00 | $36.43–$175.70 | 121% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office Visit Level 3 Est | $125.50 | $251.00 | $36.43–$175.70 | 121% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office Visit Level 3 Est | $125.50 | $251.00 | $36.43–$175.70 | — | 50% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PATIENT VISIT-LEVEL - 3 | $125.50 | $251.00 | $36.43–$175.70 | — | 50% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PATIENT EVAL LEVEL 3 CHARGE | $125.50 | $251.00 | $36.43–$175.70 | — | 50% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Wound Care - LTAC/SNF | $125.50 | $251.00 | $36.43–$175.70 | — | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office Visit Level 4 Est | $169.00 | $338.00 | $45.80–$236.60 | 155% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PATIENT EVAL LEVEL 4 CHARGE | $169.00 | $338.00 | $45.80–$236.60 | 155% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PATIENT VISIT-LEVEL - 4 | $169.00 | $338.00 | $45.80–$236.60 | 155% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office Visit Level 4 Est | $169.00 | $338.00 | $45.80–$236.60 | — | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PATIENT VISIT-LEVEL - 4 | $169.00 | $338.00 | $45.80–$236.60 | — | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PATIENT EVAL LEVEL 4 CHARGE | $169.00 | $338.00 | $45.80–$236.60 | — | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PATIENT VISIT-LEVEL - 2 | $87.00 | $174.00 | $30.36–$121.80 | 62% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office Visit Level 2 Est | $102.50 | $205.00 | $30.36–$143.50 | 91% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PATIENT EVAL LEVEL 2 CHARGE | $102.50 | $205.00 | $30.36–$143.50 | 91% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PATIENT VISIT-LEVEL - 2 | $87.00 | $174.00 | $30.36–$121.80 | — | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PATIENT EVAL LEVEL 2 CHARGE | $102.50 | $205.00 | $30.36–$143.50 | — | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office Visit Level 2 Est | $102.50 | $205.00 | $30.36–$143.50 | — | 50% |
| Spirometry (breathing test) CPT 94010 RT Incentive Spirometry Initial CHARGE | $185.00 | $370.00 | $185.00–$704.00 | 45% above | 50% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY CHARGE | $185.00 | $370.00 | $185.00–$704.00 | 45% above | 50% |
| Spirometry (breathing test) CPT 94010 RT Incentive Spirometry Subseq CHARGE | $185.00 | $370.00 | $185.00–$704.00 | 45% above | 50% |
| Spirometry (breathing test) inpatient CPT 94010 RT Incentive Spirometry Initial CHARGE | $185.00 | $370.00 | $185.00–$704.00 | — | 50% |
| Spirometry (breathing test) inpatient CPT 94010 RT Incentive Spirometry Subseq CHARGE | $185.00 | $370.00 | $185.00–$704.00 | — | 50% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY CHARGE | $185.00 | $370.00 | $185.00–$704.00 | — | 50% |
| Spirometry before and after a bronchodilator CPT 94060 PFT SPIROMETRY B/A CHARGE | $254.50 | $509.00 | $254.50–$704.00 | 14% above | 50% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 PFT SPIROMETRY B/A CHARGE | $254.50 | $509.00 | $254.50–$704.00 | — | 50% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy Charge | $104.00 | $208.00 | $104.00–$197.50 | at median | 50% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy 1 | $104.00 | $208.00 | $104.00–$197.50 | at median | 50% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Therapeutic Phlebotomy 1 | $104.00 | $208.00 | $104.00–$197.50 | — | 50% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Therapeutic Phlebotomy Charge | $104.00 | $208.00 | $104.00–$197.50 | — | 50% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Louisiana | Off list |
|---|---|---|---|---|---|
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Administration | $84.00 | $168.00 | $19.31–$117.60 | 108% above | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE TechFee | $84.00 | $168.00 | $19.31–$117.60 | 108% above | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Initial Immunization Charge | $84.00 | $168.00 | $19.31–$117.60 | 108% above | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE IM INJECTION SINGLE CHARGE | $84.00 | $168.00 | $19.31–$117.60 | 108% above | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE TechFee | $84.00 | $168.00 | $19.31–$117.60 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE IM INJECTION SINGLE CHARGE | $84.00 | $168.00 | $19.31–$117.60 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Administration | $84.00 | $168.00 | $19.31–$117.60 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Initial Immunization Charge | $84.00 | $168.00 | $19.31–$117.60 | — | 50% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE IM INJECTION EA ADDL CHARGE | $73.00 | $146.00 | $14.92–$102.20 | 166% above | 50% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Administration Each Addl | $73.00 | $146.00 | $14.92–$102.20 | 166% above | 50% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Administration Each Addl | $73.00 | $146.00 | $14.92–$102.20 | — | 50% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 VACCINE IM INJECTION EA ADDL CHARGE | $73.00 | $146.00 | $14.92–$102.20 | — | 50% |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.