Hospital Jackson, MS

Merit Health Central

Merit Health Central in Jackson, MS publishes cash prices for 304 common procedures listed here, from its own machine-readable price file updated Dec 18, 2024. Compared with other hospitals in the state, its outpatient cash prices are above the Mississippi median for 287 of 299 procedures and below it for 12. Select a procedure to compare it with other hospitals nearby.

1850 Chadwick Dr, Jackson, MS 39204 Collected Nov 12, 2026 Source price file Check a bill from this hospital

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 1 action for a hospital named Merit Health Central in Jackson, MS:

Apr 17, 2025 Met requirements

Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Mississippi	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen WWO	$2,525.85	$10,103.40	$136.13–$9,093.06	123% above	75%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen WWO	$2,525.85	$10,103.40	$1,040.65–$9,093.06	—	75%
Abdominal X-ray, 2 views CPT 74019 XR Abd w Decub or Upright DR	$181.71	$726.84	$21.64–$726.84	14% above	75%
Abdominal X-ray, 2 views inpatient CPT 74019 XR Abd w Decub or Upright DR	$181.71	$726.84	$74.86–$654.16	—	75%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 XR Ankle Complete Min 3 V Bilateral DR	$506.79	$2,027.16	$23.58–$2,027.16	—	75%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete Min 3 V Left DR	$288.63	$1,154.52	$23.58–$1,154.52	134% above	75%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete Min 3 V Right DR	$288.63	$1,154.52	$23.58–$1,154.52	134% above	75%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 XR Ankle Complete Min 3 V Bilateral DR	$506.79	$2,027.16	$208.80–$1,824.44	—	75%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete Min 3 V Left DR	$288.63	$1,154.52	$118.92–$1,039.07	—	75%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete Min 3 V Right DR	$288.63	$1,154.52	$118.92–$1,039.07	—	75%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 US LE Arterial Doppler Single Lvl Bilat	$1,144.53	$4,578.12	$94.64–$4,578.12	—	75%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 US LE Arterial Doppler Single Lvl Bilat	$1,144.53	$4,578.12	$471.55–$4,120.31	—	75%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder Right WO	$1,631.88	$6,527.52	$81.46–$6,527.52	113% above	75%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow Left WO	$1,631.88	$6,527.52	$81.46–$6,527.52	113% above	75%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow Right WO	$1,631.88	$6,527.52	$81.46–$6,527.52	113% above	75%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm Left WO	$1,631.88	$6,527.52	$81.46–$6,527.52	113% above	75%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm Right WO	$1,631.88	$6,527.52	$81.46–$6,527.52	113% above	75%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand Left WO	$1,631.88	$6,527.52	$81.46–$6,527.52	113% above	75%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand Right WO	$1,631.88	$6,527.52	$81.46–$6,527.52	113% above	75%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus Left WO	$1,631.88	$6,527.52	$81.46–$6,527.52	113% above	75%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus Right WO	$1,631.88	$6,527.52	$81.46–$6,527.52	113% above	75%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder Left WO	$1,631.88	$6,527.52	$81.46–$6,527.52	113% above	75%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist Left WO	$1,631.88	$6,527.52	$81.46–$6,527.52	113% above	75%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist Right WO	$1,631.88	$6,527.52	$81.46–$6,527.52	113% above	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand Right WO	$1,631.88	$6,527.52	$672.33–$5,874.77	—	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Humerus Left WO	$1,631.88	$6,527.52	$672.33–$5,874.77	—	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand Left WO	$1,631.88	$6,527.52	$672.33–$5,874.77	—	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Humerus Right WO	$1,631.88	$6,527.52	$672.33–$5,874.77	—	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Forearm Right WO	$1,631.88	$6,527.52	$672.33–$5,874.77	—	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder Left WO	$1,631.88	$6,527.52	$672.33–$5,874.77	—	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow Left WO	$1,631.88	$6,527.52	$672.33–$5,874.77	—	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist Right WO	$1,631.88	$6,527.52	$672.33–$5,874.77	—	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow Right WO	$1,631.88	$6,527.52	$672.33–$5,874.77	—	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Forearm Left WO	$1,631.88	$6,527.52	$672.33–$5,874.77	—	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder Right WO	$1,631.88	$6,527.52	$672.33–$5,874.77	—	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist Left WO	$1,631.88	$6,527.52	$672.33–$5,874.77	—	75%
Barium swallow (esophagus X-ray with contrast) CPT 74220 RF Esophagus Gastrografin	$565.11	$2,260.44	$57.74–$2,260.44	155% above	75%
Barium swallow (esophagus X-ray with contrast) CPT 74220 RF Esophagus Barium	$565.11	$2,260.44	$57.74–$2,260.44	155% above	75%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 RF Esophagus Barium	$565.11	$2,260.44	$232.83–$2,034.40	—	75%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 RF Esophagus Gastrografin	$565.11	$2,260.44	$232.83–$2,034.40	—	75%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone and or Joint Whole Body Scan 1 - NM Bone	$1,868.94	$7,475.76	$227.11–$7,475.76	188% above	75%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone and or Joint Whole Body Scan 1 - NM Bone	$1,868.94	$7,475.76	$770.00–$6,728.18	—	75%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Left	$505.98	$2,023.92	$81.46–$2,023.92	174% above	75%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Right	$505.98	$2,023.92	$81.46–$2,023.92	174% above	75%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Left	$505.98	$2,023.92	$208.46–$1,821.53	—	75%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Right	$505.98	$2,023.92	$208.46–$1,821.53	—	75%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Left CM	$468.50	$1,874.00	$67.32–$1,874.00	199% above	75%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Right CM	$468.50	$1,874.00	$67.32–$1,874.00	199% above	75%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Left	$505.98	$2,023.92	$67.32–$2,023.92	222% above	75%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Right	$505.98	$2,023.92	$67.32–$2,023.92	222% above	75%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Right CM	$468.50	$1,874.00	$193.02–$1,686.60	—	75%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Left CM	$468.50	$1,874.00	$193.02–$1,686.60	—	75%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Left	$505.98	$2,023.92	$208.46–$1,821.53	—	75%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Right	$505.98	$2,023.92	$208.46–$1,821.53	—	75%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA Abdomen Pelvis	$5,913.27	$23,653.08	$284.93–$21,287.77	261% above	75%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA Abdomen Pelvis	$5,913.27	$23,653.08	$2,436.27–$21,287.77	—	75%
CT angiography (CTA) of the head CPT 70496 CTA Head	$2,470.23	$9,880.92	$136.13–$8,892.83	133% above	75%
CT angiography (CTA) of the head CPT 70496 CTA Head Stroke	$2,470.23	$9,880.92	$136.13–$8,892.83	133% above	75%
CT angiography (CTA) of the head inpatient CPT 70496 CTA Head	$2,470.23	$9,880.92	$1,017.73–$8,892.83	—	75%
CT angiography (CTA) of the head inpatient CPT 70496 CTA Head Stroke	$2,470.23	$9,880.92	$1,017.73–$8,892.83	—	75%
CT angiography (CTA) of the neck CPT 70498 CTA Neck	$2,738.88	$10,955.52	$136.13–$9,859.97	153% above	75%
CT angiography (CTA) of the neck CPT 70498 CTA Neck Stroke	$2,738.88	$10,955.52	$136.13–$9,859.97	153% above	75%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA Neck Stroke	$2,738.88	$10,955.52	$1,128.42–$9,859.97	—	75%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA Neck	$2,738.88	$10,955.52	$1,128.42–$9,859.97	—	75%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest for PE	$2,664.63	$10,658.52	$136.13–$9,592.67	133% above	75%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest	$2,664.63	$10,658.52	$136.13–$9,592.67	133% above	75%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA Chest	$2,664.63	$10,658.52	$1,097.83–$9,592.67	—	75%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA Chest for PE	$2,664.63	$10,658.52	$1,097.83–$9,592.67	—	75%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Heart WO	$108.81	$435.24	$44.83–$435.24	37% above	75%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Heart WO	$108.81	$435.24	$44.83–$391.72	—	75%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen Pelvis WO	$4,071.87	$16,287.48	$161.99–$14,658.73	211% above	75%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen Pelvis Stone Protocol	$4,071.87	$16,287.48	$161.99–$14,658.73	211% above	75%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen Pelvis Stone Protocol	$4,071.87	$16,287.48	$1,677.61–$14,658.73	—	75%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen Pelvis WO	$4,071.87	$16,287.48	$1,677.61–$14,658.73	—	75%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen Pelvis W	$4,472.55	$17,890.20	$265.29–$16,101.18	178% above	75%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen Pelvis W	$4,472.55	$17,890.20	$1,842.69–$16,101.18	—	75%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen Pelvis WWO	$5,045.49	$20,181.96	$284.93–$18,163.76	184% above	75%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen Pelvis WWO	$5,045.49	$20,181.96	$2,078.74–$18,163.76	—	75%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen W	$2,571.48	$10,285.92	$136.13–$9,257.33	166% above	75%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen W	$2,571.48	$10,285.92	$1,059.45–$9,257.33	—	75%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen WO	$2,345.76	$9,383.04	$81.46–$8,512.68	189% above	75%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen WO	$2,345.76	$9,383.04	$966.45–$8,444.74	—	75%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial WO	$1,104.84	$4,419.36	$81.46–$4,419.36	68% above	75%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus WO	$1,104.84	$4,419.36	$81.46–$4,419.36	68% above	75%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial WO	$1,104.84	$4,419.36	$455.19–$3,977.42	—	75%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus WO	$1,104.84	$4,419.36	$455.19–$3,977.42	—	75%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head Stroke Alert	$1,710.72	$6,842.88	$81.46–$6,842.88	128% above	75%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain WO	$1,710.72	$6,842.88	$81.46–$6,842.88	128% above	75%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head Stroke Alert	$1,710.72	$6,842.88	$704.82–$6,158.59	—	75%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain WO	$1,710.72	$6,842.88	$704.82–$6,158.59	—	75%
CT scan of the head with contrast CPT 70460 CT Head or Brain W	$1,686.69	$6,746.76	$130.30–$6,746.76	81% above	75%
CT scan of the head with contrast inpatient CPT 70460 CT Head or Brain W	$1,686.69	$6,746.76	$694.92–$6,072.08	—	75%
CT scan of the head without and with contrast CPT 70470 CT Head or Brain WWO	$2,205.36	$8,821.44	$136.13–$8,512.68	110% above	75%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head or Brain WWO	$2,205.36	$8,821.44	$908.61–$7,939.30	—	75%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar WO	$2,984.04	$11,936.16	$81.46–$10,742.54	239% above	75%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar WO	$2,984.04	$11,936.16	$1,229.42–$10,742.54	—	75%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical WO	$3,030.75	$12,123.00	$81.46–$10,910.70	247% above	75%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical WO	$3,030.75	$12,123.00	$1,248.67–$10,910.70	—	75%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis W	$2,138.40	$8,553.60	$136.13–$8,512.68	119% above	75%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis W	$2,138.40	$8,553.60	$881.02–$7,698.24	—	75%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Bilateral	$434.70	$1,738.80	$179.10–$1,738.80	—	75%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Duplex Bilateral	$434.70	$1,738.80	$179.10–$1,564.92	—	75%
Chest CT scan without and with contrast CPT 71270 CT Chest Diagnostic WWO	$3,226.23	$12,904.92	$136.13–$11,614.43	177% above	75%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest Diagnostic WWO	$3,226.23	$12,904.92	$1,329.21–$11,614.43	—	75%
Chest X-ray, 2 views CPT 71046 XR Chest 2 V DR	$349.38	$1,397.52	$28.75–$1,397.52	150% above	75%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 V DR	$349.38	$1,397.52	$143.94–$1,257.77	—	75%
Chest X-ray, single view CPT 71045 XR Chest 1 V Frontal CR	$214.65	$858.60	$21.95–$858.60	103% above	75%
Chest X-ray, single view CPT 71045 XR Chest 1 V Frontal DR	$214.65	$858.60	$21.95–$858.60	103% above	75%
Chest X-ray, single view CPT 71045 XR Chest 1 V Portable CR	$214.65	$858.60	$21.95–$858.60	103% above	75%
Chest X-ray, single view CPT 71045 XR Chest 1 V Portable DR	$214.65	$858.60	$21.95–$858.60	103% above	75%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 V Portable CR	$214.65	$858.60	$88.44–$772.74	—	75%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 V Frontal CR	$214.65	$858.60	$88.44–$772.74	—	75%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 V Frontal DR	$214.65	$858.60	$88.44–$772.74	—	75%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 V Portable DR	$214.65	$858.60	$88.44–$772.74	—	75%
Collarbone (clavicle) X-ray, complete both sides CPT 73000 XR Clavicle Bilateral DR	$506.79	$2,027.16	$20.53–$2,027.16	—	75%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Right DR	$253.26	$1,013.04	$20.53–$1,013.04	133% above	75%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Left DR	$253.26	$1,013.04	$20.53–$1,013.04	133% above	75%
Collarbone (clavicle) X-ray, complete inpatient both sides CPT 73000 XR Clavicle Bilateral DR	$506.79	$2,027.16	$208.80–$1,824.44	—	75%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Left DR	$253.26	$1,013.04	$104.34–$911.74	—	75%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Right DR	$253.26	$1,013.04	$104.34–$911.74	—	75%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$708.75	$2,835.00	$81.46–$2,835.00	108% above	75%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete	$708.75	$2,835.00	$292.00–$2,551.50	—	75%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton	$445.50	$1,782.00	$51.28–$1,782.00	88% above	75%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Density DEXA Axial Skeleton	$445.50	$1,782.00	$183.55–$1,603.80	—	75%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US Pregnancy Complete w Detail	$832.68	$3,330.72	$115.00–$3,330.72	94% above	75%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US Pregnancy Complete w Detail	$832.68	$3,330.72	$343.06–$2,997.65	—	75%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest Diagnostic WO	$2,121.66	$8,486.64	$81.46–$8,486.64	160% above	75%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest Diagnostic WO	$2,121.66	$8,486.64	$874.12–$7,637.98	—	75%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest Diagnostic W	$2,563.11	$10,252.44	$136.13–$9,227.20	156% above	75%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest Diagnostic W	$2,563.11	$10,252.44	$1,056.00–$9,227.20	—	75%
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Diagnostic Bilateral WWO CAD CM	$328.75	$1,315.00	$65.00–$1,315.00	—	75%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Diagnostic Bilateral WWO CAD CM	$328.75	$1,315.00	$135.45–$1,183.50	—	75%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Diagnostic Right WWO CAD CM	$291.60	$1,166.40	$65.00–$1,166.40	127% above	75%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Diagnostic Left WWO CAD CM	$291.60	$1,166.40	$65.00–$1,166.40	127% above	75%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Diagnostic Right WWO CAD CM	$291.60	$1,166.40	$120.14–$1,049.76	—	75%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Diagnostic Left WWO CAD CM	$291.60	$1,166.40	$120.14–$1,049.76	—	75%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US LE Arterial Duplex Bilateral	$1,456.11	$5,824.44	$181.55–$5,824.44	—	75%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US LE Arterial Bypass Grafts Comp Bilat	$1,456.11	$5,824.44	$181.55–$5,824.44	—	75%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US LE Arterial Duplex Bilateral	$1,456.11	$5,824.44	$599.92–$5,242.00	—	75%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US LE Arterial Bypass Grafts Comp Bilat	$1,456.11	$5,824.44	$599.92–$5,242.00	—	75%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LE Venous Duplex Bilateral	$1,302.48	$5,209.92	$157.95–$5,209.92	—	75%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US LE Venous Duplex Bilateral	$1,302.48	$5,209.92	$536.62–$4,688.93	—	75%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 NI Echo TTE 2D Complete w Color Doppler	$1,625.40	$6,501.60	$168.33–$6,501.60	69% above	75%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 NI Echo TTE 2D Complete w Color Doppler	$1,625.40	$6,501.60	$669.66–$5,851.44	—	75%
Elbow X-ray, 2 views both sides CPT 73070 XR Elbow 2 V Bilateral DR	$503.82	$2,015.28	$17.75–$2,015.28	—	75%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 V Right DR	$251.91	$1,007.64	$17.75–$1,007.64	116% above	75%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 V Left DR	$251.91	$1,007.64	$17.75–$1,007.64	116% above	75%
Elbow X-ray, 2 views inpatient both sides CPT 73070 XR Elbow 2 V Bilateral DR	$503.82	$2,015.28	$207.57–$1,813.75	—	75%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 V Right DR	$251.91	$1,007.64	$103.79–$906.88	—	75%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 V Left DR	$251.91	$1,007.64	$103.79–$906.88	—	75%
Elbow X-ray, complete, 3 or more views both sides CPT 73080 XR Elbow Complete Min 3 V Bilateral DR	$486.54	$1,946.16	$20.53–$1,946.16	—	75%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete Min 3 V Right DR - XR Elbow Com	$244.35	$977.40	$20.53–$977.40	120% above	75%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete Min 3 V Left DR	$244.35	$977.40	$20.53–$977.40	120% above	75%
Elbow X-ray, complete, 3 or more views inpatient both sides CPT 73080 XR Elbow Complete Min 3 V Bilateral DR	$486.54	$1,946.16	$200.45–$1,751.54	—	75%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Complete Min 3 V Left DR	$244.35	$977.40	$100.67–$879.66	—	75%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Complete Min 3 V Right DR - XR Elbow Com	$244.35	$977.40	$100.67–$879.66	—	75%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Mastoids WO	$940.14	$3,760.56	$81.46–$3,760.56	34% above	75%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Orbit WO	$940.14	$3,760.56	$81.46–$3,760.56	34% above	75%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Sella WO	$940.14	$3,760.56	$81.46–$3,760.56	34% above	75%
Eye socket (orbit) CT scan without contrast CPT 70480 CT IAC Temporal WO	$940.14	$3,760.56	$81.46–$3,760.56	34% above	75%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Sella WO	$940.14	$3,760.56	$387.34–$3,384.50	—	75%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Orbit WO	$940.14	$3,760.56	$387.34–$3,384.50	—	75%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Mastoids WO	$940.14	$3,760.56	$387.34–$3,384.50	—	75%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT IAC Temporal WO	$940.14	$3,760.56	$387.34–$3,384.50	—	75%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR Facial Bones Comp Minimum 3 V DR	$459.54	$1,838.16	$29.13–$1,838.16	202% above	75%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR Facial Bones Comp Minimum 3 V DR	$459.54	$1,838.16	$189.33–$1,654.34	—	75%
Forearm X-ray (radius and ulna), 2 views both sides CPT 73090 XR Forearm 2 V Bilateral DR	$506.79	$2,027.16	$18.03–$2,027.16	—	75%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 V Left DR	$254.61	$1,018.44	$18.03–$1,018.44	127% above	75%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 V Right DR	$254.61	$1,018.44	$18.03–$1,018.44	127% above	75%
Forearm X-ray (radius and ulna), 2 views inpatient both sides CPT 73090 XR Forearm 2 V Bilateral DR	$506.79	$2,027.16	$208.80–$1,824.44	—	75%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 V Right DR	$254.61	$1,018.44	$104.90–$916.60	—	75%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 V Left DR	$254.61	$1,018.44	$104.90–$916.60	—	75%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary System Scan 1	$1,725.84	$6,903.36	$249.45–$6,903.36	203% above	75%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary System Scan 1	$1,725.84	$6,903.36	$711.05–$6,213.02	—	75%
Hand X-ray, 2 views both sides CPT 73120 XR Hand 2 V Bilateral DR	$506.79	$2,027.16	$19.69–$2,027.16	—	75%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 V Right DR	$259.47	$1,037.88	$19.69–$1,037.88	132% above	75%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 V Left DR	$259.47	$1,037.88	$19.69–$1,037.88	132% above	75%
Hand X-ray, 2 views inpatient both sides CPT 73120 XR Hand 2 V Bilateral DR	$506.79	$2,027.16	$208.80–$1,824.44	—	75%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 V Left DR	$259.47	$1,037.88	$106.90–$934.09	—	75%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 V Right DR	$259.47	$1,037.88	$106.90–$934.09	—	75%
Heel bone (calcaneus) X-ray, 2 or more views both sides CPT 73650 XR Calcaneus Min 2 V Bilateral DR	$477.90	$1,911.60	$17.47–$1,911.60	—	75%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneus 2 V Right DR	$238.95	$955.80	$17.47–$955.80	114% above	75%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR XR Calcaneus 2 V Left DR	$238.95	$955.80	$17.47–$955.80	114% above	75%
Heel bone (calcaneus) X-ray, 2 or more views inpatient both sides CPT 73650 XR Calcaneus Min 2 V Bilateral DR	$477.90	$1,911.60	$196.89–$1,720.44	—	75%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR XR Calcaneus 2 V Left DR	$238.95	$955.80	$98.45–$860.22	—	75%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneus 2 V Right DR	$238.95	$955.80	$98.45–$860.22	—	75%
Knee X-ray, 3 views both sides CPT 73562 XR Knee 3 V Bilateral DR	$559.17	$2,236.68	$26.63–$2,236.68	—	75%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 V Right DR	$281.07	$1,124.28	$26.63–$1,124.28	113% above	75%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 V Left DR	$281.07	$1,124.28	$26.63–$1,124.28	113% above	75%
Knee X-ray, 3 views inpatient both sides CPT 73562 XR Knee 3 V Bilateral DR	$559.17	$2,236.68	$230.38–$2,013.01	—	75%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 V Right DR	$281.07	$1,124.28	$115.80–$1,011.85	—	75%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 V Left DR	$281.07	$1,124.28	$115.80–$1,011.85	—	75%
Knee X-ray, complete, 4 or more views both sides CPT 73564 XR Knee Complete 4 V Bilateral DR	$593.73	$2,374.92	$30.25–$2,374.92	—	75%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Complete 4 V Left DR	$296.73	$1,186.92	$30.25–$1,186.92	111% above	75%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Complete 4 V Right DR	$296.73	$1,186.92	$30.25–$1,186.92	111% above	75%
Knee X-ray, complete, 4 or more views inpatient both sides CPT 73564 XR Knee Complete 4 V Bilateral DR	$593.73	$2,374.92	$244.62–$2,137.43	—	75%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Complete 4 V Left DR	$296.73	$1,186.92	$122.25–$1,068.23	—	75%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Complete 4 V Right DR	$296.73	$1,186.92	$122.25–$1,068.23	—	75%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Ankle Bilateral WO	$2,863.08	$11,452.32	$81.46–$10,307.09	—	75%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Hip Bilateral WO	$2,863.08	$11,452.32	$81.46–$10,307.09	—	75%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Foot Bilateral WO	$2,863.08	$11,452.32	$81.46–$10,307.09	—	75%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Tibia Fibula Bilateral WO	$2,863.08	$11,452.32	$81.46–$10,307.09	—	75%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Knee Bilateral WO	$2,863.08	$11,452.32	$81.46–$10,307.09	—	75%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle Left WO	$1,465.02	$5,860.08	$81.46–$5,860.08	93% above	75%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia Fibula Right WO	$1,465.02	$5,860.08	$81.46–$5,860.08	93% above	75%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot Right WO	$1,465.02	$5,860.08	$81.46–$5,860.08	93% above	75%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot Left WO	$1,465.02	$5,860.08	$81.46–$5,860.08	93% above	75%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Hip Right WO	$1,465.02	$5,860.08	$81.46–$5,860.08	93% above	75%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur Right WO	$1,465.02	$5,860.08	$81.46–$5,860.08	93% above	75%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur Left WO	$1,465.02	$5,860.08	$81.46–$5,860.08	93% above	75%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle Right WO	$1,465.02	$5,860.08	$81.46–$5,860.08	93% above	75%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee Left WO	$1,465.02	$5,860.08	$81.46–$5,860.08	93% above	75%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee Right WO	$1,465.02	$5,860.08	$81.46–$5,860.08	93% above	75%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Hip Left WO	$1,465.02	$5,860.08	$81.46–$5,860.08	93% above	75%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia Fibula Left WO	$1,465.02	$5,860.08	$81.46–$5,860.08	93% above	75%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Ankle Bilateral WO	$2,863.08	$11,452.32	$1,179.59–$10,307.09	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Knee Bilateral WO	$2,863.08	$11,452.32	$1,179.59–$10,307.09	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Hip Bilateral WO	$2,863.08	$11,452.32	$1,179.59–$10,307.09	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Foot Bilateral WO	$2,863.08	$11,452.32	$1,179.59–$10,307.09	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Tibia Fibula Bilateral WO	$2,863.08	$11,452.32	$1,179.59–$10,307.09	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Hip Left WO	$1,465.02	$5,860.08	$603.59–$5,274.07	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle Right WO	$1,465.02	$5,860.08	$603.59–$5,274.07	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Femur Left WO	$1,465.02	$5,860.08	$603.59–$5,274.07	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Femur Right WO	$1,465.02	$5,860.08	$603.59–$5,274.07	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot Left WO	$1,465.02	$5,860.08	$603.59–$5,274.07	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot Right WO	$1,465.02	$5,860.08	$603.59–$5,274.07	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Hip Right WO	$1,465.02	$5,860.08	$603.59–$5,274.07	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Tibia Fibula Right WO	$1,465.02	$5,860.08	$603.59–$5,274.07	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Tibia Fibula Left WO	$1,465.02	$5,860.08	$603.59–$5,274.07	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee Right WO	$1,465.02	$5,860.08	$603.59–$5,274.07	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee Left WO	$1,465.02	$5,860.08	$603.59–$5,274.07	—	75%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle Left WO	$1,465.02	$5,860.08	$603.59–$5,274.07	—	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Pylorus	$539.19	$2,156.76	$74.39–$2,156.76	102% above	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Pancreas	$539.19	$2,156.76	$74.39–$2,156.76	102% above	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Liver	$539.19	$2,156.76	$74.39–$2,156.76	102% above	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Spleen	$539.19	$2,156.76	$74.39–$2,156.76	102% above	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Gallbladder	$539.19	$2,156.76	$74.39–$2,156.76	102% above	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited	$539.19	$2,156.76	$74.39–$2,156.76	102% above	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Spleen	$539.19	$2,156.76	$222.15–$1,941.08	—	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Limited	$539.19	$2,156.76	$222.15–$1,941.08	—	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Gallbladder	$539.19	$2,156.76	$222.15–$1,941.08	—	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Liver	$539.19	$2,156.76	$222.15–$1,941.08	—	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Pancreas	$539.19	$2,156.76	$222.15–$1,941.08	—	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Pylorus	$539.19	$2,156.76	$222.15–$1,941.08	—	75%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Non Vascular Limited Rt	$743.85	$2,975.40	$54.99–$2,975.40	277% above	75%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Non Vascular Limited Lt	$743.85	$2,975.40	$54.99–$2,975.40	277% above	75%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Non Vascular Limited Rt	$743.85	$2,975.40	$306.47–$2,677.86	—	75%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Non Vascular Limited Lt	$743.85	$2,975.40	$306.47–$2,677.86	—	75%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Low Dose Cancer Screening WO	$95.04	$380.16	$39.16–$400.00	47% below	75%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Low Dose Cncr Scrn Rtn Annual WO	$95.04	$380.16	$39.16–$400.00	47% below	75%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Low Dose Cncr Scrn Rtn Annual WO	$95.04	$380.16	$39.16–$342.14	—	75%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Low Dose Cancer Screening WO	$95.04	$380.16	$39.16–$342.14	—	75%
Lower leg X-ray (tibia and fibula), 2 views both sides CPT 73590 XR Tibia Fibula Bilateral DR	$506.79	$2,027.16	$19.97–$2,027.16	—	75%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia Fibula Left DR	$287.55	$1,150.20	$19.97–$1,150.20	130% above	75%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia Fibula Right DR	$287.55	$1,150.20	$19.97–$1,150.20	130% above	75%
Lower leg X-ray (tibia and fibula), 2 views inpatient both sides CPT 73590 XR Tibia Fibula Bilateral DR	$506.79	$2,027.16	$208.80–$1,824.44	—	75%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia Fibula Right DR	$287.55	$1,150.20	$118.47–$1,035.18	—	75%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia Fibula Left DR	$287.55	$1,150.20	$118.47–$1,035.18	—	75%
MR angiography (MRA) of the head without contrast CPT 70544 MRA Head WO	$1,183.68	$4,734.72	$181.55–$4,734.72	3% above	75%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA Head WO	$1,183.68	$4,734.72	$487.68–$4,261.25	—	75%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip Right WO	$1,767.69	$7,070.76	$177.93–$7,070.76	57% above	75%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip Left WO	$1,767.69	$7,070.76	$177.93–$7,070.76	57% above	75%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle Left WO	$1,767.69	$7,070.76	$177.93–$7,070.76	57% above	75%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee Left WO	$1,767.69	$7,070.76	$177.93–$7,070.76	57% above	75%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee Right WO	$1,767.69	$7,070.76	$177.93–$7,070.76	57% above	75%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle Right WO	$1,767.69	$7,070.76	$177.93–$7,070.76	57% above	75%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle Left WO	$1,767.69	$7,070.76	$728.29–$6,363.68	—	75%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle Right WO	$1,767.69	$7,070.76	$728.29–$6,363.68	—	75%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip Left WO	$1,767.69	$7,070.76	$728.29–$6,363.68	—	75%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip Right WO	$1,767.69	$7,070.76	$728.29–$6,363.68	—	75%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee Left WO	$1,767.69	$7,070.76	$728.29–$6,363.68	—	75%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee Right WO	$1,767.69	$7,070.76	$728.29–$6,363.68	—	75%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle Right WWO	$3,567.51	$14,270.04	$284.93–$12,843.04	118% above	75%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle Left WWO	$3,567.51	$14,270.04	$284.93–$12,843.04	118% above	75%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip Right WWO	$3,567.51	$14,270.04	$284.93–$12,843.04	118% above	75%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip Left WWO	$3,567.51	$14,270.04	$284.93–$12,843.04	118% above	75%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee Left WWO	$3,567.51	$14,270.04	$284.93–$12,843.04	118% above	75%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee Right WWO	$3,567.51	$14,270.04	$284.93–$12,843.04	118% above	75%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee Right WWO	$3,567.51	$14,270.04	$1,469.81–$12,843.04	—	75%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle Right WWO	$3,567.51	$14,270.04	$1,469.81–$12,843.04	—	75%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip Left WWO	$3,567.51	$14,270.04	$1,469.81–$12,843.04	—	75%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee Left WWO	$3,567.51	$14,270.04	$1,469.81–$12,843.04	—	75%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle Left WWO	$3,567.51	$14,270.04	$1,469.81–$12,843.04	—	75%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip Right WWO	$3,567.51	$14,270.04	$1,469.81–$12,843.04	—	75%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen WO	$2,915.19	$11,660.76	$172.45–$10,494.68	114% above	75%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen WO	$2,915.19	$11,660.76	$1,201.06–$10,494.68	—	75%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen WWO	$4,852.98	$19,411.92	$284.93–$17,470.73	152% above	75%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen WWO	$4,852.98	$19,411.92	$1,999.43–$17,470.73	—	75%
MRI of the brain, no contrast dye CPT 70551 MRI Brain WO	$2,641.25	$10,565.00	$172.79–$9,508.50	96% above	75%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain WO	$2,641.25	$10,565.00	$1,088.20–$9,508.50	—	75%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain WWO	$3,967.25	$15,869.00	$280.12–$14,282.10	90% above	75%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain WWO	$3,967.25	$15,869.00	$1,634.51–$14,282.10	—	75%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar WO	$3,158.46	$12,633.84	$168.63–$11,370.46	146% above	75%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar WO	$3,158.46	$12,633.84	$1,301.29–$11,370.46	—	75%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar WWO	$4,799.25	$19,197.00	$280.95–$17,277.30	147% above	75%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar WWO	$4,799.25	$19,197.00	$1,977.29–$17,277.30	—	75%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic WO	$3,165.48	$12,661.92	$167.80–$11,395.73	135% above	75%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic WO	$3,165.48	$12,661.92	$1,304.18–$11,395.73	—	75%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical WWO	$4,180.41	$16,721.64	$281.51–$15,049.48	125% above	75%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical WWO	$4,180.41	$16,721.64	$1,722.33–$15,049.48	—	75%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical WO	$3,513.51	$14,054.04	$168.07–$12,648.64	175% above	75%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical WO	$3,513.51	$14,054.04	$1,447.57–$12,648.64	—	75%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis WWO	$4,131.54	$16,526.16	$284.93–$14,873.54	135% above	75%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis WWO	$4,131.54	$16,526.16	$1,702.19–$14,873.54	—	75%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis WO	$3,035.07	$12,140.28	$181.55–$10,926.25	165% above	75%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis WO	$3,035.07	$12,140.28	$1,250.45–$10,926.25	—	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow Left WO	$1,968.30	$7,873.20	$178.21–$7,873.20	68% above	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist Left WO	$1,968.30	$7,873.20	$178.21–$7,873.20	68% above	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist Right WO	$1,968.30	$7,873.20	$178.21–$7,873.20	68% above	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder Right WO	$1,968.30	$7,873.20	$178.21–$7,873.20	68% above	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow Right WO	$1,968.30	$7,873.20	$178.21–$7,873.20	68% above	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder Left WO	$1,968.30	$7,873.20	$178.21–$7,873.20	68% above	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist Right WO	$1,968.30	$7,873.20	$810.94–$7,085.88	—	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder Right WO	$1,968.30	$7,873.20	$810.94–$7,085.88	—	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder Left WO	$1,968.30	$7,873.20	$810.94–$7,085.88	—	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist Left WO	$1,968.30	$7,873.20	$810.94–$7,085.88	—	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow Right WO	$1,968.30	$7,873.20	$810.94–$7,085.88	—	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow Left WO	$1,968.30	$7,873.20	$810.94–$7,085.88	—	75%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR Spine Cervical Minimum 4 V DR	$455.76	$1,823.04	$34.13–$1,823.04	140% above	75%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR Spine Cervical Minimum 4 V DR	$455.76	$1,823.04	$187.77–$1,640.74	—	75%
Neck soft tissue CT scan with contrast CPT 70491 CT Soft Tissue Neck W	$2,189.43	$8,757.72	$136.13–$8,512.68	130% above	75%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Soft Tissue Neck W	$2,189.43	$8,757.72	$902.05–$7,881.95	—	75%
Neck soft tissue CT scan without contrast CPT 70490 CT Soft Tissue Neck WO	$1,835.19	$7,340.76	$81.46–$7,340.76	136% above	75%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Soft Tissue Neck WO	$1,835.19	$7,340.76	$756.10–$6,606.68	—	75%
Neck soft tissue X-ray CPT 70360 XR Neck Soft Tissue DR	$330.21	$1,320.84	$18.86–$1,320.84	206% above	75%
Neck soft tissue X-ray inpatient CPT 70360 XR Neck Soft Tissue DR	$330.21	$1,320.84	$136.05–$1,188.76	—	75%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Perfusion Rest Multi 1	$4,706.37	$18,825.48	$365.90–$16,942.93	145% above	75%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Perfusion Stress Multi 1	$4,706.37	$18,825.48	$365.90–$16,942.93	145% above	75%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Perfusion RestStr Mult Sc1 - NM Myoc	$4,706.37	$18,825.48	$365.90–$16,942.93	145% above	75%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial Perfusion Stress Multi 1	$4,706.37	$18,825.48	$1,939.02–$16,942.93	—	75%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial Perfusion Rest Multi 1	$4,706.37	$18,825.48	$1,939.02–$16,942.93	—	75%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial Perfusion RestStr Mult Sc1 - NM Myoc	$4,706.37	$18,825.48	$1,939.02–$16,942.93	—	75%
Pelvic CT scan without contrast CPT 72192 CT Pelvis WO	$1,945.89	$7,783.56	$81.46–$7,783.56	141% above	75%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis WO	$1,945.89	$7,783.56	$801.71–$7,005.20	—	75%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvis Non OB FU	$493.83	$1,975.32	$42.73–$1,975.32	134% above	75%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvis Non OB FU	$493.83	$1,975.32	$203.46–$1,777.79	—	75%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 76856 US-PELVIS NON OB	$778.95	$3,115.80	$81.46–$3,115.80	160% above	75%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Non OB Complete	$778.95	$3,115.80	$81.46–$3,115.80	160% above	75%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis Non OB Complete	$778.95	$3,115.80	$320.93–$2,804.22	—	75%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 76856 US-PELVIS NON OB	$778.95	$3,115.80	$320.93–$2,804.22	—	75%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pregnancy After 1st Trimester Transabdominal	$828.36	$3,313.44	$81.46–$3,313.44	140% above	75%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pregnancy After 1st Trimester Transabdominal	$828.36	$3,313.44	$341.28–$2,982.10	—	75%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Pregnancy 1st Trimester Transabdominal	$587.79	$2,351.16	$81.46–$2,351.16	95% above	75%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Pregnancy 1st Trimester Transabdominal	$587.79	$2,351.16	$242.17–$2,116.04	—	75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pregnancy Limited	$250.56	$1,002.24	$69.59–$1,002.24	19% above	75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Pregnancy Limited	$250.56	$1,002.24	$103.23–$902.02	—	75%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 V Right DR	$342.90	$1,371.60	$21.91–$1,371.60	182% above	75%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 V Left DR	$342.90	$1,371.60	$21.91–$1,371.60	182% above	75%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 V Right DR	$342.90	$1,371.60	$141.27–$1,234.44	—	75%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 V Left DR	$342.90	$1,371.60	$141.27–$1,234.44	—	75%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w PA Chest Right Min 3 V DR	$503.01	$2,012.04	$24.69–$2,012.04	220% above	75%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w PA Chest Left Min 3 V DR	$503.01	$2,012.04	$24.69–$2,012.04	220% above	75%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs w PA Chest Left Min 3 V DR	$503.01	$2,012.04	$207.24–$1,810.84	—	75%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs w PA Chest Right Min 3 V DR	$503.01	$2,012.04	$207.24–$1,810.84	—	75%
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Screen Bilateral WWO CAD CM	$234.09	$936.36	$65.00–$936.36	—	75%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Screen Left WWO CAD CM	$234.09	$936.36	$65.00–$936.36	36% above	75%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Screen Right WWO CAD CM	$234.09	$936.36	$65.00–$936.36	36% above	75%
Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Screen Bilateral WWO CAD CM	$234.09	$936.36	$96.45–$842.72	—	75%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Screen Right WWO CAD CM	$234.09	$936.36	$96.45–$842.72	—	75%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Screen Left WWO CAD CM	$234.09	$936.36	$96.45–$842.72	—	75%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 XR Shoulder Comp Min 2 V Bilateral DR	$506.79	$2,027.16	$21.64–$2,027.16	—	75%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete Min 2 V Right DR	$259.47	$1,037.88	$21.64–$1,037.88	91% above	75%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete Min 2 V Left DR	$259.47	$1,037.88	$21.64–$1,037.88	91% above	75%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 XR Shoulder Comp Min 2 V Bilateral DR	$506.79	$2,027.16	$208.80–$1,824.44	—	75%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete Min 2 V Left DR	$259.47	$1,037.88	$106.90–$934.09	—	75%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete Min 2 V Right DR	$259.47	$1,037.88	$106.90–$934.09	—	75%
Sinus X-ray, complete, 3 or more views CPT 70220 XR Sinuses Paranasal Complete DR	$459.54	$1,838.16	$22.75–$1,838.16	223% above	75%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR Sinuses Paranasal Complete DR	$459.54	$1,838.16	$189.33–$1,654.34	—	75%
Skull X-ray, fewer than 4 views CPT 70250 XR Skull Less Than 4 V DR	$223.02	$892.08	$22.75–$892.08	62% above	75%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR Skull Less Than 4 V DR	$223.02	$892.08	$91.88–$802.87	—	75%
Swallow study (modified barium swallow, video X-ray) CPT 74230 RF Modified Barium Swallow	$748.98	$2,995.92	$83.01–$2,995.92	212% above	75%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 RF Modified Barium Swallow	$748.98	$2,995.92	$308.58–$2,696.33	—	75%
Thigh bone (femur) X-ray, 2 or more views both sides CPT 73552 XR Femur Minimum 2 Views Bilat DR	$494.91	$1,979.64	$22.47–$1,979.64	—	75%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur Minimum 2 Views Right DR	$247.32	$989.28	$22.47–$989.28	104% above	75%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur Minimum 2 Views Left DR	$247.32	$989.28	$22.47–$989.28	104% above	75%
Thigh bone (femur) X-ray, 2 or more views inpatient both sides CPT 73552 XR Femur Minimum 2 Views Bilat DR	$494.91	$1,979.64	$203.90–$1,781.68	—	75%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur Minimum 2 Views Right DR	$247.32	$989.28	$101.90–$890.35	—	75%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur Minimum 2 Views Left DR	$247.32	$989.28	$101.90–$890.35	—	75%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Spine Thoracic WO	$2,789.37	$11,157.48	$81.46–$10,041.73	216% above	75%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Spine Thoracic WO	$2,789.37	$11,157.48	$1,149.22–$10,041.73	—	75%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 2nd Digit Min 2 V Left DR	$258.93	$1,035.72	$19.14–$1,035.72	133% above	75%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 3rd Digit Min 2 V Right DR	$258.93	$1,035.72	$19.14–$1,035.72	133% above	75%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 4th Digit Min 2 V Left DR	$258.93	$1,035.72	$19.14–$1,035.72	133% above	75%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 4th Digit Min 2 V Right DR	$258.93	$1,035.72	$19.14–$1,035.72	133% above	75%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 5th Digit Min 2 V Left DR	$258.93	$1,035.72	$19.14–$1,035.72	133% above	75%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 5th Digit Min 2 V Right DR	$258.93	$1,035.72	$19.14–$1,035.72	133% above	75%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes Great Min 2 V Left DR	$258.93	$1,035.72	$19.14–$1,035.72	133% above	75%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes Great Min 2 V Right DR	$258.93	$1,035.72	$19.14–$1,035.72	133% above	75%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 2nd Digit Min 2 V Right DR	$258.93	$1,035.72	$19.14–$1,035.72	133% above	75%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 3rd Digit Min 2 V Left DR	$258.93	$1,035.72	$19.14–$1,035.72	133% above	75%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 3rd Digit Min 2 V Right DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes Great Min 2 V Left DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes Great Min 2 V Right DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 3rd Digit Min 2 V Left DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 4th Digit Min 2 V Left DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 2nd Digit Min 2 V Left DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 2nd Digit Min 2 V Right DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 4th Digit Min 2 V Right DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 5th Digit Min 2 V Left DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 5th Digit Min 2 V Right DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non OB	$778.14	$3,112.56	$81.46–$3,112.56	158% above	75%
Transvaginal pelvic ultrasound CPT 76830 76830 US-TRANSVAGINAL	$778.14	$3,112.56	$81.46–$3,112.56	158% above	75%
Transvaginal pelvic ultrasound inpatient CPT 76830 76830 US-TRANSVAGINAL	$778.14	$3,112.56	$320.59–$2,801.30	—	75%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non OB	$778.14	$3,112.56	$320.59–$2,801.30	—	75%
Transvaginal ultrasound during pregnancy CPT 76817 US Pregnancy Transvaginal	$763.83	$3,055.32	$79.65–$3,055.32	184% above	75%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Pregnancy Transvaginal	$763.83	$3,055.32	$314.70–$2,749.79	—	75%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$988.20	$3,952.80	$81.46–$3,952.80	155% above	75%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$988.20	$3,952.80	$407.14–$3,557.52	—	75%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum Contents	$837.81	$3,351.24	$81.46–$3,351.24	211% above	75%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum Contents	$837.81	$3,351.24	$345.18–$3,016.12	—	75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid	$647.73	$2,590.92	$81.46–$2,590.92	138% above	75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head Neck Soft Tissue	$647.73	$2,590.92	$81.46–$2,590.92	138% above	75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head Neck Soft Tissue	$647.73	$2,590.92	$266.86–$2,331.83	—	75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid	$647.73	$2,590.92	$266.86–$2,331.83	—	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 74240 FL-UPPER GI SINGLE	$907.20	$3,628.80	$70.79–$3,628.80	217% above	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 RF Upper GI w or wo KUB Gastrografin	$907.20	$3,628.80	$70.79–$3,628.80	217% above	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 RF Upper GI w or wo KUB Barium	$907.20	$3,628.80	$70.79–$3,628.80	217% above	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 RF Upper GI w or wo KUB Gastrografin	$907.20	$3,628.80	$373.77–$3,265.92	—	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 74240 FL-UPPER GI SINGLE	$907.20	$3,628.80	$373.77–$3,265.92	—	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 RF Upper GI w or wo KUB Barium	$907.20	$3,628.80	$373.77–$3,265.92	—	75%
Upper arm X-ray (humerus), 2 views both sides CPT 73060 XR Humerus Min 2 V Bilateral DR	$506.79	$2,027.16	$20.25–$2,027.16	—	75%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Min 2 V Left DR	$259.20	$1,036.80	$20.25–$1,036.80	114% above	75%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Min 2 V Right DR	$259.20	$1,036.80	$20.25–$1,036.80	114% above	75%
Upper arm X-ray (humerus), 2 views inpatient both sides CPT 73060 XR Humerus Min 2 V Bilateral DR	$506.79	$2,027.16	$208.80–$1,824.44	—	75%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Min 2 V Right DR	$259.20	$1,036.80	$106.79–$933.12	—	75%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Min 2 V Left DR	$259.20	$1,036.80	$106.79–$933.12	—	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Venous Duplex Right	$1,294.65	$5,178.60	$81.46–$5,178.60	289% above	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Venous Duplex Left	$1,294.65	$5,178.60	$81.46–$5,178.60	289% above	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Venous Duplex Right	$1,294.65	$5,178.60	$81.46–$5,178.60	289% above	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Venous Duplex Left	$1,294.65	$5,178.60	$81.46–$5,178.60	289% above	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Venous Duplex Left	$1,294.65	$5,178.60	$533.40–$4,660.74	—	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Venous Duplex Right	$1,294.65	$5,178.60	$533.40–$4,660.74	—	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Venous Duplex Left	$1,294.65	$5,178.60	$533.40–$4,660.74	—	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Venous Duplex Right	$1,294.65	$5,178.60	$533.40–$4,660.74	—	75%
Wrist X-ray, 2 views both sides CPT 73100 XR Wrist 2 V Bilateral DR	$460.62	$1,842.48	$21.64–$1,842.48	—	75%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 V Left DR	$230.31	$921.24	$21.64–$921.24	98% above	75%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 V Right DR	$230.31	$921.24	$21.64–$921.24	98% above	75%
Wrist X-ray, 2 views inpatient both sides CPT 73100 XR Wrist 2 V Bilateral DR	$460.62	$1,842.48	$189.78–$1,658.23	—	75%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 V Left DR	$230.31	$921.24	$94.89–$829.12	—	75%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 V Right DR	$230.31	$921.24	$94.89–$829.12	—	75%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 XR Wrist Complete Min 3 V Bilateral DR	$506.79	$2,027.16	$27.47–$2,027.16	—	75%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete Min 3 V Right DR	$258.93	$1,035.72	$27.47–$1,035.72	112% above	75%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete Min 3 V Left DR	$258.93	$1,035.72	$27.47–$1,035.72	112% above	75%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 XR Wrist Complete Min 3 V Bilateral DR	$506.79	$2,027.16	$208.80–$1,824.44	—	75%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete Min 3 V Left DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete Min 3 V Right DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Left w Pelvis 2 or 3 Views DR	$356.40	$1,425.60	$30.80–$1,425.60	201% above	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Right w Pelvis 2 or 3 Views DR	$356.40	$1,425.60	$30.80–$1,425.60	201% above	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Left w Pelvis 2 or 3 Views DR	$356.40	$1,425.60	$146.84–$1,283.04	—	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Right w Pelvis 2 or 3 Views DR	$356.40	$1,425.60	$146.84–$1,283.04	—	75%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen AP KUB DR	$445.50	$1,782.00	$18.03–$1,782.00	248% above	75%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen AP KUB DR	$445.50	$1,782.00	$183.55–$1,603.80	—	75%
X-ray of the ankle, 2 views both sides CPT 73600 XR Ankle 2 V Bilateral DR	$442.50	$1,770.00	$20.53–$1,770.00	—	75%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 V Left DR	$244.62	$978.48	$20.53–$978.48	114% above	75%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 V Right DR	$244.62	$978.48	$20.53–$978.48	114% above	75%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 XR Ankle 2 V Bilateral DR	$442.50	$1,770.00	$182.31–$1,593.00	—	75%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 V Right DR	$244.62	$978.48	$100.78–$880.63	—	75%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 V Left DR	$244.62	$978.48	$100.78–$880.63	—	75%
X-ray of the finger(s), 2 or more views both sides CPT 73140 XR Finger Min 2 V 5th Digit Bilateral DR	$437.40	$1,749.60	$26.36–$1,749.60	—	75%
X-ray of the finger(s), 2 or more views both sides CPT 73140 XR Finger Min 2 V 4th Digit Bilateral DR	$437.40	$1,749.60	$26.36–$1,749.60	—	75%
X-ray of the finger(s), 2 or more views both sides CPT 73140 XR Finger Min 2 V Thumb Bilateral DR	$437.40	$1,749.60	$26.36–$1,749.60	—	75%
X-ray of the finger(s), 2 or more views both sides CPT 73140 XR Finger Min 2 V 3rd Digit Bilateral DR	$437.40	$1,749.60	$26.36–$1,749.60	—	75%
X-ray of the finger(s), 2 or more views both sides CPT 73140 XR Finger Min 2 V 2nd Digit Bilateral DR	$437.40	$1,749.60	$26.36–$1,749.60	—	75%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V Thumb Left DR	$250.56	$1,002.24	$26.36–$1,002.24	132% above	75%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 3rd Digit Right DR	$250.56	$1,002.24	$26.36–$1,002.24	132% above	75%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V Thumb Right DR	$250.56	$1,002.24	$26.36–$1,002.24	132% above	75%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 3rd Digit Left DR	$250.56	$1,002.24	$26.36–$1,002.24	132% above	75%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 2nd Digit Right DR	$250.56	$1,002.24	$26.36–$1,002.24	132% above	75%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 4th Digit Left DR	$250.56	$1,002.24	$26.36–$1,002.24	132% above	75%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 2nd Digit Left DR	$250.56	$1,002.24	$26.36–$1,002.24	132% above	75%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 5th Digit Right DR	$250.56	$1,002.24	$26.36–$1,002.24	132% above	75%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 5th Digit Left DR	$250.56	$1,002.24	$26.36–$1,002.24	132% above	75%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Min 2 V 4th Digit Right DR	$250.56	$1,002.24	$26.36–$1,002.24	132% above	75%
X-ray of the finger(s), 2 or more views inpatient both sides CPT 73140 XR Finger Min 2 V 4th Digit Bilateral DR	$437.40	$1,749.60	$180.21–$1,574.64	—	75%
X-ray of the finger(s), 2 or more views inpatient both sides CPT 73140 XR Finger Min 2 V 2nd Digit Bilateral DR	$437.40	$1,749.60	$180.21–$1,574.64	—	75%
X-ray of the finger(s), 2 or more views inpatient both sides CPT 73140 XR Finger Min 2 V 3rd Digit Bilateral DR	$437.40	$1,749.60	$180.21–$1,574.64	—	75%
X-ray of the finger(s), 2 or more views inpatient both sides CPT 73140 XR Finger Min 2 V Thumb Bilateral DR	$437.40	$1,749.60	$180.21–$1,574.64	—	75%
X-ray of the finger(s), 2 or more views inpatient both sides CPT 73140 XR Finger Min 2 V 5th Digit Bilateral DR	$437.40	$1,749.60	$180.21–$1,574.64	—	75%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 4th Digit Left DR	$250.56	$1,002.24	$103.23–$902.02	—	75%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 2nd Digit Left DR	$250.56	$1,002.24	$103.23–$902.02	—	75%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 4th Digit Right DR	$250.56	$1,002.24	$103.23–$902.02	—	75%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 5th Digit Left DR	$250.56	$1,002.24	$103.23–$902.02	—	75%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 5th Digit Right DR	$250.56	$1,002.24	$103.23–$902.02	—	75%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V Thumb Left DR	$250.56	$1,002.24	$103.23–$902.02	—	75%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V Thumb Right DR	$250.56	$1,002.24	$103.23–$902.02	—	75%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 3rd Digit Right DR	$250.56	$1,002.24	$103.23–$902.02	—	75%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 3rd Digit Left DR	$250.56	$1,002.24	$103.23–$902.02	—	75%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Min 2 V 2nd Digit Right DR	$250.56	$1,002.24	$103.23–$902.02	—	75%
X-ray of the foot, 2 views both sides CPT 73620 XR Foot 2 V Bilateral DR	$460.62	$1,842.48	$17.75–$1,842.48	—	75%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 V Right DR	$230.31	$921.24	$17.75–$921.24	104% above	75%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 V Left DR	$230.31	$921.24	$17.75–$921.24	104% above	75%
X-ray of the foot, 2 views inpatient both sides CPT 73620 XR Foot 2 V Bilateral DR	$460.62	$1,842.48	$189.78–$1,658.23	—	75%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 V Right DR	$230.31	$921.24	$94.89–$829.12	—	75%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 V Left DR	$230.31	$921.24	$94.89–$829.12	—	75%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 XR Foot Complete Min 3 V Bilateral DR	$506.79	$2,027.16	$21.91–$2,027.16	—	75%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete Min 3 V Left DR	$287.82	$1,151.28	$21.91–$1,151.28	135% above	75%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete Min 3 V Right DR	$287.82	$1,151.28	$21.91–$1,151.28	135% above	75%
X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 XR Foot Complete Min 3 V Bilateral DR	$506.79	$2,027.16	$208.80–$1,824.44	—	75%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete Min 3 V Left DR	$287.82	$1,151.28	$118.58–$1,036.15	—	75%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete Min 3 V Right DR	$287.82	$1,151.28	$118.58–$1,036.15	—	75%
X-ray of the hand, 3 or more views both sides CPT 73130 XR Hand Complete Min 3 V Bilateral DR	$574.29	$2,297.16	$24.14–$2,297.16	—	75%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete Min 3 V Left DR	$294.30	$1,177.20	$24.14–$1,177.20	138% above	75%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete Min 3 V Right DR	$294.30	$1,177.20	$24.14–$1,177.20	138% above	75%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 XR Hand Complete Min 3 V Bilateral DR	$574.29	$2,297.16	$236.61–$2,067.44	—	75%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete Min 3 V Left DR	$294.30	$1,177.20	$121.25–$1,059.48	—	75%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete Min 3 V Right DR	$294.30	$1,177.20	$121.25–$1,059.48	—	75%
X-ray of the knee, 1 or 2 views both sides CPT 73560 XR Knee 1 or 2 V Bilateral DR	$506.79	$2,027.16	$21.91–$2,027.16	—	75%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 V Left DR	$258.93	$1,035.72	$21.91–$1,035.72	113% above	75%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 V Right DR	$258.93	$1,035.72	$21.91–$1,035.72	113% above	75%
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 XR Knee 1 or 2 V Bilateral DR	$506.79	$2,027.16	$208.80–$1,824.44	—	75%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 V Right DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 V Left DR	$258.93	$1,035.72	$106.68–$932.15	—	75%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 V DR	$248.67	$994.68	$24.41–$994.68	77% above	75%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 V DR	$248.67	$994.68	$102.45–$895.21	—	75%
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Minimum 4 V DR	$489.24	$1,956.96	$33.02–$1,956.96	136% above	75%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Minimum 4 V DR	$489.24	$1,956.96	$201.57–$1,761.26	—	75%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 V DR	$292.68	$1,170.72	$19.41–$1,170.72	126% above	75%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 V DR	$292.68	$1,170.72	$120.58–$1,053.65	—	75%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Comp Minimum 3 V DR	$243.27	$973.08	$24.69–$973.08	77% above	75%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones Comp Minimum 3 V DR	$243.27	$973.08	$100.23–$875.77	—	75%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 V DR	$322.92	$1,291.68	$24.14–$1,291.68	136% above	75%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical 2 or 3 V DR	$322.92	$1,291.68	$133.04–$1,162.51	—	75%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 V DR	$218.97	$875.88	$16.36–$875.88	63% above	75%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 V DR	$218.97	$875.88	$90.22–$788.29	—	75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum Coccyx Minimum 2 V DR	$253.26	$1,013.04	$20.25–$1,013.04	90% above	75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum Coccyx Minimum 2 V DR	$253.26	$1,013.04	$104.34–$911.74	—	75%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Mississippi	Off list
ACTH blood test CPT 82024 Adrenocorticotropic Hormone Plasma (LC)	$441.18	$1,764.72	$32.83–$1,764.72	217% above	75%
ACTH blood test inpatient CPT 82024 Adrenocorticotropic Hormone Plasma (LC)	$441.18	$1,764.72	$181.77–$1,588.25	—	75%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 84460 L550140 TRANSFERASE ALT 889	$107.25	$429.00	$4.51–$500.00	294% above	75%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase	$115.83	$463.32	$4.51–$500.00	326% above	75%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 84460 L550140 TRANSFERASE ALT 889	$107.25	$429.00	$44.19–$386.10	—	75%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine Aminotransferase	$115.83	$463.32	$47.72–$416.99	—	75%
AST (aspartate aminotransferase) enzyme test CPT 84450 84450 L550140 TRANSFERASE AST 889	$107.25	$429.00	$4.40–$500.00	293% above	75%
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate Aminotransferase	$115.83	$463.32	$4.40–$500.00	324% above	75%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 84450 L550140 TRANSFERASE AST 889	$107.25	$429.00	$44.19–$386.10	—	75%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Aspartate Aminotransferase	$115.83	$463.32	$47.72–$416.99	—	75%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel Acute	$494.91	$1,979.64	$40.49–$1,979.64	246% above	75%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Panel Acute	$494.91	$1,979.64	$203.90–$1,781.68	—	75%
Albumin blood test CPT 82040 Albumin Level	$88.56	$354.24	$4.21–$500.00	198% above	75%
Albumin blood test inpatient CPT 82040 Albumin Level	$88.56	$354.24	$36.49–$318.82	—	75%
Aldosterone blood test CPT 82088 Aldosterone LCMS Level LC	$265.68	$1,062.72	$34.64–$1,062.72	141% above	75%
Aldosterone blood test inpatient CPT 82088 Aldosterone LCMS Level LC	$265.68	$1,062.72	$109.46–$956.45	—	75%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$102.06	$408.24	$4.40–$500.00	241% above	75%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase	$102.06	$408.24	$42.05–$367.42	—	75%
Allergy blood test, specific IgE, per allergen CPT 86003 F001-IgE Egg White LC	$8.37	$33.48	$3.45–$500.00	35% below	75%
Allergy blood test, specific IgE, per allergen CPT 86003 F004-IgE Wheat LC	$8.37	$33.48	$3.45–$500.00	35% below	75%
Allergy blood test, specific IgE, per allergen CPT 86003 F014-IgE Soybean LC	$8.37	$33.48	$3.45–$500.00	35% below	75%
Allergy blood test, specific IgE, per allergen CPT 86003 F013-IgE Peanut LC	$8.37	$33.48	$3.45–$500.00	35% below	75%
Allergy blood test, specific IgE, per allergen CPT 86003 F002-IgE Milk (Cow) LC	$8.37	$33.48	$3.45–$500.00	35% below	75%
Allergy blood test, specific IgE, per allergen CPT 86003 86003 L602633 ALG IGE QT	$8.37	$33.48	$3.45–$500.00	35% below	75%
Allergy blood test, specific IgE, per allergen CPT 86003 F075-IgE Egg (Yolk) LC	$8.37	$33.48	$3.45–$500.00	35% below	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F075-IgE Egg (Yolk) LC	$8.37	$33.48	$3.45–$30.13	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F002-IgE Milk (Cow) LC	$8.37	$33.48	$3.45–$30.13	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F004-IgE Wheat LC	$8.37	$33.48	$3.45–$30.13	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F001-IgE Egg White LC	$8.37	$33.48	$3.45–$30.13	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F014-IgE Soybean LC	$8.37	$33.48	$3.45–$30.13	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003 L602633 ALG IGE QT	$8.37	$33.48	$3.45–$30.13	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 F013-IgE Peanut LC	$8.37	$33.48	$3.45–$30.13	—	75%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein Tumor Marker (LC)	$131.49	$525.96	$9.44–$525.96	161% above	75%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha Fetoprotein Tumor Marker (LC)	$131.49	$525.96	$54.17–$473.36	—	75%
Ammonia blood test CPT 82140 Ammonia Level	$168.48	$673.92	$12.38–$673.92	130% above	75%
Ammonia blood test inpatient CPT 82140 Ammonia Level	$168.48	$673.92	$69.41–$606.53	—	75%
Amylase blood test CPT 82150 Amylase Blood	$123.39	$493.56	$5.51–$500.00	206% above	75%
Amylase blood test CPT 82150 Amylase Urine	$123.39	$493.56	$5.51–$500.00	206% above	75%
Amylase blood test CPT 82150 Amylase Body Fluid	$123.39	$493.56	$5.51–$500.00	206% above	75%
Amylase blood test inpatient CPT 82150 Amylase Blood	$123.39	$493.56	$50.84–$444.20	—	75%
Amylase blood test inpatient CPT 82150 Amylase Urine	$123.39	$493.56	$50.84–$444.20	—	75%
Amylase blood test inpatient CPT 82150 Amylase Body Fluid	$123.39	$493.56	$50.84–$444.20	—	75%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide Ab IgG IgA (LC)	$55.89	$223.56	$11.01–$500.00	22% above	75%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrullinated Peptide Ab IgG IgA (LC)	$55.89	$223.56	$23.03–$201.20	—	75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA w/Reflex if Positive (LC)	$140.67	$562.68	$10.28–$562.68	134% above	75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Anti Nuclear Antibodies Direct (LC)	$140.67	$562.68	$10.28–$562.68	134% above	75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Anti Nuclear Antibody IFA (LC)	$140.67	$562.68	$10.28–$562.68	134% above	75%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA w/Reflex if Positive (LC)	$140.67	$562.68	$57.96–$506.41	—	75%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Anti Nuclear Antibodies Direct (LC)	$140.67	$562.68	$57.96–$506.41	—	75%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Anti Nuclear Antibody IFA (LC)	$140.67	$562.68	$57.96–$506.41	—	75%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B Type Natriuretic Peptide Prohormone	$103.68	$414.72	$33.37–$500.00	2% below	75%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B Type Natriuretic Peptide	$103.68	$414.72	$33.37–$500.00	2% below	75%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B Type Natriuretic Peptide Prohormone	$103.68	$414.72	$42.72–$373.25	—	75%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B Type Natriuretic Peptide	$103.68	$414.72	$42.72–$373.25	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Ear Culture without Gram Stain	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Throat Culture	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Body Fluid Culture without Gram Stain	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Tissue Culture without Gram Stain	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Catheter Tip Culture	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Transfusion Reaction Culture	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Wound Culture without Gram stain	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 CULTURE BACTERIA OTH	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Respiratory Culture without Gram Stain	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Cerebrospinal Fluid Culture without Gram Stain	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 zzEnvironmental Culture	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bone Marrow Culture	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Eye Culture without Gram Stain	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Aerobic Culture without Gram Stain	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Strep Culture QA NC	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture without Gram Stain	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bone Culture	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Sputum Culture without Gram Stain	$327.24	$1,308.96	$7.33–$1,308.96	517% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Strep Culture QA NC	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Body Fluid Culture without Gram Stain	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bone Marrow Culture	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Cerebrospinal Fluid Culture without Gram Stain	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Ear Culture without Gram Stain	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Eye Culture without Gram Stain	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 zzEnvironmental Culture	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Aerobic Culture without Gram Stain	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Genital Culture without Gram Stain	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Sputum Culture without Gram Stain	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Respiratory Culture without Gram Stain	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Throat Culture	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Tissue Culture without Gram Stain	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Wound Culture without Gram stain	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Transfusion Reaction Culture	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 87070 CULTURE BACTERIA OTH	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bone Culture	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Catheter Tip Culture	$327.24	$1,308.96	$134.82–$1,178.06	—	75%
Basic metabolic panel (blood test) CPT 80048 BMPWTCA	$191.43	$765.72	$7.19–$765.72	236% above	75%
Basic metabolic panel (blood test) inpatient CPT 80048 BMPWTCA	$191.43	$765.72	$78.87–$689.15	—	75%
Bilirubin blood test, total CPT 82247 82247 L550140 BILIRUBIN TOTAL 889	$51.75	$207.00	$4.27–$500.00	119% above	75%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$55.89	$223.56	$4.27–$500.00	137% above	75%
Bilirubin blood test, total inpatient CPT 82247 82247 L550140 BILIRUBIN TOTAL 889	$51.75	$207.00	$21.32–$186.30	—	75%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total	$55.89	$223.56	$23.03–$201.20	—	75%
Blood culture for bacteria CPT 87040 Blood Culture	$343.17	$1,372.68	$8.77–$1,372.68	285% above	75%
Blood culture for bacteria inpatient CPT 87040 Blood Culture	$343.17	$1,372.68	$141.39–$1,235.41	—	75%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw Chg BCE	$2.21	$8.83	$0.91–$19.87	72% below	75%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw Chg	$38.07	$152.28	$2.70–$152.28	376% above	75%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE	$4,283.75	$17,135.00	$2.99–$17,135.00	53447% above	75%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw Chg BCE	$2.21	$8.83	$0.91–$7.95	—	75%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw Chg	$38.07	$152.28	$15.68–$137.05	—	75%
Blood glucose (sugar) test CPT 82947 82947 L550140 GLUCOSE, QUANT 889	$69.00	$276.00	$3.34–$500.00	152% above	75%
Blood glucose (sugar) test CPT 82947 .Glucose Fasting	$74.52	$298.08	$3.34–$500.00	172% above	75%
Blood glucose (sugar) test CPT 82947 .GTT 2nd Hr OB	$74.52	$298.08	$3.34–$500.00	172% above	75%
Blood glucose (sugar) test CPT 82947 Glucose 3 Hour Postprandial	$74.52	$298.08	$3.34–$500.00	172% above	75%
Blood glucose (sugar) test CPT 82947 Glucose 4 Hour Postprandial	$74.52	$298.08	$3.34–$500.00	172% above	75%
Blood glucose (sugar) test CPT 82947 .Glucose POC	$74.52	$298.08	$3.34–$500.00	172% above	75%
Blood glucose (sugar) test CPT 82947 Glucose Level	$74.52	$298.08	$3.34–$500.00	172% above	75%
Blood glucose (sugar) test inpatient CPT 82947 82947 L550140 GLUCOSE, QUANT 889	$69.00	$276.00	$28.43–$248.40	—	75%
Blood glucose (sugar) test inpatient CPT 82947 Glucose 4 Hour Postprandial	$74.52	$298.08	$30.70–$268.27	—	75%
Blood glucose (sugar) test inpatient CPT 82947 .Glucose Fasting	$74.52	$298.08	$30.70–$268.27	—	75%
Blood glucose (sugar) test inpatient CPT 82947 .Glucose POC	$74.52	$298.08	$30.70–$268.27	—	75%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level	$74.52	$298.08	$30.70–$268.27	—	75%
Blood glucose (sugar) test inpatient CPT 82947 .GTT 2nd Hr OB	$74.52	$298.08	$30.70–$268.27	—	75%
Blood glucose (sugar) test inpatient CPT 82947 Glucose 3 Hour Postprandial	$74.52	$298.08	$30.70–$268.27	—	75%
Blood lead test CPT 83655 83655 L7046 LEAD	$69.66	$278.64	$10.29–$500.00	68% above	75%
Blood lead test CPT 83655 Lead Blood Pediatric (LC)	$69.66	$278.64	$10.29–$500.00	68% above	75%
Blood lead test CPT 83655 Lead Blood Adult (LC)	$69.66	$278.64	$10.29–$500.00	68% above	75%
Blood lead test inpatient CPT 83655 Lead Blood Adult (LC)	$69.66	$278.64	$28.70–$250.78	—	75%
Blood lead test inpatient CPT 83655 Lead Blood Pediatric (LC)	$69.66	$278.64	$28.70–$250.78	—	75%
Blood lead test inpatient CPT 83655 83655 L7046 LEAD	$69.66	$278.64	$28.70–$250.78	—	75%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 hCG Qual, Urine CQ	$83.16	$332.64	$6.39–$500.00	81% above	75%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Human Chorionic Gonadotropin Qual	$83.16	$332.64	$6.39–$500.00	81% above	75%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Human Chorionic Gonadotropin Qual	$83.16	$332.64	$34.26–$299.38	—	75%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 hCG Qual, Urine CQ	$83.16	$332.64	$34.26–$299.38	—	75%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB Bill ABO Reverse	$56.16	$224.64	$2.54–$500.00	4% above	75%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB Bill ABO	$56.16	$224.64	$2.54–$500.00	4% above	75%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB Bill ABO Forward	$56.16	$224.64	$2.54–$500.00	4% above	75%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB Bill ABO Reverse	$56.16	$224.64	$23.14–$202.18	—	75%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB Bill ABO	$56.16	$224.64	$23.14–$202.18	—	75%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB Bill ABO Forward	$56.16	$224.64	$23.14–$202.18	—	75%
Blood urea nitrogen (BUN) test CPT 84520 Urea Nitrogen Body Fluid	$72.36	$289.44	$3.36–$500.00	138% above	75%
Blood urea nitrogen (BUN) test CPT 84520 Blood Urea Nitrogen	$72.36	$289.44	$3.36–$500.00	138% above	75%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea Nitrogen Body Fluid	$72.36	$289.44	$29.81–$260.50	—	75%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Blood Urea Nitrogen	$72.36	$289.44	$29.81–$260.50	—	75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C Reactive Protein	$123.39	$493.56	$4.40–$500.00	284% above	75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C Reactive Protein	$123.39	$493.56	$50.84–$444.20	—	75%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLI PROBE - BCE	$74.25	$297.00	$30.59–$500.00	34% above	75%
C. difficile toxin gene test (stool PCR) CPT 87493 C diff AB PCR	$74.25	$297.00	$30.59–$500.00	34% above	75%
C. difficile toxin gene test (stool PCR) CPT 87493 C difficile PCR w/reflex Toxin Confirmation	$74.25	$297.00	$30.59–$500.00	34% above	75%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF AMPLI PROBE - BCE	$74.25	$297.00	$30.59–$267.30	—	75%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C diff AB PCR	$74.25	$297.00	$30.59–$267.30	—	75%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C difficile PCR w/reflex Toxin Confirmation	$74.25	$297.00	$30.59–$267.30	—	75%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 LC	$148.23	$592.92	$17.69–$592.92	108% above	75%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 LC	$148.23	$592.92	$61.07–$533.63	—	75%
CA-125 blood test (ovarian cancer marker) CPT 86304 Cancer Antigen (CA) 125 LC	$156.87	$627.48	$17.69–$627.48	97% above	75%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Cancer Antigen (CA) 125 LC	$156.87	$627.48	$64.63–$564.73	—	75%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 PCR	$36.45	$145.80	$15.02–$145.80	18% below	75%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 NAA (LC)	$36.45	$145.80	$15.02–$145.80	18% below	75%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 NAA (LC)	$36.45	$145.80	$15.02–$131.22	—	75%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 PCR	$36.45	$145.80	$15.02–$131.22	—	75%
Calcium blood test, total CPT 82310 Calcium Level	$77.76	$311.04	$4.39–$500.00	177% above	75%
Calcium blood test, total CPT 82310 Calcium, Random Urine (CQ)	$77.76	$311.04	$4.39–$500.00	177% above	75%
Calcium blood test, total inpatient CPT 82310 Calcium, Random Urine (CQ)	$77.76	$311.04	$32.04–$279.94	—	75%
Calcium blood test, total inpatient CPT 82310 Calcium Level	$77.76	$311.04	$32.04–$279.94	—	75%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen (LC)	$226.80	$907.20	$16.12–$907.20	133% above	75%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen (LC)	$226.80	$907.20	$93.44–$816.48	—	75%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Virus Ab IgM (LC)	$92.34	$369.36	$10.95–$500.00	70% above	75%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Virus Ab IgG (LC)	$92.34	$369.36	$10.95–$500.00	70% above	75%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Virus Ab IgM (LC)	$92.34	$369.36	$38.04–$332.42	—	75%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Virus Ab IgG (LC)	$92.34	$369.36	$38.04–$332.42	—	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia DNA Amplified Probe	$130.14	$520.56	$29.83–$520.56	94% above	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia DNA Amplified Probe	$130.14	$520.56	$53.62–$468.50	—	75%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$220.32	$881.28	$11.38–$881.28	301% above	75%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$220.32	$881.28	$90.77–$793.15	—	75%
Complete blood count (CBC) with differential CPT 85025 CBCADIFF	$131.22	$524.88	$6.60–$524.88	235% above	75%
Complete blood count (CBC) with differential inpatient CPT 85025 CBCADIFF	$131.22	$524.88	$54.06–$472.39	—	75%
Complete blood count (CBC), no differential CPT 85027 CBC	$47.79	$191.16	$5.50–$500.00	35% above	75%
Complete blood count (CBC), no differential CPT 85027 85027 CBC W-PLT	$47.79	$191.16	$5.50–$500.00	35% above	75%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC	$47.79	$191.16	$19.69–$172.04	—	75%
Complete blood count (CBC), no differential inpatient CPT 85027 85027 CBC W-PLT	$47.79	$191.16	$19.69–$172.04	—	75%
Comprehensive metabolic panel (blood test) CPT 80053 CMP	$331.83	$1,327.32	$8.98–$1,327.32	298% above	75%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP	$331.83	$1,327.32	$136.71–$1,194.59	—	75%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase	$106.11	$424.44	$5.53–$500.00	162% above	75%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase	$106.11	$424.44	$43.72–$382.00	—	75%
Creatinine blood test CPT 82565 CREA	$96.39	$385.56	$4.35–$500.00	229% above	75%
Creatinine blood test CPT 82565 ISCREA	$96.39	$385.56	$4.35–$500.00	229% above	75%
Creatinine blood test inpatient CPT 82565 ISCREA	$96.39	$385.56	$39.71–$347.00	—	75%
Creatinine blood test inpatient CPT 82565 CREA	$96.39	$385.56	$39.71–$347.00	—	75%
D-dimer blood test (blood clot marker) CPT 85379 D Dimer Quant	$110.43	$441.72	$8.65–$500.00	77% above	75%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D Dimer Quant	$110.43	$441.72	$45.50–$397.55	—	75%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone Sulfate (LC)	$428.49	$1,713.96	$18.90–$1,713.96	405% above	75%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone Sulfate (LC)	$428.49	$1,713.96	$176.54–$1,542.56	—	75%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 10 w Rfx Conf Meconium LC	$544.59	$2,178.36	$52.82–$2,178.36	889% above	75%
Drug screen by lab instrument (any number of drug classes) CPT 80307 UDS8AQualAuto	$544.59	$2,178.36	$52.82–$2,178.36	889% above	75%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 UDS8AQualAuto	$544.59	$2,178.36	$224.37–$1,960.52	—	75%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen 10 w Rfx Conf Meconium LC	$544.59	$2,178.36	$224.37–$1,960.52	—	75%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolytes Panel	$147.96	$591.84	$5.96–$591.84	141% above	75%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolytes Panel	$147.96	$591.84	$60.96–$532.66	—	75%
Estradiol blood test CPT 82670 Estradiol Sendout to LabCorp	$31.59	$126.36	$13.02–$500.00	63% below	75%
Estradiol blood test inpatient CPT 82670 Estradiol Sendout to LabCorp	$31.59	$126.36	$13.02–$113.72	—	75%
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone (LC)	$226.53	$906.12	$15.79–$906.12	198% above	75%
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone Serum	$226.53	$906.12	$15.79–$906.12	198% above	75%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stimulating Hormone (LC)	$226.53	$906.12	$93.33–$815.51	—	75%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stimulating Hormone Serum	$226.53	$906.12	$93.33–$815.51	—	75%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$143.10	$572.40	$11.59–$572.40	109% above	75%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$143.10	$572.40	$58.96–$515.16	—	75%
Fibrinogen blood test CPT 85384 Fibrinogen Level	$89.10	$356.40	$8.26–$500.00	67% above	75%
Fibrinogen blood test inpatient CPT 85384 Fibrinogen Level	$89.10	$356.40	$36.71–$320.76	—	75%
Folate (folic acid) blood test CPT 82746 Folate Level	$151.47	$605.88	$12.50–$605.88	186% above	75%
Folate (folic acid) blood test CPT 82746 Folate (Folic Acid) Serum Sendout to LabCorp	$151.47	$605.88	$12.50–$605.88	186% above	75%
Folate (folic acid) blood test inpatient CPT 82746 Folate (Folic Acid) Serum Sendout to LabCorp	$151.47	$605.88	$62.41–$545.29	—	75%
Folate (folic acid) blood test inpatient CPT 82746 Folate Level	$151.47	$605.88	$62.41–$545.29	—	75%
Free T3 thyroid hormone test CPT 84481 Triiodothyronine 3 Free Serum (LC)	$248.13	$992.52	$12.02–$992.52	368% above	75%
Free T3 thyroid hormone test inpatient CPT 84481 Triiodothyronine 3 Free Serum (LC)	$248.13	$992.52	$102.23–$893.27	—	75%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine 4 Free	$120.15	$480.60	$7.67–$500.00	239% above	75%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Thyroxine 4 Free	$120.15	$480.60	$49.50–$432.54	—	75%
Free testosterone test CPT 84402 Testosterone Free Direct LC	$241.11	$964.44	$21.65–$964.44	216% above	75%
Free testosterone test inpatient CPT 84402 Testosterone Free Direct LC	$241.11	$964.44	$99.34–$868.00	—	75%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 82977 L550140 GGT 889	$78.00	$312.00	$6.12–$500.00	167% above	75%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT - BCE	$84.24	$336.96	$6.12–$500.00	188% above	75%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase	$84.24	$336.96	$6.12–$500.00	188% above	75%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 82977 L550140 GGT 889	$78.00	$312.00	$32.14–$280.80	—	75%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Gamma Glutamyl Transferase	$84.24	$336.96	$34.71–$303.26	—	75%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT - BCE	$84.24	$336.96	$34.71–$303.26	—	75%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 2 Hour Postprandial	$64.80	$259.20	$4.04–$500.00	92% above	75%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 2 Hour Postprandial	$64.80	$259.20	$26.70–$233.28	—	75%
Glucose tolerance test, 3 samples CPT 82951 .GTT Fasting	$210.87	$843.48	$10.94–$843.48	217% above	75%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT Fasting	$210.87	$843.48	$86.88–$759.13	—	75%
H. pylori antibody blood test CPT 86677 Heliobacter pylori Ab IgG (LC)	$310.23	$1,240.92	$14.15–$1,240.92	529% above	75%
H. pylori antibody blood test CPT 86677 Heliobacter pylori Ab IgM (LC)	$310.23	$1,240.92	$14.15–$1,240.92	529% above	75%
H. pylori antibody blood test CPT 86677 Heliobacter pylori Ab IgA (LC)	$310.23	$1,240.92	$14.15–$1,240.92	529% above	75%
H. pylori antibody blood test inpatient CPT 86677 Heliobacter pylori Ab IgA (LC)	$310.23	$1,240.92	$127.81–$1,116.83	—	75%
H. pylori antibody blood test inpatient CPT 86677 Heliobacter pylori Ab IgG (LC)	$310.23	$1,240.92	$127.81–$1,116.83	—	75%
H. pylori antibody blood test inpatient CPT 86677 Heliobacter pylori Ab IgM (LC)	$310.23	$1,240.92	$127.81–$1,116.83	—	75%
H. pylori stool antigen test CPT 87338 Heliobacter pylori Stool Ag EIA (LC)	$473.58	$1,894.32	$6.46–$1,894.32	566% above	75%
H. pylori stool antigen test inpatient CPT 87338 Heliobacter pylori Stool Ag EIA (LC)	$473.58	$1,894.32	$195.11–$1,704.89	—	75%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 RNA Real Time PCR (Graph) LC	$438.75	$1,755.00	$72.33–$1,755.00	122% above	75%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 .GenoSure PRIme(R) Quant RNA PCR (LC)	$438.75	$1,755.00	$72.33–$1,755.00	122% above	75%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 RNA Real Time PCR (Graph) LC	$438.75	$1,755.00	$180.76–$1,579.50	—	75%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 .GenoSure PRIme(R) Quant RNA PCR (LC)	$438.75	$1,755.00	$180.76–$1,579.50	—	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1 2 Ab Ag 4th Generation Auto w/Rfx	$45.90	$183.60	$18.91–$500.00	14% above	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV Ab/p24 Ag w/Reflex (LC)	$45.90	$183.60	$18.91–$500.00	14% above	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV Ab/p24 Ag w/Reflex (LC)	$45.90	$183.60	$18.91–$165.24	—	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1 2 Ab Ag 4th Generation Auto w/Rfx	$45.90	$183.60	$18.91–$165.24	—	75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c	$104.49	$417.96	$8.25–$500.00	129% above	75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c	$104.49	$417.96	$43.05–$376.16	—	75%
Hemoglobin blood test CPT 85018 Hemoglobin, Free, Plasma LC	$57.50	$230.00	$2.01–$500.00	255% above	75%
Hemoglobin blood test CPT 85018 Hemoglobin	$62.10	$248.40	$2.01–$500.00	283% above	75%
Hemoglobin blood test CPT 85018 85018 HEMOGLOBIN 171	$62.10	$248.40	$2.01–$500.00	283% above	75%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin, Free, Plasma LC	$57.50	$230.00	$23.69–$207.00	—	75%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin	$62.10	$248.40	$25.59–$223.56	—	75%
Hemoglobin blood test inpatient CPT 85018 85018 HEMOGLOBIN 171	$62.10	$248.40	$25.59–$223.56	—	75%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Ab Total (LC)	$131.49	$525.96	$10.24–$525.96	198% above	75%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Ab Total (LC)	$131.49	$525.96	$54.17–$473.36	—	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURF AB - BCE	$119.34	$477.36	$9.13–$500.00	174% above	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody w/Interp	$119.34	$477.36	$9.13–$500.00	174% above	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab (LC)	$119.34	$477.36	$9.13–$500.00	174% above	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURF AB - BCE	$119.34	$477.36	$49.17–$429.62	—	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Ab (LC)	$119.34	$477.36	$49.17–$429.62	—	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Antibody w/Interp	$119.34	$477.36	$49.17–$429.62	—	75%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HBSAG- BCE	$89.10	$356.40	$8.78–$500.00	99% above	75%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag w/Interp	$89.10	$356.40	$8.78–$500.00	99% above	75%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Ag w/Interp	$89.10	$356.40	$36.71–$320.76	—	75%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HBSAG- BCE	$89.10	$356.40	$36.71–$320.76	—	75%
Hepatitis C antibody blood test (screening) CPT 86803 HCAB2	$129.06	$516.24	$12.13–$516.24	115% above	75%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCAB2	$129.06	$516.24	$53.17–$464.62	—	75%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Virus RNA PCR Quant Reflex Geno. (LC)	$647.25	$2,589.00	$36.41–$2,589.00	309% above	75%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 Hepatitis C Virus RT PCR Quant Non-Graph (LC)	$699.03	$2,796.12	$36.41–$2,796.12	342% above	75%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Virus RNA PCR Quant Reflex Geno. (LC)	$647.25	$2,589.00	$266.67–$2,330.10	—	75%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 Hepatitis C Virus RT PCR Quant Non-Graph (LC)	$699.03	$2,796.12	$288.00–$2,516.51	—	75%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IgG, Type Spec LC	$29.97	$119.88	$11.21–$500.00	3% below	75%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Virus 1 Specific Antibody IgG (LC)	$29.97	$119.88	$11.21–$500.00	3% below	75%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex Virus 1 Specific Antibody IgG (LC)	$29.97	$119.88	$12.35–$107.89	—	75%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IgG, Type Spec LC	$29.97	$119.88	$12.35–$107.89	—	75%
Herpes blood test, HSV-2 antibody CPT 86696 .HSV2 IgG Supplemental (LC)	$29.97	$119.88	$12.35–$500.00	22% below	75%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 .HSV2 IgG Supplemental (LC)	$29.97	$119.88	$12.35–$107.89	—	75%
High-sensitivity CRP (hs-CRP) test CPT 86141 C Reactive Protein Cardiac (LC)	$256.77	$1,027.08	$11.01–$1,027.08	708% above	75%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C Reactive Protein Cardiac (LC)	$256.77	$1,027.08	$105.79–$924.37	—	75%
Iron blood test (serum iron) CPT 83540 83540 IRON	$70.20	$280.80	$5.50–$500.00	101% above	75%
Iron blood test (serum iron) CPT 83540 IRON	$70.20	$280.80	$5.50–$500.00	101% above	75%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$70.20	$280.80	$28.92–$252.72	—	75%
Iron blood test (serum iron) inpatient CPT 83540 83540 IRON	$70.20	$280.80	$28.92–$252.72	—	75%
Iron-binding capacity (TIBC) test CPT 83550 Total Iron Binding Capacity DM	$160.65	$642.60	$7.43–$642.60	289% above	75%
Iron-binding capacity (TIBC) test CPT 83550 83550 IRON BINDING CAPACIT	$160.65	$642.60	$7.43–$642.60	289% above	75%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Total Iron Binding Capacity DM	$160.65	$642.60	$66.19–$578.34	—	75%
Iron-binding capacity (TIBC) test inpatient CPT 83550 83550 IRON BINDING CAPACIT	$160.65	$642.60	$66.19–$578.34	—	75%
Kidney function blood test panel CPT 80069 RFP	$242.46	$969.84	$7.38–$969.84	217% above	75%
Kidney function blood test panel inpatient CPT 80069 RFP	$242.46	$969.84	$99.89–$872.86	—	75%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone	$200.88	$803.52	$15.74–$803.52	139% above	75%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone S (LC)	$200.88	$803.52	$15.74–$803.52	139% above	75%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone	$200.88	$803.52	$82.76–$723.17	—	75%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone S (LC)	$200.88	$803.52	$82.76–$723.17	—	75%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid	$162.81	$651.24	$9.15–$651.24	195% above	75%
Lactate (lactic acid) blood test CPT 83605 .Lactate POC	$162.81	$651.24	$9.15–$651.24	195% above	75%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid w/ Reflex LA	$162.81	$651.24	$9.15–$651.24	195% above	75%
Lactate (lactic acid) blood test CPT 83605 .Lactic Acid Reflex	$162.81	$651.24	$9.15–$651.24	195% above	75%
Lactate (lactic acid) blood test CPT 83605 .Lactic Acid Reflex 2	$162.81	$651.24	$9.15–$651.24	195% above	75%
Lactate (lactic acid) blood test inpatient CPT 83605 .Lactic Acid Reflex	$162.81	$651.24	$67.08–$586.12	—	75%
Lactate (lactic acid) blood test inpatient CPT 83605 .Lactate POC	$162.81	$651.24	$67.08–$586.12	—	75%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid	$162.81	$651.24	$67.08–$586.12	—	75%
Lactate (lactic acid) blood test inpatient CPT 83605 .Lactic Acid Reflex 2	$162.81	$651.24	$67.08–$586.12	—	75%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid w/ Reflex LA	$162.81	$651.24	$67.08–$586.12	—	75%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase (LC)	$106.11	$424.44	$5.13–$500.00	247% above	75%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase Body Fluid (LC)	$106.11	$424.44	$5.13–$500.00	247% above	75%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase Body Fluid (LC)	$106.11	$424.44	$43.72–$382.00	—	75%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase (LC)	$106.11	$424.44	$43.72–$382.00	—	75%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase, Body Fluid Sendout to LabCorp	$129.06	$516.24	$5.86–$516.24	234% above	75%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$129.06	$516.24	$5.86–$516.24	234% above	75%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase, Body Fluid Sendout to LabCorp	$129.06	$516.24	$53.17–$464.62	—	75%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$129.06	$516.24	$53.17–$464.62	—	75%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$232.74	$930.96	$6.94–$930.96	241% above	75%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$232.74	$930.96	$95.89–$837.86	—	75%
Lyme disease antibody test CPT 86618 Lyme Disease Total Ab Rfx Immunoassay LC	$95.85	$383.40	$14.48–$500.00	83% above	75%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Total Ab Rfx Immunoassay LC	$95.85	$383.40	$39.49–$345.06	—	75%
Magnesium blood test CPT 83735 Magnesium Serum	$95.31	$381.24	$5.70–$500.00	167% above	75%
Magnesium blood test inpatient CPT 83735 Magnesium Serum	$95.31	$381.24	$39.27–$343.12	—	75%
Measles (rubeola) antibody test CPT 86765 Measles (Rubeola) Antibodies, IgG (LC)	$142.02	$568.08	$10.95–$568.08	275% above	75%
Measles (rubeola) antibody test inpatient CPT 86765 Measles (Rubeola) Antibodies, IgG (LC)	$142.02	$568.08	$58.51–$511.27	—	75%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$106.92	$427.68	$4.40–$500.00	234% above	75%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen	$106.92	$427.68	$44.05–$384.91	—	75%
Mumps immunity blood test CPT 86735 Mumps Antibodies IgG LC	$25.11	$100.44	$10.35–$500.00	50% below	75%
Mumps immunity blood test inpatient CPT 86735 Mumps Antibodies IgG LC	$25.11	$100.44	$10.35–$90.40	—	75%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Ag Total	$206.28	$825.12	$15.63–$825.12	171% above	75%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Ag Total	$206.28	$825.12	$84.99–$742.61	—	75%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Intact (LC)	$79.38	$317.52	$32.70–$500.00	37% below	75%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone Intact (LC)	$79.38	$317.52	$32.70–$285.77	—	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$74.79	$299.16	$5.11–$500.00	90% above	75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time	$74.79	$299.16	$30.81–$269.24	—	75%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Serum	$95.31	$381.24	$4.03–$500.00	253% above	75%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Serum	$95.31	$381.24	$39.27–$343.12	—	75%
Potassium blood test CPT 84132 84132 POTASSIUM SER PL WB	$70.20	$280.80	$4.05–$500.00	158% above	75%
Potassium blood test CPT 84132 Potassium Serum	$70.20	$280.80	$4.05–$500.00	158% above	75%
Potassium blood test inpatient CPT 84132 Potassium Serum	$70.20	$280.80	$28.92–$252.72	—	75%
Potassium blood test inpatient CPT 84132 84132 POTASSIUM SER PL WB	$70.20	$280.80	$28.92–$252.72	—	75%
Progesterone blood test CPT 84144 Progesterone Sendout to LabCorp	$206.82	$827.28	$17.73–$827.28	142% above	75%
Progesterone blood test inpatient CPT 84144 Progesterone Sendout to LabCorp	$206.82	$827.28	$85.21–$744.55	—	75%
Prolactin blood test CPT 84146 Prolactin LC	$298.89	$1,195.56	$16.47–$1,195.56	221% above	75%
Prolactin blood test inpatient CPT 84146 Prolactin LC	$298.89	$1,195.56	$123.14–$1,076.00	—	75%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time w/INR	$74.79	$299.16	$3.65–$500.00	173% above	75%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time w/INR	$74.79	$299.16	$30.81–$269.24	—	75%
Rapid flu test (influenza antigen) CPT 87804 Influenza B Antigen Result	$70.47	$281.88	$14.07–$500.00	137% above	75%
Rapid flu test (influenza antigen) CPT 87804 Influenza A Antigen Result	$70.47	$281.88	$14.07–$500.00	137% above	75%
Rapid flu test (influenza antigen) CPT 87804 87804 INFLUENZA ASSAY W-OP	$70.47	$281.88	$14.07–$500.00	137% above	75%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza B Antigen Result	$70.47	$281.88	$29.03–$253.69	—	75%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza A Antigen Result	$70.47	$281.88	$29.03–$253.69	—	75%
Rapid flu test (influenza antigen) inpatient CPT 87804 87804 INFLUENZA ASSAY W-OP	$70.47	$281.88	$29.03–$253.69	—	75%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Rapid Strep A FIA	$104.49	$417.96	$14.05–$500.00	203% above	75%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Rapid Strep A FIA	$104.49	$417.96	$43.05–$376.16	—	75%
Renin blood test CPT 84244 Renin Activity Plasma LC	$166.32	$665.28	$18.69–$665.28	163% above	75%
Renin blood test inpatient CPT 84244 Renin Activity Plasma LC	$166.32	$665.28	$68.52–$598.75	—	75%
Rh blood typing CPT 86901 BB Bill Rh Test	$56.16	$224.64	$2.54–$500.00	50% above	75%
Rh blood typing inpatient CPT 86901 BB Bill Rh Test	$56.16	$224.64	$23.14–$202.18	—	75%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Arthritis Factor (LC)	$14.58	$58.32	$4.82–$500.00	57% below	75%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Arthritis Factor (LC)	$14.58	$58.32	$6.01–$52.49	—	75%
Rubella antibody test (immunity check) CPT 86762 Rubella Ab IgG Auto w/Interp	$104.22	$416.88	$12.23–$500.00	155% above	75%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibodies IgG LC	$104.22	$416.88	$12.23–$500.00	155% above	75%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibodies IgG LC	$104.22	$416.88	$42.94–$375.19	—	75%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Ab IgG Auto w/Interp	$104.22	$416.88	$42.94–$375.19	—	75%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESRA	$55.08	$220.32	$2.30–$500.00	43% above	75%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESRA	$55.08	$220.32	$22.69–$198.29	—	75%
Sodium blood test CPT 84295 Sodium Serum	$70.47	$281.88	$4.09–$500.00	113% above	75%
Sodium blood test CPT 84295 84295 SODIUM,SER PL OR WB	$70.47	$281.88	$4.09–$500.00	113% above	75%
Sodium blood test inpatient CPT 84295 84295 SODIUM,SER PL OR WB	$70.47	$281.88	$29.03–$253.69	—	75%
Sodium blood test inpatient CPT 84295 Sodium Serum	$70.47	$281.88	$29.03–$253.69	—	75%
Stool ova and parasites exam CPT 87177 87177 L8623 OVA-PARASITES SMEARS	$156.33	$625.32	$7.57–$625.32	281% above	75%
Stool ova and parasites exam inpatient CPT 87177 87177 L8623 OVA-PARASITES SMEARS	$156.33	$625.32	$64.41–$562.79	—	75%
Stool test for hidden blood (guaiac FOBT) CPT 82270 FOBT	$43.74	$174.96	$3.23–$500.00	107% above	75%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 FOBT	$43.74	$174.96	$18.02–$157.46	—	75%
Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema pallidum Antibodies (LC)	$43.20	$172.80	$11.25–$500.00	10% above	75%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Antibody w Rfx to RPR	$43.20	$172.80	$11.25–$500.00	10% above	75%
Syphilis antibody test (Treponema pallidum) CPT 86780 zzTreponema pallidum Ab FTA (LC)	$43.20	$172.80	$11.25–$500.00	10% above	75%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 zzTreponema pallidum Ab FTA (LC)	$43.20	$172.80	$17.80–$155.52	—	75%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis Antibody w Rfx to RPR	$43.20	$172.80	$17.80–$155.52	—	75%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema pallidum Antibodies (LC)	$43.20	$172.80	$17.80–$155.52	—	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin Qual w/Reflex Quant	$150.66	$602.64	$3.63–$602.64	498% above	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin Qual	$150.66	$602.64	$3.63–$602.64	498% above	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL CSF LC	$150.66	$602.64	$3.63–$602.64	498% above	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagin Qual	$150.66	$602.64	$62.07–$542.38	—	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagin Qual w/Reflex Quant	$150.66	$602.64	$62.07–$542.38	—	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL CSF LC	$150.66	$602.64	$62.07–$542.38	—	75%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON-TB Gold Plus (Client Incubated) LC	$171.45	$685.80	$52.68–$685.80	63% above	75%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QuantiFERON-TB Gold Plus (Client Incubated) LC	$171.45	$685.80	$70.64–$617.22	—	75%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Level LC	$241.11	$964.44	$21.94–$964.44	206% above	75%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total	$241.11	$964.44	$21.94–$964.44	206% above	75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Level LC	$241.11	$964.44	$99.34–$868.00	—	75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total	$241.11	$964.44	$99.34–$868.00	—	75%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibody (LC)	$159.30	$637.20	$12.37–$637.20	463% above	75%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Antibody (LC)	$159.30	$637.20	$65.63–$573.48	—	75%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$132.84	$531.36	$14.28–$531.36	150% above	75%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone w/Reflex to Free T4	$132.84	$531.36	$14.28–$531.36	150% above	75%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone w/Reflex to Free T4	$132.84	$531.36	$54.73–$478.22	—	75%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$132.84	$531.36	$54.73–$478.22	—	75%
Total IgE blood test CPT 82785 Immunoglobulin E Total (LC)	$162.81	$651.24	$13.99–$651.24	237% above	75%
Total IgE blood test inpatient CPT 82785 Immunoglobulin E Total (LC)	$162.81	$651.24	$67.08–$586.12	—	75%
Total cholesterol blood test CPT 82465 82465 L550140 CHOLESTEROL TOTAL 889	$71.75	$287.00	$3.70–$500.00	159% above	75%
Total cholesterol blood test CPT 82465 Cholesterol	$77.49	$309.96	$3.70–$500.00	180% above	75%
Total cholesterol blood test CPT 82465 Cholesterol Body Fluid	$77.49	$309.96	$3.70–$500.00	180% above	75%
Total cholesterol blood test inpatient CPT 82465 82465 L550140 CHOLESTEROL TOTAL 889	$71.75	$287.00	$29.56–$258.30	—	75%
Total cholesterol blood test inpatient CPT 82465 Cholesterol Body Fluid	$77.49	$309.96	$31.93–$278.96	—	75%
Total cholesterol blood test inpatient CPT 82465 Cholesterol	$77.49	$309.96	$31.93–$278.96	—	75%
Total thyroxine (T4) blood test CPT 84436 Thyroxine 4 (LC)	$88.56	$354.24	$5.84–$500.00	136% above	75%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine 4 (LC)	$88.56	$354.24	$36.49–$318.82	—	75%
Total triiodothyronine (T3) blood test CPT 84480 Triiodothyronine (LC)	$118.53	$474.12	$7.83–$500.00	150% above	75%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Triiodothyronine (LC)	$118.53	$474.12	$48.83–$426.71	—	75%
Transferrin blood test CPT 84466 Transferrin LC	$59.13	$236.52	$9.15–$500.00	31% above	75%
Transferrin blood test inpatient CPT 84466 Transferrin LC	$59.13	$236.52	$24.36–$212.87	—	75%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis, NAA (LC)	$81.00	$324.00	$29.83–$500.00	69% above	75%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis, NAA (LC)	$81.00	$324.00	$33.37–$291.60	—	75%
Triglycerides blood test CPT 84478 84478 L550140 TRIGLYCERIDES 889	$64.75	$259.00	$4.88–$500.00	95% above	75%
Triglycerides blood test CPT 84478 Triglycerides Body Fluid	$69.93	$279.72	$4.88–$500.00	111% above	75%
Triglycerides blood test CPT 84478 Triglycerides	$69.93	$279.72	$4.88–$500.00	111% above	75%
Triglycerides blood test inpatient CPT 84478 84478 L550140 TRIGLYCERIDES 889	$64.75	$259.00	$26.68–$233.10	—	75%
Triglycerides blood test inpatient CPT 84478 Triglycerides	$69.93	$279.72	$28.81–$251.75	—	75%
Triglycerides blood test inpatient CPT 84478 Triglycerides Body Fluid	$69.93	$279.72	$28.81–$251.75	—	75%
Troponin test, quantitative CPT 84484 .Troponin I HS 2 Hour	$238.41	$953.64	$10.60–$953.64	206% above	75%
Troponin test, quantitative CPT 84484 Troponin I HS x 3 Series	$238.41	$953.64	$10.60–$953.64	206% above	75%
Troponin test, quantitative CPT 84484 Troponin I HS	$238.41	$953.64	$10.60–$953.64	206% above	75%
Troponin test, quantitative CPT 84484 .Troponin I HS 4 Hour	$238.41	$953.64	$10.60–$953.64	206% above	75%
Troponin test, quantitative inpatient CPT 84484 .Troponin I HS 4 Hour	$238.41	$953.64	$98.22–$858.28	—	75%
Troponin test, quantitative inpatient CPT 84484 Troponin I HS	$238.41	$953.64	$98.22–$858.28	—	75%
Troponin test, quantitative inpatient CPT 84484 .Troponin I HS 2 Hour	$238.41	$953.64	$98.22–$858.28	—	75%
Troponin test, quantitative inpatient CPT 84484 Troponin I HS x 3 Series	$238.41	$953.64	$98.22–$858.28	—	75%
Uric acid blood test CPT 84550 Uric Acid Level	$70.20	$280.80	$3.84–$500.00	124% above	75%
Uric acid blood test inpatient CPT 84550 Uric Acid Level	$70.20	$280.80	$28.92–$252.72	—	75%
Urinalysis with microscope exam, automated CPT 81001 Perform Microscopic - Yes	$86.13	$344.52	$2.69–$500.00	204% above	75%
Urinalysis with microscope exam, automated CPT 81001 .Bill Only DS Auto/MSc Reqd	$86.13	$344.52	$2.69–$500.00	204% above	75%
Urinalysis with microscope exam, automated inpatient CPT 81001 Perform Microscopic - Yes	$86.13	$344.52	$35.49–$310.07	—	75%
Urinalysis with microscope exam, automated inpatient CPT 81001 .Bill Only DS Auto/MSc Reqd	$86.13	$344.52	$35.49–$310.07	—	75%
Urinalysis with microscope exam, manual CPT 81000 .Bill Only DS Man/MSc Reqd	$104.76	$419.04	$3.42–$500.00	424% above	75%
Urinalysis with microscope exam, manual CPT 81000 Urinalysis w/Microscopic Manual	$104.76	$419.04	$3.42–$500.00	424% above	75%
Urinalysis with microscope exam, manual inpatient CPT 81000 .Bill Only DS Man/MSc Reqd	$104.76	$419.04	$43.16–$377.14	—	75%
Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis w/Microscopic Manual	$104.76	$419.04	$43.16–$377.14	—	75%
Urinalysis without microscope exam, automated CPT 81003 Perform Microscopic - No	$40.50	$162.00	$1.91–$500.00	168% above	75%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis w/o Microscopic Automated	$40.50	$162.00	$1.91–$500.00	168% above	75%
Urinalysis without microscope exam, automated CPT 81003 .Bill Only DS Auto/No MSc	$40.50	$162.00	$1.91–$500.00	168% above	75%
Urinalysis without microscope exam, automated CPT 81003 Dipstick Type? - Auto	$40.50	$162.00	$1.91–$500.00	168% above	75%
Urinalysis without microscope exam, automated CPT 81003 Urine Color Urine Dipstick	$40.50	$162.00	$1.91–$500.00	168% above	75%
Urinalysis without microscope exam, automated inpatient CPT 81003 Dipstick Type? - Auto	$40.50	$162.00	$16.69–$145.80	—	75%
Urinalysis without microscope exam, automated inpatient CPT 81003 Perform Microscopic - No	$40.50	$162.00	$16.69–$145.80	—	75%
Urinalysis without microscope exam, automated inpatient CPT 81003 .Bill Only DS Auto/No MSc	$40.50	$162.00	$16.69–$145.80	—	75%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Color Urine Dipstick	$40.50	$162.00	$16.69–$145.80	—	75%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis w/o Microscopic Automated	$40.50	$162.00	$16.69–$145.80	—	75%
Urinalysis without microscope exam, manual CPT 81002 Ketones Ur Ql	$79.92	$319.68	$2.96–$500.00	452% above	75%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis w/o Microscopic Manual	$79.92	$319.68	$2.96–$500.00	452% above	75%
Urinalysis without microscope exam, manual CPT 81002 .Bill Only DS Man/No MSc	$79.92	$319.68	$2.96–$500.00	452% above	75%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis w/o Microscopic Manual	$79.92	$319.68	$32.93–$287.71	—	75%
Urinalysis without microscope exam, manual inpatient CPT 81002 .Bill Only DS Man/No MSc	$79.92	$319.68	$32.93–$287.71	—	75%
Urinalysis without microscope exam, manual inpatient CPT 81002 Ketones Ur Ql	$79.92	$319.68	$32.93–$287.71	—	75%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture Qn	$206.01	$824.04	$6.86–$824.04	394% above	75%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture Qn	$206.01	$824.04	$84.88–$741.64	—	75%
Urine microalbumin (albumin) test CPT 82043 Microalbumin 24 hr Urine Sendout to LabCorp	$106.92	$427.68	$4.91–$500.00	240% above	75%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Random Urine Sendout to LabCorp	$106.92	$427.68	$4.91–$500.00	240% above	75%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Random Urine Sendout to LabCorp	$106.92	$427.68	$44.05–$384.91	—	75%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin 24 hr Urine Sendout to LabCorp	$106.92	$427.68	$44.05–$384.91	—	75%
Urine pregnancy test, read by color change CPT 81025 Human Chorionic Gonadotropin Urine Qual Manual	$81.27	$325.08	$7.32–$500.00	103% above	75%
Urine pregnancy test, read by color change CPT 81025 POC HCG Patient Test Result	$81.27	$325.08	$7.32–$500.00	103% above	75%
Urine pregnancy test, read by color change inpatient CPT 81025 POC HCG Patient Test Result	$81.27	$325.08	$33.48–$292.57	—	75%
Urine pregnancy test, read by color change inpatient CPT 81025 Human Chorionic Gonadotropin Urine Qual Manual	$81.27	$325.08	$33.48–$292.57	—	75%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12	$90.99	$363.96	$12.82–$500.00	44% above	75%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12	$90.99	$363.96	$37.49–$327.56	—	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 hydroxy	$291.60	$1,166.40	$25.16–$1,166.40	322% above	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 hydroxy	$291.60	$1,166.40	$120.14–$1,049.76	—	75%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Calcitriol Level (LC)	$325.62	$1,302.48	$20.52–$1,302.48	164% above	75%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Calcitriol Level (LC)	$325.62	$1,302.48	$134.16–$1,172.23	—	75%
Zinc blood test CPT 84630 Zinc Plasma or Serum (LC)	$86.94	$347.76	$9.68–$500.00	53% above	75%
Zinc blood test CPT 84630 Zinc, Whole Blood (LC)	$86.94	$347.76	$9.68–$500.00	53% above	75%
Zinc blood test inpatient CPT 84630 Zinc Plasma or Serum (LC)	$86.94	$347.76	$35.82–$312.98	—	75%
Zinc blood test inpatient CPT 84630 Zinc, Whole Blood (LC)	$86.94	$347.76	$35.82–$312.98	—	75%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Human Chorionic Gonadotropin Quant	$169.29	$677.16	$12.79–$677.16	139% above	75%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Human Chorionic Gonadotropin Beta Sub unit Quant (	$169.29	$677.16	$12.79–$677.16	139% above	75%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Human Chorionic Gonadotropin Quant	$169.29	$677.16	$69.75–$609.44	—	75%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Human Chorionic Gonadotropin Beta Sub unit Quant (	$169.29	$677.16	$69.75–$609.44	—	75%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Mississippi	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BX BREAST 1ST LESION STRTCTC	$4,742.25	$18,969.00	$436.45–$17,072.10	174% above	75%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MG Breast Biopsy w Loc w Stereo 1 Lsn Rt	$2,917.89	$11,671.56	$422.76–$10,504.40	69% above	75%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MG Breast Biopsy w Loc w Stereo 1 Lsn Lt	$2,917.89	$11,671.56	$422.76–$10,504.40	69% above	75%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MG Breast Biopsy w Loc w Stereo 1 Lsn Lt	$2,917.89	$11,671.56	$1,202.17–$10,504.40	—	75%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MG Breast Biopsy w Loc w Stereo 1 Lsn Rt	$2,917.89	$11,671.56	$1,202.17–$10,504.40	—	75%
Cardiac catheterization with coronary angiogram CPT 93458 EP-EVALUATION AICD, DFT TESTING WITH AN EXTERNAL A	$1,516.32	$6,065.28	$624.72–$8,870.00	73% below	75%
Cardiac catheterization with coronary angiogram one side CPT 93458 CC-CORONARY W LEFT HEART CATH[MSMH]	$4,806.81	$19,227.24	$628.62–$19,227.24	15% below	75%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 EP-EVALUATION AICD, DFT TESTING WITH AN EXTERNAL A	$1,516.32	$6,065.28	$624.72–$5,458.75	—	75%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 CC-CORONARY W LEFT HEART CATH[MSMH]	$4,806.81	$19,227.24	$1,980.41–$17,304.52	—	75%
Cardioversion, elective (restoring heart rhythm) CPT 92960 $ED Cardioversion/Defibrillation	$747.36	$2,989.44	$139.61–$2,989.44	28% above	75%
Cardioversion, elective (restoring heart rhythm) CPT 92960 NI-CARDIOVERSION [MSMH]	$1,084.32	$4,337.28	$139.61–$4,337.28	85% above	75%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 $ED Cardioversion/Defibrillation	$747.36	$2,989.44	$307.91–$2,690.50	—	75%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 NI-CARDIOVERSION [MSMH]	$1,084.32	$4,337.28	$446.74–$3,903.55	—	75%
Coronary stent placement, one artery CPT 92928 IC-PRQ CRD STN W-ANG[MSMH]	$17,956.89	$71,827.56	$534.59–$64,644.80	100% above	75%
Coronary stent placement, one artery inpatient CPT 92928 IC-PRQ CRD STN W-ANG[MSMH]	$17,956.89	$71,827.56	$7,398.24–$64,644.80	—	75%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$982.50	$3,930.00	$13.59–$3,930.00	1630% above	75%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI	$711.25	$2,845.00	$43.62–$2,845.00	784% above	75%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 S-INJ CATH HYSTERSO	$1,038.96	$4,155.84	$209.84–$4,155.84	398% above	75%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER FOR HYSTEROGRAPHY	$2,340.75	$9,363.00	$209.84–$8,512.68	1022% above	75%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 S-INJ CATH HYSTERSO	$1,038.96	$4,155.84	$428.05–$3,740.26	—	75%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$1,565.75	$6,263.00	$114.27–$6,263.00	615% above	75%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$3,684.75	$14,739.00	$59.12–$13,265.10	1380% above	75%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$2,147.25	$8,589.00	$50.18–$8,512.68	875% above	75%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/<	$2,041.50	$8,166.00	$233.49–$8,166.00	735% above	75%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$1,109.50	$4,438.00	$103.05–$4,438.00	547% above	75%
Paracentesis with imaging guidance CPT 49083 US Paracentesis Abd w Image	$1,872.72	$7,490.88	$256.32–$7,490.88	174% above	75%
Paracentesis with imaging guidance CPT 49083 IR Abdominal Paracentesis w Imaging	$2,920.05	$11,680.20	$256.32–$10,512.18	328% above	75%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$3,225.25	$12,901.00	$256.32–$11,610.90	373% above	75%
Paracentesis with imaging guidance inpatient CPT 49083 US Paracentesis Abd w Image	$1,872.72	$7,490.88	$771.56–$6,741.79	—	75%
Paracentesis with imaging guidance inpatient CPT 49083 IR Abdominal Paracentesis w Imaging	$2,920.05	$11,680.20	$1,203.06–$10,512.18	—	75%
Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL	$834.50	$3,338.00	$135.77–$3,338.00	199% above	75%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT	$2,589.25	$10,357.00	$60.35–$9,321.30	1923% above	75%
Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLINT	$4,021.50	$16,086.00	$65.97–$14,477.40	2678% above	75%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/<	$1,565.75	$6,263.00	$84.24–$6,263.00	753% above	75%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM	$2,512.25	$10,049.00	$102.56–$9,044.10	1224% above	75%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5 CM/<	$1,826.50	$7,306.00	$100.54–$7,306.00	895% above	75%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING	$1,296.75	$5,187.00	$275.74–$5,187.00	54% above	75%
Thoracentesis with imaging guidance CPT 32555 CT Thoracentesis w Imaging Guidance	$2,421.63	$9,686.52	$266.83–$8,717.87	187% above	75%
Thoracentesis with imaging guidance CPT 32555 IR Thoracentesis w Imging Guidance	$3,726.00	$14,904.00	$266.83–$13,413.60	342% above	75%
Thoracentesis with imaging guidance inpatient CPT 32555 CT Thoracentesis w Imaging Guidance	$2,421.63	$9,686.52	$997.71–$8,717.87	—	75%
Thoracentesis with imaging guidance inpatient CPT 32555 IR Thoracentesis w Imging Guidance	$3,726.00	$14,904.00	$1,535.11–$13,413.60	—	75%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG	$2,876.00	$11,504.00	$434.09–$10,353.60	75% above	75%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy w Loc 1 Lesion Right	$2,209.41	$8,837.64	$420.73–$8,512.68	35% above	75%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy w Loc 1 Lesion Left	$2,209.41	$8,837.64	$420.73–$8,512.68	35% above	75%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy w Loc 1 Lesion Right	$2,209.41	$8,837.64	$910.28–$7,953.88	—	75%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy w Loc 1 Lesion Left	$2,209.41	$8,837.64	$910.28–$7,953.88	—	75%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<	$2,079.00	$8,316.00	$115.22–$8,316.00	489% above	75%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Mississippi	Off list
Blood transfusion (giving blood or blood components) CPT 36430 CHRG - BLOOD TRANSFUSION - Blood Transfusion Perfo	$453.25	$1,813.00	$35.93–$1,813.00	14% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Verified with Pt Information: - Transfu	$643.95	$2,575.80	$35.93–$2,575.80	63% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 $ED Transfusion >2 yrs	$643.95	$2,575.80	$35.93–$2,575.80	63% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Packed red blood cells	$865.08	$3,460.32	$35.93–$3,460.32	118% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Whole blood	$865.08	$3,460.32	$35.93–$3,460.32	118% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration Fee	$865.08	$3,460.32	$35.93–$3,460.32	118% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Platelets (single donor)	$865.08	$3,460.32	$35.93–$3,460.32	118% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Fresh frozen plasma	$865.08	$3,460.32	$35.93–$3,460.32	118% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Red blood cells (postoperati	$865.08	$3,460.32	$35.93–$3,460.32	118% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Red blood cells (preoperativ	$865.08	$3,460.32	$35.93–$3,460.32	118% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Cryoprecipitate	$865.08	$3,460.32	$35.93–$3,460.32	118% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Unit Product: - Platelets (random donor)	$865.08	$3,460.32	$35.93–$3,460.32	118% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 Blood transfusions	$865.08	$3,460.32	$35.93–$3,460.32	118% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLD/BLD COMPNT	$9,352.25	$37,409.00	$35.93–$33,668.10	2262% above	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 CHRG - BLOOD TRANSFUSION - Blood Transfusion Perfo	$453.25	$1,813.00	$186.74–$1,631.70	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 $ED Transfusion >2 yrs	$643.95	$2,575.80	$265.31–$2,318.22	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Verified with Pt Information: - Transfu	$643.95	$2,575.80	$265.31–$2,318.22	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Cryoprecipitate	$865.08	$3,460.32	$356.41–$3,114.29	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood transfusions	$865.08	$3,460.32	$356.41–$3,114.29	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Administration Fee	$865.08	$3,460.32	$356.41–$3,114.29	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Fresh frozen plasma	$865.08	$3,460.32	$356.41–$3,114.29	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Packed red blood cells	$865.08	$3,460.32	$356.41–$3,114.29	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Platelets (random donor)	$865.08	$3,460.32	$356.41–$3,114.29	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Platelets (single donor)	$865.08	$3,460.32	$356.41–$3,114.29	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Whole blood	$865.08	$3,460.32	$356.41–$3,114.29	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Red blood cells (preoperativ	$865.08	$3,460.32	$356.41–$3,114.29	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Unit Product: - Red blood cells (postoperati	$865.08	$3,460.32	$356.41–$3,114.29	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Charge - IPPB Subsequent	$285.93	$1,143.72	$6.64–$1,143.72	330% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Charge - IPPB Initial	$285.93	$1,143.72	$6.64–$1,143.72	330% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Charge - Initial	$285.93	$1,143.72	$6.64–$1,143.72	330% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler Charge - Subsequent	$285.93	$1,143.72	$6.64–$1,143.72	330% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Charge - IPV Initial	$285.93	$1,143.72	$6.64–$1,143.72	330% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Charge - Subsequent	$285.93	$1,143.72	$6.64–$1,143.72	330% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Charge - IPV Subsequent	$285.93	$1,143.72	$6.64–$1,143.72	330% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler Charge - Initial	$285.93	$1,143.72	$6.64–$1,143.72	330% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment Charge - IPPB Subsequent	$285.93	$1,143.72	$117.80–$1,029.35	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment Charge - IPV Initial	$285.93	$1,143.72	$117.80–$1,029.35	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment Charge - IPV Subsequent	$285.93	$1,143.72	$117.80–$1,029.35	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Meter Dose Inhaler Charge - Initial	$285.93	$1,143.72	$117.80–$1,029.35	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Meter Dose Inhaler Charge - Subsequent	$285.93	$1,143.72	$117.80–$1,029.35	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment Charge - Subsequent	$285.93	$1,143.72	$117.80–$1,029.35	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment Charge - Initial	$285.93	$1,143.72	$117.80–$1,029.35	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment Charge - IPPB Initial	$285.93	$1,143.72	$117.80–$1,029.35	—	75%
Chemotherapy IV infusion, first hour CPT 96413 CHRG - CHEMO IV INFU 1ST HR	$510.84	$2,043.36	$111.22–$2,043.36	43% above	75%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHRG - CHEMO IV INFU 1ST HR	$510.84	$2,043.36	$210.47–$1,839.02	—	75%
Critical care, first 30 to 74 minutes CPT 99291 99291 - Critical Care	$2,262.87	$9,051.48	$252.99–$8,512.68	113% above	75%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 - Critical Care	$2,262.87	$9,051.48	$932.30–$8,146.33	—	75%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG Including Recording Awake and Drowsy	$834.57	$3,338.28	$232.56–$3,338.28	160% above	75%
EEG (brain wave test), awake and drowsy, routine CPT 95816 CHRG - EEG AWAKE DROWSY	$834.57	$3,338.28	$232.56–$3,338.28	160% above	75%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG Including Recording Awake and Drowsy	$834.57	$3,338.28	$343.84–$3,004.45	—	75%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 CHRG - EEG AWAKE DROWSY	$834.57	$3,338.28	$343.84–$3,004.45	—	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ED EKG Start Time	$389.34	$1,557.36	$5.25–$1,557.36	321% above	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG Series 3 Hours	$389.34	$1,557.36	$5.25–$1,557.36	321% above	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG BCE	$389.34	$1,557.36	$5.25–$1,557.36	321% above	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ED EKG Series 3 Hours	$389.34	$1,557.36	$5.25–$1,557.36	321% above	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram 12 Lead	$389.34	$1,557.36	$5.25–$1,557.36	321% above	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG Series 6 Hours	$389.34	$1,557.36	$5.25–$1,557.36	321% above	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG Series 6 Hours	$389.34	$1,557.36	$160.41–$1,401.62	—	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ED EKG Series 3 Hours	$389.34	$1,557.36	$160.41–$1,401.62	—	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram 12 Lead	$389.34	$1,557.36	$160.41–$1,401.62	—	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ED EKG Start Time	$389.34	$1,557.36	$160.41–$1,401.62	—	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG BCE	$389.34	$1,557.36	$160.41–$1,401.62	—	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG Series 3 Hours	$389.34	$1,557.36	$160.41–$1,401.62	—	75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 - Level 1	$231.12	$924.48	$10.79–$924.48	123% above	75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 - Level 1	$231.12	$924.48	$95.22–$832.03	—	75%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 - Level 2	$435.51	$1,742.04	$39.47–$1,742.04	124% above	75%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 - Level 2	$435.51	$1,742.04	$179.43–$1,567.84	—	75%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 - Level 3	$797.85	$3,191.40	$67.25–$3,191.40	122% above	75%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 - Level 3	$797.85	$3,191.40	$328.71–$2,872.26	—	75%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 - Level 4	$1,433.43	$5,733.72	$114.50–$5,733.72	156% above	75%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 - Level 4	$1,433.43	$5,733.72	$590.57–$5,160.35	—	75%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Trauma Notification Level - No Prior Notification	$1,441.22	$5,764.86	$166.01–$5,764.86	78% above	75%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 - Level 5	$1,566.54	$6,266.16	$166.01–$6,266.16	94% above	75%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Trauma Notification Level - No Prior Notification	$1,441.22	$5,764.86	$593.78–$5,188.37	—	75%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 - Level 5	$1,566.54	$6,266.16	$645.41–$5,639.54	—	75%
Exercise stress test, tracing only, the hospital charge CPT 93017 NM Stress Test	$629.10	$2,516.40	$31.33–$2,516.40	65% above	75%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiac Stress Test	$629.10	$2,516.40	$31.33–$2,516.40	65% above	75%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiac Stress Test	$629.10	$2,516.40	$259.19–$2,264.76	—	75%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 NM Stress Test	$629.10	$2,516.40	$259.19–$2,264.76	—	75%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 - Hydration, first hour	$727.65	$2,910.60	$28.32–$2,910.60	295% above	75%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hydration therapy 1st hour	$727.65	$2,910.60	$28.32–$2,910.60	295% above	75%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OB CHRG - Inf/Inj/Hydration Once - IV HYDRATION 1	$727.65	$2,910.60	$28.32–$2,910.60	295% above	75%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 CHRG - Inf/Inj/Hydration - IV HYDRATION 1 HR	$727.65	$2,910.60	$28.32–$2,910.60	295% above	75%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hydration therapy 1st hour	$727.65	$2,910.60	$299.79–$2,619.54	—	75%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 - Hydration, first hour	$727.65	$2,910.60	$299.79–$2,619.54	—	75%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 OB CHRG - Inf/Inj/Hydration Once - IV HYDRATION 1	$727.65	$2,910.60	$299.79–$2,619.54	—	75%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 CHRG - Inf/Inj/Hydration - IV HYDRATION 1 HR	$727.65	$2,910.60	$299.79–$2,619.54	—	75%
IV infusion of a medicine, first hour CPT 96365 OB CHRG - Inf/Inj/Hydration Once - IV THERAPY DX 1	$597.51	$2,390.04	$54.24–$2,390.04	166% above	75%
IV infusion of a medicine, first hour CPT 96365 Infusion 1st hour	$597.51	$2,390.04	$54.24–$2,390.04	166% above	75%
IV infusion of a medicine, first hour CPT 96365 96365 - IV tx, first hour	$597.51	$2,390.04	$54.24–$2,390.04	166% above	75%
IV infusion of a medicine, first hour CPT 96365 CHRG - Inf/Inj/Hydration - IV THERAPY DX 1 HR	$597.51	$2,390.04	$54.24–$2,390.04	166% above	75%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 - IV tx, first hour	$597.51	$2,390.04	$246.17–$2,151.04	—	75%
IV infusion of a medicine, first hour inpatient CPT 96365 OB CHRG - Inf/Inj/Hydration Once - IV THERAPY DX 1	$597.51	$2,390.04	$246.17–$2,151.04	—	75%
IV infusion of a medicine, first hour inpatient CPT 96365 Infusion 1st hour	$597.51	$2,390.04	$246.17–$2,151.04	—	75%
IV infusion of a medicine, first hour inpatient CPT 96365 CHRG - Inf/Inj/Hydration - IV THERAPY DX 1 HR	$597.51	$2,390.04	$246.17–$2,151.04	—	75%
IV push of a medicine, first drug CPT 96374 CHRG - Inf/Inj/Hydration - THERAPEUTIC IV PUSH	$419.31	$1,677.24	$32.03–$1,677.24	208% above	75%
IV push of a medicine, first drug CPT 96374 OB CHRG - Inf/Inj/Hydration Once - THERAPEUTIC IV	$419.31	$1,677.24	$32.03–$1,677.24	208% above	75%
IV push of a medicine, first drug CPT 96374 96374 - IV Injection, single/initial	$419.31	$1,677.24	$32.03–$1,677.24	208% above	75%
IV push of a medicine, first drug CPT 96374 IV push initial	$419.31	$1,677.24	$32.03–$1,677.24	208% above	75%
IV push of a medicine, first drug inpatient CPT 96374 96374 - IV Injection, single/initial	$419.31	$1,677.24	$172.76–$1,509.52	—	75%
IV push of a medicine, first drug inpatient CPT 96374 IV push initial	$419.31	$1,677.24	$172.76–$1,509.52	—	75%
IV push of a medicine, first drug inpatient CPT 96374 OB CHRG - Inf/Inj/Hydration Once - THERAPEUTIC IV	$419.31	$1,677.24	$172.76–$1,509.52	—	75%
IV push of a medicine, first drug inpatient CPT 96374 CHRG - Inf/Inj/Hydration - THERAPEUTIC IV PUSH	$419.31	$1,677.24	$172.76–$1,509.52	—	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 OB CHRG - THERAPEUTIC DX SQ IM	$222.21	$888.84	$13.00–$888.84	275% above	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM Injection	$222.21	$888.84	$13.00–$888.84	275% above	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 - Subq/IM Injection	$222.21	$888.84	$13.00–$888.84	275% above	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 CHRG - THERAPEUTIC DX SQ IM	$222.21	$888.84	$13.00–$888.84	275% above	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM Injection	$222.21	$888.84	$91.55–$799.96	—	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 OB CHRG - THERAPEUTIC DX SQ IM	$222.21	$888.84	$91.55–$799.96	—	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 CHRG - THERAPEUTIC DX SQ IM	$222.21	$888.84	$91.55–$799.96	—	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 - Subq/IM Injection	$222.21	$888.84	$91.55–$799.96	—	75%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation Units	$112.05	$448.20	$27.51–$448.20	112% above	75%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Units	$112.05	$448.20	$27.51–$448.20	112% above	75%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation Charges	$112.05	$448.20	$27.51–$448.20	112% above	75%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Charges	$112.05	$448.20	$27.51–$448.20	112% above	75%
Neuromuscular re-education, 15 minutes CPT 97112 NEURO RE-ED-15 MIN - REDOC 181	$112.05	$448.20	$27.51–$448.20	112% above	75%
Neuromuscular re-education, 15 minutes CPT 97112 NEURO RE-ED-15 MIN - REDOC 185	$112.05	$448.20	$27.51–$448.20	112% above	75%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducatn Assist Charge	$112.05	$448.20	$27.51–$448.20	112% above	75%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-EDUCATION EA 15 MIN PTA - Redoc 1	$112.05	$448.20	$27.51–$448.20	112% above	75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT Neuromuscular Reeducation Units	$112.05	$448.20	$46.16–$403.38	—	75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducation Charges	$112.05	$448.20	$46.16–$403.38	—	75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEURO RE-ED-15 MIN - REDOC 185	$112.05	$448.20	$46.16–$403.38	—	75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-EDUCATION EA 15 MIN PTA - Redoc 1	$112.05	$448.20	$46.16–$403.38	—	75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEURO RE-ED-15 MIN - REDOC 181	$112.05	$448.20	$46.16–$403.38	—	75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT Neuromuscular Reeducation Charges	$112.05	$448.20	$46.16–$403.38	—	75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducatn Assist Charge	$112.05	$448.20	$46.16–$403.38	—	75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducation Units	$112.05	$448.20	$46.16–$403.38	—	75%
New patient office visit, about 30 minutes CPT 99203 Outpatient EM Charges - Level 3 NP	$380.44	$1,521.76	$37.83–$1,521.76	233% above	75%
New patient office visit, about 30 minutes CPT 99203 CHRG - WOUND CARE LEVEL 3 NEW PT	$394.74	$1,578.96	$37.83–$1,578.96	246% above	75%
New patient office visit, about 30 minutes inpatient CPT 99203 Outpatient EM Charges - Level 3 NP	$380.44	$1,521.76	$156.74–$1,369.58	—	75%
New patient office visit, about 30 minutes inpatient CPT 99203 CHRG - WOUND CARE LEVEL 3 NEW PT	$394.74	$1,578.96	$162.63–$1,421.06	—	75%
New patient office visit, about 45 minutes CPT 99204 CHRG - WOUND CARE LEVEL 4 NEW PT	$428.49	$1,713.96	$56.77–$1,713.96	171% above	75%
New patient office visit, about 45 minutes CPT 99204 Outpatient EM Charges - Level 4 NP	$458.26	$1,833.02	$56.77–$1,833.02	189% above	75%
New patient office visit, about 45 minutes inpatient CPT 99204 CHRG - WOUND CARE LEVEL 4 NEW PT	$428.49	$1,713.96	$176.54–$1,542.56	—	75%
New patient office visit, about 45 minutes inpatient CPT 99204 Outpatient EM Charges - Level 4 NP	$458.26	$1,833.02	$188.80–$1,649.72	—	75%
New patient office visit, about 60 minutes CPT 99205 CHRG - WOUND CARE LEVEL 5 NEW PT	$446.31	$1,785.24	$56.77–$1,785.24	127% above	75%
New patient office visit, about 60 minutes CPT 99205 Outpatient EM Charges - Level 5 NP	$506.60	$2,026.40	$56.77–$2,026.40	157% above	75%
New patient office visit, about 60 minutes inpatient CPT 99205 CHRG - WOUND CARE LEVEL 5 NEW PT	$446.31	$1,785.24	$183.88–$1,606.72	—	75%
New patient office visit, about 60 minutes inpatient CPT 99205 Outpatient EM Charges - Level 5 NP	$506.60	$2,026.40	$208.72–$1,823.76	—	75%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 CHRG - WOUND CARE LEVEL 2 NEW PT	$320.22	$1,280.88	$32.87–$1,280.88	313% above	75%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Outpatient EM Charges - Level 2 NP	$360.62	$1,442.48	$32.87–$1,442.48	365% above	75%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 CHRG - WOUND CARE LEVEL 2 NEW PT	$320.22	$1,280.88	$131.93–$1,152.79	—	75%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Outpatient EM Charges - Level 2 NP	$360.62	$1,442.48	$148.58–$1,298.23	—	75%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL- LOW COMP - REDOC 185	$292.41	$1,169.64	$65.24–$1,169.64	133% above	75%
Occupational therapy evaluation, low complexity CPT 97165 IRF OT EVAL LOW	$292.41	$1,169.64	$65.24–$1,169.64	133% above	75%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW Unit - Yes	$292.41	$1,169.64	$65.24–$1,169.64	133% above	75%
Occupational therapy evaluation, low complexity CPT 97165 OT Eval Low Assistant Unit - Yes	$292.41	$1,169.64	$65.24–$1,169.64	133% above	75%
Occupational therapy evaluation, low complexity CPT 97165 OCCUPAT THERAPY EVAL LOW COMPLEXITY COTA - Redoc 1	$292.41	$1,169.64	$65.24–$1,169.64	133% above	75%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OCCUPAT THERAPY EVAL LOW COMPLEXITY COTA - Redoc 1	$292.41	$1,169.64	$120.47–$1,052.68	—	75%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT Eval Low Assistant Unit - Yes	$292.41	$1,169.64	$120.47–$1,052.68	—	75%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL- LOW COMP - REDOC 185	$292.41	$1,169.64	$120.47–$1,052.68	—	75%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW Unit - Yes	$292.41	$1,169.64	$120.47–$1,052.68	—	75%
Occupational therapy evaluation, low complexity inpatient CPT 97165 IRF OT EVAL LOW	$292.41	$1,169.64	$120.47–$1,052.68	—	75%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 IRF PT EVAL HIGH	$322.92	$1,291.68	$45.00–$1,291.68	114% above	75%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL- HGH COMP - REDOC 181	$322.92	$1,291.68	$45.00–$1,291.68	114% above	75%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH Unit - Yes	$322.92	$1,291.68	$45.00–$1,291.68	114% above	75%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL- HGH COMP - REDOC 181	$322.92	$1,291.68	$133.04–$1,162.51	—	75%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 IRF PT EVAL HIGH	$322.92	$1,291.68	$133.04–$1,162.51	—	75%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH Unit - Yes	$322.92	$1,291.68	$133.04–$1,162.51	—	75%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL- LOW COMP - REDOC 181	$270.81	$1,083.24	$45.00–$1,083.24	132% above	75%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW Unit - Yes	$270.81	$1,083.24	$45.00–$1,083.24	132% above	75%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 IRF PT EVAL LOW	$270.81	$1,083.24	$45.00–$1,083.24	132% above	75%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 IRF PT EVAL LOW	$270.81	$1,083.24	$111.57–$974.92	—	75%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW Unit - Yes	$270.81	$1,083.24	$111.57–$974.92	—	75%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL- LOW COMP - REDOC 181	$270.81	$1,083.24	$111.57–$974.92	—	75%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL- MOD COMP - REDOC 181	$305.91	$1,223.64	$45.00–$1,223.64	139% above	75%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD Unit - Yes	$305.91	$1,223.64	$45.00–$1,223.64	139% above	75%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 IRF PT EVAL MOD	$305.91	$1,223.64	$45.00–$1,223.64	139% above	75%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL- MOD COMP - REDOC 181	$305.91	$1,223.64	$126.03–$1,101.28	—	75%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MOD Unit - Yes	$305.91	$1,223.64	$126.03–$1,101.28	—	75%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 IRF PT EVAL MOD	$305.91	$1,223.64	$126.03–$1,101.28	—	75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THRPY-15 MIN - REDOC 181	$96.39	$385.56	$22.19–$385.56	64% above	75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY EA 15 MINUTES PTA - Redoc 181	$96.39	$385.56	$22.19–$385.56	64% above	75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Assistant Charges	$96.39	$385.56	$22.19–$385.56	64% above	75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THRPY-15 MIN - REDOC 185	$96.39	$385.56	$22.19–$385.56	64% above	75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Assistant Charges	$96.39	$385.56	$22.19–$385.56	64% above	75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Charges	$96.39	$385.56	$22.19–$385.56	64% above	75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Charges	$96.39	$385.56	$22.19–$385.56	64% above	75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Units	$96.39	$385.56	$22.19–$385.56	64% above	75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Units	$96.39	$385.56	$22.19–$385.56	64% above	75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY EA 15 MINUTES COTA - Redoc 185	$96.39	$385.56	$22.19–$385.56	64% above	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THRPY-15 MIN - REDOC 185	$96.39	$385.56	$39.71–$347.00	—	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Units	$96.39	$385.56	$39.71–$347.00	—	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Units	$96.39	$385.56	$39.71–$347.00	—	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Charges	$96.39	$385.56	$39.71–$347.00	—	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Charges	$96.39	$385.56	$39.71–$347.00	—	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THRPY-15 MIN - REDOC 181	$96.39	$385.56	$39.71–$347.00	—	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Assistant Charges	$96.39	$385.56	$39.71–$347.00	—	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Assistant Charges	$96.39	$385.56	$39.71–$347.00	—	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY EA 15 MINUTES PTA - Redoc 181	$96.39	$385.56	$39.71–$347.00	—	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY EA 15 MINUTES COTA - Redoc 185	$96.39	$385.56	$39.71–$347.00	—	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Units	$134.19	$536.76	$10.96–$536.76	150% above	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Units	$134.19	$536.76	$10.96–$536.76	150% above	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES EA 15 MIN COTA - Redoc 185	$134.19	$536.76	$10.96–$536.76	150% above	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Assistant Charge	$134.19	$536.76	$10.96–$536.76	150% above	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Assistant Charge	$134.19	$536.76	$10.96–$536.76	150% above	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAP EXERCS-15 MIN - REDOC 185	$134.19	$536.76	$10.96–$536.76	150% above	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAP EXERCS-15 MIN - REDOC 181	$134.19	$536.76	$10.96–$536.76	150% above	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES EA 15 MIN PTA - Redoc 181	$134.19	$536.76	$10.96–$536.76	150% above	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Charges	$134.19	$536.76	$10.96–$536.76	150% above	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Charges	$134.19	$536.76	$10.96–$536.76	150% above	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise Assistant Charge	$134.19	$536.76	$55.29–$483.08	—	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES EA 15 MIN COTA - Redoc 185	$134.19	$536.76	$55.29–$483.08	—	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES EA 15 MIN PTA - Redoc 181	$134.19	$536.76	$55.29–$483.08	—	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise Units	$134.19	$536.76	$55.29–$483.08	—	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Units	$134.19	$536.76	$55.29–$483.08	—	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise Charges	$134.19	$536.76	$55.29–$483.08	—	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Charges	$134.19	$536.76	$55.29–$483.08	—	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAP EXERCS-15 MIN - REDOC 181	$134.19	$536.76	$55.29–$483.08	—	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAP EXERCS-15 MIN - REDOC 185	$134.19	$536.76	$55.29–$483.08	—	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Assistant Charge	$134.19	$536.76	$55.29–$483.08	—	75%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco counseling Charge - 3-10 minutes	$41.58	$166.32	$12.99–$316.00	27% above	75%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Behavior change Smoke Charge - 1-10 minutes	$41.58	$166.32	$12.99–$316.00	27% above	75%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco counseling Charge - 3-10 minutes	$41.58	$166.32	$17.13–$149.69	—	75%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Behavior change Smoke Charge - 1-10 minutes	$41.58	$166.32	$17.13–$149.69	—	75%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Outpatient EM Charges - Level 5 EP	$235.76	$943.05	$56.77–$943.05	27% above	75%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 CHRG - WOUND CARE LEVEL 5 EST PT	$508.95	$2,035.80	$56.77–$2,035.80	174% above	75%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Outpatient EM Charges - Level 5 EP	$235.76	$943.05	$97.13–$848.74	—	75%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 CHRG - WOUND CARE LEVEL 5 EST PT	$508.95	$2,035.80	$209.69–$1,832.22	—	75%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CHRG - WOUND CARE LEVEL 3 EST PT	$606.96	$2,427.84	$37.83–$2,427.84	481% above	75%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 CHRG - WOUND CARE LEVEL 3 EST PT	$606.96	$2,427.84	$250.07–$2,185.06	—	75%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Outpatient EM Charges - Level 4 EP	$169.47	$677.87	$56.77–$677.87	28% above	75%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CHRG - WOUND CARE LEVEL 4 EST PT	$603.99	$2,415.96	$56.77–$2,415.96	356% above	75%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Outpatient EM Charges - Level 4 EP	$169.47	$677.87	$69.82–$610.08	—	75%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 CHRG - WOUND CARE LEVEL 4 EST PT	$603.99	$2,415.96	$248.84–$2,174.36	—	75%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Outpatient EM Charges - Level 2 EP	$125.39	$501.54	$29.17–$501.54	63% above	75%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CHRG - WOUND CARE LEVEL 2 EST PT	$392.31	$1,569.24	$29.17–$1,569.24	410% above	75%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Outpatient EM Charges - Level 2 EP	$125.39	$501.54	$51.66–$451.39	—	75%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 CHRG - WOUND CARE LEVEL 2 EST PT	$392.31	$1,569.24	$161.63–$1,412.32	—	75%
Speech and language evaluation CPT 92523 SP SOUND LANG COMP - REDOC 187	$202.77	$811.08	$83.54–$811.08	8% above	75%
Speech and language evaluation CPT 92523 Speech Evaluation with Language Charge - Yes	$202.77	$811.08	$83.54–$811.08	8% above	75%
Speech and language evaluation CPT 92523 SLP Eval Lang Comprehension,Express Unit	$202.77	$811.08	$83.54–$811.08	8% above	75%
Speech and language evaluation CPT 92523 Speech Evaluation with Language Units	$202.77	$811.08	$83.54–$811.08	8% above	75%
Speech and language evaluation inpatient CPT 92523 SP SOUND LANG COMP - REDOC 187	$202.77	$811.08	$83.54–$729.97	—	75%
Speech and language evaluation inpatient CPT 92523 Speech Evaluation with Language Units	$202.77	$811.08	$83.54–$729.97	—	75%
Speech and language evaluation inpatient CPT 92523 Speech Evaluation with Language Charge - Yes	$202.77	$811.08	$83.54–$729.97	—	75%
Speech and language evaluation inpatient CPT 92523 SLP Eval Lang Comprehension,Express Unit	$202.77	$811.08	$83.54–$729.97	—	75%
Speech therapy session, individual CPT 92507 Speech Treatment Charge - Yes	$197.10	$788.40	$32.79–$788.40	59% above	75%
Speech therapy session, individual CPT 92507 SLP Auditory Processing Tx Units	$197.10	$788.40	$32.79–$788.40	59% above	75%
Speech therapy session, individual CPT 92507 Speech Treatment Charge	$197.10	$788.40	$32.79–$788.40	59% above	75%
Speech therapy session, individual CPT 92507 SP-HEAR-TX-INDI VIST - REDOC 187	$197.10	$788.40	$32.79–$788.40	59% above	75%
Speech therapy session, individual inpatient CPT 92507 SLP Auditory Processing Tx Units	$197.10	$788.40	$81.21–$709.56	—	75%
Speech therapy session, individual inpatient CPT 92507 SP-HEAR-TX-INDI VIST - REDOC 187	$197.10	$788.40	$81.21–$709.56	—	75%
Speech therapy session, individual inpatient CPT 92507 Speech Treatment Charge - Yes	$197.10	$788.40	$81.21–$709.56	—	75%
Speech therapy session, individual inpatient CPT 92507 Speech Treatment Charge	$197.10	$788.40	$81.21–$709.56	—	75%
Spirometry (breathing test) CPT 94010 Pulmonary Function Test Charge - spirometry	$523.26	$2,093.04	$23.30–$2,093.04	291% above	75%
Spirometry (breathing test) inpatient CPT 94010 Pulmonary Function Test Charge - spirometry	$523.26	$2,093.04	$215.58–$1,883.74	—	75%
Spirometry before and after a bronchodilator CPT 94060 Pulmonary Function Test Charge - Pre and post bron	$480.87	$1,923.48	$33.19–$1,923.48	92% above	75%
Spirometry before and after a bronchodilator inpatient CPT 94060 Pulmonary Function Test Charge - Pre and post bron	$480.87	$1,923.48	$198.12–$1,731.13	—	75%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activities Charge	$127.17	$508.68	$8.76–$508.68	137% above	75%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activity Units	$127.17	$508.68	$8.76–$508.68	137% above	75%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES DIR EA 15MIN COTA - Redoc 1	$127.17	$508.68	$8.76–$508.68	137% above	75%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES DIR EA 15 MIN PTA - Redoc 1	$127.17	$508.68	$8.76–$508.68	137% above	75%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Assist Charges	$127.17	$508.68	$8.76–$508.68	137% above	75%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Charges	$127.17	$508.68	$8.76–$508.68	137% above	75%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Units	$127.17	$508.68	$8.76–$508.68	137% above	75%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activities Assist Charge	$127.17	$508.68	$8.76–$508.68	137% above	75%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAP ACTVTS-15 MIN - REDOC 181	$127.17	$508.68	$8.76–$508.68	137% above	75%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAP ACTVTS-15 MIN - REDOC 185	$127.17	$508.68	$8.76–$508.68	137% above	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAP ACTVTS-15 MIN - REDOC 185	$127.17	$508.68	$52.39–$457.81	—	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAP ACTVTS-15 MIN - REDOC 181	$127.17	$508.68	$52.39–$457.81	—	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activities Charge	$127.17	$508.68	$52.39–$457.81	—	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activities Units	$127.17	$508.68	$52.39–$457.81	—	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activity Units	$127.17	$508.68	$52.39–$457.81	—	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activities Charges	$127.17	$508.68	$52.39–$457.81	—	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITIES DIR EA 15MIN COTA - Redoc 1	$127.17	$508.68	$52.39–$457.81	—	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITIES DIR EA 15 MIN PTA - Redoc 1	$127.17	$508.68	$52.39–$457.81	—	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activities Assist Charges	$127.17	$508.68	$52.39–$457.81	—	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activities Assist Charge	$127.17	$508.68	$52.39–$457.81	—	75%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Mississippi	Off list
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pt. Location - Vaccine Charge - Infusion Center	$222.21	$888.84	$18.39–$888.84	308% above	75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pt. Location - Vaccine Charge - Emergency Departme	$222.21	$888.84	$18.39–$888.84	308% above	75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pt. Location - Vaccine Charge - In House/Observati	$222.21	$888.84	$18.39–$888.84	308% above	75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 $ED Admin Vaccine	$222.21	$888.84	$18.39–$888.84	308% above	75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pt. Location - Vaccine Charge - Infusion Center	$222.21	$888.84	$91.55–$799.96	—	75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 $ED Admin Vaccine	$222.21	$888.84	$91.55–$799.96	—	75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pt. Location - Vaccine Charge - In House/Observati	$222.21	$888.84	$91.55–$799.96	—	75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pt. Location - Vaccine Charge - Emergency Departme	$222.21	$888.84	$91.55–$799.96	—	75%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Pt. Location - Vaccine Charge - ED Additional	$94.77	$379.08	$13.19–$379.08	201% above	75%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Pt. Location - Vaccine Charge - ED Additional	$94.77	$379.08	$39.05–$341.17	—	75%

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

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

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

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

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

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

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

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

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

Source file: https://www.merithealthcentral.com/Uploads/Public/Documents/charge-masters/charge-masters-2024/640907122_merit-health-central_standardcharges.csv