York Hospital
York Hospital in York, ME publishes cash prices for 394 common procedures listed here, from its own machine-readable price file updated Jul 4, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Maine median for 191 of 386 procedures and above it for 179. By typical cash price it ranks #15 of 28 Maine hospitals and #3 of 6 hospitals in the Portland, ME area, cheapest first. Select a procedure to compare it with other hospitals nearby.
15 Hospital Drive, York ME 03902 Collected Sep 23, 2026 Source price file Check a bill from this hospital (207) 351-2478
Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 200020 · CMS hospital register NPI 1376528398
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
York Hospital is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.
You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.
Source: IRS, section 501(r) requirements for nonprofit hospitals.
CMS price transparency record
The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 4 actions for a hospital named York Hospital in York, ME:
- Aug 25, 2021 Warning notice
- Jan 14, 2022 Case closed
- Mar 27, 2025 Warning notice
- Jun 30, 2025 Case closed
Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems.
A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Maine | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W/O & W/CON 74170 | $1,627.20 | $2,712.00 | — | 16% above | 40% |
| Abdominal CT scan without and with contrast CPT 74170 W-CT ABDOMEN W&W/O 74170 | $1,627.20 | $2,712.00 | — | 16% above | 40% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/O & W/CON 74170 | $1,627.20 | $2,712.00 | — | — | 40% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 W-CT ABDOMEN W&W/O 74170 | $1,627.20 | $2,712.00 | — | — | 40% |
| Abdominal X-ray, 2 views CPT 74019 ABDOMEN SUPINE/ERECT 2 VIEW 74019 | $261.60 | $436.00 | — | 7% above | 40% |
| Abdominal X-ray, 2 views CPT 74019 B-ABDOMEN SUPINE/ERECT COMPLETE 74019 | $261.60 | $436.00 | — | 7% above | 40% |
| Abdominal X-ray, 2 views CPT 74019 W-ABDOMEN SUPINE/ERECT OR DECUB 74019 | $261.60 | $436.00 | — | 7% above | 40% |
| Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN SUPINE/ERECT 2 VIEW 74019 | $261.60 | $436.00 | — | — | 40% |
| Abdominal X-ray, 2 views inpatient CPT 74019 W-ABDOMEN SUPINE/ERECT OR DECUB 74019 | $261.60 | $436.00 | — | — | 40% |
| Abdominal X-ray, 2 views inpatient CPT 74019 B-ABDOMEN SUPINE/ERECT COMPLETE 74019 | $261.60 | $436.00 | — | — | 40% |
| Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE 3 VIEW 73610 | $178.20 | $297.00 | — | 16% below | 40% |
| Ankle X-ray, complete, 3 or more views CPT 73610 W-ANKLE 3 VIEW 73610 | $178.20 | $297.00 | — | 16% below | 40% |
| Ankle X-ray, complete, 3 or more views CPT 73610 B-ANKLE 3 VIEWS 73610 | $178.20 | $297.00 | — | 16% below | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE 3 VIEW RIGHT 73610 | $178.20 | $297.00 | — | 16% below | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 B-ANKLE 3 VIEWS RIGHT 73610 | $178.20 | $297.00 | — | 16% below | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 B-ANKLE 3 VIEWS LEFT 73610 | $178.20 | $297.00 | — | 16% below | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 W-ANKLE 3 VIEW RT 73610 | $178.20 | $297.00 | — | 16% below | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 W-ANKLE 3 VIEW LT 73610 | $178.20 | $297.00 | — | 16% below | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE 3 VIEW LEFT 73610 | $178.20 | $297.00 | — | 16% below | 40% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 W-ANKLE 3 VIEW 73610 | $178.20 | $297.00 | — | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 ANKLE 3 VIEW 73610 | $178.20 | $297.00 | — | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 B-ANKLE 3 VIEWS 73610 | $178.20 | $297.00 | — | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 W-ANKLE 3 VIEW RT 73610 | $178.20 | $297.00 | — | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE 3 VIEW LEFT 73610 | $178.20 | $297.00 | — | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 B-ANKLE 3 VIEWS RIGHT 73610 | $178.20 | $297.00 | — | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 B-ANKLE 3 VIEWS LEFT 73610 | $178.20 | $297.00 | — | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE 3 VIEW RIGHT 73610 | $178.20 | $297.00 | — | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 W-ANKLE 3 VIEW LT 73610 | $178.20 | $297.00 | — | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 NON-INV PHYSLGC UP/LOW SN | $257.40 | $429.00 | — | 76% above | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 NON-INV PHYSLGC UP/LOW SN | $257.40 | $429.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 W-CT UPPR EXT W/O 73200 | $861.00 | $1,435.00 | — | 24% below | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXT WO CON 73200 | $861.00 | $1,435.00 | — | 24% below | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UPPER EXT WO CON 73200LT | $861.00 | $1,435.00 | — | 24% below | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UPPER EXT WO CON 73200RT | $861.00 | $1,435.00 | — | 24% below | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXT WO CON 73200 | $861.00 | $1,435.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 W-CT UPPR EXT W/O 73200 | $861.00 | $1,435.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPPER EXT WO CON 73200RT | $861.00 | $1,435.00 | — | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPPER EXT WO CON 73200LT | $861.00 | $1,435.00 | — | — | 40% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 BARIUM SWALLOW/ESOPHAGRAM SGL CONT 74220 | $305.40 | $509.00 | — | 14% below | 40% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 BARIUM SWALLOW/ESOPHAGRAM SGL CONT 74220 | $305.40 | $509.00 | — | — | 40% |
| Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE SCAN TOTAL 78306 | $1,177.80 | $1,963.00 | — | at median | 40% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE SCAN TOTAL 78306 | $1,177.80 | $1,963.00 | — | — | 40% |
| Breast ultrasound, complete, one breast one side CPT 76641 W-US BREAST LT COMPLETE 76641 | $169.80 | $283.00 | — | 16% below | 40% |
| Breast ultrasound, complete, one breast one side CPT 76641 US BREAST LT (BC) COMPLETE 76641 | $169.80 | $283.00 | — | 16% below | 40% |
| Breast ultrasound, complete, one breast one side CPT 76641 W-US BREAST RT COMPLETE 76641 | $169.80 | $283.00 | — | 16% below | 40% |
| Breast ultrasound, complete, one breast one side CPT 76641 US BREAST RT (BC) COMPLETE 76641 | $169.80 | $283.00 | — | 16% below | 40% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST RT (BC) COMPLETE 76641 | $169.80 | $283.00 | — | — | 40% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST LT (BC) COMPLETE 76641 | $169.80 | $283.00 | — | — | 40% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 W-US BREAST LT COMPLETE 76641 | $169.80 | $283.00 | — | — | 40% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 W-US BREAST RT COMPLETE 76641 | $169.80 | $283.00 | — | — | 40% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 W-US BREAST LT LIMITED 76642 | $194.40 | $324.00 | — | 18% below | 40% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 W-US BREAST RT LIMITED 76642 | $194.40 | $324.00 | — | 18% below | 40% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST RT (BC) LIMITED 76642 | $194.40 | $324.00 | — | 18% below | 40% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LT (BC) LIMITED 76642 | $194.40 | $324.00 | — | 18% below | 40% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 W-US BREAST LT LIMITED 76642 | $194.40 | $324.00 | — | — | 40% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LT (BC) LIMITED 76642 | $194.40 | $324.00 | — | — | 40% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST RT (BC) LIMITED 76642 | $194.40 | $324.00 | — | — | 40% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 W-US BREAST RT LIMITED 76642 | $194.40 | $324.00 | — | — | 40% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 W-CT ANGIO ABD/PEL W/CON 74174 | $2,428.80 | $4,048.00 | — | 59% above | 40% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABD/PEL W/CON, NC 74174 | $2,428.80 | $4,048.00 | — | 59% above | 40% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ANGIO ABD/PEL W/CON, NC 74174 | $2,428.80 | $4,048.00 | — | — | 40% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 W-CT ANGIO ABD/PEL W/CON 74174 | $2,428.80 | $4,048.00 | — | — | 40% |
| CT angiography (CTA) of the head CPT 70496 CT ANGIO HEAD W/CON NC 70496 | $1,603.80 | $2,673.00 | — | 3% above | 40% |
| CT angiography (CTA) of the head CPT 70496 W-CTV HEAD W/CONTRAST 70496 | $1,603.80 | $2,673.00 | — | 3% above | 40% |
| CT angiography (CTA) of the head CPT 70496 W-CT ANGIO HEAD W/CON 70496 | $1,603.80 | $2,673.00 | — | 3% above | 40% |
| CT angiography (CTA) of the head CPT 70496 CTV HEAD W/CONTRAST 70496 | $1,603.80 | $2,673.00 | — | 3% above | 40% |
| CT angiography (CTA) of the head inpatient CPT 70496 CTV HEAD W/CONTRAST 70496 | $1,603.80 | $2,673.00 | — | — | 40% |
| CT angiography (CTA) of the head inpatient CPT 70496 W-CTV HEAD W/CONTRAST 70496 | $1,603.80 | $2,673.00 | — | — | 40% |
| CT angiography (CTA) of the head inpatient CPT 70496 W-CT ANGIO HEAD W/CON 70496 | $1,603.80 | $2,673.00 | — | — | 40% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIO HEAD W/CON NC 70496 | $1,603.80 | $2,673.00 | — | — | 40% |
| CT angiography (CTA) of the neck CPT 70498 W-CT ANGIO NECK W/CON 70498 | $1,603.80 | $2,673.00 | — | 2% above | 40% |
| CT angiography (CTA) of the neck CPT 70498 CT ANGIO NECK W/CON 70498 | $1,603.80 | $2,673.00 | — | 2% above | 40% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIO NECK W/CON 70498 | $1,603.80 | $2,673.00 | — | — | 40% |
| CT angiography (CTA) of the neck inpatient CPT 70498 W-CT ANGIO NECK W/CON 70498 | $1,603.80 | $2,673.00 | — | — | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 W-CT ANGIO CHEST W/CON 71275 | $1,832.40 | $3,054.00 | — | at median | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST W/CON 71275 | $1,832.40 | $3,054.00 | — | at median | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 W-CT ANGIO CHEST W/CON 71275 | $1,832.40 | $3,054.00 | — | — | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST W/CON 71275 | $1,832.40 | $3,054.00 | — | — | 40% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO HRT W/3D IMAGE 75574 | $1,183.20 | $1,972.00 | — | 125% above | 40% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT ANGIO HRT W/3D IMAGE 75574 | $1,183.20 | $1,972.00 | — | — | 40% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT CHEST (HEART) W/O CALCIUM SCORE 75571 | $133.80 | $223.00 | — | 2% above | 40% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT CHEST (HEART) W/O CALCIUM SCORE 75571 | $133.80 | $223.00 | — | — | 40% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 W-CT ABDOMEN & PELVIS W/O 74176 | $1,668.00 | $2,780.00 | — | 20% above | 40% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN & PELVIS W/O CON 74176 | $1,668.00 | $2,780.00 | — | 20% above | 40% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN & PELVIS W/O CON 74176 | $1,668.00 | $2,780.00 | — | — | 40% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 W-CT ABDOMEN & PELVIS W/O 74176 | $1,668.00 | $2,780.00 | — | — | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 W-CT ABDOMEN & PELVIS W/CON 74177 | $1,996.20 | $3,327.00 | — | at median | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN & PELVIS W/ CON 74177 | $1,996.20 | $3,327.00 | — | at median | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 W-CT ABDOMEN & PELVIS W/CON 74177 | $1,996.20 | $3,327.00 | — | — | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN & PELVIS W/ CON 74177 | $1,996.20 | $3,327.00 | — | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN & PELVIS W/O & W/CON 74178 | $3,102.00 | $5,170.00 | — | 41% above | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 W-CT ABDOMEN & PELVIS WO & W/CON 74178 | $3,102.00 | $5,170.00 | — | 41% above | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 W-CT ABDOMEN & PELVIS WO & W/CON 74178 | $3,102.00 | $5,170.00 | — | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN & PELVIS W/O & W/CON 74178 | $3,102.00 | $5,170.00 | — | — | 40% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CON 74160 | $1,170.00 | $1,950.00 | — | 5% above | 40% |
| CT scan of the abdomen with contrast CPT 74160 W-CT ABDOMEN W/C 74160 | $1,170.00 | $1,950.00 | — | 5% above | 40% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CON 74160 | $1,170.00 | $1,950.00 | — | — | 40% |
| CT scan of the abdomen with contrast inpatient CPT 74160 W-CT ABDOMEN W/C 74160 | $1,170.00 | $1,950.00 | — | — | 40% |
| CT scan of the abdomen without contrast CPT 74150 IR CT ABDOMEN W/O CON S&I | $237.60 | $396.00 | — | 72% below | 40% |
| CT scan of the abdomen without contrast CPT 74150 W-CT ABDOMEN W/O 74150 | $965.40 | $1,609.00 | — | 15% above | 40% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CON 74150 | $965.40 | $1,609.00 | — | 15% above | 40% |
| CT scan of the abdomen without contrast inpatient CPT 74150 IR CT ABDOMEN W/O CON S&I | $237.60 | $396.00 | — | — | 40% |
| CT scan of the abdomen without contrast inpatient CPT 74150 W-CT ABDOMEN W/O 74150 | $965.40 | $1,609.00 | — | — | 40% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CON 74150 | $965.40 | $1,609.00 | — | — | 40% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 W-CT SINUS/FAC W/O 70486 | $860.40 | $1,434.00 | — | 2% below | 40% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS/FACIAL WO 70486 | $860.40 | $1,434.00 | — | 2% below | 40% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 W-CT SINUS/FAC W/O 70486 | $860.40 | $1,434.00 | — | — | 40% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS/FACIAL WO 70486 | $860.40 | $1,434.00 | — | — | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 W-CT HEAD W/O CON 70450 | $860.40 | $1,434.00 | — | 12% below | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CON 70450 | $860.40 | $1,434.00 | — | 12% below | 40% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 W-CT HEAD W/O CON 70450 | $860.40 | $1,434.00 | — | — | 40% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CON 70450 | $860.40 | $1,434.00 | — | — | 40% |
| CT scan of the head with contrast CPT 70460 W-CT HEAD W/CONT 70460 | $1,012.80 | $1,688.00 | — | 5% below | 40% |
| CT scan of the head with contrast CPT 70460 CT HEAD W/CONTRAST 70460 | $1,012.80 | $1,688.00 | — | 5% below | 40% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/CONTRAST 70460 | $1,012.80 | $1,688.00 | — | — | 40% |
| CT scan of the head with contrast inpatient CPT 70460 W-CT HEAD W/CONT 70460 | $1,012.80 | $1,688.00 | — | — | 40% |
| CT scan of the head without and with contrast CPT 70470 W-CT HEAD WO/W CON 70470 | $1,462.80 | $2,438.00 | — | at median | 40% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD WO/W CON 70470 | $1,462.80 | $2,438.00 | — | at median | 40% |
| CT scan of the head without and with contrast inpatient CPT 70470 W-CT HEAD WO/W CON 70470 | $1,462.80 | $2,438.00 | — | — | 40% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WO/W CON 70470 | $1,462.80 | $2,438.00 | — | — | 40% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 IR CT L/SPINE W/O CONT S&I | $237.60 | $396.00 | — | 76% below | 40% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O CON 72131 | $890.40 | $1,484.00 | — | 9% below | 40% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 W-CT LUMBAR W/O 72131 | $890.40 | $1,484.00 | — | 9% below | 40% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 IR CT L/SPINE W/O CONT S&I | $237.60 | $396.00 | — | — | 40% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 W-CT LUMBAR W/O 72131 | $890.40 | $1,484.00 | — | — | 40% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O CON 72131 | $890.40 | $1,484.00 | — | — | 40% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 IR CT CERVICAL W/O S&I | $237.60 | $396.00 | — | 76% below | 40% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 W-CT CERVICAL W/O 72125 | $1,162.20 | $1,937.00 | — | 18% above | 40% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O CON 72125 | $1,162.20 | $1,937.00 | — | 18% above | 40% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 IR CT CERVICAL W/O S&I | $237.60 | $396.00 | — | — | 40% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 W-CT CERVICAL W/O 72125 | $1,162.20 | $1,937.00 | — | — | 40% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O CON 72125 | $1,162.20 | $1,937.00 | — | — | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 W-CT PELVIS W/C 72193 | $834.00 | $1,390.00 | — | 17% below | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CON 72193 | $834.00 | $1,390.00 | — | 17% below | 40% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 W-CT PELVIS W/C 72193 | $834.00 | $1,390.00 | — | — | 40% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CON 72193 | $834.00 | $1,390.00 | — | — | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 W-US CAROTID ARTERIES BILAT 93880 | $406.80 | $678.00 | — | — | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID ARTERIES BILAT COMPLETE 93880 | $406.80 | $678.00 | — | — | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 DUPLEX CAROTID CMPLT WELLS | $535.80 | $893.00 | — | 19% below | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 DUPLEX CAROTID CMPLT | $535.80 | $893.00 | — | 19% below | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID ARTERIES BILAT COMPLETE 93880 | $406.80 | $678.00 | — | — | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 W-US CAROTID ARTERIES BILAT 93880 | $406.80 | $678.00 | — | — | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 DUPLEX CAROTID CMPLT WELLS | $535.80 | $893.00 | — | — | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 DUPLEX CAROTID CMPLT | $535.80 | $893.00 | — | — | 40% |
| Chest CT scan without and with contrast CPT 71270 W-CT CHEST W&W/O CON 71270 | $1,328.40 | $2,214.00 | — | 22% below | 40% |
| Chest CT scan without and with contrast CPT 71270 CT CHEST WO/W CON 71270 | $1,328.40 | $2,214.00 | — | 22% below | 40% |
| Chest CT scan without and with contrast inpatient CPT 71270 W-CT CHEST W&W/O CON 71270 | $1,328.40 | $2,214.00 | — | — | 40% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST WO/W CON 71270 | $1,328.40 | $2,214.00 | — | — | 40% |
| Chest X-ray, 2 views CPT 71046 B-CHEST 2 VIEW 71046 | $204.60 | $341.00 | — | 3% below | 40% |
| Chest X-ray, 2 views CPT 71046 W-CHEST 2 VIEWS 71046 | $204.60 | $341.00 | — | 3% below | 40% |
| Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS 71046 | $204.60 | $341.00 | — | 3% below | 40% |
| Chest X-ray, 2 views CPT 71046 W-CHEST DECUB (S)1-2 71046 | $204.60 | $341.00 | — | 3% below | 40% |
| Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS WITH FLUORO 71046 | $204.60 | $341.00 | — | 3% below | 40% |
| Chest X-ray, 2 views CPT 71046 B-CHEST DECUB(S)1-2 71046 | $204.60 | $341.00 | — | 3% below | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS WITH FLUORO 71046 | $204.60 | $341.00 | — | — | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 W-CHEST 2 VIEWS 71046 | $204.60 | $341.00 | — | — | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 W-CHEST DECUB (S)1-2 71046 | $204.60 | $341.00 | — | — | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS 71046 | $204.60 | $341.00 | — | — | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 B-CHEST 2 VIEW 71046 | $204.60 | $341.00 | — | — | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 B-CHEST DECUB(S)1-2 71046 | $204.60 | $341.00 | — | — | 40% |
| Chest X-ray, single view CPT 71045 B-CHEST 1 VIEW 71045 | $154.80 | $258.00 | — | 23% below | 40% |
| Chest X-ray, single view CPT 71045 CHEST DECUB [1] VIEW 71045 | $154.80 | $258.00 | — | 23% below | 40% |
| Chest X-ray, single view CPT 71045 CHEST EXPIRATION (1)71045 | $154.80 | $258.00 | — | 23% below | 40% |
| Chest X-ray, single view CPT 71045 CHEST 1 VIEW 71045 | $154.80 | $258.00 | — | 23% below | 40% |
| Chest X-ray, single view CPT 71045 B-CHEST EXP/DECUB (1) 71045 | $154.80 | $258.00 | — | 23% below | 40% |
| Chest X-ray, single view CPT 71045 W-CHEST EXPIRATION (1) 71045 | $154.80 | $258.00 | — | 23% below | 40% |
| Chest X-ray, single view inpatient CPT 71045 B-CHEST 1 VIEW 71045 | $154.80 | $258.00 | — | — | 40% |
| Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW 71045 | $154.80 | $258.00 | — | — | 40% |
| Chest X-ray, single view inpatient CPT 71045 B-CHEST EXP/DECUB (1) 71045 | $154.80 | $258.00 | — | — | 40% |
| Chest X-ray, single view inpatient CPT 71045 CHEST DECUB [1] VIEW 71045 | $154.80 | $258.00 | — | — | 40% |
| Chest X-ray, single view inpatient CPT 71045 W-CHEST EXPIRATION (1) 71045 | $154.80 | $258.00 | — | — | 40% |
| Chest X-ray, single view inpatient CPT 71045 CHEST EXPIRATION (1)71045 | $154.80 | $258.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete CPT 73000 B-CLAVICLE 73000 | $150.00 | $250.00 | — | 32% below | 40% |
| Collarbone (clavicle) X-ray, complete CPT 73000 W-CLAVICLE COMPLETE 73000 | $150.00 | $250.00 | — | 32% below | 40% |
| Collarbone (clavicle) X-ray, complete CPT 73000 CLAVICLE COMPLETE 73000 | $150.00 | $250.00 | — | 32% below | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 W-CLAVICLE RT COMPLETE 73000 | $150.00 | $250.00 | — | 32% below | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE LEFT COMPLETE 73000 | $150.00 | $250.00 | — | 32% below | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE RT COMPLETE 73000 | $150.00 | $250.00 | — | 32% below | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 B-CLAVICLE LT COMPLETE 73000 | $150.00 | $250.00 | — | 32% below | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 B-CLAVICLE RT COMPLETE 73000 | $150.00 | $250.00 | — | 32% below | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 W-CLAVICLE LT COMPLETE 73000 | $150.00 | $250.00 | — | 32% below | 40% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 B-CLAVICLE 73000 | $150.00 | $250.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 W-CLAVICLE COMPLETE 73000 | $150.00 | $250.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 CLAVICLE COMPLETE 73000 | $150.00 | $250.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE RT COMPLETE 73000 | $150.00 | $250.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 W-CLAVICLE RT COMPLETE 73000 | $150.00 | $250.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 B-CLAVICLE LT COMPLETE 73000 | $150.00 | $250.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 B-CLAVICLE RT COMPLETE 73000 | $150.00 | $250.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 W-CLAVICLE LT COMPLETE 73000 | $150.00 | $250.00 | — | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE LEFT COMPLETE 73000 | $150.00 | $250.00 | — | — | 40% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 W-US RENAL/AORTA COMP 76770 | $415.80 | $693.00 | — | 9% below | 40% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL/AORTA COMP 76770 | $415.80 | $693.00 | — | 9% below | 40% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL/AORTA COMP 76770 | $415.80 | $693.00 | — | — | 40% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 W-US RENAL/AORTA COMP 76770 | $415.80 | $693.00 | — | — | 40% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY(DEXA SCAN AXIAL)77080 | $352.20 | $587.00 | — | 40% above | 40% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY(DEXA SCAN AXIAL)77080 | $352.20 | $587.00 | — | — | 40% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BONE DENSITY(DEXA SCAN APPEND)77081 | $177.60 | $296.00 | — | 10% above | 40% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BONE DENSITY(DEXA SCAN APPEND)77081 | $177.60 | $296.00 | — | — | 40% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 W-CT CHEST W/O CON 71250 | $966.00 | $1,610.00 | — | 3% above | 40% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CON 71250 | $966.00 | $1,610.00 | — | 3% above | 40% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 W-CT CHEST W/O CON 71250 | $966.00 | $1,610.00 | — | — | 40% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CON 71250 | $966.00 | $1,610.00 | — | — | 40% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CON 71260 | $1,170.00 | $1,950.00 | — | 9% below | 40% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 W-CT CHEST W/CON 71260 | $1,170.00 | $1,950.00 | — | 9% below | 40% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 W-CT CHEST W/CON 71260 | $1,170.00 | $1,950.00 | — | — | 40% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CON 71260 | $1,170.00 | $1,950.00 | — | — | 40% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIGITAL BILAT DIAG 77066 | $345.60 | $576.00 | — | — | 40% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIGITAL DIAG BILAT ADDL VS 77066 | $345.60 | $576.00 | — | — | 40% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO DIGITAL BILAT DIAG 77066 | $345.60 | $576.00 | — | — | 40% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO DIGITAL DIAG BILAT ADDL VS 77066 | $345.60 | $576.00 | — | — | 40% |
| Diagnostic mammogram, one breast CPT 77065 MAMMO DIGITAL UNI DIAG 77065 | $280.80 | $468.00 | — | 78% above | 40% |
| Diagnostic mammogram, one breast CPT 77065 MAMMO DIGITAL AVS UNI DIAG 77065 | $280.80 | $468.00 | — | 78% above | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAM DIAG UNILAT W CAD 77065 | $313.80 | $523.00 | — | 99% above | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 MAMMO DIGITAL UNI DIAG 77065 | $280.80 | $468.00 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 MAMMO DIGITAL AVS UNI DIAG 77065 | $280.80 | $468.00 | — | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAM DIAG UNILAT W CAD 77065 | $313.80 | $523.00 | — | — | 40% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 DUPLEX SCAN LE ART BILATERAL | $499.80 | $833.00 | — | — | 40% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US DUP ART LOW EXT BILAT 93925 | $514.80 | $858.00 | — | — | 40% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 DUPLEX ARTERIAL LWR CMPLT WELLS | $514.80 | $858.00 | — | 38% above | 40% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 DUPLEX ARTERIAL LWR CMPLT | $514.80 | $858.00 | — | 38% above | 40% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 DUPLEX SCAN LE ART BILATERAL | $499.80 | $833.00 | — | — | 40% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US DUP ART LOW EXT BILAT 93925 | $514.80 | $858.00 | — | — | 40% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 DUPLEX ARTERIAL LWR CMPLT | $514.80 | $858.00 | — | — | 40% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 DUPLEX ARTERIAL LWR CMPLT WELLS | $514.80 | $858.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 IR US EXTREM VEINS BILAT | $472.20 | $787.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 DUPLEX VENOUS CMPLT WELLS | $514.80 | $858.00 | — | at median | 40% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 DUPLEX VENOUS CMPLT | $514.80 | $858.00 | — | at median | 40% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 W-US DUPLEX EXT BIL COMP 93970 | $567.60 | $946.00 | — | 10% above | 40% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 US DUPLEX EXT BIL 93970 | $567.60 | $946.00 | — | 10% above | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 IR US EXTREM VEINS BILAT | $472.20 | $787.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 DUPLEX VENOUS CMPLT | $514.80 | $858.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 DUPLEX VENOUS CMPLT WELLS | $514.80 | $858.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US DUPLEX EXT BIL 93970 | $567.60 | $946.00 | — | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 W-US DUPLEX EXT BIL COMP 93970 | $567.60 | $946.00 | — | — | 40% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHOCARDIOGRAM WELLS 09 | $1,190.40 | $1,984.00 | — | 10% above | 40% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHOCARDIOGRAM 09 | $1,190.40 | $1,984.00 | — | 10% above | 40% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHOCARDIOGRAM 09 | $1,190.40 | $1,984.00 | — | — | 40% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHOCARDIOGRAM WELLS 09 | $1,190.40 | $1,984.00 | — | — | 40% |
| Elbow X-ray, 2 views CPT 73070 W-ELBOW AP/LAT 73070 | $164.40 | $274.00 | — | 25% below | 40% |
| Elbow X-ray, 2 views CPT 73070 ELBOW AP/LAT 73070 | $164.40 | $274.00 | — | 25% below | 40% |
| Elbow X-ray, 2 views CPT 73070 B-ELBOW AP/LAT 73070 | $164.40 | $274.00 | — | 25% below | 40% |
| Elbow X-ray, 2 views one side CPT 73070 W-ELBOW AP/LAT RT 73070 | $164.40 | $274.00 | — | 25% below | 40% |
| Elbow X-ray, 2 views one side CPT 73070 B-ELBOW AP/LAT LEFT 73070 | $164.40 | $274.00 | — | 25% below | 40% |
| Elbow X-ray, 2 views one side CPT 73070 ELBOW AP/LAT LT 73070 | $164.40 | $274.00 | — | 25% below | 40% |
| Elbow X-ray, 2 views one side CPT 73070 ELBOW AP/LAT RT 73070 | $164.40 | $274.00 | — | 25% below | 40% |
| Elbow X-ray, 2 views one side CPT 73070 W-ELBOW AP/LAT LT 73070 | $164.40 | $274.00 | — | 25% below | 40% |
| Elbow X-ray, 2 views one side CPT 73070 B-ELBOW AP/LAT RIGHT 73070 | $164.40 | $274.00 | — | 25% below | 40% |
| Elbow X-ray, 2 views inpatient CPT 73070 ELBOW AP/LAT 73070 | $164.40 | $274.00 | — | — | 40% |
| Elbow X-ray, 2 views inpatient CPT 73070 W-ELBOW AP/LAT 73070 | $164.40 | $274.00 | — | — | 40% |
| Elbow X-ray, 2 views inpatient CPT 73070 B-ELBOW AP/LAT 73070 | $164.40 | $274.00 | — | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 W-ELBOW AP/LAT LT 73070 | $164.40 | $274.00 | — | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW AP/LAT RT 73070 | $164.40 | $274.00 | — | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 B-ELBOW AP/LAT RIGHT 73070 | $164.40 | $274.00 | — | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 B-ELBOW AP/LAT LEFT 73070 | $164.40 | $274.00 | — | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW AP/LAT LT 73070 | $164.40 | $274.00 | — | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 W-ELBOW AP/LAT RT 73070 | $164.40 | $274.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views CPT 73080 B-ELBOW W/OBL 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views CPT 73080 W-ELBOW W/OBL MIN 3 VIEWS 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views CPT 73080 ELBOW W/OBL MIN 3 VIEWS 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW W/OBL LT 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 B-ELBOW W/OBL RIGHT MIN 3 VIEWS 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 B-ELBOW W/OBL MIN 3 VIEWS 73080RT | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 B-ELBOW W/OBL MIN 3 VIEWS 73080LT | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 B-ELBOW W/OBL LEFT MIN 3 VIEWS 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 W-ELBOW W/OBL RT MIN 3 VIEWS 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 W-ELBOW W/OBL MIN 3 VIEWS RT 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 W-ELBOW W/OBL MIN 3 VIEWS LT 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 W-ELBOW W/OBL LT MIN 3 VIEWS 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW W/OBL RT 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW W/OBL MIN 3 VIEWS RT 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW W/OBL MIN 3 VIEWS LT 73080 | $187.20 | $312.00 | — | 15% below | 40% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 B-ELBOW W/OBL 73080 | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 W-ELBOW W/OBL MIN 3 VIEWS 73080 | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 ELBOW W/OBL MIN 3 VIEWS 73080 | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW W/OBL LT 73080 | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 W-ELBOW W/OBL LT MIN 3 VIEWS 73080 | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW W/OBL MIN 3 VIEWS LT 73080 | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 W-ELBOW W/OBL MIN 3 VIEWS LT 73080 | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 B-ELBOW W/OBL MIN 3 VIEWS 73080LT | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW W/OBL RT 73080 | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 B-ELBOW W/OBL LEFT MIN 3 VIEWS 73080 | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 W-ELBOW W/OBL RT MIN 3 VIEWS 73080 | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 B-ELBOW W/OBL RIGHT MIN 3 VIEWS 73080 | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 B-ELBOW W/OBL MIN 3 VIEWS 73080RT | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW W/OBL MIN 3 VIEWS RT 73080 | $187.20 | $312.00 | — | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 W-ELBOW W/OBL MIN 3 VIEWS RT 73080 | $187.20 | $312.00 | — | — | 40% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBITS W/O 70480 | $918.00 | $1,530.00 | — | 6% below | 40% |
| Eye socket (orbit) CT scan without contrast CPT 70480 W-CT ORBITS W/O 70480 | $918.00 | $1,530.00 | — | 6% below | 40% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 W-CT ORBITS W/O 70480 | $918.00 | $1,530.00 | — | — | 40% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBITS W/O 70480 | $918.00 | $1,530.00 | — | — | 40% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES COMPLETE MIN 3 VIEWS 70150 | $235.20 | $392.00 | — | 3% above | 40% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 B-FACIAL BONES COMPLETE MIN 3 VIEW 70150 | $235.20 | $392.00 | — | 3% above | 40% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 W-FACIAL BONES COMPLETE MIN 3 VIEW 70150 | $235.20 | $392.00 | — | 3% above | 40% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 B-FACIAL BONES COMPLETE MIN 3 VIEW 70150 | $235.20 | $392.00 | — | — | 40% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES COMPLETE MIN 3 VIEWS 70150 | $235.20 | $392.00 | — | — | 40% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 W-FACIAL BONES COMPLETE MIN 3 VIEW 70150 | $235.20 | $392.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 B-FOREARM AP/LAT 73090 | $175.80 | $293.00 | — | 17% below | 40% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 FOREARM AP/LAT 73090 | $175.80 | $293.00 | — | 17% below | 40% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 W-FOREARM AP/LAT 73090 | $175.80 | $293.00 | — | 17% below | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 B-FOREARM AP/LAT LEFT 73090 | $175.80 | $293.00 | — | 17% below | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 W-FOREARM AP/LAT LT73090 | $175.80 | $293.00 | — | 17% below | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 W-FOREARM AP/LAT RT 73090 | $175.80 | $293.00 | — | 17% below | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 B-FOREARM AP/LAT RIGHT 73090 | $175.80 | $293.00 | — | 17% below | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM 2 VIEWS RIGHT 73090 | $175.80 | $293.00 | — | 17% below | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM 2 VIEWS LEFT 73090 | $175.80 | $293.00 | — | 17% below | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 FOREARM AP/LAT 73090 | $175.80 | $293.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 B-FOREARM AP/LAT 73090 | $175.80 | $293.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 W-FOREARM AP/LAT 73090 | $175.80 | $293.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 B-FOREARM AP/LAT LEFT 73090 | $175.80 | $293.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM 2 VIEWS RIGHT 73090 | $175.80 | $293.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 W-FOREARM AP/LAT RT 73090 | $175.80 | $293.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 W-FOREARM AP/LAT LT73090 | $175.80 | $293.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 B-FOREARM AP/LAT RIGHT 73090 | $175.80 | $293.00 | — | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM 2 VIEWS LEFT 73090 | $175.80 | $293.00 | — | — | 40% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY W/O EF 78226 | $1,652.40 | $2,754.00 | — | 65% above | 40% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY W/O EF 78226 | $1,652.40 | $2,754.00 | — | — | 40% |
| Hand X-ray, 2 views CPT 73120 HAND 2 VIEWS 73120 | $163.20 | $272.00 | — | 23% below | 40% |
| Hand X-ray, 2 views CPT 73120 B-HAND 2 VIEWS 73120 | $163.20 | $272.00 | — | 23% below | 40% |
| Hand X-ray, 2 views CPT 73120 W-HAND 2 VIEWS 73120 | $163.20 | $272.00 | — | 23% below | 40% |
| Hand X-ray, 2 views one side CPT 73120 HAND 2 VIEWS RIGHT 73120 | $163.20 | $272.00 | — | 23% below | 40% |
| Hand X-ray, 2 views one side CPT 73120 B-HAND 2 VIEWS LEFT 73120 | $163.20 | $272.00 | — | 23% below | 40% |
| Hand X-ray, 2 views one side CPT 73120 W-HAND 2 VIEWS LT 73120 | $163.20 | $272.00 | — | 23% below | 40% |
| Hand X-ray, 2 views one side CPT 73120 B-HAND 2 VIEWS RIGHT 73120 | $163.20 | $272.00 | — | 23% below | 40% |
| Hand X-ray, 2 views one side CPT 73120 HAND 2 VIEWS LEFT 73120 | $163.20 | $272.00 | — | 23% below | 40% |
| Hand X-ray, 2 views one side CPT 73120 W-HAND 2 VIEWS RT 73120 | $163.20 | $272.00 | — | 23% below | 40% |
| Hand X-ray, 2 views inpatient CPT 73120 HAND 2 VIEWS 73120 | $163.20 | $272.00 | — | — | 40% |
| Hand X-ray, 2 views inpatient CPT 73120 W-HAND 2 VIEWS 73120 | $163.20 | $272.00 | — | — | 40% |
| Hand X-ray, 2 views inpatient CPT 73120 B-HAND 2 VIEWS 73120 | $163.20 | $272.00 | — | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 VIEWS RIGHT 73120 | $163.20 | $272.00 | — | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 VIEWS LEFT 73120 | $163.20 | $272.00 | — | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 B-HAND 2 VIEWS RIGHT 73120 | $163.20 | $272.00 | — | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 B-HAND 2 VIEWS LEFT 73120 | $163.20 | $272.00 | — | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 W-HAND 2 VIEWS LT 73120 | $163.20 | $272.00 | — | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 W-HAND 2 VIEWS RT 73120 | $163.20 | $272.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 W-CALCANEUS MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | 22% below | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 B-CALCANEUS 73650 | $163.20 | $272.00 | — | 22% below | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 CALCANEUS MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | 22% below | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 W-CALCANEUS RT MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | 22% below | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 CALCANEUS LEFT MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | 22% below | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 CALCANEUS RIGHT MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | 22% below | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 W-CALCANEUS LT MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | 22% below | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 B-CALCANEUS LEFT MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | 22% below | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 B-CALCANEUS RIGHT MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | 22% below | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 B-CALCANEUS 73650 | $163.20 | $272.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 W-CALCANEUS MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 CALCANEUS MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 W-CALCANEUS LT MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 B-CALCANEUS RIGHT MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 B-CALCANEUS LEFT MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 CALCANEUS LEFT MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 CALCANEUS RIGHT MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 W-CALCANEUS RT MIN 2 VIEWS 73650 | $163.20 | $272.00 | — | — | 40% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLP STDY UNAT SIM REC HRT,02,RESP AIR&EF | $390.00 | $650.00 | — | 40% above | 40% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLP STDY UNAT SIM REC HRT,02,RESP AIR&EF | $390.00 | $650.00 | — | — | 40% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP LAB - PSG & CPAP | $1,830.60 | $3,051.00 | — | 5% above | 40% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP LAB - PSG & CPAP | $1,830.60 | $3,051.00 | — | — | 40% |
| Knee X-ray, 3 views CPT 73562 KNEE 3 VIEWS 73562 | $205.80 | $343.00 | — | 9% below | 40% |
| Knee X-ray, 3 views CPT 73562 W-KNEE 3 VIEWS 73562 | $205.80 | $343.00 | — | 9% below | 40% |
| Knee X-ray, 3 views CPT 73562 B-KNEE 3 VIEWS 73562 | $205.80 | $343.00 | — | 9% below | 40% |
| Knee X-ray, 3 views one side CPT 73562 B-KNEE 3 VIEWS LEFT 73562 | $205.80 | $343.00 | — | 9% below | 40% |
| Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS RIGHT 73562 | $205.80 | $343.00 | — | 9% below | 40% |
| Knee X-ray, 3 views one side CPT 73562 B-KNEE 3 VIEWS RIGHT 73562 | $205.80 | $343.00 | — | 9% below | 40% |
| Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS LEFT 73562 | $205.80 | $343.00 | — | 9% below | 40% |
| Knee X-ray, 3 views one side CPT 73562 W-KNEE 3 VIEWS RT 73562 | $205.80 | $343.00 | — | 9% below | 40% |
| Knee X-ray, 3 views one side CPT 73562 W-KNEE 3 VIEWS LT 73562 | $205.80 | $343.00 | — | 9% below | 40% |
| Knee X-ray, 3 views inpatient CPT 73562 B-KNEE 3 VIEWS 73562 | $205.80 | $343.00 | — | — | 40% |
| Knee X-ray, 3 views inpatient CPT 73562 W-KNEE 3 VIEWS 73562 | $205.80 | $343.00 | — | — | 40% |
| Knee X-ray, 3 views inpatient CPT 73562 KNEE 3 VIEWS 73562 | $205.80 | $343.00 | — | — | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS LEFT 73562 | $205.80 | $343.00 | — | — | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 B-KNEE 3 VIEWS LEFT 73562 | $205.80 | $343.00 | — | — | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 B-KNEE 3 VIEWS RIGHT 73562 | $205.80 | $343.00 | — | — | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 W-KNEE 3 VIEWS RT 73562 | $205.80 | $343.00 | — | — | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 W-KNEE 3 VIEWS LT 73562 | $205.80 | $343.00 | — | — | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS RIGHT 73562 | $205.80 | $343.00 | — | — | 40% |
| Knee X-ray, complete, 4 or more views CPT 73564 W-KNEE 4 VIEWS 73564 | $243.00 | $405.00 | — | 4% below | 40% |
| Knee X-ray, complete, 4 or more views CPT 73564 KNEE 4 VIEWS 73564 | $243.00 | $405.00 | — | 4% below | 40% |
| Knee X-ray, complete, 4 or more views CPT 73564 B-KNEE 4 VIEWS 73564 | $243.00 | $405.00 | — | 4% below | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE 4 VIEWS RIGHT 73564 | $243.00 | $405.00 | — | 4% below | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 W-KNEE 4 VIEWS RT 73564 | $243.00 | $405.00 | — | 4% below | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 B-KNEE 4 VIEWS LEFT COMPLETE 73564 | $243.00 | $405.00 | — | 4% below | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 W-KNEE 4 VIEWS LT 73564 | $243.00 | $405.00 | — | 4% below | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 B-KNEE 4 VIEWS RIGHT COMPLETE 73564 | $243.00 | $405.00 | — | 4% below | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE 4 VIEWS LEFT 73564 | $243.00 | $405.00 | — | 4% below | 40% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 B-KNEE 4 VIEWS 73564 | $243.00 | $405.00 | — | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 W-KNEE 4 VIEWS 73564 | $243.00 | $405.00 | — | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 KNEE 4 VIEWS 73564 | $243.00 | $405.00 | — | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE 4 VIEWS LEFT 73564 | $243.00 | $405.00 | — | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 W-KNEE 4 VIEWS RT 73564 | $243.00 | $405.00 | — | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 B-KNEE 4 VIEWS RIGHT COMPLETE 73564 | $243.00 | $405.00 | — | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE 4 VIEWS RIGHT 73564 | $243.00 | $405.00 | — | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 W-KNEE 4 VIEWS LT 73564 | $243.00 | $405.00 | — | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 B-KNEE 4 VIEWS LEFT COMPLETE 73564 | $243.00 | $405.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 W-CT LOWER EXT W/O 73700 | $862.20 | $1,437.00 | — | 18% below | 40% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXT WO CON 73700 | $862.20 | $1,437.00 | — | 18% below | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER EXT WO CON 73700LT | $862.20 | $1,437.00 | — | 18% below | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER EXT WO CON 73700RT | $862.20 | $1,437.00 | — | 18% below | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT HIP MAP RIGHT 73700 | $1,247.40 | $2,079.00 | — | 18% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT HIP MAP LEFT 73700 | $1,247.40 | $2,079.00 | — | 18% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 W-CT LOWER EXT W/O 73700 | $862.20 | $1,437.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXT WO CON 73700 | $862.20 | $1,437.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER EXT WO CON 73700RT | $862.20 | $1,437.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER EXT WO CON 73700LT | $862.20 | $1,437.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT HIP MAP LEFT 73700 | $1,247.40 | $2,079.00 | — | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT HIP MAP RIGHT 73700 | $1,247.40 | $2,079.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ER ECHO EXAM OF ABDOMEN | $194.40 | $324.00 | — | 20% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 W-US ABDOMEN LIMITED 76705 | $336.60 | $561.00 | — | 38% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED-SINGLE ORGAN | $336.60 | $561.00 | — | 38% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED 76705 | $336.60 | $561.00 | — | 38% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 IR U/S ABD LIMITED | $336.60 | $561.00 | — | 38% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ER ECHO EXAM OF ABDOMEN | $194.40 | $324.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED 76705 | $336.60 | $561.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED-SINGLE ORGAN | $336.60 | $561.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 W-US ABDOMEN LIMITED 76705 | $336.60 | $561.00 | — | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 IR U/S ABD LIMITED | $336.60 | $561.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXTREMITY LTD | $58.80 | $98.00 | — | 65% below | 40% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 W-US EXTREMITY LTD 76882 | $193.80 | $323.00 | — | 16% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXTREMITY LTD 76882 | $193.80 | $323.00 | — | 16% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 ER US LIMITED JOINT SOFT TISSUE MASS MCL | $194.40 | $324.00 | — | 16% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US BREAST LEFT AXILLA 76882LT | $231.60 | $386.00 | — | 39% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US BREAST RIGHT AXILLA 76882RT | $231.60 | $386.00 | — | 39% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXTREMITY LTD | $58.80 | $98.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 W-US EXTREMITY LTD 76882 | $193.80 | $323.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXTREMITY LTD 76882 | $193.80 | $323.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 ER US LIMITED JOINT SOFT TISSUE MASS MCL | $194.40 | $324.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US BREAST LEFT AXILLA 76882LT | $231.60 | $386.00 | — | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US BREAST RIGHT AXILLA 76882RT | $231.60 | $386.00 | — | — | 40% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 W-CT LUNG CANCER SCR 71271 | $158.40 | $264.00 | — | 30% below | 40% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG CANCER SCR 71271 | $158.40 | $264.00 | — | 30% below | 40% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 W-CT LUNG CANCER SCR 71271 | $158.40 | $264.00 | — | — | 40% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG CANCER SCR 71271 | $158.40 | $264.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 B-LOWER LEG AP/LAT 73590 | $204.60 | $341.00 | — | 4% below | 40% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 LOWER LEG AP/LAT 73590 | $204.60 | $341.00 | — | 4% below | 40% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 W-LOWER LEG AP/LAT 73590 | $204.60 | $341.00 | — | 4% below | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LOWER LEG AP/LAT RIGHT 73590 | $204.60 | $341.00 | — | 4% below | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 B-LOWER LEG AP/LAT LEFT 73590 | $204.60 | $341.00 | — | 4% below | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 W-LOWER LEG AP/LAT RT 73590 | $204.60 | $341.00 | — | 4% below | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LOWER LEG AP/LAT LEFT 73590 | $204.60 | $341.00 | — | 4% below | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 B-LOWER LEG AP/LAT RIGHT 73590 | $204.60 | $341.00 | — | 4% below | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 W-LOWER LEG AP/LAT LT 73590 | $204.60 | $341.00 | — | 4% below | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 B-LOWER LEG AP/LAT 73590 | $204.60 | $341.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 LOWER LEG AP/LAT 73590 | $204.60 | $341.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 W-LOWER LEG AP/LAT 73590 | $204.60 | $341.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 B-LOWER LEG AP/LAT LEFT 73590 | $204.60 | $341.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LOWER LEG AP/LAT LEFT 73590 | $204.60 | $341.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 W-LOWER LEG AP/LAT LT 73590 | $204.60 | $341.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LOWER LEG AP/LAT RIGHT 73590 | $204.60 | $341.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 B-LOWER LEG AP/LAT RIGHT 73590 | $204.60 | $341.00 | — | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 W-LOWER LEG AP/LAT RT 73590 | $204.60 | $341.00 | — | — | 40% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA BRAIN W/O 70544 | $1,691.40 | $2,819.00 | — | 4% below | 40% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA BRAIN W/O 70544 | $1,691.40 | $2,819.00 | — | — | 40% |
| MRI of both breasts, without and then with contrast dye CPT 77049 MRI BREAST C-+ W/CAD BIL 77049 | $2,682.00 | $4,470.00 | — | 6% above | 40% |
| MRI of both breasts, without and then with contrast dye inpatient CPT 77049 MRI BREAST C-+ W/CAD BIL 77049 | $2,682.00 | $4,470.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW JOINT W/O 73721 | $1,656.60 | $2,761.00 | — | 10% above | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI RT KNEE W/O GAD 73721RT | $1,330.20 | $2,217.00 | — | 11% below | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LT KNEE W/O GAD 73721LT | $1,330.20 | $2,217.00 | — | 11% below | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOW JOINT W/O 73721 | $1,656.60 | $2,761.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LT KNEE W/O GAD 73721LT | $1,330.20 | $2,217.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI RT KNEE W/O GAD 73721RT | $1,330.20 | $2,217.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOW JOINT W/WO 73723 | $3,685.20 | $6,142.00 | — | 42% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LT KNEE W/WO GAD 73723LT | $3,357.00 | $5,595.00 | — | 29% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI RT KNEE W/WO GAD 73723RT | $3,357.00 | $5,595.00 | — | 29% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOW JOINT W/WO 73723 | $3,685.20 | $6,142.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI RT KNEE W/WO GAD 73723RT | $3,357.00 | $5,595.00 | — | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LT KNEE W/WO GAD 73723LT | $3,357.00 | $5,595.00 | — | — | 40% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O 74181 | $1,671.60 | $2,786.00 | — | 3% below | 40% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O 74181 | $1,671.60 | $2,786.00 | — | — | 40% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/WO 74183 | $3,685.20 | $6,142.00 | — | 69% above | 40% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/WO 74183 | $3,685.20 | $6,142.00 | — | — | 40% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O GAD 70551 | $1,691.40 | $2,819.00 | — | 17% above | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O GAD 70551 | $1,691.40 | $2,819.00 | — | — | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO GAD 70553 | $3,750.60 | $6,251.00 | — | 70% above | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO GAD 70553 | $3,750.60 | $6,251.00 | — | — | 40% |
| MRI of the lower back, no contrast dye CPT 72148 MRI L/SPINE W/O GAD 72148 | $1,874.40 | $3,124.00 | — | 32% above | 40% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L/SPINE W/O GAD 72148 | $1,874.40 | $3,124.00 | — | — | 40% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI L/SPINE W/WO 72158 | $3,750.60 | $6,251.00 | — | 62% above | 40% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L/SPINE W/WO 72158 | $3,750.60 | $6,251.00 | — | — | 40% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O GAD 72146 | $1,874.40 | $3,124.00 | — | 32% above | 40% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE W/O GAD 72146 | $1,874.40 | $3,124.00 | — | — | 40% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C/SPINE W/WO 72156 | $3,750.60 | $6,251.00 | — | 83% above | 40% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C/SPINE W/WO 72156 | $3,750.60 | $6,251.00 | — | — | 40% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C/SPINE W/O GAD 72141 | $1,691.40 | $2,819.00 | — | 19% above | 40% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C/SPINE W/O GAD 72141 | $1,691.40 | $2,819.00 | — | — | 40% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PROSTATE W/WO 72197 | $3,685.20 | $6,142.00 | — | 58% above | 40% |
| MRI of the pelvis without and with contrast CPT 72197 MRI SACRUM W/WO 72197 | $3,685.20 | $6,142.00 | — | 58% above | 40% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/WO 72197 | $3,685.20 | $6,142.00 | — | 58% above | 40% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PROSTATE W/WO 72197 | $3,685.20 | $6,142.00 | — | — | 40% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/WO 72197 | $3,685.20 | $6,142.00 | — | — | 40% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI SACRUM W/WO 72197 | $3,685.20 | $6,142.00 | — | — | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O GAD 72195 | $1,294.80 | $2,158.00 | — | 17% below | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI SACRUM W/O GAD 72195 | $1,294.80 | $2,158.00 | — | 17% below | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PROSTATE W/O GAD 72195 | $1,294.80 | $2,158.00 | — | 17% below | 40% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PROSTATE W/O GAD 72195 | $1,294.80 | $2,158.00 | — | — | 40% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI SACRUM W/O GAD 72195 | $1,294.80 | $2,158.00 | — | — | 40% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O GAD 72195 | $1,294.80 | $2,158.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPR JOINT W/O 73221 | $1,656.60 | $2,761.00 | — | 10% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI LT SHOULDER W/O GAD 73221LT | $1,330.20 | $2,217.00 | — | 11% below | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI RT SHOULDER W/O GAD 73221RT | $1,330.20 | $2,217.00 | — | 11% below | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPR JOINT W/O 73221 | $1,656.60 | $2,761.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI LT SHOULDER W/O GAD 73221LT | $1,330.20 | $2,217.00 | — | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI RT SHOULDER W/O GAD 73221RT | $1,330.20 | $2,217.00 | — | — | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 W-CERVICAL 4 OR 5 VIEWS 72050 | $288.60 | $481.00 | — | 2% below | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 B-CERVICAL 4 OR 5 VIEWS 72050 | $288.60 | $481.00 | — | 2% below | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERVICAL SPINE 4-5 VIEWS 72050 | $288.60 | $481.00 | — | 2% below | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 W-CERVICAL 4 OR 5 VIEWS 72050 | $288.60 | $481.00 | — | — | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERVICAL SPINE 4-5 VIEWS 72050 | $288.60 | $481.00 | — | — | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 B-CERVICAL 4 OR 5 VIEWS 72050 | $288.60 | $481.00 | — | — | 40% |
| Neck soft tissue CT scan with contrast CPT 70491 CT NECK W/CON 70491 | $1,170.00 | $1,950.00 | — | 9% below | 40% |
| Neck soft tissue CT scan with contrast CPT 70491 W-CT NECK W/CON 70491 | $1,170.00 | $1,950.00 | — | 9% below | 40% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK W/CON 70491 | $1,170.00 | $1,950.00 | — | — | 40% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 W-CT NECK W/CON 70491 | $1,170.00 | $1,950.00 | — | — | 40% |
| Neck soft tissue CT scan without contrast CPT 70490 W-CT NECK W/O CON 70490 | $1,006.20 | $1,677.00 | — | at median | 40% |
| Neck soft tissue CT scan without contrast CPT 70490 CT NECK W/O CON 70490 | $1,006.20 | $1,677.00 | — | at median | 40% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 W-CT NECK W/O CON 70490 | $1,006.20 | $1,677.00 | — | — | 40% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK W/O CON 70490 | $1,006.20 | $1,677.00 | — | — | 40% |
| Neck soft tissue X-ray CPT 70360 NECK SOFT TISSUE 70360 | $164.40 | $274.00 | — | 22% below | 40% |
| Neck soft tissue X-ray CPT 70360 B-NECK SOFT TISSUE 70360 | $164.40 | $274.00 | — | 22% below | 40% |
| Neck soft tissue X-ray CPT 70360 W-NECK SOFT TISSUE 70360 | $164.40 | $274.00 | — | 22% below | 40% |
| Neck soft tissue X-ray inpatient CPT 70360 W-NECK SOFT TISSUE 70360 | $164.40 | $274.00 | — | — | 40% |
| Neck soft tissue X-ray inpatient CPT 70360 NECK SOFT TISSUE 70360 | $164.40 | $274.00 | — | — | 40% |
| Neck soft tissue X-ray inpatient CPT 70360 B-NECK SOFT TISSUE 70360 | $164.40 | $274.00 | — | — | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 SPECT STRESS TEST | $2,039.40 | $3,399.00 | — | 1% below | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCARDIAL MULT 78452 | $2,448.00 | $4,080.00 | — | 19% above | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM CARDIAC SPECT MULT 78452 | $2,448.00 | $4,080.00 | — | 19% above | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 SPECT SCAN MULTI STDY REST/STRESS | $2,631.60 | $4,386.00 | — | 28% above | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 SPECT SCAN MULTI | $2,631.60 | $4,386.00 | — | 28% above | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 SPECT STRESS TEST | $2,039.40 | $3,399.00 | — | — | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM CARDIAC SPECT MULT 78452 | $2,448.00 | $4,080.00 | — | — | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOCARDIAL MULT 78452 | $2,448.00 | $4,080.00 | — | — | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 SPECT SCAN MULTI STDY REST/STRESS | $2,631.60 | $4,386.00 | — | — | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 SPECT SCAN MULTI | $2,631.60 | $4,386.00 | — | — | 40% |
| Pelvic CT scan without contrast CPT 72192 W-CT PELVIS W/O 72192 | $706.20 | $1,177.00 | — | 25% below | 40% |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS WO CON 72192 | $706.20 | $1,177.00 | — | 25% below | 40% |
| Pelvic CT scan without contrast inpatient CPT 72192 W-CT PELVIS W/O 72192 | $706.20 | $1,177.00 | — | — | 40% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS WO CON 72192 | $706.20 | $1,177.00 | — | — | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED | $109.80 | $183.00 | — | 37% below | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BLADDER 76857 | $258.00 | $430.00 | — | 48% above | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 W-US BLADDER 76857 | $258.00 | $430.00 | — | 48% above | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC F/U LTD 76857 | $258.00 | $430.00 | — | 48% above | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 W-US PELVIC F/U LTD 76857 | $258.00 | $430.00 | — | 48% above | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US EXAM PELVIC LIMITED | $109.80 | $183.00 | — | — | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 W-US BLADDER 76857 | $258.00 | $430.00 | — | — | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US BLADDER 76857 | $258.00 | $430.00 | — | — | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 W-US PELVIC F/U LTD 76857 | $258.00 | $430.00 | — | — | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC F/U LTD 76857 | $258.00 | $430.00 | — | — | 40% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 W-US PELVIC COMPLETE 76856 | $410.40 | $684.00 | — | 4% above | 40% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE 76856 | $410.40 | $684.00 | — | 4% above | 40% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE 76856 | $410.40 | $684.00 | — | — | 40% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 W-US PELVIC COMPLETE 76856 | $410.40 | $684.00 | — | — | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 W-US OB>14 WK(S)1ST GEST 76805 | $497.40 | $829.00 | — | 13% above | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB>14 WK SINGLE 76805 | $497.40 | $829.00 | — | 13% above | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 W-US OB>14 WK(S)1ST GEST 76805 | $497.40 | $829.00 | — | — | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB>14 WK SINGLE 76805 | $497.40 | $829.00 | — | — | 40% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 W-US OB<14 WK(S)1ST GEST 76801 | $322.80 | $538.00 | — | 4% above | 40% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB<14 WK SINGLE 76801 | $381.60 | $636.00 | — | 23% above | 40% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 W-US OB<14 WK(S)1ST GEST 76801 | $322.80 | $538.00 | — | — | 40% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB<14 WK SINGLE 76801 | $381.60 | $636.00 | — | — | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ER OB US LIMITED FETUS(S) | $194.40 | $324.00 | — | 1% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED EXAM | $210.00 | $350.00 | — | 9% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB VERSION (OB LIMITED) 76815 | $287.40 | $479.00 | — | 49% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 W-US OB VERSION (OB LIMITED)76815 | $287.40 | $479.00 | — | 49% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 W-US OB LIMITED 76815 | $287.40 | $479.00 | — | 49% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED 76815 | $287.40 | $479.00 | — | 49% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 ER OB US LIMITED FETUS(S) | $194.40 | $324.00 | — | — | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED EXAM | $210.00 | $350.00 | — | — | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED 76815 | $287.40 | $479.00 | — | — | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 W-US OB LIMITED 76815 | $287.40 | $479.00 | — | — | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 W-US OB VERSION (OB LIMITED)76815 | $287.40 | $479.00 | — | — | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB VERSION (OB LIMITED) 76815 | $287.40 | $479.00 | — | — | 40% |
| Rib X-ray, one side, 2 views CPT 71100 W-RIBS 2 VIEWS 71100 | $200.40 | $334.00 | — | 13% below | 40% |
| Rib X-ray, one side, 2 views CPT 71100 B-RIBS 2 VIEWS 71100 | $200.40 | $334.00 | — | 13% below | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 B-RIBS 2 VIEWS LEFT 71100 | $200.40 | $334.00 | — | 13% below | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 W-RIBS LEFT 2 VIEWS 71100 | $200.40 | $334.00 | — | 13% below | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 W-RIBS RIGHT 2 VIEWS 71100 | $200.40 | $334.00 | — | 13% below | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIBS 2 VIEWS LEFT UNILAT 71100 | $200.40 | $334.00 | — | 13% below | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIBS 2 VIEWS RIGHT UNILAT 71100 | $200.40 | $334.00 | — | 13% below | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIBS 2 VIEWS UNILATERAL 71100 | $200.40 | $334.00 | — | 13% below | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 B-RIBS 2 VIEWS RIGHT 71100 | $200.40 | $334.00 | — | 13% below | 40% |
| Rib X-ray, one side, 2 views inpatient CPT 71100 B-RIBS 2 VIEWS 71100 | $200.40 | $334.00 | — | — | 40% |
| Rib X-ray, one side, 2 views inpatient CPT 71100 W-RIBS 2 VIEWS 71100 | $200.40 | $334.00 | — | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 B-RIBS 2 VIEWS LEFT 71100 | $200.40 | $334.00 | — | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 W-RIBS LEFT 2 VIEWS 71100 | $200.40 | $334.00 | — | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS 2 VIEWS UNILATERAL 71100 | $200.40 | $334.00 | — | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS 2 VIEWS RIGHT UNILAT 71100 | $200.40 | $334.00 | — | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 W-RIBS RIGHT 2 VIEWS 71100 | $200.40 | $334.00 | — | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS 2 VIEWS LEFT UNILAT 71100 | $200.40 | $334.00 | — | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 B-RIBS 2 VIEWS RIGHT 71100 | $200.40 | $334.00 | — | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 B-RIBS UNILAT/PA CHEST MIN 3 VIEWS 71101 | $253.80 | $423.00 | — | 23% below | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS LEFT W/PA CHEST MIN 3 VIEW 71101 | $253.80 | $423.00 | — | 23% below | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS RIGHT W/PA CHEST MIN 3 VIEW 71101 | $253.80 | $423.00 | — | 23% below | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS UNILAT/PA CHEST MIN 3 VIEWS 71101 | $253.80 | $423.00 | — | 23% below | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 W-RIBS LEFT UNILAT W/PA CHEST 71101 | $253.80 | $423.00 | — | 23% below | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 W-RIBS RIGHT UNILAT W/PA CHEST 71101 | $253.80 | $423.00 | — | 23% below | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 W-RIBS UNILAT/PA CHEST 71101 | $253.80 | $423.00 | — | 23% below | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 B-RIBS UNILAT/PA CHEST LEFT 71101 | $253.80 | $423.00 | — | 23% below | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 B-RIBS UNILAT/PA CHEST RIGHT 71101 | $253.80 | $423.00 | — | 23% below | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 B-RIBS UNILAT/PA CHEST MIN 3 VIEWS 71101 | $253.80 | $423.00 | — | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS LEFT W/PA CHEST MIN 3 VIEW 71101 | $253.80 | $423.00 | — | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS RIGHT W/PA CHEST MIN 3 VIEW 71101 | $253.80 | $423.00 | — | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS UNILAT/PA CHEST MIN 3 VIEWS 71101 | $253.80 | $423.00 | — | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 W-RIBS LEFT UNILAT W/PA CHEST 71101 | $253.80 | $423.00 | — | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 W-RIBS RIGHT UNILAT W/PA CHEST 71101 | $253.80 | $423.00 | — | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 W-RIBS UNILAT/PA CHEST 71101 | $253.80 | $423.00 | — | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 B-RIBS UNILAT/PA CHEST LEFT 71101 | $253.80 | $423.00 | — | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 B-RIBS UNILAT/PA CHEST RIGHT 71101 | $253.80 | $423.00 | — | — | 40% |
| Screening mammogram, both breasts both sides CPT 77067 MAMMO DIGITAL BILAT SCREEN 77067 | $301.80 | $503.00 | — | — | 40% |
| Screening mammogram, both breasts both sides CPT 77067 MAMMO DIGITAL BILAT SCREEN 77067 | $343.80 | $573.00 | — | — | 40% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO DIGITAL BILAT SCREEN 77067 | $301.80 | $503.00 | — | — | 40% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO DIGITAL BILAT SCREEN 77067 | $343.80 | $573.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 W-SHOULDER 2-3 VIEW COMPLETE 73030 | $230.40 | $384.00 | — | 1% above | 40% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 B-SHOULDER 2-3 VIEW 73030 | $230.40 | $384.00 | — | 1% above | 40% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 SHOULDER 2-3 VIEW 73030 | $230.40 | $384.00 | — | 1% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER 2-3 VIEW RIGHT 73030 | $230.40 | $384.00 | — | 1% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 W-SHOULDER RIGHT 2-3 VIEW COMPLETE 73030 | $230.40 | $384.00 | — | 1% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 B-SHOULDER 2-3 VIEW LEFT 73030 | $230.40 | $384.00 | — | 1% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 W-SHOULDER LEFT 2-3 VIEW COMPLETE 73030 | $230.40 | $384.00 | — | 1% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER 2-3 VIEW LEFT 73030 | $230.40 | $384.00 | — | 1% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 B-SHOULDER 2-3 VIEW RT 73030 | $230.40 | $384.00 | — | 1% above | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 B-SHOULDER 2-3 VIEW 73030 | $230.40 | $384.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 W-SHOULDER 2-3 VIEW COMPLETE 73030 | $230.40 | $384.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 SHOULDER 2-3 VIEW 73030 | $230.40 | $384.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 W-SHOULDER RIGHT 2-3 VIEW COMPLETE 73030 | $230.40 | $384.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 W-SHOULDER LEFT 2-3 VIEW COMPLETE 73030 | $230.40 | $384.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 B-SHOULDER 2-3 VIEW RT 73030 | $230.40 | $384.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER 2-3 VIEW RIGHT 73030 | $230.40 | $384.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 B-SHOULDER 2-3 VIEW LEFT 73030 | $230.40 | $384.00 | — | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER 2-3 VIEW LEFT 73030 | $230.40 | $384.00 | — | — | 40% |
| Sinus X-ray, complete, 3 or more views CPT 70220 B-SINUSES COMPLETE MIN 3 VIEWS 70220 | $249.00 | $415.00 | — | 10% above | 40% |
| Sinus X-ray, complete, 3 or more views CPT 70220 W-SINUSES COMPLETE MIN 3 VIEWS 70220 | $249.00 | $415.00 | — | 10% above | 40% |
| Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES COMPLETE MIN 3 VIEWS 70220 | $249.00 | $415.00 | — | 10% above | 40% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES COMPLETE MIN 3 VIEWS 70220 | $249.00 | $415.00 | — | — | 40% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 W-SINUSES COMPLETE MIN 3 VIEWS 70220 | $249.00 | $415.00 | — | — | 40% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 B-SINUSES COMPLETE MIN 3 VIEWS 70220 | $249.00 | $415.00 | — | — | 40% |
| Skull X-ray, fewer than 4 views CPT 70250 SKULL 2 V 70250 | $192.60 | $321.00 | — | 11% below | 40% |
| Skull X-ray, fewer than 4 views CPT 70250 W-SKULL 2 V 70250 | $192.60 | $321.00 | — | 11% below | 40% |
| Skull X-ray, fewer than 4 views CPT 70250 B-SKULL 2 V 70250 | $192.60 | $321.00 | — | 11% below | 40% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL 2 V 70250 | $192.60 | $321.00 | — | — | 40% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 B-SKULL 2 V 70250 | $192.60 | $321.00 | — | — | 40% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 W-SKULL 2 V 70250 | $192.60 | $321.00 | — | — | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 SLEEP LAB - PSG | $1,830.60 | $3,051.00 | — | 12% above | 40% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 SLEEP LAB - PSG | $1,830.60 | $3,051.00 | — | — | 40% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 VIDEO SWALLOW 74230 | $331.20 | $552.00 | — | 25% below | 40% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 VIDEO SWALLOW 74230 | $331.20 | $552.00 | — | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR, UNI 1 MIN 2 VW RT 73552 | $133.80 | $223.00 | — | 37% below | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 W-FEMUR, NI 1 MIN 2 VW LT | $133.80 | $223.00 | — | 37% below | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 W-FEMUR, UNI 1 MIN 2 VW RT | $133.80 | $223.00 | — | 37% below | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR, UNI 1 MIN 2 VW LT 73552 | $133.80 | $223.00 | — | 37% below | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 B-FEMUR, UNI 1 MINM 2 VW RT | $133.80 | $223.00 | — | 37% below | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 B-FEMUR, UNI 1 MIN 2VW LT | $133.80 | $223.00 | — | 37% below | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR, UNI 1 MIN 2 VW RT 73552 | $133.80 | $223.00 | — | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 W-FEMUR, UNI 1 MIN 2 VW RT | $133.80 | $223.00 | — | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 W-FEMUR, NI 1 MIN 2 VW LT | $133.80 | $223.00 | — | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 B-FEMUR, UNI 1 MIN 2VW LT | $133.80 | $223.00 | — | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 B-FEMUR, UNI 1 MINM 2 VW RT | $133.80 | $223.00 | — | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR, UNI 1 MIN 2 VW LT 73552 | $133.80 | $223.00 | — | — | 40% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 IR CT T/SPINE W/O CONT S&I | $237.60 | $396.00 | — | 78% below | 40% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 W-CT THORACIC W/O 72128 | $1,058.40 | $1,764.00 | — | at median | 40% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC WO CON 72128 | $1,058.40 | $1,764.00 | — | at median | 40% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 IR CT T/SPINE W/O CONT S&I | $237.60 | $396.00 | — | — | 40% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC WO CON 72128 | $1,058.40 | $1,764.00 | — | — | 40% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 W-CT THORACIC W/O 72128 | $1,058.40 | $1,764.00 | — | — | 40% |
| Toe X-ray, 2 or more views CPT 73660 W-TOE(S) MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | 31% below | 40% |
| Toe X-ray, 2 or more views CPT 73660 B-TOE(S) 73660 | $123.60 | $206.00 | — | 31% below | 40% |
| Toe X-ray, 2 or more views CPT 73660 TOE(S) MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | 31% below | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 B-TOE(S) RIGHT MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | 31% below | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE(S) LEFT MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | 31% below | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE(S) RIGHT MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | 31% below | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 W-TOE(S) LEFT MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | 31% below | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 B-TOE(S) LEFT MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | 31% below | 40% |
| Toe X-ray, 2 or more views one side CPT 73660 W-TOE(S) RIGHT MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | 31% below | 40% |
| Toe X-ray, 2 or more views inpatient CPT 73660 W-TOE(S) MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient CPT 73660 B-TOE(S) 73660 | $123.60 | $206.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient CPT 73660 TOE(S) MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 B-TOE(S) LEFT MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE(S) LEFT MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE(S) RIGHT MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 W-TOE(S) LEFT MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 W-TOE(S) RIGHT MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | — | 40% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 B-TOE(S) RIGHT MIN 2 VIEWS 73660 | $123.60 | $206.00 | — | — | 40% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL 76830 | $474.60 | $791.00 | — | 27% above | 40% |
| Transvaginal pelvic ultrasound CPT 76830 W-US TRANSVAGINAL 76830 | $474.60 | $791.00 | — | 27% above | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 W-US TRANSVAGINAL 76830 | $474.60 | $791.00 | — | — | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL 76830 | $474.60 | $791.00 | — | — | 40% |
| Transvaginal ultrasound during pregnancy CPT 76817 W-US OB TRANSVAGINAL 76817 | $287.40 | $479.00 | — | 7% below | 40% |
| Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL 76817 | $287.40 | $479.00 | — | 7% below | 40% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 W-US OB TRANSVAGINAL 76817 | $287.40 | $479.00 | — | — | 40% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB TRANSVAGINAL 76817 | $287.40 | $479.00 | — | — | 40% |
| Ultrasound of the abdomen, complete CPT 76700 W-US ABDOMEN COMPLETE 76700 | $447.60 | $746.00 | — | 5% below | 40% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE 76700 | $447.60 | $746.00 | — | 5% below | 40% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 W-US ABDOMEN COMPLETE 76700 | $447.60 | $746.00 | — | — | 40% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE 76700 | $447.60 | $746.00 | — | — | 40% |
| Ultrasound of the scrotum and testicles CPT 76870 W-US TESTICLE/SCROTUM 76870 | $287.40 | $479.00 | — | 38% below | 40% |
| Ultrasound of the scrotum and testicles CPT 76870 US TESTICLE/SCROTUM 76870 | $287.40 | $479.00 | — | 38% below | 40% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US TESTICLE/SCROTUM 76870 | $287.40 | $479.00 | — | — | 40% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 W-US TESTICLE/SCROTUM 76870 | $287.40 | $479.00 | — | — | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID/NECK 76536 | $478.20 | $797.00 | — | 18% above | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 W-US THYROID/NECK 76536 | $478.20 | $797.00 | — | 18% above | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID/NECK 76536 | $478.20 | $797.00 | — | — | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 W-US THYROID/NECK 76536 | $478.20 | $797.00 | — | — | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI/NO AIR W/O KUB 74240 | $337.80 | $563.00 | — | 23% below | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI/NO AIR W/O KUB 74240 | $337.80 | $563.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views CPT 73060 B-HUMERUS AP/LAT 73060 | $193.80 | $323.00 | — | 7% below | 40% |
| Upper arm X-ray (humerus), 2 views CPT 73060 HUMERUS AP/LAT 73060 | $193.80 | $323.00 | — | 7% below | 40% |
| Upper arm X-ray (humerus), 2 views CPT 73060 W-HUMERUS AP/LAT 73060 | $193.80 | $323.00 | — | 7% below | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 B-HUMERUS AP/LAT RIGHT 73060 | $193.80 | $323.00 | — | 7% below | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS AP/LAT LEFT 73060 | $193.80 | $323.00 | — | 7% below | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS AP/LAT RIGHT 73060 | $193.80 | $323.00 | — | 7% below | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 W-HUMERUS AP/LAT LT 73060 | $193.80 | $323.00 | — | 7% below | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 W-HUMERUS AP/LAT RT 73060 | $193.80 | $323.00 | — | 7% below | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 B-HUMERUS AP/LAT LEFT 73060 | $193.80 | $323.00 | — | 7% below | 40% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 W-HUMERUS AP/LAT 73060 | $193.80 | $323.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 B-HUMERUS AP/LAT 73060 | $193.80 | $323.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HUMERUS AP/LAT 73060 | $193.80 | $323.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS AP/LAT RIGHT 73060 | $193.80 | $323.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 B-HUMERUS AP/LAT RIGHT 73060 | $193.80 | $323.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 W-HUMERUS AP/LAT RT 73060 | $193.80 | $323.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 W-HUMERUS AP/LAT LT 73060 | $193.80 | $323.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS AP/LAT LEFT 73060 | $193.80 | $323.00 | — | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 B-HUMERUS AP/LAT LEFT 73060 | $193.80 | $323.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 DUPLEX VENOUS UNI/LTD | $322.80 | $538.00 | — | 35% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 DUPLEX VENOUS UNI/LTD WELLS | $322.80 | $538.00 | — | 35% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US DUPLEX EXT UNI 93971 | $354.60 | $591.00 | — | 28% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 W-US DUP EXT UNI 93971 | $372.60 | $621.00 | — | 24% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 ER DVT SCAN UNILATERAL OR LIMITED | $194.40 | $324.00 | — | 61% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 IR US EXTREM VEINS UNILAT | $237.60 | $396.00 | — | 52% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 DUPLEX VENOUS UNI/LTD WELLS | $322.80 | $538.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 DUPLEX VENOUS UNI/LTD | $322.80 | $538.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US DUPLEX EXT UNI 93971 | $354.60 | $591.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 W-US DUP EXT UNI 93971 | $372.60 | $621.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 ER DVT SCAN UNILATERAL OR LIMITED | $194.40 | $324.00 | — | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 IR US EXTREM VEINS UNILAT | $237.60 | $396.00 | — | — | 40% |
| Wrist X-ray, 2 views CPT 73100 B-WRIST 2 VIEW 73100 | $150.00 | $250.00 | — | 34% below | 40% |
| Wrist X-ray, 2 views CPT 73100 WRIST 2 VIEW 73100 | $164.40 | $274.00 | — | 28% below | 40% |
| Wrist X-ray, 2 views CPT 73100 W-WRIST 2 VIEW 73100 | $164.40 | $274.00 | — | 28% below | 40% |
| Wrist X-ray, 2 views one side CPT 73100 B-WRIST 2 VIEW LEFT 73100 | $150.00 | $250.00 | — | 34% below | 40% |
| Wrist X-ray, 2 views one side CPT 73100 B-WRIST 2 VIEW RIGHT 73100 | $150.00 | $250.00 | — | 34% below | 40% |
| Wrist X-ray, 2 views one side CPT 73100 W-WRIST 2 VIEW LT73100 | $164.40 | $274.00 | — | 28% below | 40% |
| Wrist X-ray, 2 views one side CPT 73100 W-WRIST 2 VIEW RT 73100 | $164.40 | $274.00 | — | 28% below | 40% |
| Wrist X-ray, 2 views one side CPT 73100 WRIST 2 VIEW RIGHT 73100 | $164.40 | $274.00 | — | 28% below | 40% |
| Wrist X-ray, 2 views one side CPT 73100 WRIST 2 VIEW LEFT 73100 | $164.40 | $274.00 | — | 28% below | 40% |
| Wrist X-ray, 2 views inpatient CPT 73100 B-WRIST 2 VIEW 73100 | $150.00 | $250.00 | — | — | 40% |
| Wrist X-ray, 2 views inpatient CPT 73100 W-WRIST 2 VIEW 73100 | $164.40 | $274.00 | — | — | 40% |
| Wrist X-ray, 2 views inpatient CPT 73100 WRIST 2 VIEW 73100 | $164.40 | $274.00 | — | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 B-WRIST 2 VIEW RIGHT 73100 | $150.00 | $250.00 | — | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 B-WRIST 2 VIEW LEFT 73100 | $150.00 | $250.00 | — | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 W-WRIST 2 VIEW RT 73100 | $164.40 | $274.00 | — | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 W-WRIST 2 VIEW LT73100 | $164.40 | $274.00 | — | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST 2 VIEW LEFT 73100 | $164.40 | $274.00 | — | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST 2 VIEW RIGHT 73100 | $164.40 | $274.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views CPT 73110 WRIST 3 VIEW 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views CPT 73110 B-WRIST 3 VIEW 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views CPT 73110 W-WRIST 3 VIEW 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 B-WRIST 3 VIEW LEFT 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST4 VIEW LEFT 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 W-WRIST4 VIEW RT 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 B-WRIST 4 VIEW RIGHT 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 B-WRIST 4 VIEW LEFT 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 4 VIEW RIGHT 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 B-WRIST 3 VIEW RIGHT 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VIEW RIGHT 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 W-WRIST 3 VIEW LT 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 W-WRIST 3 VIEW RT 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VIEW LEFT 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 W-WRIST 4 VIEW LT 73110 | $193.80 | $323.00 | — | 12% below | 40% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 W-WRIST 3 VIEW 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 WRIST 3 VIEW 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 B-WRIST 3 VIEW 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 W-WRIST 3 VIEW LT 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 W-WRIST 3 VIEW RT 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 B-WRIST 4 VIEW RIGHT 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 W-WRIST 4 VIEW LT 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 W-WRIST4 VIEW RT 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3 VIEW LEFT 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3 VIEW RIGHT 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 4 VIEW RIGHT 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST4 VIEW LEFT 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 B-WRIST 3 VIEW LEFT 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 B-WRIST 3 VIEW RIGHT 73110 | $193.80 | $323.00 | — | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 B-WRIST 4 VIEW LEFT 73110 | $193.80 | $323.00 | — | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 W-HIP, UNI W/ OR W/O PELVIS 2-3 VW LT | $133.80 | $223.00 | — | 34% below | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 B-HIP, UNI W/ OR W/O PELVIS 2-3 VW RT | $133.80 | $223.00 | — | 34% below | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 W-HIP, UNI W/ OR W/O PELVIS 2-3 VW RT | $133.80 | $223.00 | — | 34% below | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP, UNI W/OR W/O PELVIS 2-3 VW RT 73502 | $133.80 | $223.00 | — | 34% below | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP, UNI W/ ORW/O PELVIS 2-3 VW LT 73502 | $133.80 | $223.00 | — | 34% below | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 B-HIP, UNI W/ OR S/O PELVIS 2-3 VW LT | $133.80 | $223.00 | — | 34% below | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP, UNI W/ ORW/O PELVIS 2-3 VW LT 73502 | $133.80 | $223.00 | — | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP, UNI W/OR W/O PELVIS 2-3 VW RT 73502 | $133.80 | $223.00 | — | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 W-HIP, UNI W/ OR W/O PELVIS 2-3 VW LT | $133.80 | $223.00 | — | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 W-HIP, UNI W/ OR W/O PELVIS 2-3 VW RT | $133.80 | $223.00 | — | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 B-HIP, UNI W/ OR S/O PELVIS 2-3 VW LT | $133.80 | $223.00 | — | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 B-HIP, UNI W/ OR W/O PELVIS 2-3 VW RT | $133.80 | $223.00 | — | — | 40% |
| X-ray of the abdomen, 1 view CPT 74018 ABDOMEN/KUB AP SUPINE 1 VIEW 74018 | $199.80 | $333.00 | — | 6% below | 40% |
| X-ray of the abdomen, 1 view CPT 74018 ABDOMEN/KUB FEEDING TUBE PLACE 74018 | $199.80 | $333.00 | — | 6% below | 40% |
| X-ray of the abdomen, 1 view CPT 74018 B-ABDOMEN/KUB SUPINE 1 VIEW 74018 | $199.80 | $333.00 | — | 6% below | 40% |
| X-ray of the abdomen, 1 view CPT 74018 W-ABDOMEN/KUB SUPINE 1 VIEW 74018 | $199.80 | $333.00 | — | 6% below | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 W-ABDOMEN/KUB SUPINE 1 VIEW 74018 | $199.80 | $333.00 | — | — | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN/KUB AP SUPINE 1 VIEW 74018 | $199.80 | $333.00 | — | — | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 B-ABDOMEN/KUB SUPINE 1 VIEW 74018 | $199.80 | $333.00 | — | — | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN/KUB FEEDING TUBE PLACE 74018 | $199.80 | $333.00 | — | — | 40% |
| X-ray of the ankle, 2 views CPT 73600 B-ANKLE 2 VIEWS 73600 | $123.60 | $206.00 | — | 40% below | 40% |
| X-ray of the ankle, 2 views CPT 73600 W-ANKLE 2 VIEWS 73600 | $123.60 | $206.00 | — | 40% below | 40% |
| X-ray of the ankle, 2 views CPT 73600 ANKLE 2 VIEWS 73600 | $123.60 | $206.00 | — | 40% below | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 VIEWS RIGHT 73600 | $123.60 | $206.00 | — | 40% below | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 W-ANKLE 2 VIEWS LT 73600 | $123.60 | $206.00 | — | 40% below | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 VIEWS LEFT 73600 | $123.60 | $206.00 | — | 40% below | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 B-ANKLE 2 VIEWS LEFT 73600 | $123.60 | $206.00 | — | 40% below | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 W-ANKLE 2 VIEWS RT 73600 | $123.60 | $206.00 | — | 40% below | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 B-ANKLE 2 VIEWS RIGHT 73600 | $123.60 | $206.00 | — | 40% below | 40% |
| X-ray of the ankle, 2 views inpatient CPT 73600 ANKLE 2 VIEWS 73600 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the ankle, 2 views inpatient CPT 73600 B-ANKLE 2 VIEWS 73600 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the ankle, 2 views inpatient CPT 73600 W-ANKLE 2 VIEWS 73600 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 W-ANKLE 2 VIEWS LT 73600 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 B-ANKLE 2 VIEWS RIGHT 73600 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 W-ANKLE 2 VIEWS RT 73600 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 VIEWS RIGHT 73600 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 VIEWS LEFT 73600 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 B-ANKLE 2 VIEWS LEFT 73600 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views CPT 73140 B-FINGER (S) 73140 | $123.60 | $206.00 | — | 37% below | 40% |
| X-ray of the finger(s), 2 or more views CPT 73140 FINGER(S) MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | 37% below | 40% |
| X-ray of the finger(s), 2 or more views CPT 73140 W-FINGER(S)MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | 37% below | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 W-FINGER(S)LT MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | 37% below | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 B-FINGER (S) LEFT MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | 37% below | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 B-FINGER (S) RIGHT 73140 | $123.60 | $206.00 | — | 37% below | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 W-FINGER(S)RT MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | 37% below | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER(S) RIGHT MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | 37% below | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER(S) LEFT MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | 37% below | 40% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 W-FINGER(S)MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 FINGER(S) MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 B-FINGER (S) 73140 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER(S) RIGHT MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 W-FINGER(S)LT MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 W-FINGER(S)RT MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 B-FINGER (S) LEFT MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 B-FINGER (S) RIGHT 73140 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER(S) LEFT MIN 2 VIEWS 73140 | $123.60 | $206.00 | — | — | 40% |
| X-ray of the foot, 2 views CPT 73620 FOOT AP/LAT 73620 | $163.20 | $272.00 | — | 20% below | 40% |
| X-ray of the foot, 2 views CPT 73620 W-FOOT AP/LAT 73620 | $163.20 | $272.00 | — | 20% below | 40% |
| X-ray of the foot, 2 views CPT 73620 B-FOOT AP/LAT 73620 | $163.20 | $272.00 | — | 20% below | 40% |
| X-ray of the foot, 2 views one side CPT 73620 B-FOOT AP/LAT RIGHT 73620 | $163.20 | $272.00 | — | 20% below | 40% |
| X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEWS RIGHT 73620 | $163.20 | $272.00 | — | 20% below | 40% |
| X-ray of the foot, 2 views one side CPT 73620 W-FOOT AP/LAT LT 73620 | $163.20 | $272.00 | — | 20% below | 40% |
| X-ray of the foot, 2 views one side CPT 73620 W-FOOT AP/LAT RT 73620 | $163.20 | $272.00 | — | 20% below | 40% |
| X-ray of the foot, 2 views one side CPT 73620 B-FOOT AP/LAT LEFT 73620 | $163.20 | $272.00 | — | 20% below | 40% |
| X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEWS LEFT 73620 | $163.20 | $272.00 | — | 20% below | 40% |
| X-ray of the foot, 2 views inpatient CPT 73620 FOOT AP/LAT 73620 | $163.20 | $272.00 | — | — | 40% |
| X-ray of the foot, 2 views inpatient CPT 73620 B-FOOT AP/LAT 73620 | $163.20 | $272.00 | — | — | 40% |
| X-ray of the foot, 2 views inpatient CPT 73620 W-FOOT AP/LAT 73620 | $163.20 | $272.00 | — | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 VIEWS LEFT 73620 | $163.20 | $272.00 | — | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 VIEWS RIGHT 73620 | $163.20 | $272.00 | — | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 W-FOOT AP/LAT LT 73620 | $163.20 | $272.00 | — | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 W-FOOT AP/LAT RT 73620 | $163.20 | $272.00 | — | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 B-FOOT AP/LAT LEFT 73620 | $163.20 | $272.00 | — | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 B-FOOT AP/LAT RIGHT 73620 | $163.20 | $272.00 | — | — | 40% |
| X-ray of the foot, complete, 3 or more views CPT 73630 B-FOOT AP/LAT/OBL 73630 | $196.20 | $327.00 | — | 8% below | 40% |
| X-ray of the foot, complete, 3 or more views CPT 73630 FOOT 3 VIEWS 73630 | $196.20 | $327.00 | — | 8% below | 40% |
| X-ray of the foot, complete, 3 or more views CPT 73630 W-FOOT AP/LAT/OBL 73630 | $196.20 | $327.00 | — | 8% below | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 W-FOOT AP/LAT/OBL LT 73630 | $196.20 | $327.00 | — | 8% below | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 B-FOOT AP/LAT/OBL LEFT 73630 | $196.20 | $327.00 | — | 8% below | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 B-FOOT AP/LAT/OBL RIGHT 73630 | $196.20 | $327.00 | — | 8% below | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT 3 VIEWS LEFT 73630 | $196.20 | $327.00 | — | 8% below | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 W-FOOT AP/LAT/OBL RT 73630 | $196.20 | $327.00 | — | 8% below | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT 3 VIEWS RIGHT 73630 | $196.20 | $327.00 | — | 8% below | 40% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 B-FOOT AP/LAT/OBL 73630 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT 3 VIEWS 73630 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 W-FOOT AP/LAT/OBL 73630 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 B-FOOT AP/LAT/OBL LEFT 73630 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT 3 VIEWS LEFT 73630 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 W-FOOT AP/LAT/OBL RT 73630 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 W-FOOT AP/LAT/OBL LT 73630 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT 3 VIEWS RIGHT 73630 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 B-FOOT AP/LAT/OBL RIGHT 73630 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the hand, 3 or more views CPT 73130 B-HAND 3 VIEWS 73130 | $196.20 | $327.00 | — | 11% below | 40% |
| X-ray of the hand, 3 or more views CPT 73130 W-HAND 3 VIEWS 73130 | $196.20 | $327.00 | — | 11% below | 40% |
| X-ray of the hand, 3 or more views CPT 73130 HAND 3 VIEWS 73130 | $196.20 | $327.00 | — | 11% below | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 B-HAND 3 VIEWS RIGHT 73130 | $196.20 | $327.00 | — | 11% below | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 W-HAND 3 VIEWS RT73130 | $196.20 | $327.00 | — | 11% below | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 W-HAND 3 VIEWS LT73130 | $196.20 | $327.00 | — | 11% below | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 HAND 3 VIEWS RIGHT 73130 | $196.20 | $327.00 | — | 11% below | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 HAND 3 VIEWS LEFT 73130 | $196.20 | $327.00 | — | 11% below | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 B-HAND 3 VIEWS LEFT 73130 | $196.20 | $327.00 | — | 11% below | 40% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 W-HAND 3 VIEWS 73130 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 B-HAND 3 VIEWS 73130 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 HAND 3 VIEWS 73130 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND 3 VIEWS LEFT 73130 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND 3 VIEWS RIGHT 73130 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 W-HAND 3 VIEWS LT73130 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 W-HAND 3 VIEWS RT73130 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 B-HAND 3 VIEWS LEFT 73130 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 B-HAND 3 VIEWS RIGHT 73130 | $196.20 | $327.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views CPT 73560 PATELLA 1-2 VIEWS 73560 | $150.00 | $250.00 | — | 32% below | 40% |
| X-ray of the knee, 1 or 2 views CPT 73560 B-PATELLA 73560 | $150.00 | $250.00 | — | 32% below | 40% |
| X-ray of the knee, 1 or 2 views CPT 73560 W-PATELLA 1-2 VIEWS 73560 | $150.00 | $250.00 | — | 32% below | 40% |
| X-ray of the knee, 1 or 2 views CPT 73560 KNEE 2 VIEWS 73560 | $163.80 | $273.00 | — | 25% below | 40% |
| X-ray of the knee, 1 or 2 views CPT 73560 W-KNEE 2 VIEWS 73560 | $163.80 | $273.00 | — | 25% below | 40% |
| X-ray of the knee, 1 or 2 views CPT 73560 B-KNEE 2 VIEWS 73560 | $163.80 | $273.00 | — | 25% below | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 W-PATELLA LT 1-2 VIEWS 73560 | $150.00 | $250.00 | — | 32% below | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 W-PATELLA RT 1-2 VIEWS 73560 | $150.00 | $250.00 | — | 32% below | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 B-PATELLA LT 1-2 VIEWS 73560 | $150.00 | $250.00 | — | 32% below | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 B-PATELLA RT 1-2 VIEWS 73560 | $150.00 | $250.00 | — | 32% below | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 PATELLA 1-2 VIEWS LT 73560 | $150.00 | $250.00 | — | 32% below | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 PATELLA RT 1-2 VIEWS 73560 | $150.00 | $250.00 | — | 32% below | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 2 VIEWS RIGHT 73560 | $163.80 | $273.00 | — | 25% below | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 W-KNEE 2 VIEWS RT 73560 | $163.80 | $273.00 | — | 25% below | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 W-KNEE 2 VIEWS LT 73560 | $163.80 | $273.00 | — | 25% below | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 B-KNEE 2 VIEWS LEFT 73560 | $163.80 | $273.00 | — | 25% below | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 B-KNEE 2 VIEWS RIGHT 73560 | $163.80 | $273.00 | — | 25% below | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 2 VIEWS LEFT 73560 | $163.80 | $273.00 | — | 25% below | 40% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 B-PATELLA 73560 | $150.00 | $250.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 PATELLA 1-2 VIEWS 73560 | $150.00 | $250.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 W-PATELLA 1-2 VIEWS 73560 | $150.00 | $250.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 B-KNEE 2 VIEWS 73560 | $163.80 | $273.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 W-KNEE 2 VIEWS 73560 | $163.80 | $273.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 KNEE 2 VIEWS 73560 | $163.80 | $273.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 B-PATELLA LT 1-2 VIEWS 73560 | $150.00 | $250.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PATELLA RT 1-2 VIEWS 73560 | $150.00 | $250.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PATELLA 1-2 VIEWS LT 73560 | $150.00 | $250.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 W-PATELLA LT 1-2 VIEWS 73560 | $150.00 | $250.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 W-PATELLA RT 1-2 VIEWS 73560 | $150.00 | $250.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 B-PATELLA RT 1-2 VIEWS 73560 | $150.00 | $250.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 B-KNEE 2 VIEWS RIGHT 73560 | $163.80 | $273.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 W-KNEE 2 VIEWS RT 73560 | $163.80 | $273.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 W-KNEE 2 VIEWS LT 73560 | $163.80 | $273.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 2 VIEWS RIGHT 73560 | $163.80 | $273.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 2 VIEWS LEFT 73560 | $163.80 | $273.00 | — | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 B-KNEE 2 VIEWS LEFT 73560 | $163.80 | $273.00 | — | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 IR LUMBAR SPINE 2-3 VIEWS S&I | $237.60 | $396.00 | — | 3% below | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 B-LUMBAR SPINE 2-3 72100 | $307.80 | $513.00 | — | 25% above | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 W-LUMBAR SPINE 2-3 72100 | $307.80 | $513.00 | — | 25% above | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE 2-3 72100 | $307.80 | $513.00 | — | 25% above | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 IR LUMBAR SPINE 2-3 VIEWS S&I | $237.60 | $396.00 | — | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR SPINE 2-3 72100 | $307.80 | $513.00 | — | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 B-LUMBAR SPINE 2-3 72100 | $307.80 | $513.00 | — | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 W-LUMBAR SPINE 2-3 72100 | $307.80 | $513.00 | — | — | 40% |
| X-ray of the lower back, 4 or more views CPT 72110 B-LUMBAR W/OBLIQUES MIN 4 VIEWS 72110 | $322.20 | $537.00 | — | at median | 40% |
| X-ray of the lower back, 4 or more views CPT 72110 LUMBAR W/OBLIQUES MIN 4 VIEWS 72110 | $322.20 | $537.00 | — | at median | 40% |
| X-ray of the lower back, 4 or more views CPT 72110 W-LUMBAR W/OBLIQUES MIN 4 VIEWS 72110 | $322.20 | $537.00 | — | at median | 40% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 B-LUMBAR W/OBLIQUES MIN 4 VIEWS 72110 | $322.20 | $537.00 | — | — | 40% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 W-LUMBAR W/OBLIQUES MIN 4 VIEWS 72110 | $322.20 | $537.00 | — | — | 40% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR W/OBLIQUES MIN 4 VIEWS 72110 | $322.20 | $537.00 | — | — | 40% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2 VIEW 72070 | $193.80 | $323.00 | — | 15% below | 40% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 B-THORACIC SPINE 2 VIEW 72070 | $193.80 | $323.00 | — | 15% below | 40% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 W-THORACIC SPINE 2 VIEWS 72070 | $193.80 | $323.00 | — | 15% below | 40% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 IR T/SPINE S&I 2 VIEWS | $237.60 | $396.00 | — | 5% above | 40% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 B-THORACIC SPINE 2 VIEW 72070 | $193.80 | $323.00 | — | — | 40% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 W-THORACIC SPINE 2 VIEWS 72070 | $193.80 | $323.00 | — | — | 40% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE 2 VIEW 72070 | $193.80 | $323.00 | — | — | 40% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 IR T/SPINE S&I 2 VIEWS | $237.60 | $396.00 | — | — | 40% |
| X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES COMPLETE MIN 3 VIEWS 70160 | $235.20 | $392.00 | — | 3% above | 40% |
| X-ray of the nasal bones, 3 or more views CPT 70160 W-NASAL BONES COMPLETE MIN 3 VIEWS 70160 | $235.20 | $392.00 | — | 3% above | 40% |
| X-ray of the nasal bones, 3 or more views CPT 70160 B-NASAL BONES COMPLETE MIN 3 VIEW 70160 | $235.20 | $392.00 | — | 3% above | 40% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 W-NASAL BONES COMPLETE MIN 3 VIEWS 70160 | $235.20 | $392.00 | — | — | 40% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES COMPLETE MIN 3 VIEWS 70160 | $235.20 | $392.00 | — | — | 40% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 B-NASAL BONES COMPLETE MIN 3 VIEW 70160 | $235.20 | $392.00 | — | — | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 2-3 VIEWS 72040 | $198.00 | $330.00 | — | 6% below | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 B-CERVICAL SPINE 2-3 VIEWS 72040 | $198.00 | $330.00 | — | 6% below | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 W-CERVICAL SPINE 2-3 VIEWS 72040 | $198.00 | $330.00 | — | 6% below | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE 2-3 VIEWS 72040 | $198.00 | $330.00 | — | — | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 W-CERVICAL SPINE 2-3 VIEWS 72040 | $198.00 | $330.00 | — | — | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 B-CERVICAL SPINE 2-3 VIEWS 72040 | $198.00 | $330.00 | — | — | 40% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1-2 VIEW 72170 | $144.60 | $241.00 | — | 32% below | 40% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 B-PELVIS 1-2 VIEW 72170 | $144.60 | $241.00 | — | 32% below | 40% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 W-PELVIS 1-2 VIEW 72170 | $144.60 | $241.00 | — | 32% below | 40% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1-2 VIEW 72170 | $144.60 | $241.00 | — | — | 40% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 W-PELVIS 1-2 VIEW 72170 | $144.60 | $241.00 | — | — | 40% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 B-PELVIS 1-2 VIEW 72170 | $144.60 | $241.00 | — | — | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 COCCYX/SACRUM MIN 2 VIEWS 72220 | $144.60 | $241.00 | — | 36% below | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 W-COCCYX/SACRUM MIN 2 VIEWS 72220 | $144.60 | $241.00 | — | 36% below | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 B-COCCYX/SACRUM MIN 2 VIEWS 72220 | $144.60 | $241.00 | — | 36% below | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 W-COCCYX/SACRUM MIN 2 VIEWS 72220 | $144.60 | $241.00 | — | — | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 COCCYX/SACRUM MIN 2 VIEWS 72220 | $144.60 | $241.00 | — | — | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 B-COCCYX/SACRUM MIN 2 VIEWS 72220 | $144.60 | $241.00 | — | — | 40% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Maine | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ACTH | $307.80 | $513.00 | — | 92% above | 40% |
| ACTH blood test inpatient CPT 82024 ACTH | $307.80 | $513.00 | — | — | 40% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE ASPARTATE AMINO ALT SGOT | $49.80 | $83.00 | — | 48% above | 40% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (SGPT) | $61.80 | $103.00 | — | 83% above | 40% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 P-ALT | $61.80 | $103.00 | — | 83% above | 40% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 W ALT / SGPT (WELLS) | $62.40 | $104.00 | — | 85% above | 40% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE ASPARTATE AMINO ALT SGOT | $49.80 | $83.00 | — | — | 40% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 P-ALT | $61.80 | $103.00 | — | — | 40% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT (SGPT) | $61.80 | $103.00 | — | — | 40% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 W ALT / SGPT (WELLS) | $62.40 | $104.00 | — | — | 40% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE ASPARTATE AMINO AST SGOT | $49.80 | $83.00 | — | 62% above | 40% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 P-AST | $60.00 | $100.00 | — | 95% above | 40% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 AST (SGOT) | $60.00 | $100.00 | — | 95% above | 40% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 W AST / SGOT (WELLS) | $60.60 | $101.00 | — | 97% above | 40% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE ASPARTATE AMINO AST SGOT | $49.80 | $83.00 | — | — | 40% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 P-AST | $60.00 | $100.00 | — | — | 40% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST (SGOT) | $60.00 | $100.00 | — | — | 40% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 W AST / SGOT (WELLS) | $60.60 | $101.00 | — | — | 40% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL ACUTE W/REFLUX TO CONFIR | $81.00 | $135.00 | — | 50% below | 40% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL ACUTE W/REFLUX TO CONFIR | $81.00 | $135.00 | — | — | 40% |
| Albumin blood test CPT 82040 W ALBUMIN, SERUM (WELLS) | $19.80 | $33.00 | — | 14% below | 40% |
| Albumin blood test CPT 82040 ALBUMIN, SERUM | $46.20 | $77.00 | — | 101% above | 40% |
| Albumin blood test inpatient CPT 82040 W ALBUMIN, SERUM (WELLS) | $19.80 | $33.00 | — | — | 40% |
| Albumin blood test inpatient CPT 82040 ALBUMIN, SERUM | $46.20 | $77.00 | — | — | 40% |
| Aldosterone blood test CPT 82088 ALDOSTERONE | $154.80 | $258.00 | — | 1% below | 40% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE | $154.80 | $258.00 | — | — | 40% |
| Alkaline phosphatase (ALP) blood test CPT 84075 W ALKALINE PHOSPHATASE (WELLS) | $45.00 | $75.00 | — | 64% above | 40% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE (CHG) | $45.00 | $75.00 | — | 64% above | 40% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE | $45.00 | $75.00 | — | 64% above | 40% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE BONE SPECIFIC | $59.40 | $99.00 | — | 116% above | 40% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE | $45.00 | $75.00 | — | — | 40% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 W ALKALINE PHOSPHATASE (WELLS) | $45.00 | $75.00 | — | — | 40% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE (CHG) | $45.00 | $75.00 | — | — | 40% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE BONE SPECIFIC | $59.40 | $99.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 PAPRIKA SWEET PEPPER F218 IgE | $9.60 | $16.00 | — | 58% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MUSTARD TOMATO EGGPLANT | $9.60 | $16.00 | — | 58% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 TROUT IgE | $11.40 | $19.00 | — | 50% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CODFISH IgE | $11.40 | $19.00 | — | 50% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 GUINEA PIG EPITHELIA (E6) IgE | $11.40 | $19.00 | — | 50% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 GULF FLOUNDER IgE | $11.40 | $19.00 | — | 50% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SALMON IgE | $11.40 | $19.00 | — | 50% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 TUNA IgE | $11.40 | $19.00 | — | 50% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT | $12.60 | $21.00 | — | 45% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 NORTHEAST REGIONAL MIXED PANEL #1 | $12.60 | $21.00 | — | 45% below | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 BUDGERIGAR FEATHER | $29.40 | $49.00 | — | 28% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IGE, QNT (Sent to IBT) | $38.40 | $64.00 | — | 67% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGY DUST PANEL #4 | $40.80 | $68.00 | — | 78% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPEC IGE CURDE ALLERGAN EXTRACT | $43.80 | $73.00 | — | 91% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 DAIRY AND GRAIN ALLERGAN PROFILE | $47.40 | $79.00 | — | 107% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 (MAYO) DAIRY & GRAIN ALLERGEN PROFILE | $50.40 | $84.00 | — | 120% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO TAPIOCA IgE | $52.20 | $87.00 | — | 128% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 GALACTOSE-ALPHA-S1,3 ALPHA GAL IGE | $69.60 | $116.00 | — | 203% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPEC IGE QNT/SEMI CRD ALLRG EA | $122.40 | $204.00 | — | 434% above | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MUSTARD TOMATO EGGPLANT | $9.60 | $16.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PAPRIKA SWEET PEPPER F218 IgE | $9.60 | $16.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TROUT IgE | $11.40 | $19.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CODFISH IgE | $11.40 | $19.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GUINEA PIG EPITHELIA (E6) IgE | $11.40 | $19.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GULF FLOUNDER IgE | $11.40 | $19.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SALMON IgE | $11.40 | $19.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TUNA IgE | $11.40 | $19.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT | $12.60 | $21.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 NORTHEAST REGIONAL MIXED PANEL #1 | $12.60 | $21.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BUDGERIGAR FEATHER | $29.40 | $49.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IGE, QNT (Sent to IBT) | $38.40 | $64.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGY DUST PANEL #4 | $40.80 | $68.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPEC IGE CURDE ALLERGAN EXTRACT | $43.80 | $73.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DAIRY AND GRAIN ALLERGAN PROFILE | $47.40 | $79.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 (MAYO) DAIRY & GRAIN ALLERGEN PROFILE | $50.40 | $84.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO TAPIOCA IgE | $52.20 | $87.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GALACTOSE-ALPHA-S1,3 ALPHA GAL IGE | $69.60 | $116.00 | — | — | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPEC IGE QNT/SEMI CRD ALLRG EA | $122.40 | $204.00 | — | — | 40% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFP(NON-MATERNAL) TUMOR MARKER, SERUM | $146.40 | $244.00 | — | 122% above | 40% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP(NON-MATERNAL) TUMOR MARKER, SERUM | $146.40 | $244.00 | — | — | 40% |
| Ammonia blood test CPT 82140 AMMONIA | $87.60 | $146.00 | — | 4% below | 40% |
| Ammonia blood test inpatient CPT 82140 AMMONIA | $87.60 | $146.00 | — | — | 40% |
| Amylase blood test CPT 82150 W AMYLASE, BODY FLUID (WELLS) | $37.20 | $62.00 | — | 10% below | 40% |
| Amylase blood test CPT 82150 AMYLASE, TOTAL | $40.80 | $68.00 | — | 2% below | 40% |
| Amylase blood test CPT 82150 AMYLASE, URINE RANDOM | $57.00 | $95.00 | — | 37% above | 40% |
| Amylase blood test CPT 82150 W AMYLASE, SERUM (WELLS) | $60.60 | $101.00 | — | 46% above | 40% |
| Amylase blood test CPT 82150 AMYLASE, BODY FLUID | $61.80 | $103.00 | — | 49% above | 40% |
| Amylase blood test CPT 82150 AMYLASE, SERUM | $94.20 | $157.00 | — | 127% above | 40% |
| Amylase blood test inpatient CPT 82150 W AMYLASE, BODY FLUID (WELLS) | $37.20 | $62.00 | — | — | 40% |
| Amylase blood test inpatient CPT 82150 AMYLASE, TOTAL | $40.80 | $68.00 | — | — | 40% |
| Amylase blood test inpatient CPT 82150 AMYLASE, URINE RANDOM | $57.00 | $95.00 | — | — | 40% |
| Amylase blood test inpatient CPT 82150 W AMYLASE, SERUM (WELLS) | $60.60 | $101.00 | — | — | 40% |
| Amylase blood test inpatient CPT 82150 AMYLASE, BODY FLUID | $61.80 | $103.00 | — | — | 40% |
| Amylase blood test inpatient CPT 82150 AMYLASE, SERUM | $94.20 | $157.00 | — | — | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE ANTIBODY | $22.80 | $38.00 | — | 68% below | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTDE ANTIBODY | $29.40 | $49.00 | — | 59% below | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE (CCP), AB | $89.40 | $149.00 | — | 25% above | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 (NORDX) CYCLIC CITRULLINATED PEPTIDE ANT | $141.60 | $236.00 | — | 98% above | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE ANTIBODY | $22.80 | $38.00 | — | — | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTDE ANTIBODY | $29.40 | $49.00 | — | — | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE (CCP), AB | $89.40 | $149.00 | — | — | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 (NORDX) CYCLIC CITRULLINATED PEPTIDE ANT | $141.60 | $236.00 | — | — | 40% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA MULTIPLEX W/RFX TO 11 ANTIBODY CASDE | $22.20 | $37.00 | — | 60% below | 40% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES | $23.40 | $39.00 | — | 57% below | 40% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES ANALYSIS | $26.40 | $44.00 | — | 52% below | 40% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANIBODIES ANA | $60.00 | $100.00 | — | 9% above | 40% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTI-NUCLEAR ANTIBODY SCREEN (ANA | $104.40 | $174.00 | — | 90% above | 40% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 LABCORP ANTINUCLEAR ANTIBODIES ANA | $109.80 | $183.00 | — | 100% above | 40% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA MULTIPLEX W/RFX TO 11 ANTIBODY CASDE | $22.20 | $37.00 | — | — | 40% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES | $23.40 | $39.00 | — | — | 40% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES ANALYSIS | $26.40 | $44.00 | — | — | 40% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANIBODIES ANA | $60.00 | $100.00 | — | — | 40% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTI-NUCLEAR ANTIBODY SCREEN (ANA | $104.40 | $174.00 | — | — | 40% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 LABCORP ANTINUCLEAR ANTIBODIES ANA | $109.80 | $183.00 | — | — | 40% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 WELLS NATRUIRETIC PEPTIDE BNP | $66.00 | $110.00 | — | 58% below | 40% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B TYPE NATRIURETIC PEPTIDE (BNP) | $157.80 | $263.00 | — | at median | 40% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 W B-TYPE NATRIURETIC PEPTIDE BNP | $157.80 | $263.00 | — | at median | 40% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 WELLS NATRUIRETIC PEPTIDE BNP | $66.00 | $110.00 | — | — | 40% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B TYPE NATRIURETIC PEPTIDE (BNP) | $157.80 | $263.00 | — | — | 40% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 W B-TYPE NATRIURETIC PEPTIDE BNP | $157.80 | $263.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 STATE BACTI MISC ALL OTHER SOURCES | $54.00 | $90.00 | — | at median | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, RECTAL | $68.40 | $114.00 | — | 27% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, INCISION | $68.40 | $114.00 | — | 27% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, VAGINAL | $86.40 | $144.00 | — | 60% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, FASCIA | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, EYE | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, ENVIRONMENTAL | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, EAR | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, DRAINAGE | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, DIALYSIS | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, DECUBITUS | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, CYST | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, CSF | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, BURN | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, BONE | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, BODY FLUID | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, BIOPSY | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, ABSCESS | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, ULCER | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, IMPLANT | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, NOSE | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, PENIS | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, RASH | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, RESPIRATORY | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, TISSUE | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, SINUS | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, SPUTUM | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, GENITAL | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, FISTULA | $90.60 | $151.00 | — | 68% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, WOUND | $99.00 | $165.00 | — | 83% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, CATHETER | $99.60 | $166.00 | — | 84% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, SKIN | $99.60 | $166.00 | — | 84% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, THROAT | $125.40 | $209.00 | — | 132% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 STATE BACTI MISC ALL OTHER SOURCES | $54.00 | $90.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, INCISION | $68.40 | $114.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, RECTAL | $68.40 | $114.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, VAGINAL | $86.40 | $144.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, ENVIRONMENTAL | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, RASH | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, EYE | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, RESPIRATORY | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, DIALYSIS | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, NOSE | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, DECUBITUS | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, DRAINAGE | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, FISTULA | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, GENITAL | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, SPUTUM | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, BONE | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, BURN | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, TISSUE | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, ULCER | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, EAR | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, PENIS | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, ABSCESS | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, FASCIA | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, BIOPSY | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, BODY FLUID | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, CYST | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, CSF | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, SINUS | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, IMPLANT | $90.60 | $151.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, WOUND | $99.00 | $165.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, CATHETER | $99.60 | $166.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, SKIN | $99.60 | $166.00 | — | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, THROAT | $125.40 | $209.00 | — | — | 40% |
| Basic metabolic panel (blood test) CPT 80048 W BASIC METABOLIC PANEL (WELLS) | $152.40 | $254.00 | — | 95% above | 40% |
| Basic metabolic panel (blood test) CPT 80048 M BMP-PICCOLO (MY HEALTH KITTERY) | $152.40 | $254.00 | — | 95% above | 40% |
| Basic metabolic panel (blood test) CPT 80048 SB PICCOLO BASIC METABOLIC PANEL | $152.40 | $254.00 | — | 95% above | 40% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PNL-PICCOLO (KITTERY) | $152.40 | $254.00 | — | 95% above | 40% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $152.40 | $254.00 | — | 95% above | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PNL-PICCOLO (KITTERY) | $152.40 | $254.00 | — | — | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 M BMP-PICCOLO (MY HEALTH KITTERY) | $152.40 | $254.00 | — | — | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 SB PICCOLO BASIC METABOLIC PANEL | $152.40 | $254.00 | — | — | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 W BASIC METABOLIC PANEL (WELLS) | $152.40 | $254.00 | — | — | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $152.40 | $254.00 | — | — | 40% |
| Bilirubin blood test, total CPT 82247 W BILIRUBIN, NEONATAL (WELLS) | $22.80 | $38.00 | — | 26% below | 40% |
| Bilirubin blood test, total CPT 82247 W BILIRUBIN, TOTAL (WELLS) | $22.80 | $38.00 | — | 26% below | 40% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN, TOTAL | $45.00 | $75.00 | — | 45% above | 40% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL | $49.80 | $83.00 | — | 61% above | 40% |
| Bilirubin blood test, total inpatient CPT 82247 W BILIRUBIN, TOTAL (WELLS) | $22.80 | $38.00 | — | — | 40% |
| Bilirubin blood test, total inpatient CPT 82247 W BILIRUBIN, NEONATAL (WELLS) | $22.80 | $38.00 | — | — | 40% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN, TOTAL | $45.00 | $75.00 | — | — | 40% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL | $49.80 | $83.00 | — | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 CARIS TISSUE EXAM FV 88305 | $54.60 | $91.00 | — | 61% below | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV TISSUE - CHRG ONLY (88305) | $141.00 | $235.00 | — | 2% above | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 NORDX TISSUE EXAM BY PATHOLOGIST | $141.00 | $235.00 | — | 2% above | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 NORDX CYTOLOGY NON GYN LEVEL IV PATH | $141.00 | $235.00 | — | 2% above | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 NORDX BONE MARROW ASPIRATION AND EXAM | $141.00 | $235.00 | — | 2% above | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 GROSS AND MASS LEVEL IV (NORDX) | $188.40 | $314.00 | — | 36% above | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 CARIS TISSUE EXAM FV 88305 | $54.60 | $91.00 | — | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 NORDX BONE MARROW ASPIRATION AND EXAM | $141.00 | $235.00 | — | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 NORDX CYTOLOGY NON GYN LEVEL IV PATH | $141.00 | $235.00 | — | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV TISSUE - CHRG ONLY (88305) | $141.00 | $235.00 | — | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 NORDX TISSUE EXAM BY PATHOLOGIST | $141.00 | $235.00 | — | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 GROSS AND MASS LEVEL IV (NORDX) | $188.40 | $314.00 | — | — | 40% |
| Blood culture for bacteria CPT 87040 CULTURE, BLOOD | $146.40 | $244.00 | — | 72% above | 40% |
| Blood culture for bacteria inpatient CPT 87040 CULTURE, BLOOD | $146.40 | $244.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION VENOUS BLOOD VENIPUNCTURE | $15.60 | $26.00 | — | 11% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 YWC PHLEBOTOMY CHARGE - CHRG ONLY | $16.20 | $27.00 | — | 15% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD DRAW | $18.00 | $30.00 | — | 28% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD DRAW PRPL | $18.00 | $30.00 | — | 28% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 SB PHLEBOTOMY CHARGE - CHRG ONLY | $18.00 | $30.00 | — | 28% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ER BLOOD DRAW | $18.00 | $30.00 | — | 28% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 LAB PHLEBOTOMY(KITTERY MHK / WALKER ST) | $18.00 | $30.00 | — | 28% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 K PHLEBOTOMY CHARGE - CHRG ONLY | $18.00 | $30.00 | — | 28% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 W PHLEBOTOMY CHARGE - CHRG ONLY | $18.00 | $30.00 | — | 28% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 OBV/PPR-BLOOD DRAW | $18.00 | $30.00 | — | 28% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD DRAW (OUTPT) | $18.00 | $30.00 | — | 28% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 B PHLEBOTOMY CHARGE - CHRG ONLY | $18.00 | $30.00 | — | 28% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 WELLS VENIPUNCTURE | $18.00 | $30.00 | — | 28% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 SCC PHLEBOTOMY CHARGE - CHRG ONLY | $18.00 | $30.00 | — | 28% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE | $19.80 | $33.00 | — | 40% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 LAB PHLEBOTOMY LEV 1 - CHRG ONLY | $25.80 | $43.00 | — | 83% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 LAB PHLEBOTOMY NEONAT - CHRG ONLY | $33.60 | $56.00 | — | 138% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION VENOUS BLOOD VENIPUNCTURE | $15.60 | $26.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 YWC PHLEBOTOMY CHARGE - CHRG ONLY | $16.20 | $27.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 W PHLEBOTOMY CHARGE - CHRG ONLY | $18.00 | $30.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 WELLS VENIPUNCTURE | $18.00 | $30.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 B PHLEBOTOMY CHARGE - CHRG ONLY | $18.00 | $30.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 K PHLEBOTOMY CHARGE - CHRG ONLY | $18.00 | $30.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 SB PHLEBOTOMY CHARGE - CHRG ONLY | $18.00 | $30.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 SCC PHLEBOTOMY CHARGE - CHRG ONLY | $18.00 | $30.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 LAB PHLEBOTOMY(KITTERY MHK / WALKER ST) | $18.00 | $30.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD DRAW PRPL | $18.00 | $30.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ER BLOOD DRAW | $18.00 | $30.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD DRAW | $18.00 | $30.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD DRAW (OUTPT) | $18.00 | $30.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 OBV/PPR-BLOOD DRAW | $18.00 | $30.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE | $19.80 | $33.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 LAB PHLEBOTOMY LEV 1 - CHRG ONLY | $25.80 | $43.00 | — | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 LAB PHLEBOTOMY NEONAT - CHRG ONLY | $33.60 | $56.00 | — | — | 40% |
| Blood glucose (sugar) test CPT 82947 W GLUCOSE, RANDOM (WELLS) | $19.80 | $33.00 | — | 14% below | 40% |
| Blood glucose (sugar) test CPT 82947 W GLUCOSE, FASTING (WELLS) | $19.80 | $33.00 | — | 14% below | 40% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE, 2HR PP PROFILE | $43.80 | $73.00 | — | 89% above | 40% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE, QUANTITATIVE, BLOOD | $43.80 | $73.00 | — | 89% above | 40% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE, RANDOM (SERUM) | $45.00 | $75.00 | — | 94% above | 40% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT | $49.80 | $83.00 | — | 115% above | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 W GLUCOSE, RANDOM (WELLS) | $19.80 | $33.00 | — | — | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 W GLUCOSE, FASTING (WELLS) | $19.80 | $33.00 | — | — | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE, 2HR PP PROFILE | $43.80 | $73.00 | — | — | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE, QUANTITATIVE, BLOOD | $43.80 | $73.00 | — | — | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE, RANDOM (SERUM) | $45.00 | $75.00 | — | — | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT | $49.80 | $83.00 | — | — | 40% |
| Blood lead test CPT 83655 LEAD, BLOOD | $47.40 | $79.00 | — | 5% above | 40% |
| Blood lead test CPT 83655 LEAD AT STATE LAB (BLOOD) | $48.60 | $81.00 | — | 8% above | 40% |
| Blood lead test CPT 83655 LEAD, URINE | $64.20 | $107.00 | — | 43% above | 40% |
| Blood lead test CPT 83655 LAB CORP LEAD BLOOD | $129.00 | $215.00 | — | 187% above | 40% |
| Blood lead test inpatient CPT 83655 LEAD, BLOOD | $47.40 | $79.00 | — | — | 40% |
| Blood lead test inpatient CPT 83655 LEAD AT STATE LAB (BLOOD) | $48.60 | $81.00 | — | — | 40% |
| Blood lead test inpatient CPT 83655 LEAD, URINE | $64.20 | $107.00 | — | — | 40% |
| Blood lead test inpatient CPT 83655 LAB CORP LEAD BLOOD | $129.00 | $215.00 | — | — | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 W PREGNANCY TEST, SERUM (WELLS) | $43.20 | $72.00 | — | at median | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY TEST, SERUM | $99.60 | $166.00 | — | 131% above | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 W PREGNANCY TEST, SERUM (WELLS) | $43.20 | $72.00 | — | — | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY TEST, SERUM | $99.60 | $166.00 | — | — | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO TYPING - HBB TST CHG | $47.40 | $79.00 | — | 4% below | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO TYPING -CHG ONLY | $47.40 | $79.00 | — | 4% below | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ARC ABO TYPE - CHRG ONLY | $91.80 | $153.00 | — | 86% above | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO TYPING - HBB TST CHG | $47.40 | $79.00 | — | — | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO TYPING -CHG ONLY | $47.40 | $79.00 | — | — | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ARC ABO TYPE - CHRG ONLY | $91.80 | $153.00 | — | — | 40% |
| Blood urea nitrogen (BUN) test CPT 84520 W BUN (WELLS), QNT | $19.80 | $33.00 | — | 21% below | 40% |
| Blood urea nitrogen (BUN) test CPT 84520 BUN - BLOOD UREA NITROGEN, QNT | $43.80 | $73.00 | — | 74% above | 40% |
| Blood urea nitrogen (BUN) test CPT 84520 P-BUN | $43.80 | $73.00 | — | 74% above | 40% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 W BUN (WELLS), QNT | $19.80 | $33.00 | — | — | 40% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN - BLOOD UREA NITROGEN, QNT | $43.80 | $73.00 | — | — | 40% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 P-BUN | $43.80 | $73.00 | — | — | 40% |
| C-peptide blood test CPT 84681 ASSAY OF C-PEPTIDE | $46.80 | $78.00 | — | 33% below | 40% |
| C-peptide blood test CPT 84681 C-PEPTIDE | $157.80 | $263.00 | — | 124% above | 40% |
| C-peptide blood test inpatient CPT 84681 ASSAY OF C-PEPTIDE | $46.80 | $78.00 | — | — | 40% |
| C-peptide blood test inpatient CPT 84681 C-PEPTIDE | $157.80 | $263.00 | — | — | 40% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $29.40 | $49.00 | — | 21% below | 40% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP (C-REACTIVE PROTEIN) | $55.20 | $92.00 | — | 49% above | 40% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN | $29.40 | $49.00 | — | — | 40% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP (C-REACTIVE PROTEIN) | $55.20 | $92.00 | — | — | 40% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C. DIFFICILE DNA AMPLIFIED PROBE BY PCR | $88.20 | $147.00 | — | 14% below | 40% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF TOXIN GENE | $138.60 | $231.00 | — | 35% above | 40% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C. DIFFICILE DNA AMPLIFIED PROBE BY PCR | $88.20 | $147.00 | — | — | 40% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF TOXIN GENE | $138.60 | $231.00 | — | — | 40% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 | $86.40 | $144.00 | — | 34% above | 40% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 | $86.40 | $144.00 | — | — | 40% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 | $109.20 | $182.00 | — | 27% above | 40% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 | $109.20 | $182.00 | — | — | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID 19 PCR | $156.00 | $260.00 | — | 77% above | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SEACOAST COVID-19 PCR | $156.00 | $260.00 | — | 77% above | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID ABBOT ID NOW TEST | $156.00 | $260.00 | — | 77% above | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS COVID PCR | $218.40 | $364.00 | — | 148% above | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID 19 PCR HIGH THROUGHPUT | $218.40 | $364.00 | — | 148% above | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID 19 PCR | $156.00 | $260.00 | — | — | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SEACOAST COVID-19 PCR | $156.00 | $260.00 | — | — | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID ABBOT ID NOW TEST | $156.00 | $260.00 | — | — | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS COVID PCR | $218.40 | $364.00 | — | — | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID 19 PCR HIGH THROUGHPUT | $218.40 | $364.00 | — | — | 40% |
| Calcium blood test, total CPT 82310 CALCIUM TOTAL | $12.00 | $20.00 | — | 57% below | 40% |
| Calcium blood test, total CPT 82310 CALCIUM, TOTAL (CHG) | $36.00 | $60.00 | — | 28% above | 40% |
| Calcium blood test, total CPT 82310 CALCIUM, TOTAL, SERUM | $36.00 | $60.00 | — | 28% above | 40% |
| Calcium blood test, total CPT 82310 W CALCIUM, TOTAL, SERUM (WELLS) | $36.00 | $60.00 | — | 28% above | 40% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM TOTAL | $12.00 | $20.00 | — | — | 40% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM, TOTAL (CHG) | $36.00 | $60.00 | — | — | 40% |
| Calcium blood test, total inpatient CPT 82310 W CALCIUM, TOTAL, SERUM (WELLS) | $36.00 | $60.00 | — | — | 40% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM, TOTAL, SERUM | $36.00 | $60.00 | — | — | 40% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CEA-CARCINOEMBRYONIC ANTIGEN | $78.00 | $130.00 | — | 11% below | 40% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA-CARCINOEMBRYONIC ANTIGEN | $78.00 | $130.00 | — | — | 40% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER VIRUS IMMUNITY SCREEN | $38.40 | $64.00 | — | 21% below | 40% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER IGM ANTIBODY | $67.20 | $112.00 | — | 38% above | 40% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER IGG ANTIBODY | $71.40 | $119.00 | — | 47% above | 40% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER VIRUS IMMUNITY SCREEN | $38.40 | $64.00 | — | — | 40% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER IGM ANTIBODY | $67.20 | $112.00 | — | — | 40% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER IGG ANTIBODY | $71.40 | $119.00 | — | — | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACH. RNA THROAT | $120.00 | $200.00 | — | 66% above | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHYLMD TRACH, DNA, AMP PROBE (CHG) | $120.00 | $200.00 | — | 66% above | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS, DNA,SDA | $120.00 | $200.00 | — | 66% above | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 NORDX CHLMYD TRACH DNA AMP PROBE | $120.00 | $200.00 | — | 66% above | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 NORDX CHLMYD TRACH DNA AMP PROBE | $120.00 | $200.00 | — | — | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACH. RNA THROAT | $120.00 | $200.00 | — | — | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS, DNA,SDA | $120.00 | $200.00 | — | — | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHYLMD TRACH, DNA, AMP PROBE (CHG) | $120.00 | $200.00 | — | — | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 (LABCORP) NMR LIPOPROFILELIP WITH GRAPH | $52.80 | $88.00 | — | 29% below | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE (CARDIAC RISK 1) | $148.20 | $247.00 | — | 100% above | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 W CARDIAC RISK 1 (WELLS) | $148.20 | $247.00 | — | 100% above | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 (LABCORP) NMR LIPOPROFILELIP WITH GRAPH | $52.80 | $88.00 | — | — | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE (CARDIAC RISK 1) | $148.20 | $247.00 | — | — | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 W CARDIAC RISK 1 (WELLS) | $148.20 | $247.00 | — | — | 40% |
| Complete blood count (CBC) with differential CPT 85025 CBC W AUTO DIFF WBC | $15.60 | $26.00 | — | 67% below | 40% |
| Complete blood count (CBC) with differential CPT 85025 W CBC (WELLS) | $57.00 | $95.00 | — | 21% above | 40% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE BLOOD COUNT, CHG.ONLY | $89.40 | $149.00 | — | 90% above | 40% |
| Complete blood count (CBC) with differential CPT 85025 HEMOGRAM | $89.40 | $149.00 | — | 90% above | 40% |
| Complete blood count (CBC) with differential CPT 85025 CBC WITH DIFFERENTIAL | $89.40 | $149.00 | — | 90% above | 40% |
| Complete blood count (CBC) with differential CPT 85025 K CBC AUTO DIFF (REFLEX TO MANUAL | $89.40 | $149.00 | — | 90% above | 40% |
| Complete blood count (CBC) with differential CPT 85025 W HEMOGRAM (WELLS) | $89.40 | $149.00 | — | 90% above | 40% |
| Complete blood count (CBC) with differential CPT 85025 HEMOGRAM, PRENATAL | $89.40 | $149.00 | — | 90% above | 40% |
| Complete blood count (CBC) with differential CPT 85025 M HEMOGRAM (MY HEALTH KITTERY) | $89.40 | $149.00 | — | 90% above | 40% |
| Complete blood count (CBC) with differential CPT 85025 M CBC AUTO DIFF (REFLEX TO MANUAL | $89.40 | $149.00 | — | 90% above | 40% |
| Complete blood count (CBC) with differential CPT 85025 SB HEMOGRAM | $89.40 | $149.00 | — | 90% above | 40% |
| Complete blood count (CBC) with differential CPT 85025 K HEMOGRAM (KITTERY) | $89.40 | $149.00 | — | 90% above | 40% |
| Complete blood count (CBC) with differential CPT 85025 SB CBC AUTO DIFF (REFLEX MANUAL) | $89.40 | $149.00 | — | 90% above | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC W AUTO DIFF WBC | $15.60 | $26.00 | — | — | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 W CBC (WELLS) | $57.00 | $95.00 | — | — | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE BLOOD COUNT, CHG.ONLY | $89.40 | $149.00 | — | — | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 W HEMOGRAM (WELLS) | $89.40 | $149.00 | — | — | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HEMOGRAM | $89.40 | $149.00 | — | — | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH DIFFERENTIAL | $89.40 | $149.00 | — | — | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HEMOGRAM, PRENATAL | $89.40 | $149.00 | — | — | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 M HEMOGRAM (MY HEALTH KITTERY) | $89.40 | $149.00 | — | — | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 M CBC AUTO DIFF (REFLEX TO MANUAL | $89.40 | $149.00 | — | — | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 SB HEMOGRAM | $89.40 | $149.00 | — | — | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 SB CBC AUTO DIFF (REFLEX MANUAL) | $89.40 | $149.00 | — | — | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 K HEMOGRAM (KITTERY) | $89.40 | $149.00 | — | — | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 K CBC AUTO DIFF (REFLEX TO MANUAL | $89.40 | $149.00 | — | — | 40% |
| Complete blood count (CBC), no differential CPT 85027 CBC AUTOMATED | $15.60 | $26.00 | — | 50% below | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC AUTOMATED | $15.60 | $26.00 | — | — | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 SB PICCOLO COMP. METABOLIC PANEL | $192.60 | $321.00 | — | 83% above | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 M CMP-PICCOLO (MY HEALTH KITTERY) | $192.60 | $321.00 | — | 83% above | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 PICCOLO COMP. METABOLIC PANEL | $192.60 | $321.00 | — | 83% above | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 W COMP.METABOLIC PANEL (WELLS) | $192.60 | $321.00 | — | 83% above | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 K CMP-PICCOLO (KITTERY) | $192.60 | $321.00 | — | 83% above | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $192.60 | $321.00 | — | 83% above | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 K CMP-PICCOLO (KITTERY) | $192.60 | $321.00 | — | — | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 M CMP-PICCOLO (MY HEALTH KITTERY) | $192.60 | $321.00 | — | — | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 PICCOLO COMP. METABOLIC PANEL | $192.60 | $321.00 | — | — | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 SB PICCOLO COMP. METABOLIC PANEL | $192.60 | $321.00 | — | — | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $192.60 | $321.00 | — | — | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 W COMP.METABOLIC PANEL (WELLS) | $192.60 | $321.00 | — | — | 40% |
| Cortisol blood test, total CPT 82533 CORTISOL | $91.80 | $153.00 | — | 31% above | 40% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL | $91.80 | $153.00 | — | — | 40% |
| Creatine kinase (CK) blood test, total CPT 82550 W CK REFLEX (WELLS) | $48.00 | $80.00 | — | 6% above | 40% |
| Creatine kinase (CK) blood test, total CPT 82550 CK REFLEX | $70.80 | $118.00 | — | 56% above | 40% |
| Creatine kinase (CK) blood test, total CPT 82550 CK | $70.80 | $118.00 | — | 56% above | 40% |
| Creatine kinase (CK) blood test, total CPT 82550 W CK (WELLS) | $70.80 | $118.00 | — | 56% above | 40% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 W CK REFLEX (WELLS) | $48.00 | $80.00 | — | — | 40% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 W CK (WELLS) | $70.80 | $118.00 | — | — | 40% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CK | $70.80 | $118.00 | — | — | 40% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CK REFLEX | $70.80 | $118.00 | — | — | 40% |
| Creatinine blood test CPT 82565 CREATININE, BLOOD (CHG) | $22.80 | $38.00 | — | 21% below | 40% |
| Creatinine blood test CPT 82565 W CREATININE, SERUM (WELLS) | $22.80 | $38.00 | — | 21% below | 40% |
| Creatinine blood test CPT 82565 CREATININE, SERUM | $57.00 | $95.00 | — | 98% above | 40% |
| Creatinine blood test CPT 82565 P-CREA | $57.00 | $95.00 | — | 98% above | 40% |
| Creatinine blood test inpatient CPT 82565 CREATININE, BLOOD (CHG) | $22.80 | $38.00 | — | — | 40% |
| Creatinine blood test inpatient CPT 82565 W CREATININE, SERUM (WELLS) | $22.80 | $38.00 | — | — | 40% |
| Creatinine blood test inpatient CPT 82565 P-CREA | $57.00 | $95.00 | — | — | 40% |
| Creatinine blood test inpatient CPT 82565 CREATININE, SERUM | $57.00 | $95.00 | — | — | 40% |
| Cytomegalovirus (CMV) antibody test CPT 86644 CMV AB,IGG | $110.40 | $184.00 | — | 75% above | 40% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV AB,IGG | $110.40 | $184.00 | — | — | 40% |
| D-dimer blood test (blood clot marker) CPT 85379 W D-DIMER, QUANTITATIVE (WELLS) | $67.20 | $112.00 | — | 7% below | 40% |
| D-dimer blood test (blood clot marker) CPT 85379 D-DIMER ELSA METHOD | $125.40 | $209.00 | — | 74% above | 40% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 W D-DIMER, QUANTITATIVE (WELLS) | $67.20 | $112.00 | — | — | 40% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER ELSA METHOD | $125.40 | $209.00 | — | — | 40% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-SULFATE | $90.60 | $151.00 | — | at median | 40% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-SULFATE | $90.60 | $151.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE DRUG PANEL W/O MED MATCH | $73.20 | $122.00 | — | 25% below | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE DRUG PANEL W/ MED MATCH | $73.20 | $122.00 | — | 25% below | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN PANEL 5, MECONIUM | $97.20 | $162.00 | — | at median | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 GAMMA-HYDROXYBUTYRIC ACIDSCREEN URINE | $99.00 | $165.00 | — | 2% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG MONITORING 5 PANEL URINE | $100.80 | $168.00 | — | 4% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 GAMMA-HYDROXYBUTYRIC | $100.80 | $168.00 | — | 4% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 LABCORP CANNABINOID CREATINE RATIO URINE | $114.00 | $190.00 | — | 17% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG MONIT BUPRE W/CONF INC NAXOLN URINE | $117.00 | $195.00 | — | 21% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 THC, MS, WB/SP REFLEXT (SERUM) | $143.40 | $239.00 | — | 48% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG MON, ANTIPSYCHOTICS, W/CONF URINE | $148.80 | $248.00 | — | 53% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRG TST PRES ANY CLASSES CHM ANALY/DOS | $193.80 | $323.00 | — | 100% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN 13 PANEL WITH CONF (SERUM) | $217.80 | $363.00 | — | 124% above | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE DRUG PANEL W/O MED MATCH | $73.20 | $122.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE DRUG PANEL W/ MED MATCH | $73.20 | $122.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN PANEL 5, MECONIUM | $97.20 | $162.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 GAMMA-HYDROXYBUTYRIC ACIDSCREEN URINE | $99.00 | $165.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG MONITORING 5 PANEL URINE | $100.80 | $168.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 GAMMA-HYDROXYBUTYRIC | $100.80 | $168.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 LABCORP CANNABINOID CREATINE RATIO URINE | $114.00 | $190.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG MONIT BUPRE W/CONF INC NAXOLN URINE | $117.00 | $195.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 THC, MS, WB/SP REFLEXT (SERUM) | $143.40 | $239.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG MON, ANTIPSYCHOTICS, W/CONF URINE | $148.80 | $248.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRG TST PRES ANY CLASSES CHM ANALY/DOS | $193.80 | $323.00 | — | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN 13 PANEL WITH CONF (SERUM) | $217.80 | $363.00 | — | — | 40% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 W ELECTROLYTE PANEL, SERUM (WELLS | $47.40 | $79.00 | — | 6% below | 40% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL, SERUM | $107.40 | $179.00 | — | 114% above | 40% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 W ELECTROLYTE PANEL, SERUM (WELLS | $47.40 | $79.00 | — | — | 40% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL, SERUM | $107.40 | $179.00 | — | — | 40% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EBV(VCA) IGG | $91.80 | $153.00 | — | 50% above | 40% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EBV(VCA),IGM | $91.80 | $153.00 | — | 50% above | 40% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV(VCA) IGG | $91.80 | $153.00 | — | — | 40% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV(VCA),IGM | $91.80 | $153.00 | — | — | 40% |
| Estradiol blood test CPT 82670 ESTRADIOL, ULTRASENSITIVE, LC/MS | $58.20 | $97.00 | — | 43% below | 40% |
| Estradiol blood test CPT 82670 ESTRADIOL | $139.20 | $232.00 | — | 36% above | 40% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL, ULTRASENSITIVE, LC/MS | $58.20 | $97.00 | — | — | 40% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL | $139.20 | $232.00 | — | — | 40% |
| FSH (follicle-stimulating hormone) test CPT 83001 PEDS FOLLICLE STIMULATING HORMONE | $67.20 | $112.00 | — | 15% below | 40% |
| FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIMULATING HORMONE | $88.80 | $148.00 | — | 12% above | 40% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 PEDS FOLLICLE STIMULATING HORMONE | $67.20 | $112.00 | — | — | 40% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE STIMULATING HORMONE | $88.80 | $148.00 | — | — | 40% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN (CHG) | $168.60 | $281.00 | — | 10% above | 40% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN (CHG) | $168.60 | $281.00 | — | — | 40% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN (FBR) | $58.80 | $98.00 | — | 21% below | 40% |
| Ferritin blood test (iron stores) CPT 82728 Q FERRITIN (QUEST) | $109.80 | $183.00 | — | 47% above | 40% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $114.00 | $190.00 | — | 53% above | 40% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN (FBR) | $58.80 | $98.00 | — | — | 40% |
| Ferritin blood test (iron stores) inpatient CPT 82728 Q FERRITIN (QUEST) | $109.80 | $183.00 | — | — | 40% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN | $114.00 | $190.00 | — | — | 40% |
| Fibrinogen blood test CPT 85384 FIBRINOGEN, ACTIVITY | $109.20 | $182.00 | — | 81% above | 40% |
| Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN, ACTIVITY | $109.20 | $182.00 | — | — | 40% |
| Folate (folic acid) blood test CPT 82746 FOLATE (FOLIC ACID) | $104.40 | $174.00 | — | 39% above | 40% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLATE (FOLIC ACID) | $104.40 | $174.00 | — | — | 40% |
| Free T3 thyroid hormone test CPT 84481 T3, FREE | $33.00 | $55.00 | — | 62% below | 40% |
| Free T3 thyroid hormone test CPT 84481 Q FREE T3 | $70.80 | $118.00 | — | 18% below | 40% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3, FREE | $33.00 | $55.00 | — | — | 40% |
| Free T3 thyroid hormone test inpatient CPT 84481 Q FREE T3 | $70.80 | $118.00 | — | — | 40% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 DIRECT DIALYSIS | $23.40 | $39.00 | — | 61% below | 40% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE | $43.80 | $73.00 | — | 27% below | 40% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROID REFLEX 1 | $43.80 | $73.00 | — | 27% below | 40% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROID REFLEX 2 | $43.80 | $73.00 | — | 27% below | 40% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4, THYROXINE, FREE | $96.60 | $161.00 | — | 61% above | 40% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4 DIRECT DIALYSIS | $23.40 | $39.00 | — | — | 40% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE | $43.80 | $73.00 | — | — | 40% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROID REFLEX 2 | $43.80 | $73.00 | — | — | 40% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROID REFLEX 1 | $43.80 | $73.00 | — | — | 40% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4, THYROXINE, FREE | $96.60 | $161.00 | — | — | 40% |
| Free testosterone test CPT 84402 TESTOSTERONE, FREE | $180.00 | $300.00 | — | 76% above | 40% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE | $180.00 | $300.00 | — | — | 40% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 W GAMMA GT (WELLS) | $33.60 | $56.00 | — | 24% below | 40% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 ASSAY OF GLUTAMYLTRASE GAMMA | $49.80 | $83.00 | — | 12% above | 40% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 GAMMA GT | $66.00 | $110.00 | — | 48% above | 40% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 W GAMMA GT (WELLS) | $33.60 | $56.00 | — | — | 40% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 ASSAY OF GLUTAMYLTRASE GAMMA | $49.80 | $83.00 | — | — | 40% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GAMMA GT | $66.00 | $110.00 | — | — | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TOLERANCE, 1 HR GLUCOLA | $43.80 | $73.00 | — | 18% above | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 W GLUCOSE TOL.1HR 50G OBS (WELLS) | $43.80 | $73.00 | — | 18% above | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 W GLUCOSE TOL.1HR 75G NON OBS (WELLS) | $43.80 | $73.00 | — | 18% above | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE TOLERANCE, 1 HR GLUCOLA | $43.80 | $73.00 | — | — | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 W GLUCOSE TOL.1HR 50G OBS (WELLS) | $43.80 | $73.00 | — | — | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 W GLUCOSE TOL.1HR 75G NON OBS (WELLS) | $43.80 | $73.00 | — | — | 40% |
| Glucose tolerance test, 3 samples CPT 82951 W GLUCOSE TOLERANCE, CHG ONLY | $50.40 | $84.00 | — | 21% below | 40% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE, CHARGE ONLY | $50.40 | $84.00 | — | 21% below | 40% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 W GLUCOSE TOLERANCE, CHG ONLY | $50.40 | $84.00 | — | — | 40% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE, CHARGE ONLY | $50.40 | $84.00 | — | — | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE, DNA,SDA | $120.00 | $200.00 | — | 82% above | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NORDX N.GONORROEAE DNA AMP PROBE | $120.00 | $200.00 | — | 82% above | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA MALE URINE, PCR | $120.00 | $200.00 | — | 82% above | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA M/F URINEPCR | $120.00 | $200.00 | — | 82% above | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE, RNA THROAT | $120.00 | $200.00 | — | 82% above | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NORDX N.GONORROEAE DNA AMP PROBE | $120.00 | $200.00 | — | — | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.GONORRHOEAE, RNA THROAT | $120.00 | $200.00 | — | — | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE, DNA,SDA | $120.00 | $200.00 | — | — | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.GONORRHOEAE DNA MALE URINE, PCR | $120.00 | $200.00 | — | — | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.GONORRHOEAE DNA M/F URINEPCR | $120.00 | $200.00 | — | — | 40% |
| H. pylori antibody blood test CPT 86677 H.PYLORI AB (IGA) | $87.00 | $145.00 | — | 13% above | 40% |
| H. pylori antibody blood test CPT 86677 H.PYLORI AB (IGM) | $93.60 | $156.00 | — | 22% above | 40% |
| H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI AB, IGG | $95.40 | $159.00 | — | 24% above | 40% |
| H. pylori antibody blood test CPT 86677 H PYLORI AB (IGG) | $109.80 | $183.00 | — | 43% above | 40% |
| H. pylori antibody blood test inpatient CPT 86677 H.PYLORI AB (IGA) | $87.00 | $145.00 | — | — | 40% |
| H. pylori antibody blood test inpatient CPT 86677 H.PYLORI AB (IGM) | $93.60 | $156.00 | — | — | 40% |
| H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI AB, IGG | $95.40 | $159.00 | — | — | 40% |
| H. pylori antibody blood test inpatient CPT 86677 H PYLORI AB (IGG) | $109.80 | $183.00 | — | — | 40% |
| H. pylori stool antigen test CPT 87338 H. PYLORI ANTIGEN, STOOL | $115.20 | $192.00 | — | at median | 40% |
| H. pylori stool antigen test inpatient CPT 87338 H. PYLORI ANTIGEN, STOOL | $115.20 | $192.00 | — | — | 40% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA QUANT INC REV TRANSCRIPTION | $236.40 | $394.00 | — | 3% above | 40% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA QUANT INC REV TRANSCRIPTION | $236.40 | $394.00 | — | — | 40% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/2 EIA AB SCREEN, W/ REFLEX | $58.80 | $98.00 | — | 29% above | 40% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1/2 EIA AB SCREEN, W/ REFLEX | $58.80 | $98.00 | — | — | 40% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG, AB, HIV-2 AB SINGLE RESULT | $25.80 | $43.00 | — | 45% below | 40% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 NORDX HIV 1/2 AB HIV AG9 | $39.00 | $65.00 | — | 17% below | 40% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG, AB, HIV-2 AB SINGLE RESULT | $25.80 | $43.00 | — | — | 40% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 NORDX HIV 1/2 AB HIV AG9 | $39.00 | $65.00 | — | — | 40% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 NORDX HPV | $103.80 | $173.00 | — | 45% above | 40% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV, HIGH-RISK TYPES (CHG) | $103.80 | $173.00 | — | 45% above | 40% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 NORDX HPV | $103.80 | $173.00 | — | — | 40% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV, HIGH-RISK TYPES (CHG) | $103.80 | $173.00 | — | — | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1c | $36.00 | $60.00 | — | 31% below | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Q GLYCOHEMOGLOBIN (SENDOUT) | $61.80 | $103.00 | — | 18% above | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOHEMOGLOBIN | $87.00 | $145.00 | — | 66% above | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1c | $36.00 | $60.00 | — | — | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Q GLYCOHEMOGLOBIN (SENDOUT) | $61.80 | $103.00 | — | — | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOHEMOGLOBIN | $87.00 | $145.00 | — | — | 40% |
| Hemoglobin blood test CPT 85018 HEMOGLOBIN | $11.40 | $19.00 | — | 25% below | 40% |
| Hemoglobin blood test CPT 85018 HEMOGLOBIN (H&H) | $21.60 | $36.00 | — | 42% above | 40% |
| Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN | $11.40 | $19.00 | — | — | 40% |
| Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN (H&H) | $21.60 | $36.00 | — | — | 40% |
| Hepatitis B core antibody test (total) CPT 86704 Q HEPATITIS B CORE AB, TOTAL | $76.20 | $127.00 | — | 25% above | 40% |
| Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE AB (AHBC), TOTAL | $76.20 | $127.00 | — | 25% above | 40% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE AB (AHBC), TOTAL | $76.20 | $127.00 | — | — | 40% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 Q HEPATITIS B CORE AB, TOTAL | $76.20 | $127.00 | — | — | 40% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURF AB (AHBS ) | $55.20 | $92.00 | — | 10% above | 40% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Q HEPATITIS B SURF AB | $55.20 | $92.00 | — | 10% above | 40% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURF AB (AHBS ) | $55.20 | $92.00 | — | — | 40% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Q HEPATITIS B SURF AB | $55.20 | $92.00 | — | — | 40% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Q HEPATITIS B SURF AG | $73.80 | $123.00 | — | 52% above | 40% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURF AG (HBSAG) | $85.20 | $142.00 | — | 75% above | 40% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Q HEPATITIS B SURF AG | $73.80 | $123.00 | — | — | 40% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURF AG (HBSAG) | $85.20 | $142.00 | — | — | 40% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C VIRUS AB (AHCV) | $107.40 | $179.00 | — | 46% above | 40% |
| Hepatitis C antibody blood test (screening) CPT 86803 Q HEPATITIS C SEROLOGY | $107.40 | $179.00 | — | 46% above | 40% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C VIRUS AB (AHCV) | $107.40 | $179.00 | — | — | 40% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 Q HEPATITIS C SEROLOGY | $107.40 | $179.00 | — | — | 40% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C RNA PCR (QUAN INC REV TRANSC | $349.80 | $583.00 | — | 103% above | 40% |
| Hepatitis C viral load (HCV RNA) test one side CPT 87522 LABCORP HCV RT-PCR QUANT REAL TIME PCR | $466.20 | $777.00 | — | 171% above | 40% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C RNA PCR (QUAN INC REV TRANSC | $349.80 | $583.00 | — | — | 40% |
| Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 LABCORP HCV RT-PCR QUANT REAL TIME PCR | $466.20 | $777.00 | — | — | 40% |
| Herpes blood test, HSV-1 antibody CPT 86695 HSV12 IgG | $25.20 | $42.00 | — | 52% below | 40% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX, TYPE I - AB (CHG) | $52.80 | $88.00 | — | at median | 40% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV12 IgG | $25.20 | $42.00 | — | — | 40% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX, TYPE I - AB (CHG) | $52.80 | $88.00 | — | — | 40% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX, TYPE II - AB (CHG) | $78.00 | $130.00 | — | 10% above | 40% |
| Herpes blood test, HSV-2 antibody CPT 86696 HSV12 IgG INHIBITION REFLEX | $138.00 | $230.00 | — | 94% above | 40% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX, TYPE II - AB (CHG) | $78.00 | $130.00 | — | — | 40% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV12 IgG INHIBITION REFLEX | $138.00 | $230.00 | — | — | 40% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 QUEST HS-CRP | $23.40 | $39.00 | — | 55% below | 40% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 FULL RANGE CRP | $87.00 | $145.00 | — | 68% above | 40% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 Q CARDIO CRP | $88.20 | $147.00 | — | 71% above | 40% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 CRP, HIGH SENSITIVITY | $88.20 | $147.00 | — | 71% above | 40% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 QUEST HS-CRP | $23.40 | $39.00 | — | — | 40% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 FULL RANGE CRP | $87.00 | $145.00 | — | — | 40% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 Q CARDIO CRP | $88.20 | $147.00 | — | — | 40% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP, HIGH SENSITIVITY | $88.20 | $147.00 | — | — | 40% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE | $47.40 | $79.00 | — | 35% below | 40% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTINE | $49.80 | $83.00 | — | 31% below | 40% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE, URINE | $109.80 | $183.00 | — | 51% above | 40% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE,[NUTRITION/CONGENIT] | $136.80 | $228.00 | — | 88% above | 40% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE | $147.60 | $246.00 | — | 103% above | 40% |
| Homocysteine blood test inpatient CPT 83090 ASSAY OF HOMOCYSTEINE | $47.40 | $79.00 | — | — | 40% |
| Homocysteine blood test inpatient CPT 83090 ASSAY OF HOMOCYSTINE | $49.80 | $83.00 | — | — | 40% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE, URINE | $109.80 | $183.00 | — | — | 40% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE,[NUTRITION/CONGENIT] | $136.80 | $228.00 | — | — | 40% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE | $147.60 | $246.00 | — | — | 40% |
| Insulin blood test CPT 83525 ASSAY OF INSULIN TOTAL | $46.80 | $78.00 | — | 28% below | 40% |
| Insulin blood test CPT 83525 INSULIN | $69.60 | $116.00 | — | 7% above | 40% |
| Insulin blood test inpatient CPT 83525 ASSAY OF INSULIN TOTAL | $46.80 | $78.00 | — | — | 40% |
| Insulin blood test inpatient CPT 83525 INSULIN | $69.60 | $116.00 | — | — | 40% |
| Iron blood test (serum iron) CPT 83540 IRON TOTAL | $15.60 | $26.00 | — | 58% below | 40% |
| Iron blood test (serum iron) CPT 83540 IRON | $68.40 | $114.00 | — | 82% above | 40% |
| Iron blood test (serum iron) CPT 83540 MILLER FISHERSYNDROME CRAN NEURO AB PAN | $81.60 | $136.00 | — | 117% above | 40% |
| Iron blood test (serum iron) CPT 83540 IRON, LIVER (BX) (CHG) | $186.60 | $311.00 | — | 397% above | 40% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON TOTAL | $15.60 | $26.00 | — | — | 40% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON | $68.40 | $114.00 | — | — | 40% |
| Iron blood test (serum iron) inpatient CPT 83540 MILLER FISHERSYNDROME CRAN NEURO AB PAN | $81.60 | $136.00 | — | — | 40% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON, LIVER (BX) (CHG) | $186.60 | $311.00 | — | — | 40% |
| Iron-binding capacity (TIBC) test CPT 83550 TOTAL IRON BINDING CAPACITY | $18.60 | $31.00 | — | 54% below | 40% |
| Iron-binding capacity (TIBC) test CPT 83550 Q IRON BINDING CAPACITY | $47.40 | $79.00 | — | 18% above | 40% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY | $69.00 | $115.00 | — | 71% above | 40% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 TOTAL IRON BINDING CAPACITY | $18.60 | $31.00 | — | — | 40% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 Q IRON BINDING CAPACITY | $47.40 | $79.00 | — | — | 40% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY | $69.00 | $115.00 | — | — | 40% |
| Kidney function blood test panel CPT 80069 W RENAL FUNCTION PANEL (WELLS) | $36.60 | $61.00 | — | 45% below | 40% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $139.20 | $232.00 | — | 108% above | 40% |
| Kidney function blood test panel inpatient CPT 80069 W RENAL FUNCTION PANEL (WELLS) | $36.60 | $61.00 | — | — | 40% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $139.20 | $232.00 | — | — | 40% |
| LH (luteinizing hormone) test CPT 83002 LH, PEDIATRIC | $49.80 | $83.00 | — | 41% below | 40% |
| LH (luteinizing hormone) test CPT 83002 LUTENIZING HORMONE | $91.80 | $153.00 | — | 8% above | 40% |
| LH (luteinizing hormone) test CPT 83002 Q LUTEINIZING HORMONE | $91.80 | $153.00 | — | 8% above | 40% |
| LH (luteinizing hormone) test inpatient CPT 83002 LH, PEDIATRIC | $49.80 | $83.00 | — | — | 40% |
| LH (luteinizing hormone) test inpatient CPT 83002 LUTENIZING HORMONE | $91.80 | $153.00 | — | — | 40% |
| LH (luteinizing hormone) test inpatient CPT 83002 Q LUTEINIZING HORMONE | $91.80 | $153.00 | — | — | 40% |
| Lactate (lactic acid) blood test CPT 83605 LACTIC ACID | $139.20 | $232.00 | — | 139% above | 40% |
| Lactate (lactic acid) blood test CPT 83605 LACTIC ACID (WELLS) | $139.20 | $232.00 | — | 139% above | 40% |
| Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID (WELLS) | $139.20 | $232.00 | — | — | 40% |
| Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID | $139.20 | $232.00 | — | — | 40% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 W LDH, TOTAL (WELLS) | $32.40 | $54.00 | — | 10% below | 40% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 W LDH, BODY FLUID (WELLS) | $32.40 | $54.00 | — | 10% below | 40% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH, BODY FLUID | $64.80 | $108.00 | — | 80% above | 40% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH TOTAL | $64.80 | $108.00 | — | 80% above | 40% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 W LDH, TOTAL (WELLS) | $32.40 | $54.00 | — | — | 40% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 W LDH, BODY FLUID (WELLS) | $32.40 | $54.00 | — | — | 40% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH, BODY FLUID | $64.80 | $108.00 | — | — | 40% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH TOTAL | $64.80 | $108.00 | — | — | 40% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $99.60 | $166.00 | — | 116% above | 40% |
| Lipase blood test (pancreas enzyme) CPT 83690 W LIPASE | $99.60 | $166.00 | — | 116% above | 40% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 W LIPASE | $99.60 | $166.00 | — | — | 40% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE | $99.60 | $166.00 | — | — | 40% |
| Liver function blood test panel CPT 80076 W HEPATIC FUNCTION PANEL (WELLS) | $43.80 | $73.00 | — | 47% below | 40% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $152.40 | $254.00 | — | 83% above | 40% |
| Liver function blood test panel inpatient CPT 80076 W HEPATIC FUNCTION PANEL (WELLS) | $43.80 | $73.00 | — | — | 40% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $152.40 | $254.00 | — | — | 40% |
| Lyme disease antibody test CPT 86618 (ARUP) BORRELIA BURG VISEE1PEPC10 ANTIB | $85.80 | $143.00 | — | 11% above | 40% |
| Lyme disease antibody test CPT 86618 LYME DISEASE AB (IGM ONLY) | $108.00 | $180.00 | — | 39% above | 40% |
| Lyme disease antibody test CPT 86618 LYME ANTIBODY IGG AND IGM | $116.40 | $194.00 | — | 50% above | 40% |
| Lyme disease antibody test CPT 86618 B.BURGDORFERI AB (LYME) | $118.20 | $197.00 | — | 52% above | 40% |
| Lyme disease antibody test inpatient CPT 86618 (ARUP) BORRELIA BURG VISEE1PEPC10 ANTIB | $85.80 | $143.00 | — | — | 40% |
| Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB (IGM ONLY) | $108.00 | $180.00 | — | — | 40% |
| Lyme disease antibody test inpatient CPT 86618 LYME ANTIBODY IGG AND IGM | $116.40 | $194.00 | — | — | 40% |
| Lyme disease antibody test inpatient CPT 86618 B.BURGDORFERI AB (LYME) | $118.20 | $197.00 | — | — | 40% |
| Magnesium blood test CPT 83735 W MAGNESIUM ASSAY (WELLS) | $46.80 | $78.00 | — | 17% above | 40% |
| Magnesium blood test CPT 83735 SB PICCOLO MAGNESIUM | $75.60 | $126.00 | — | 89% above | 40% |
| Magnesium blood test CPT 83735 MAGNESIUM ASSAY | $75.60 | $126.00 | — | 89% above | 40% |
| Magnesium blood test CPT 83735 MAGNESIUM-PICCOLO (KITTERY) | $75.60 | $126.00 | — | 89% above | 40% |
| Magnesium blood test CPT 83735 MAGNESIUM STOOL | $236.40 | $394.00 | — | 490% above | 40% |
| Magnesium blood test inpatient CPT 83735 W MAGNESIUM ASSAY (WELLS) | $46.80 | $78.00 | — | — | 40% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM ASSAY | $75.60 | $126.00 | — | — | 40% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM-PICCOLO (KITTERY) | $75.60 | $126.00 | — | — | 40% |
| Magnesium blood test inpatient CPT 83735 SB PICCOLO MAGNESIUM | $75.60 | $126.00 | — | — | 40% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM STOOL | $236.40 | $394.00 | — | — | 40% |
| Measles (rubeola) antibody test CPT 86765 MEASLES (RUBEOLA) ANTIBODY IGG | $58.80 | $98.00 | — | 67% above | 40% |
| Measles (rubeola) antibody test inpatient CPT 86765 MEASLES (RUBEOLA) ANTIBODY IGG | $58.80 | $98.00 | — | — | 40% |
| Mono test (heterophile antibody, Monospot) CPT 86308 POC MONO TEST | $33.60 | $56.00 | — | 7% below | 40% |
| Mono test (heterophile antibody, Monospot) CPT 86308 W-POC MONO TEST | $33.60 | $56.00 | — | 7% below | 40% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY | $54.60 | $91.00 | — | 52% above | 40% |
| Mono test (heterophile antibody, Monospot) CPT 86308 W MONO TEST (WELLS) | $57.00 | $95.00 | — | 58% above | 40% |
| Mono test (heterophile antibody, Monospot) CPT 86308 MONO TEST | $85.20 | $142.00 | — | 137% above | 40% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 W-POC MONO TEST | $33.60 | $56.00 | — | — | 40% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 POC MONO TEST | $33.60 | $56.00 | — | — | 40% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODY | $54.60 | $91.00 | — | — | 40% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 W MONO TEST (WELLS) | $57.00 | $95.00 | — | — | 40% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO TEST | $85.20 | $142.00 | — | — | 40% |
| Mumps immunity blood test CPT 86735 MUMPS ANTIBODY | $49.80 | $83.00 | — | 34% above | 40% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS ANTIBODY | $49.80 | $83.00 | — | — | 40% |
| Obstetric blood test panel CPT 80055 PRENATAL FIRST VISIT PANEL | $495.00 | $825.00 | — | 248% above | 40% |
| Obstetric blood test panel inpatient CPT 80055 PRENATAL FIRST VISIT PANEL | $495.00 | $825.00 | — | — | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE | $136.80 | $228.00 | — | 47% above | 40% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, FREE | $136.80 | $228.00 | — | — | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, TOTAL (Q) (70136476 EXP) | $73.80 | $123.00 | — | 3% above | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, TOTAL | $127.80 | $213.00 | — | 78% above | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE HEALTH INDEX (PHI11) | $156.00 | $260.00 | — | 117% above | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, TOTAL (Q) (70136476 EXP) | $73.80 | $123.00 | — | — | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, TOTAL | $127.80 | $213.00 | — | — | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE HEALTH INDEX (PHI11) | $156.00 | $260.00 | — | — | 40% |
| Pap test (liquid-based, automated screening with review) CPT 88175 CYTO - C/V AUTO FLUID REDO - (CHG) | $102.60 | $171.00 | — | 60% above | 40% |
| Pap test (liquid-based, automated screening with review) CPT 88175 PAP SMEAR, THIN PREP IMG SYSTEM | $102.60 | $171.00 | — | 60% above | 40% |
| Pap test (liquid-based, automated screening with review) CPT 88175 NORDX THINPREP PAP SMEAR DIAGNOSTIC | $102.60 | $171.00 | — | 60% above | 40% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 NORDX THINPREP PAP SMEAR DIAGNOSTIC | $102.60 | $171.00 | — | — | 40% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO - C/V AUTO FLUID REDO - (CHG) | $102.60 | $171.00 | — | — | 40% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP SMEAR, THIN PREP IMG SYSTEM | $102.60 | $171.00 | — | — | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP SMEAR - CYTOPATH, C/V, THIN PREP | $102.60 | $171.00 | — | 46% above | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 NORDX PAP SMEAR THIN PREP | $102.60 | $171.00 | — | 46% above | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 NORDX PAP SMEAR THIN PREP | $102.60 | $171.00 | — | — | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP SMEAR - CYTOPATH, C/V, THIN PREP | $102.60 | $171.00 | — | — | 40% |
| Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE | $77.40 | $129.00 | — | 21% below | 40% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PTH)- CHG | $163.20 | $272.00 | — | 66% above | 40% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 ASSAY OF PARATHORMONE | $77.40 | $129.00 | — | — | 40% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE (PTH)- CHG | $163.20 | $272.00 | — | — | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $35.40 | $59.00 | — | 19% below | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT (LAC) SCREEN (CHG) | $42.60 | $71.00 | — | 2% below | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE | $46.80 | $78.00 | — | 8% above | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $69.60 | $116.00 | — | 60% above | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 W PTT (WELLS) | $69.60 | $116.00 | — | 60% above | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PROLONGED APTT BLEEDING EVALUATION | $69.60 | $116.00 | — | 60% above | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 LABCORP THROMBOPLASTINE TIME PARTIAL | $125.40 | $209.00 | — | 188% above | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL | $35.40 | $59.00 | — | — | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT (LAC) SCREEN (CHG) | $42.60 | $71.00 | — | — | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE | $46.80 | $78.00 | — | — | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PROLONGED APTT BLEEDING EVALUATION | $69.60 | $116.00 | — | — | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT | $69.60 | $116.00 | — | — | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 W PTT (WELLS) | $69.60 | $116.00 | — | — | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LABCORP THROMBOPLASTINE TIME PARTIAL | $125.40 | $209.00 | — | — | 40% |
| Phosphorus (phosphate) blood test CPT 84100 W PHOSPHOROUS, SERUM (WELLS) | $20.40 | $34.00 | — | 27% below | 40% |
| Phosphorus (phosphate) blood test CPT 84100 ONCOLOGY PHOSPHOROUS | $52.20 | $87.00 | — | 88% above | 40% |
| Phosphorus (phosphate) blood test CPT 84100 PHOSPHOROUS, SERUM | $52.20 | $87.00 | — | 88% above | 40% |
| Phosphorus (phosphate) blood test CPT 84100 K PICCOLO PHOSPHOROUS | $52.20 | $87.00 | — | 88% above | 40% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 W PHOSPHOROUS, SERUM (WELLS) | $20.40 | $34.00 | — | — | 40% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 ONCOLOGY PHOSPHOROUS | $52.20 | $87.00 | — | — | 40% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 K PICCOLO PHOSPHOROUS | $52.20 | $87.00 | — | — | 40% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHOROUS, SERUM | $52.20 | $87.00 | — | — | 40% |
| Potassium blood test CPT 84132 W POTASSIUM, SERUM OR PLASMA | $22.80 | $38.00 | — | 6% below | 40% |
| Potassium blood test CPT 84132 POTASSIUM, SERUM OR PLASMA | $43.80 | $73.00 | — | 80% above | 40% |
| Potassium blood test inpatient CPT 84132 W POTASSIUM, SERUM OR PLASMA | $22.80 | $38.00 | — | — | 40% |
| Potassium blood test inpatient CPT 84132 POTASSIUM, SERUM OR PLASMA | $43.80 | $73.00 | — | — | 40% |
| Progesterone blood test CPT 84144 PROGESTERONE | $88.80 | $148.00 | — | at median | 40% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE | $88.80 | $148.00 | — | — | 40% |
| Prolactin blood test CPT 84146 PROLACTIN | $129.00 | $215.00 | — | 72% above | 40% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN | $129.00 | $215.00 | — | — | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT(INR) TEST | $11.40 | $19.00 | — | 61% below | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 POC INR | $21.60 | $36.00 | — | 27% below | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT (PROTIME with INR) | $57.00 | $95.00 | — | 94% above | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 W PT PROTIME (WELLS) | $57.00 | $95.00 | — | 94% above | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 LABCORP PROTHROMBIN TIME | $125.40 | $209.00 | — | 326% above | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT(INR) TEST | $11.40 | $19.00 | — | — | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 POC INR | $21.60 | $36.00 | — | — | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 W PT PROTIME (WELLS) | $57.00 | $95.00 | — | — | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT (PROTIME with INR) | $57.00 | $95.00 | — | — | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LABCORP PROTHROMBIN TIME | $125.40 | $209.00 | — | — | 40% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRSMV DIR OPT OBS | $25.80 | $43.00 | — | at median | 40% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TEST PRSMV DIR OPT OBS | $25.80 | $43.00 | — | — | 40% |
| Rapid flu test (influenza antigen) CPT 87804 W INFLUENZA A&B AG (WELLS),RAPID | $94.80 | $158.00 | — | 20% above | 40% |
| Rapid flu test (influenza antigen) CPT 87804 POC RAPID INFLUENZA A&B | $94.80 | $158.00 | — | 20% above | 40% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A&B AG | $94.80 | $158.00 | — | 20% above | 40% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 POC RAPID INFLUENZA A&B | $94.80 | $158.00 | — | — | 40% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A&B AG | $94.80 | $158.00 | — | — | 40% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 W INFLUENZA A&B AG (WELLS),RAPID | $94.80 | $158.00 | — | — | 40% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 QUICK STREP | $36.00 | $60.00 | — | 8% below | 40% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 POC RAPID STREP SCREEN GROUP A | $48.00 | $80.00 | — | 22% above | 40% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 QUICK STREP | $36.00 | $60.00 | — | — | 40% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 POC RAPID STREP SCREEN GROUP A | $48.00 | $80.00 | — | — | 40% |
| Renin blood test CPT 84244 RENIN ACTIVITY, PLASMA | $94.20 | $157.00 | — | 28% above | 40% |
| Renin blood test inpatient CPT 84244 RENIN ACTIVITY, PLASMA | $94.20 | $157.00 | — | — | 40% |
| Rh blood typing CPT 86901 ARC RH TYPE - CHRG ONLY | $33.60 | $56.00 | — | 8% below | 40% |
| Rh blood typing CPT 86901 DU TESTING - CHRG ONLY | $45.00 | $75.00 | — | 23% above | 40% |
| Rh blood typing CPT 86901 DU TESTING - HBB TST CHG | $45.00 | $75.00 | — | 23% above | 40% |
| Rh blood typing CPT 86901 RH (D) TYPING - CHG ONLY | $47.40 | $79.00 | — | 30% above | 40% |
| Rh blood typing CPT 86901 RH (D) TYPING - HBB TST CHG | $47.40 | $79.00 | — | 30% above | 40% |
| Rh blood typing inpatient CPT 86901 ARC RH TYPE - CHRG ONLY | $33.60 | $56.00 | — | — | 40% |
| Rh blood typing inpatient CPT 86901 DU TESTING - HBB TST CHG | $45.00 | $75.00 | — | — | 40% |
| Rh blood typing inpatient CPT 86901 DU TESTING - CHRG ONLY | $45.00 | $75.00 | — | — | 40% |
| Rh blood typing inpatient CPT 86901 RH (D) TYPING - HBB TST CHG | $47.40 | $79.00 | — | — | 40% |
| Rh blood typing inpatient CPT 86901 RH (D) TYPING - CHG ONLY | $47.40 | $79.00 | — | — | 40% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIVE | $18.60 | $31.00 | — | 45% below | 40% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT | $19.80 | $33.00 | — | 41% below | 40% |
| Rheumatoid factor (RF) test CPT 86431 ISLET CELL ANTIBODY | $22.80 | $38.00 | — | 32% below | 40% |
| Rheumatoid factor (RF) test CPT 86431 RHEMATOID FACTOR (FLUID), QUANT. | $50.40 | $84.00 | — | 50% above | 40% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR, QUANT. | $68.40 | $114.00 | — | 103% above | 40% |
| Rheumatoid factor (RF) test CPT 86431 Q RHEUMATOID FACTOR, QUANT. | $68.40 | $114.00 | — | 103% above | 40% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTITATIVE | $18.60 | $31.00 | — | — | 40% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT | $19.80 | $33.00 | — | — | 40% |
| Rheumatoid factor (RF) test inpatient CPT 86431 ISLET CELL ANTIBODY | $22.80 | $38.00 | — | — | 40% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEMATOID FACTOR (FLUID), QUANT. | $50.40 | $84.00 | — | — | 40% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR, QUANT. | $68.40 | $114.00 | — | — | 40% |
| Rheumatoid factor (RF) test inpatient CPT 86431 Q RHEUMATOID FACTOR, QUANT. | $68.40 | $114.00 | — | — | 40% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY (IgG) IMMUNE STATUS | $29.40 | $49.00 | — | 41% below | 40% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODIES, IGG (Y-ECI) | $45.60 | $76.00 | — | 9% below | 40% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG ANTIBODY | $84.60 | $141.00 | — | 69% above | 40% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODY (IgG) IMMUNE STATUS | $29.40 | $49.00 | — | — | 40% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODIES, IGG (Y-ECI) | $45.60 | $76.00 | — | — | 40% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGG ANTIBODY | $84.60 | $141.00 | — | — | 40% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS, CHG. | $87.60 | $146.00 | — | 6% above | 40% |
| Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANALYSIS, CHG. | $87.60 | $146.00 | — | — | 40% |
| Sodium blood test CPT 84295 W SODIUM, SERUM (WELLS) | $22.80 | $38.00 | — | 4% below | 40% |
| Sodium blood test CPT 84295 SODIUM, SERUM | $43.80 | $73.00 | — | 84% above | 40% |
| Sodium blood test inpatient CPT 84295 W SODIUM, SERUM (WELLS) | $22.80 | $38.00 | — | — | 40% |
| Sodium blood test inpatient CPT 84295 SODIUM, SERUM | $43.80 | $73.00 | — | — | 40% |
| Stool ova and parasites exam CPT 87177 OVA & PARASITE CONCENTRATION EXAM | $49.80 | $83.00 | — | 35% above | 40% |
| Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITE CONCENTRATION EXAM | $49.80 | $83.00 | — | — | 40% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 HEMOCULT | $15.60 | $26.00 | — | 25% below | 40% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD, QLT, FECES | $46.80 | $78.00 | — | 126% above | 40% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HEMOCULT | $15.60 | $26.00 | — | — | 40% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD, QLT, FECES | $46.80 | $78.00 | — | — | 40% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 FECAL GLOBIN BY IMMUNOCHEMISTRY (INSURE) | $69.00 | $115.00 | — | 69% above | 40% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 FECAL GLOBIN BY IMMUNOCHEMISTRY (INSURE) | $69.00 | $115.00 | — | — | 40% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 SYPHILLIS ANTIBODY CASCADING REFLEX | $49.80 | $83.00 | — | 7% below | 40% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM (FTA-ABS) | $90.00 | $150.00 | — | 68% above | 40% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 SYPHILLIS ANTIBODY CASCADING REFLEX | $49.80 | $83.00 | — | — | 40% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM (FTA-ABS) | $90.00 | $150.00 | — | — | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR, PRENATAL | $22.80 | $38.00 | — | 27% below | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR (AT STATE LAB) | $25.80 | $43.00 | — | 17% below | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST; QUALITATIVE (RPR) | $57.00 | $95.00 | — | 82% above | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHIL TEST NON TREPONEMAL AB QUAL | $59.40 | $99.00 | — | 90% above | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR, PRENATAL | $22.80 | $38.00 | — | — | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR (AT STATE LAB) | $25.80 | $43.00 | — | — | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST; QUALITATIVE (RPR) | $57.00 | $95.00 | — | — | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHIL TEST NON TREPONEMAL AB QUAL | $59.40 | $99.00 | — | — | 40% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST, CELL MEDIATED IMMUNITY MEASUREM | $154.20 | $257.00 | — | 31% above | 40% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST, CELL MEDIATED IMMUNITY MEASUREM | $154.20 | $257.00 | — | — | 40% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL MS | $52.20 | $87.00 | — | 43% below | 40% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Q TESTOSTERONE, TOTAL | $99.00 | $165.00 | — | 8% above | 40% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL | $99.00 | $165.00 | — | 8% above | 40% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Q POOLED TESTOSTERONE | $99.00 | $165.00 | — | 8% above | 40% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL MS | $52.20 | $87.00 | — | — | 40% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL | $99.00 | $165.00 | — | — | 40% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Q POOLED TESTOSTERONE | $99.00 | $165.00 | — | — | 40% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Q TESTOSTERONE, TOTAL | $99.00 | $165.00 | — | — | 40% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL AB -THYROID,LIVER,KIDNEY(CHG) | $97.20 | $162.00 | — | 13% above | 40% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 LUPUS ANALYZER PANEL | $324.60 | $541.00 | — | 278% above | 40% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL AB -THYROID,LIVER,KIDNEY(CHG) | $97.20 | $162.00 | — | — | 40% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LUPUS ANALYZER PANEL | $324.60 | $541.00 | — | — | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID CASCADING REFLEX | $33.00 | $55.00 | — | 58% below | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIM HORMONE (TSH) LAB CORP | $95.40 | $159.00 | — | 22% above | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH REFLEX | $139.20 | $232.00 | — | 78% above | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE(TSH) | $139.20 | $232.00 | — | 78% above | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID CASCADING REFLEX | $33.00 | $55.00 | — | — | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIM HORMONE (TSH) LAB CORP | $95.40 | $159.00 | — | — | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE(TSH) | $139.20 | $232.00 | — | — | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH REFLEX | $139.20 | $232.00 | — | — | 40% |
| Total IgE blood test CPT 82785 ASSAY OF GAMMAGLOBULIN IGE | $28.80 | $48.00 | — | 55% below | 40% |
| Total IgE blood test CPT 82785 IMMUNOGLOBULIN E | $28.80 | $48.00 | — | 55% below | 40% |
| Total IgE blood test CPT 82785 RAST PROFILE | $178.20 | $297.00 | — | 180% above | 40% |
| Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN E | $28.80 | $48.00 | — | — | 40% |
| Total IgE blood test inpatient CPT 82785 ASSAY OF GAMMAGLOBULIN IGE | $28.80 | $48.00 | — | — | 40% |
| Total IgE blood test inpatient CPT 82785 RAST PROFILE | $178.20 | $297.00 | — | — | 40% |
| Total cholesterol blood test CPT 82465 W CHOLESTEROL(R) REFLEX YWC WELLS | $22.20 | $37.00 | — | 9% below | 40% |
| Total cholesterol blood test CPT 82465 W CHOLESTEROL, TOTAL (WELLS) | $22.20 | $37.00 | — | 9% below | 40% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL, TOTAL | $48.00 | $80.00 | — | 97% above | 40% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL SERUM WHOLE BLOOD TOTAL | $49.80 | $83.00 | — | 104% above | 40% |
| Total cholesterol blood test CPT 82465 LIPID BY ULTRACENTRIFUGATION | $144.60 | $241.00 | — | 492% above | 40% |
| Total cholesterol blood test inpatient CPT 82465 W CHOLESTEROL(R) REFLEX YWC WELLS | $22.20 | $37.00 | — | — | 40% |
| Total cholesterol blood test inpatient CPT 82465 W CHOLESTEROL, TOTAL (WELLS) | $22.20 | $37.00 | — | — | 40% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL, TOTAL | $48.00 | $80.00 | — | — | 40% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL SERUM WHOLE BLOOD TOTAL | $49.80 | $83.00 | — | — | 40% |
| Total cholesterol blood test inpatient CPT 82465 LIPID BY ULTRACENTRIFUGATION | $144.60 | $241.00 | — | — | 40% |
| Total thyroxine (T4) blood test CPT 84436 T4, THYROXINE, TOTAL | $78.60 | $131.00 | — | 62% above | 40% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4, THYROXINE, TOTAL | $78.60 | $131.00 | — | — | 40% |
| Total triiodothyronine (T3) blood test CPT 84480 T3, TOTAL | $89.40 | $149.00 | — | 6% above | 40% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3, TOTAL | $89.40 | $149.00 | — | — | 40% |
| Transferrin blood test CPT 84466 TRANSFERRIN | $50.40 | $84.00 | — | 13% below | 40% |
| Transferrin blood test inpatient CPT 84466 TRANSFERRIN | $50.40 | $84.00 | — | — | 40% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS, AMP PROBE (CHG) | $83.40 | $139.00 | — | 7% below | 40% |
| Trichomonas test (NAAT) CPT 87661 NORDX THICHOMONAS VAGINALIS | $120.60 | $201.00 | — | 35% above | 40% |
| Trichomonas test (NAAT) CPT 87661 LABCORP TRICH VAG BY NAA | $120.60 | $201.00 | — | 35% above | 40% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS, AMP PROBE (CHG) | $83.40 | $139.00 | — | — | 40% |
| Trichomonas test (NAAT) inpatient CPT 87661 LABCORP TRICH VAG BY NAA | $120.60 | $201.00 | — | — | 40% |
| Trichomonas test (NAAT) inpatient CPT 87661 NORDX THICHOMONAS VAGINALIS | $120.60 | $201.00 | — | — | 40% |
| Triglycerides blood test CPT 84478 W TRIGLYCERIDES (WELLS) | $25.80 | $43.00 | — | 42% below | 40% |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES | $49.80 | $83.00 | — | 12% above | 40% |
| Triglycerides blood test CPT 84478 ASSAY OF TRIGLYCERIDES | $49.80 | $83.00 | — | 12% above | 40% |
| Triglycerides blood test inpatient CPT 84478 W TRIGLYCERIDES (WELLS) | $25.80 | $43.00 | — | — | 40% |
| Triglycerides blood test inpatient CPT 84478 ASSAY OF TRIGLYCERIDES | $49.80 | $83.00 | — | — | 40% |
| Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES | $49.80 | $83.00 | — | — | 40% |
| Troponin test, quantitative CPT 84484 WELLS TROPONIN | $39.00 | $65.00 | — | 51% below | 40% |
| Troponin test, quantitative CPT 84484 W TROPONIN I (I-STAT) | $132.00 | $220.00 | — | 65% above | 40% |
| Troponin test, quantitative CPT 84484 TROPONIN I (I-STAT), QNT | $132.00 | $220.00 | — | 65% above | 40% |
| Troponin test, quantitative CPT 84484 W TROPONIN I (WELLS) | $132.00 | $220.00 | — | 65% above | 40% |
| Troponin test, quantitative CPT 84484 TROPONIN I | $132.00 | $220.00 | — | 65% above | 40% |
| Troponin test, quantitative inpatient CPT 84484 WELLS TROPONIN | $39.00 | $65.00 | — | — | 40% |
| Troponin test, quantitative inpatient CPT 84484 W TROPONIN I (I-STAT) | $132.00 | $220.00 | — | — | 40% |
| Troponin test, quantitative inpatient CPT 84484 TROPONIN I (I-STAT), QNT | $132.00 | $220.00 | — | — | 40% |
| Troponin test, quantitative inpatient CPT 84484 TROPONIN I | $132.00 | $220.00 | — | — | 40% |
| Troponin test, quantitative inpatient CPT 84484 W TROPONIN I (WELLS) | $132.00 | $220.00 | — | — | 40% |
| Uric acid blood test CPT 84550 W URIC ACID, SERUM (WELLS) | $36.60 | $61.00 | — | 18% above | 40% |
| Uric acid blood test CPT 84550 URIC ACID, SERUM | $59.40 | $99.00 | — | 92% above | 40% |
| Uric acid blood test inpatient CPT 84550 W URIC ACID, SERUM (WELLS) | $36.60 | $61.00 | — | — | 40% |
| Uric acid blood test inpatient CPT 84550 URIC ACID, SERUM | $59.40 | $99.00 | — | — | 40% |
| Urinalysis with microscope exam, automated CPT 81001 W URINALYSIS W/MICRO (WELLS) | $80.40 | $134.00 | — | 135% above | 40% |
| Urinalysis with microscope exam, automated CPT 81001 UA WITH MICROSCOPIC | $80.40 | $134.00 | — | 135% above | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 W URINALYSIS W/MICRO (WELLS) | $80.40 | $134.00 | — | — | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA WITH MICROSCOPIC | $80.40 | $134.00 | — | — | 40% |
| Urinalysis with microscope exam, manual CPT 81000 URINALYSIS w/ MICRO (GL 6233) | $18.60 | $31.00 | — | 25% below | 40% |
| Urinalysis with microscope exam, manual CPT 81000 POC - URINALYSIS W MICROSCOPY | $25.80 | $43.00 | — | 3% above | 40% |
| Urinalysis with microscope exam, manual CPT 81000 POC - UA DIPSTICK, NON AUTOMATED | $33.60 | $56.00 | — | 35% above | 40% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS w/ MICRO (GL 6233) | $18.60 | $31.00 | — | — | 40% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 POC - URINALYSIS W MICROSCOPY | $25.80 | $43.00 | — | — | 40% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 POC - UA DIPSTICK, NON AUTOMATED | $33.60 | $56.00 | — | — | 40% |
| Urinalysis without microscope exam, automated CPT 81003 POC URINALYSIS (GL8085) | $11.40 | $19.00 | — | 47% below | 40% |
| Urinalysis without microscope exam, automated CPT 81003 POC URINALYSIS (GL6233) | $13.20 | $22.00 | — | 39% below | 40% |
| Urinalysis without microscope exam, automated CPT 81003 POC URINALYSIS (GL7008) | $16.80 | $28.00 | — | 22% below | 40% |
| Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITY | $37.20 | $62.00 | — | 72% above | 40% |
| Urinalysis without microscope exam, automated CPT 81003 PH | $45.00 | $75.00 | — | 108% above | 40% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, ROUTINE | $48.00 | $80.00 | — | 122% above | 40% |
| Urinalysis without microscope exam, automated CPT 81003 OCCULT BLOOD, URINE | $48.00 | $80.00 | — | 122% above | 40% |
| Urinalysis without microscope exam, automated CPT 81003 UROBILINOGEN, URINE | $48.00 | $80.00 | — | 122% above | 40% |
| Urinalysis without microscope exam, automated CPT 81003 W URINALYSIS, ROUTINE (WELLS) | $48.00 | $80.00 | — | 122% above | 40% |
| Urinalysis without microscope exam, automated CPT 81003 SB URINALYSIS, ROUTINE | $48.00 | $80.00 | — | 122% above | 40% |
| Urinalysis without microscope exam, automated CPT 81003 PROTEIN, URINE QUAL (KITTERY) | $57.00 | $95.00 | — | 164% above | 40% |
| Urinalysis without microscope exam, automated CPT 81003 PROTEIN, URINE QUAL (WELLS) | $57.00 | $95.00 | — | 164% above | 40% |
| Urinalysis without microscope exam, automated CPT 81003 PROTEIN, URINE QUAL | $57.00 | $95.00 | — | 164% above | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 POC URINALYSIS (GL8085) | $11.40 | $19.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 POC URINALYSIS (GL6233) | $13.20 | $22.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 POC URINALYSIS (GL7008) | $16.80 | $28.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 SPECIFIC GRAVITY | $37.20 | $62.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 PH | $45.00 | $75.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 OCCULT BLOOD, URINE | $48.00 | $80.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UROBILINOGEN, URINE | $48.00 | $80.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS, ROUTINE | $48.00 | $80.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 SB URINALYSIS, ROUTINE | $48.00 | $80.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 W URINALYSIS, ROUTINE (WELLS) | $48.00 | $80.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 PROTEIN, URINE QUAL (WELLS) | $57.00 | $95.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 PROTEIN, URINE QUAL (KITTERY) | $57.00 | $95.00 | — | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 PROTEIN, URINE QUAL | $57.00 | $95.00 | — | — | 40% |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK | $15.60 | $26.00 | — | 1% below | 40% |
| Urinalysis without microscope exam, manual CPT 81002 POC - UA DIPSTICK, NON AUTOMATED | $33.60 | $56.00 | — | 113% above | 40% |
| Urinalysis without microscope exam, manual CPT 81002 REDUCING SUBSTANCES, URINE | $46.80 | $78.00 | — | 197% above | 40% |
| Urinalysis without microscope exam, manual CPT 81002 KETONE,URINE | $48.00 | $80.00 | — | 204% above | 40% |
| Urinalysis without microscope exam, manual CPT 81002 BILIRUBIN, URINE | $48.00 | $80.00 | — | 204% above | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK | $15.60 | $26.00 | — | — | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POC - UA DIPSTICK, NON AUTOMATED | $33.60 | $56.00 | — | — | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 REDUCING SUBSTANCES, URINE | $46.80 | $78.00 | — | — | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 KETONE,URINE | $48.00 | $80.00 | — | — | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 BILIRUBIN, URINE | $48.00 | $80.00 | — | — | 40% |
| Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE COLONY COUNT | $15.60 | $26.00 | — | 76% below | 40% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE, URINE | $96.60 | $161.00 | — | 50% above | 40% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE COLONY COUNT | $15.60 | $26.00 | — | — | 40% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE, URINE | $96.60 | $161.00 | — | — | 40% |
| Urine microalbumin (albumin) test CPT 82043 ALBUMIN URINE (IE MICROALBUMIN) QUANT | $57.60 | $96.00 | — | 13% above | 40% |
| Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN, URINE, QNT | $83.40 | $139.00 | — | 64% above | 40% |
| Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN URINE (IE MICROALBUMIN) QUANT | $57.60 | $96.00 | — | — | 40% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN, URINE, QNT | $83.40 | $139.00 | — | — | 40% |
| Urine pregnancy test, read by color change CPT 81025 POC PREGNANCY, URINE | $30.60 | $51.00 | — | 9% above | 40% |
| Urine pregnancy test, read by color change CPT 81025 W PREGNANCY TEST, URINE (WELLS) | $36.00 | $60.00 | — | 29% above | 40% |
| Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST, URINE | $76.20 | $127.00 | — | 172% above | 40% |
| Urine pregnancy test, read by color change inpatient CPT 81025 POC PREGNANCY, URINE | $30.60 | $51.00 | — | — | 40% |
| Urine pregnancy test, read by color change inpatient CPT 81025 W PREGNANCY TEST, URINE (WELLS) | $36.00 | $60.00 | — | — | 40% |
| Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST, URINE | $76.20 | $127.00 | — | — | 40% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 QUEST | $32.40 | $54.00 | — | 62% below | 40% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 | $106.80 | $178.00 | — | 24% above | 40% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 QUEST | $32.40 | $54.00 | — | — | 40% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 | $106.80 | $178.00 | — | — | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VIT D 25 HYDROXY | $115.80 | $193.00 | — | 2% above | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D, 25- HYDROXY IA | $115.80 | $193.00 | — | 2% above | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VIT D 25 HYDROXY | $115.80 | $193.00 | — | — | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25- HYDROXY IA | $115.80 | $193.00 | — | — | 40% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D 1,25 DIHYDROXY | $144.60 | $241.00 | — | 10% above | 40% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D 1,25 DIHYDROXY | $144.60 | $241.00 | — | — | 40% |
| Zinc blood test CPT 84630 ZINC, RBC | $70.80 | $118.00 | — | 68% above | 40% |
| Zinc blood test CPT 84630 ZINC | $169.20 | $282.00 | — | 301% above | 40% |
| Zinc blood test inpatient CPT 84630 ZINC, RBC | $70.80 | $118.00 | — | — | 40% |
| Zinc blood test inpatient CPT 84630 ZINC | $169.20 | $282.00 | — | — | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG, QUANTITATIVE (WELLS) | $141.00 | $235.00 | — | 73% above | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG, QUANTITATIVE | $141.00 | $235.00 | — | 73% above | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG, QUANTITATIVE | $141.00 | $235.00 | — | — | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG, QUANTITATIVE (WELLS) | $141.00 | $235.00 | — | — | 40% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Maine | Off list |
|---|---|---|---|---|---|
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 STEREO BX BRST W/PLC LOC 1ST LESION | $2,022.60 | $3,371.00 | — | 9% above | 40% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 STEREO BX BRST RT W/PLC LOC 1ST LESION | $2,022.60 | $3,371.00 | — | 9% above | 40% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 STEREO BX BRST LT W/PLC LOC 1ST LESION | $2,022.60 | $3,371.00 | — | 9% above | 40% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 STEREO BX BRST W/PLC LOC 1ST LESION | $2,022.60 | $3,371.00 | — | — | 40% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 STEREO BX BRST RT W/PLC LOC 1ST LESION | $2,022.60 | $3,371.00 | — | — | 40% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 STEREO BX BRST LT W/PLC LOC 1ST LESION | $2,022.60 | $3,371.00 | — | — | 40% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLSD TRTMNT DIST FIBULA FRACT W/O MANIP | $496.80 | $828.00 | — | 80% above | 40% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLSD TRTMNT DIST FIBULA FRACT W/O MANIP | $496.80 | $828.00 | — | — | 40% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 FX CARE METATARSAL EA W/O MANIP | $455.40 | $759.00 | — | 87% above | 40% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 FX CARE METATARSAL EA W/O MANIP | $455.40 | $759.00 | — | — | 40% |
| Cardiac catheterization with coronary angiogram CPT 93458 C CATH LHC W/ CORS & LV 93458 | $4,966.80 | $8,278.00 | — | 29% above | 40% |
| Cardiac catheterization with coronary angiogram inpatient CPT 93458 C CATH LHC W/ CORS & LV 93458 | $4,966.80 | $8,278.00 | — | — | 40% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION-ELECTRICAL | $994.80 | $1,658.00 | — | 104% above | 40% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 E EP CVERSION 92960 | $994.80 | $1,658.00 | — | 104% above | 40% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 WELLS CARDIOVERSION | $994.80 | $1,658.00 | — | 104% above | 40% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 ER CARDIOVERSION | $994.80 | $1,658.00 | — | 104% above | 40% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION (ELECTRICAL) | $994.80 | $1,658.00 | — | 104% above | 40% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRICAL | $994.80 | $1,658.00 | — | 104% above | 40% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 E EP CVERSION 92960 | $994.80 | $1,658.00 | — | — | 40% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTRICAL | $994.80 | $1,658.00 | — | — | 40% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION-ELECTRICAL | $994.80 | $1,658.00 | — | — | 40% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION (ELECTRICAL) | $994.80 | $1,658.00 | — | — | 40% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 WELLS CARDIOVERSION | $994.80 | $1,658.00 | — | — | 40% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ER CARDIOVERSION | $994.80 | $1,658.00 | — | — | 40% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 WER CLOSED FX DISTAL RADIALW/O MANIPUL | $328.80 | $548.00 | — | 11% above | 40% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 ER CLOSED FX DISTAL RADIALW/O MANIPULATI | $328.80 | $548.00 | — | 11% above | 40% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 ER CLOSED FX DISTAL RADIALW/O MANIPULATI | $328.80 | $548.00 | — | — | 40% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 WER CLOSED FX DISTAL RADIALW/O MANIPUL | $328.80 | $548.00 | — | — | 40% |
| Coronary stent placement, one artery CPT 92928 I CATH STENT BARE METAL 92928 | $9,103.80 | $15,173.00 | — | 20% below | 40% |
| Coronary stent placement, one artery inpatient CPT 92928 I CATH STENT BARE METAL 92928 | $9,103.80 | $15,173.00 | — | — | 40% |
| Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY AND TREATMENT | $4,818.60 | $8,031.00 | — | 18% above | 40% |
| Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTOSCOPY AND TREATMENT | $4,818.60 | $8,031.00 | — | — | 40% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY | $1,117.20 | $1,862.00 | — | 102% above | 40% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY | $1,163.40 | $1,939.00 | — | 110% above | 40% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY | $1,117.20 | $1,862.00 | — | — | 40% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY | $1,163.40 | $1,939.00 | — | — | 40% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 ER REMOV IMPACTED CERUMEN IRR/LAV-UNI | $118.80 | $198.00 | — | 138% above | 40% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ER REMOV IMPACTED CERUMEN IRR/LAV-UNI | $118.80 | $198.00 | — | — | 40% |
| Earwax removal with instruments, one ear CPT 69210 REMOVAL EAR WAX W/INSTRUM, UNI | $33.60 | $56.00 | — | 42% below | 40% |
| Earwax removal with instruments, one ear CPT 69210 ER REMOVE IMPACTED EAR WAX | $57.00 | $95.00 | — | 2% below | 40% |
| Earwax removal with instruments, one ear CPT 69210 WELLS RMVL IMPACTED EAR WAX | $57.00 | $95.00 | — | 2% below | 40% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REMOVAL EAR WAX W/INSTRUM, UNI | $33.60 | $56.00 | — | — | 40% |
| Earwax removal with instruments, one ear inpatient CPT 69210 ER REMOVE IMPACTED EAR WAX | $57.00 | $95.00 | — | — | 40% |
| Earwax removal with instruments, one ear inpatient CPT 69210 WELLS RMVL IMPACTED EAR WAX | $57.00 | $95.00 | — | — | 40% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CVR/THRV W IMAGING | $1,038.60 | $1,731.00 | — | 11% above | 40% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 IR THORACIC INJECTION THERAPEUTIC | $1,059.60 | $1,766.00 | — | 13% above | 40% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 NJX INTERLAMINAR CVR/THRV W IMAGING | $1,038.60 | $1,731.00 | — | — | 40% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 IR THORACIC INJECTION THERAPEUTIC | $1,059.60 | $1,766.00 | — | — | 40% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 IR CT FACET JOINT INJ LUMBAR 64493 | $1,368.00 | $2,280.00 | — | 39% above | 40% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 SPP FACET INJECT LUMBR/SACRL 64493 | $1,423.80 | $2,373.00 | — | 44% above | 40% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 IR CT FACET JOINT INJ LUMBAR 64493 | $1,368.00 | $2,280.00 | — | — | 40% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 SPP FACET INJECT LUMBR/SACRL 64493 | $1,423.80 | $2,373.00 | — | — | 40% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 HEMORRHOID LIGATION | $939.00 | $1,565.00 | — | 24% above | 40% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HEMORRHOID LIGATION | $939.00 | $1,565.00 | — | — | 40% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVE INT/EXT HEM 1 GROUP | $2,821.80 | $4,703.00 | — | 106% above | 40% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 ER REMOVE INT/EXT HEM 1 GROUP | $4,583.40 | $7,639.00 | — | 234% above | 40% |
| Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 REMOVE INT/EXT HEM 1 GROUP | $2,821.80 | $4,703.00 | — | — | 40% |
| Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 ER REMOVE INT/EXT HEM 1 GROUP | $4,583.40 | $7,639.00 | — | — | 40% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 US CATHETER FOR HYSTEROGRAPHY 58340 | $373.20 | $622.00 | — | 11% above | 40% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 US CATHETER FOR HYSTEROGRAPHY 58340 | $373.20 | $622.00 | — | — | 40% |
| Incision and drainage of a simple or single skin abscess CPT 10060 ER I+D Abcess/paronchia - 10060 | $172.80 | $288.00 | — | 8% above | 40% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D abscess/paronchia - 10060 | $172.80 | $288.00 | — | 8% above | 40% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE or SINGLE | $340.80 | $568.00 | — | 113% above | 40% |
| Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS | $357.00 | $595.00 | — | 123% above | 40% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ER I+D Abcess/paronchia - 10060 | $172.80 | $288.00 | — | — | 40% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D abscess/paronchia - 10060 | $172.80 | $288.00 | — | — | 40% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE or SINGLE | $340.80 | $568.00 | — | — | 40% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS | $357.00 | $595.00 | — | — | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ FOR PAIN - TENDON OR LIGAMENT | $449.40 | $749.00 | — | 138% above | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION FOR PAIN - TENDON OR LIGAMENT | $449.40 | $749.00 | — | 138% above | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ FOR PAIN - TENDON OR LIGAMENT | $449.40 | $749.00 | — | — | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION FOR PAIN - TENDON OR LIGAMENT | $449.40 | $749.00 | — | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASP JOINT/HIP/KNEE/SHOULDER W/O US GUID | $223.80 | $373.00 | — | 15% below | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Asp joint/hip/knee/shoulder - 20610 | $223.80 | $373.00 | — | 15% below | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 JOINT(MAJOR)INJ PROC 20610LT | $430.20 | $717.00 | — | 63% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 JOINT INJECTION (MAJOR) | $430.20 | $717.00 | — | 63% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 JOINT(MAJOR)INJ PROC 20610RT | $430.20 | $717.00 | — | 63% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US MAJOR JOINT | $512.40 | $854.00 | — | 94% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 IR JOINT (MAJOR) INJECT PROC LEFT | $483.00 | $805.00 | — | 83% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 IR JOINT (MAJOR) INJECT PROC RIGHT | $483.00 | $805.00 | — | 83% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASP JOINT/HIP/KNEE/SHOULDER W/O US GUID | $223.80 | $373.00 | — | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Asp joint/hip/knee/shoulder - 20610 | $223.80 | $373.00 | — | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 JOINT(MAJOR)INJ PROC 20610LT | $430.20 | $717.00 | — | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 JOINT(MAJOR)INJ PROC 20610RT | $430.20 | $717.00 | — | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 JOINT INJECTION (MAJOR) | $430.20 | $717.00 | — | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JOINT/BURSA W/O US MAJOR JOINT | $512.40 | $854.00 | — | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 IR JOINT (MAJOR) INJECT PROC RIGHT | $483.00 | $805.00 | — | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 IR JOINT (MAJOR) INJECT PROC LEFT | $483.00 | $805.00 | — | — | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASP INTERM JNT/ELB/WR/ANK W/O US GUID | $379.80 | $633.00 | — | 109% above | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Asp interm joint/elbow/wrist/ankle-20605 | $379.80 | $633.00 | — | 109% above | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 IR JOINT (INTERM) INJECT PROC | $483.00 | $805.00 | — | 166% above | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIIN/INJ JOINT/BURSA W/O US INT JOINT | $512.40 | $854.00 | — | 182% above | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Asp interm joint/elbow/wrist/ankle-20605 | $379.80 | $633.00 | — | — | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASP INTERM JNT/ELB/WR/ANK W/O US GUID | $379.80 | $633.00 | — | — | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 IR JOINT (INTERM) INJECT PROC | $483.00 | $805.00 | — | — | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIIN/INJ JOINT/BURSA W/O US INT JOINT | $512.40 | $854.00 | — | — | 40% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASP SMALL JNT FINGER/TOE W/O US GUID | $211.20 | $352.00 | — | 5% above | 40% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Aspiration sm.joint finger/toe-20600 | $211.20 | $352.00 | — | 5% above | 40% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US SMALL JOINT | $512.40 | $854.00 | — | 155% above | 40% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASP SMALL JNT FINGER/TOE W/O US GUID | $211.20 | $352.00 | — | — | 40% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Aspiration sm.joint finger/toe-20600 | $211.20 | $352.00 | — | — | 40% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O US SMALL JOINT | $512.40 | $854.00 | — | — | 40% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 RPR INTMD S/A/T/EXT 2.5CM/< | $471.00 | $785.00 | — | 63% above | 40% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Interm rep/non-face </=2.5cm-12031 | $480.60 | $801.00 | — | 67% above | 40% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 RPR INTMD S/A/T/EXT 2.5CM/< | $471.00 | $785.00 | — | — | 40% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Interm rep/non-face </=2.5cm-12031 | $480.60 | $801.00 | — | — | 40% |
| Left heart catheterization, diagnostic CPT 93452 C CATH LHC W/ LV 93452 | $4,728.60 | $7,881.00 | — | 94% above | 40% |
| Left heart catheterization, diagnostic inpatient CPT 93452 C CATH LHC W/ LV 93452 | $4,728.60 | $7,881.00 | — | — | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SACRAL W IMAGING | $1,038.60 | $1,731.00 | — | 12% above | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 IR LUMBAR INJECTION THERAPEUTIC | $1,059.60 | $1,766.00 | — | 14% above | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SACRAL W IMAGING | $1,038.60 | $1,731.00 | — | — | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 IR LUMBAR INJECTION THERAPEUTIC | $1,059.60 | $1,766.00 | — | — | 40% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SACRAL W/O IMAGING | $1,038.60 | $1,731.00 | — | 15% above | 40% |
| Lower-back epidural injection, without imaging guidance CPT 62322 IR NJX INTERLAMINAR LMBR/SACRAL W/O IMAG | $1,059.60 | $1,766.00 | — | 17% above | 40% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SACRAL W/O IMAGING | $1,038.60 | $1,731.00 | — | — | 40% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 IR NJX INTERLAMINAR LMBR/SACRAL W/O IMAG | $1,059.60 | $1,766.00 | — | — | 40% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 IR CT NERVE ROOT INJ LUMB SAC 64483 | $1,046.40 | $1,744.00 | — | 8% above | 40% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 IR CT NERVE ROOT INJ LUMB SAC 64483 | $1,046.40 | $1,744.00 | — | — | 40% |
| Nail removal (partial or complete), one nail CPT 11730 Avulsion/Removal Nail Only | $253.80 | $423.00 | — | 95% above | 40% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLT 1 NAIL | $314.40 | $524.00 | — | 141% above | 40% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion/Removal Nail Only | $253.80 | $423.00 | — | — | 40% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLT 1 NAIL | $314.40 | $524.00 | — | — | 40% |
| Occipital nerve block (injection for headaches) CPT 64405 WELLS ER OCCIPITAL NERVE BLOCK | $481.80 | $803.00 | — | 62% above | 40% |
| Occipital nerve block (injection for headaches) CPT 64405 ER OCCIPITAL NERVE BLOCK | $481.80 | $803.00 | — | 62% above | 40% |
| Occipital nerve block (injection for headaches) CPT 64405 SPP NERVE BLOCK OCCIPITAL 64405 | $754.20 | $1,257.00 | — | 153% above | 40% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 ER OCCIPITAL NERVE BLOCK | $481.80 | $803.00 | — | — | 40% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 WELLS ER OCCIPITAL NERVE BLOCK | $481.80 | $803.00 | — | — | 40% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 SPP NERVE BLOCK OCCIPITAL 64405 | $754.20 | $1,257.00 | — | — | 40% |
| Pacemaker implant (dual chamber) CPT 33208 P PACER IMP/REP DEVICE W/LDS DUAL 33208 | $18,725.40 | $31,209.00 | — | 92% above | 40% |
| Pacemaker implant (dual chamber) inpatient CPT 33208 P PACER IMP/REP DEVICE W/LDS DUAL 33208 | $18,725.40 | $31,209.00 | — | — | 40% |
| Paracentesis with imaging guidance CPT 49083 PARACENTESIS ABD w/Guide | $837.00 | $1,395.00 | — | 3% above | 40% |
| Paracentesis with imaging guidance CPT 49083 PARACENTESIS(ABDOMEN)W/ IMAGES 49083 | $1,030.80 | $1,718.00 | — | 27% above | 40% |
| Paracentesis with imaging guidance CPT 49083 CT PARACENTESIS ABD WITH IMGAGES 49083 | $1,030.80 | $1,718.00 | — | 27% above | 40% |
| Paracentesis with imaging guidance CPT 49083 US PARACENTESIS ABD WITH IMGAGES 49083 | $1,030.80 | $1,718.00 | — | 27% above | 40% |
| Paracentesis with imaging guidance CPT 49083 IR PARACENTESIS W/ IMAGING | $1,461.00 | $2,435.00 | — | 79% above | 40% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING | $1,473.00 | $2,455.00 | — | 81% above | 40% |
| Paracentesis with imaging guidance CPT 49083 ER ABD PARACENTESIS WITH IMAGING | $1,473.00 | $2,455.00 | — | 81% above | 40% |
| Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS ABD w/Guide | $837.00 | $1,395.00 | — | — | 40% |
| Paracentesis with imaging guidance inpatient CPT 49083 US PARACENTESIS ABD WITH IMGAGES 49083 | $1,030.80 | $1,718.00 | — | — | 40% |
| Paracentesis with imaging guidance inpatient CPT 49083 CT PARACENTESIS ABD WITH IMGAGES 49083 | $1,030.80 | $1,718.00 | — | — | 40% |
| Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS(ABDOMEN)W/ IMAGES 49083 | $1,030.80 | $1,718.00 | — | — | 40% |
| Paracentesis with imaging guidance inpatient CPT 49083 IR PARACENTESIS W/ IMAGING | $1,461.00 | $2,435.00 | — | — | 40% |
| Paracentesis with imaging guidance inpatient CPT 49083 ER ABD PARACENTESIS WITH IMAGING | $1,473.00 | $2,455.00 | — | — | 40% |
| Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING | $1,473.00 | $2,455.00 | — | — | 40% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Nail Removal - 11750 | $507.60 | $846.00 | — | 55% above | 40% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL/MATRIX PRT/CMP | $678.00 | $1,130.00 | — | 107% above | 40% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Nail Removal - 11750 | $507.60 | $846.00 | — | — | 40% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL/MATRIX PRT/CMP | $678.00 | $1,130.00 | — | — | 40% |
| Removal of a foreign object under the skin, simple CPT 10120 FB removal inc/subQ - simple-10120 | $328.20 | $547.00 | — | 43% above | 40% |
| Removal of a foreign object under the skin, simple CPT 10120 Inc FB removal subQ simple-10120 | $328.20 | $547.00 | — | 43% above | 40% |
| Removal of a foreign object under the skin, simple CPT 10120 FOREIGN BODY INCSN/RMVL, SMPL | $586.20 | $977.00 | — | 156% above | 40% |
| Removal of a foreign object under the skin, simple CPT 10120 IR INCISION/REMOVAL FB SIMPLE | $612.60 | $1,021.00 | — | 167% above | 40% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 Inc FB removal subQ simple-10120 | $328.20 | $547.00 | — | — | 40% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 FB removal inc/subQ - simple-10120 | $328.20 | $547.00 | — | — | 40% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 FOREIGN BODY INCSN/RMVL, SMPL | $586.20 | $977.00 | — | — | 40% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 IR INCISION/REMOVAL FB SIMPLE | $612.60 | $1,021.00 | — | — | 40% |
| Short arm cast (elbow to hand) CPT 29075 WELLS SHORT ARM CAST | $363.00 | $605.00 | — | 107% above | 40% |
| Short arm cast (elbow to hand) CPT 29075 ER SHORT ARM CAST | $363.00 | $605.00 | — | 107% above | 40% |
| Short arm cast (elbow to hand) inpatient CPT 29075 WELLS SHORT ARM CAST | $363.00 | $605.00 | — | — | 40% |
| Short arm cast (elbow to hand) inpatient CPT 29075 ER SHORT ARM CAST | $363.00 | $605.00 | — | — | 40% |
| Short arm splint (forearm and hand) CPT 29125 WELLS SHORT ARM SPLINT | $146.40 | $244.00 | — | 27% above | 40% |
| Short arm splint (forearm and hand) CPT 29125 ER SHORT ARM SPLINT | $146.40 | $244.00 | — | 27% above | 40% |
| Short arm splint (forearm and hand) inpatient CPT 29125 ER SHORT ARM SPLINT | $146.40 | $244.00 | — | — | 40% |
| Short arm splint (forearm and hand) inpatient CPT 29125 WELLS SHORT ARM SPLINT | $146.40 | $244.00 | — | — | 40% |
| Short leg cast (below the knee) CPT 29405 APPL SHRT LEG CAST | $343.80 | $573.00 | — | 114% above | 40% |
| Short leg cast (below the knee) CPT 29405 WELLS SHORT LEG CAST | $363.00 | $605.00 | — | 126% above | 40% |
| Short leg cast (below the knee) CPT 29405 ER SHORT LEG CAST | $363.00 | $605.00 | — | 126% above | 40% |
| Short leg cast (below the knee) inpatient CPT 29405 APPL SHRT LEG CAST | $343.80 | $573.00 | — | — | 40% |
| Short leg cast (below the knee) inpatient CPT 29405 WELLS SHORT LEG CAST | $363.00 | $605.00 | — | — | 40% |
| Short leg cast (below the knee) inpatient CPT 29405 ER SHORT LEG CAST | $363.00 | $605.00 | — | — | 40% |
| Short leg splint (calf to foot) CPT 29515 ER SHORT LEG SPLINT | $145.20 | $242.00 | — | 15% above | 40% |
| Short leg splint (calf to foot) CPT 29515 WELLS SHORT LEG SPLINT | $145.20 | $242.00 | — | 15% above | 40% |
| Short leg splint (calf to foot) inpatient CPT 29515 ER SHORT LEG SPLINT | $145.20 | $242.00 | — | — | 40% |
| Short leg splint (calf to foot) inpatient CPT 29515 WELLS SHORT LEG SPLINT | $145.20 | $242.00 | — | — | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Smpl rep/scalp/nck/ax/gen/trnk </=2.5 | $160.20 | $267.00 | — | 8% above | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Smpl rep/scalp/neck/ax/gen/trunk </=2.5 | $160.20 | $267.00 | — | 8% above | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WHC LAC NON-FACE (< 2.5CM) | $223.80 | $373.00 | — | 50% above | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK &/OR EXTREM 2.5CM/< | $247.20 | $412.00 | — | 66% above | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Smpl rep/scalp/neck/ax/gen/trunk </=2.5 | $160.20 | $267.00 | — | — | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Smpl rep/scalp/nck/ax/gen/trnk </=2.5 | $160.20 | $267.00 | — | — | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 WHC LAC NON-FACE (< 2.5CM) | $223.80 | $373.00 | — | — | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR S/N/AX/GEN/TRNK &/OR EXTREM 2.5CM/< | $247.20 | $412.00 | — | — | 40% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION | $363.00 | $605.00 | — | 41% above | 40% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION | $363.00 | $605.00 | — | — | 40% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS <=15 LESIONS | $69.00 | $115.00 | — | 47% below | 40% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKIN TAG | $136.80 | $228.00 | — | 4% above | 40% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS <=15 LESIONS | $69.00 | $115.00 | — | — | 40% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKIN TAG | $136.80 | $228.00 | — | — | 40% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 WELLS LUMBAR PUNCTURE | $442.20 | $737.00 | — | 9% below | 40% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 ER LUMBAR PUCTURE | $442.20 | $737.00 | — | 9% below | 40% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 SPP LUMBAR PUNCTURE DX 62270 | $754.20 | $1,257.00 | — | 55% above | 40% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE (TECH) | $754.20 | $1,257.00 | — | 55% above | 40% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE CLINIC | $831.60 | $1,386.00 | — | 71% above | 40% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 IR LUMBAR PUNCTURE DIAGNOSTIC | $1,059.60 | $1,766.00 | — | 117% above | 40% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DIAGNOSTIC LUMBAR PUNCTURE | $1,152.60 | $1,921.00 | — | 136% above | 40% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LUMBAR SPINE PNXR | $1,237.20 | $2,062.00 | — | 154% above | 40% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ER LUMBAR PUCTURE | $442.20 | $737.00 | — | — | 40% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 WELLS LUMBAR PUNCTURE | $442.20 | $737.00 | — | — | 40% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE (TECH) | $754.20 | $1,257.00 | — | — | 40% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPP LUMBAR PUNCTURE DX 62270 | $754.20 | $1,257.00 | — | — | 40% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE CLINIC | $831.60 | $1,386.00 | — | — | 40% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 IR LUMBAR PUNCTURE DIAGNOSTIC | $1,059.60 | $1,766.00 | — | — | 40% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 DIAGNOSTIC LUMBAR PUNCTURE | $1,152.60 | $1,921.00 | — | — | 40% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 DX LUMBAR SPINE PNXR | $1,237.20 | $2,062.00 | — | — | 40% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Smpl rep/scalp/neck/ax/gen/trunk 2.6-7.5 | $175.80 | $293.00 | — | 6% below | 40% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Smpl rep/sclp/nck/ax/gen/trnk 2.6-7.5 | $175.80 | $293.00 | — | 6% below | 40% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 WHC LAC NON-FACE (2.6-7.5CM) | $223.80 | $373.00 | — | 20% above | 40% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Smpl rep/sclp/nck/ax/gen/trnk 2.6-7.5 | $175.80 | $293.00 | — | — | 40% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Smpl rep/scalp/neck/ax/gen/trunk 2.6-7.5 | $175.80 | $293.00 | — | — | 40% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 WHC LAC NON-FACE (2.6-7.5CM) | $223.80 | $373.00 | — | — | 40% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple rep/face </=2.5cm-12011 | $160.20 | $267.00 | — | 3% below | 40% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair/face </=2.5cm-12011 | $160.20 | $267.00 | — | 3% below | 40% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 WHC LAC FACE (<2.5CM) | $223.80 | $373.00 | — | 36% above | 40% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Simple rep/face </=2.5cm-12011 | $160.20 | $267.00 | — | — | 40% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Simple repair/face </=2.5cm-12011 | $160.20 | $267.00 | — | — | 40% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 WHC LAC FACE (<2.5CM) | $223.80 | $373.00 | — | — | 40% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES | $363.00 | $605.00 | — | 85% above | 40% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES | $363.00 | $605.00 | — | — | 40% |
| Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/IMAGING | $1,033.20 | $1,722.00 | — | 54% above | 40% |
| Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING | $1,033.20 | $1,722.00 | — | 54% above | 40% |
| Thoracentesis with imaging guidance CPT 32555 THORACENTESIS WITH IMAGING-32555 | $1,120.80 | $1,868.00 | — | 67% above | 40% |
| Thoracentesis with imaging guidance CPT 32555 ER THORACENTESIS WITH IMAGING- 32555 | $1,120.80 | $1,868.00 | — | 67% above | 40% |
| Thoracentesis with imaging guidance CPT 32555 IR THORACENTESIS W/IMAGING | $1,428.60 | $2,381.00 | — | 112% above | 40% |
| Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/ IMAGING | $1,033.20 | $1,722.00 | — | — | 40% |
| Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/IMAGING | $1,033.20 | $1,722.00 | — | — | 40% |
| Thoracentesis with imaging guidance inpatient CPT 32555 ER THORACENTESIS WITH IMAGING- 32555 | $1,120.80 | $1,868.00 | — | — | 40% |
| Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS WITH IMAGING-32555 | $1,120.80 | $1,868.00 | — | — | 40% |
| Thoracentesis with imaging guidance inpatient CPT 32555 IR THORACENTESIS W/IMAGING | $1,428.60 | $2,381.00 | — | — | 40% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ FOR PAIN - TRIG PNT 1-2 MUSCLES | $449.40 | $749.00 | — | 134% above | 40% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ FOR PAIN-TRIG PNT 1-2 MUSCLES | $449.40 | $749.00 | — | 134% above | 40% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ FOR PAIN-TRIG PNT 1-2 MUSCLES | $449.40 | $749.00 | — | — | 40% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ FOR PAIN - TRIG PNT 1-2 MUSCLES | $449.40 | $749.00 | — | — | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US BREAST BIOPSY 1ST LESION (BC) | $2,022.60 | $3,371.00 | — | 46% above | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 IR BREAST BX W/IMG 1ST LESION | $2,580.00 | $4,300.00 | — | 87% above | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BREAST BIOPSY RIGHT 1ST LESION 19083 | $1,431.00 | $2,385.00 | — | 4% above | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BREAST BIOPSY LEFT 1ST LESION 19083 | $1,431.00 | $2,385.00 | — | 4% above | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BREAST BIOPSY RT 1ST LESION (BC) | $2,022.60 | $3,371.00 | — | 46% above | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BREAST BIOPSY LT 1ST LESION (BC) | $2,022.60 | $3,371.00 | — | 46% above | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 US BREAST BIOPSY 1ST LESION (BC) | $2,022.60 | $3,371.00 | — | — | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 IR BREAST BX W/IMG 1ST LESION | $2,580.00 | $4,300.00 | — | — | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US BREAST BIOPSY LEFT 1ST LESION 19083 | $1,431.00 | $2,385.00 | — | — | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US BREAST BIOPSY RIGHT 1ST LESION 19083 | $1,431.00 | $2,385.00 | — | — | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US BREAST BIOPSY LT 1ST LESION (BC) | $2,022.60 | $3,371.00 | — | — | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US BREAST BIOPSY RT 1ST LESION (BC) | $2,022.60 | $3,371.00 | — | — | 40% |
| Upper endoscopy (EGD) with biopsy CPT 43239 ER EGD DIAGNOSTIC WITH BIOPSY | $1,425.00 | $2,375.00 | — | 21% above | 40% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 ER EGD DIAGNOSTIC WITH BIOPSY | $1,425.00 | $2,375.00 | — | — | 40% |
| Upper endoscopy (EGD), diagnostic CPT 43235 ER EGD DIAGNOSTIC | $1,425.00 | $2,375.00 | — | 40% above | 40% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 ER EGD DIAGNOSTIC | $1,425.00 | $2,375.00 | — | — | 40% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT OR DUCTS | $255.60 | $426.00 | — | 50% below | 40% |
| Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 REMOVAL OF SPERM DUCT OR DUCTS | $255.60 | $426.00 | — | — | 40% |
| Vein ablation, radiofrequency, first vein CPT 36475 US ENDOVENOUS ABLATION INITIAL 36475 | $4,629.00 | $7,715.00 | — | 20% above | 40% |
| Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS RF 1ST VEIN 36475 | $4,922.40 | $8,204.00 | — | 27% above | 40% |
| Vein ablation, radiofrequency, first vein CPT 36475 IR ENDOVENOUS ABLATION INITIAL | $4,922.40 | $8,204.00 | — | 27% above | 40% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 US ENDOVENOUS ABLATION INITIAL 36475 | $4,629.00 | $7,715.00 | — | — | 40% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 ENDOVENOUS RF 1ST VEIN 36475 | $4,922.40 | $8,204.00 | — | — | 40% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 IR ENDOVENOUS ABLATION INITIAL | $4,922.40 | $8,204.00 | — | — | 40% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LESION <15 | $253.80 | $423.00 | — | 50% above | 40% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LESION < 15 | $253.80 | $423.00 | — | 50% above | 40% |
| Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION BENIGN LESION <15 | $253.80 | $423.00 | — | — | 40% |
| Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION BENIGN LESION < 15 | $253.80 | $423.00 | — | — | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 SPP DEBRDMNT SUBQ 1ST 20 SQ CM 11042 | $327.60 | $546.00 | — | 76% above | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Exc Debride subQ;1st 20 sq cm | $328.20 | $547.00 | — | 76% above | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Exc Debride subQ;1st 20 sq cm - 11042 | $328.20 | $547.00 | — | 76% above | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRDMNT SUB Q 1ST 20 SQ CM | $588.00 | $980.00 | — | 216% above | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 SPP DEBRDMNT SUBQ 1ST 20 SQ CM 11042 | $327.60 | $546.00 | — | — | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Exc Debride subQ;1st 20 sq cm - 11042 | $328.20 | $547.00 | — | — | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Exc Debride subQ;1st 20 sq cm | $328.20 | $547.00 | — | — | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRDMNT SUB Q 1ST 20 SQ CM | $588.00 | $980.00 | — | — | 40% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Maine | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD/PROD TRANSFUSION TREATMENT | $298.20 | $497.00 | — | 39% below | 40% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD/PROD TRANSFUSION TREATMENT DAILY | $298.20 | $497.00 | — | 39% below | 40% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD/PROD TRANSFUSION TREATMENT | $298.20 | $497.00 | — | — | 40% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD/PROD TRANSFUSION TREATMENT DAILY | $298.20 | $497.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NONPRESSURIZED INHALATION | $154.20 | $257.00 | — | 16% below | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 WELLS EMERGENT CARE MININEB | $391.20 | $652.00 | — | 114% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MININEB TREATMENT | $391.20 | $652.00 | — | 114% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI / NEB TREATMENT | $391.20 | $652.00 | — | 114% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NONPRESSURIZED INHALATION | $154.20 | $257.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI / NEB TREATMENT | $391.20 | $652.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 WELLS EMERGENT CARE MININEB | $391.20 | $652.00 | — | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MININEB TREATMENT | $391.20 | $652.00 | — | — | 40% |
| Chemotherapy IV infusion, first hour CPT 96413 OBSV IV CHEMO INFUSION | $477.60 | $796.00 | — | 22% above | 40% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO INF 0-1 HR | $477.60 | $796.00 | — | 22% above | 40% |
| Chemotherapy IV infusion, first hour CPT 96413 OBV/PPR-CHEMO INFUSION 0-1 HR | $477.60 | $796.00 | — | 22% above | 40% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 OBV/PPR-CHEMO INFUSION 0-1 HR | $477.60 | $796.00 | — | — | 40% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 OBSV IV CHEMO INFUSION | $477.60 | $796.00 | — | — | 40% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INF 0-1 HR | $477.60 | $796.00 | — | — | 40% |
| Critical care, first 30 to 74 minutes CPT 99291 Crit. Care 30-74" - 99291 | $1,138.80 | $1,898.00 | — | 11% above | 40% |
| Critical care, first 30 to 74 minutes CPT 99291 *Wells Er Critical 30-74" | $1,138.80 | $1,898.00 | — | 11% above | 40% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 *Wells Er Critical 30-74" | $1,138.80 | $1,898.00 | — | — | 40% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 Crit. Care 30-74" - 99291 | $1,138.80 | $1,898.00 | — | — | 40% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY | $500.40 | $834.00 | — | 40% above | 40% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE AND DROWSY | $500.40 | $834.00 | — | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG PASS | $78.60 | $131.00 | — | 30% below | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG BY WELLS CARDIOLOGY | $88.20 | $147.00 | — | 22% below | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG BY ASP | $99.60 | $166.00 | — | 11% below | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG | $99.60 | $166.00 | — | 11% below | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG | $99.60 | $166.00 | — | 11% below | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG BY WUC | $99.60 | $166.00 | — | 11% below | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG BY WALKIN CLINIC | $99.60 | $166.00 | — | 11% below | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG PASS | $78.60 | $131.00 | — | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG BY WELLS CARDIOLOGY | $88.20 | $147.00 | — | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG BY ASP | $99.60 | $166.00 | — | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG | $99.60 | $166.00 | — | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG BY WUC | $99.60 | $166.00 | — | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG | $99.60 | $166.00 | — | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG BY WALKIN CLINIC | $99.60 | $166.00 | — | — | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 *ER MINIMUM LEVEL NOT REQ MD/QHP | $102.60 | $171.00 | — | 1% below | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 *ER LEVEL I MINIMAL NOT REQ MD /QHP | $102.60 | $171.00 | — | 1% below | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 *ER LEVEL I MINIMAL NOT REQ MD /QHP | $102.60 | $171.00 | — | — | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 *ER MINIMUM LEVEL NOT REQ MD/QHP | $102.60 | $171.00 | — | — | 40% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 *ER LEVEL II STRAIGHTFORWARD MDM | $165.60 | $276.00 | — | 21% below | 40% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 *ER WELLS LEVEL II STRAIGHTFORWARD MDM | $165.60 | $276.00 | — | 21% below | 40% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 *ER LEVEL II STRAIGHTFORWARD MDM | $165.60 | $276.00 | — | — | 40% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 *ER WELLS LEVEL II STRAIGHTFORWARD MDM | $165.60 | $276.00 | — | — | 40% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 *ER LEVEL III LOW MDM | $297.00 | $495.00 | — | 12% below | 40% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 *Er WELLS LEVEL III LOW MDM | $297.00 | $495.00 | — | 12% below | 40% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 *Er WELLS LEVEL III LOW MDM | $297.00 | $495.00 | — | — | 40% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 *ER LEVEL III LOW MDM | $297.00 | $495.00 | — | — | 40% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 *Er WELLS LEVEL IV MODERATE MDM | $452.40 | $754.00 | — | 26% below | 40% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 *ER LEVEL IV MODERATE MDM | $452.40 | $754.00 | — | 26% below | 40% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 *Er WELLS LEVEL IV MODERATE MDM | $452.40 | $754.00 | — | — | 40% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 *ER LEVEL IV MODERATE MDM | $452.40 | $754.00 | — | — | 40% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 *Er WELLS LEVEL V HIGH MDM | $696.60 | $1,161.00 | — | 29% below | 40% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 *ER LEVEL V HIGH MDM | $696.60 | $1,161.00 | — | 29% below | 40% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 *ER LEVEL V HIGH MDM | $696.60 | $1,161.00 | — | — | 40% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 *Er WELLS LEVEL V HIGH MDM | $696.60 | $1,161.00 | — | — | 40% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST | $691.80 | $1,153.00 | — | 20% above | 40% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS TEST | $691.80 | $1,153.00 | — | — | 40% |
| Group psychotherapy session CPT 90853 PHASE II GROUP FOR PHASE I PATIENTS | $48.00 | $80.00 | — | 21% below | 40% |
| Group psychotherapy session CPT 90853 PHASE II GROUP FOR NON PHASE I PATIENTS | $48.00 | $80.00 | — | 21% below | 40% |
| Group psychotherapy session CPT 90853 PHASE I | $138.00 | $230.00 | — | 127% above | 40% |
| Group psychotherapy session inpatient CPT 90853 PHASE II GROUP FOR NON PHASE I PATIENTS | $48.00 | $80.00 | — | — | 40% |
| Group psychotherapy session inpatient CPT 90853 PHASE II GROUP FOR PHASE I PATIENTS | $48.00 | $80.00 | — | — | 40% |
| Group psychotherapy session inpatient CPT 90853 PHASE I | $138.00 | $230.00 | — | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION 31 MINS-1 HR | $162.60 | $271.00 | — | 23% below | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION ONLY 31 MIN-1 HR | $166.80 | $278.00 | — | 21% below | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION INIT 31-60 MIN | $166.80 | $278.00 | — | 21% below | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION INITIAL 31 MINS-1 HR | $166.80 | $278.00 | — | 21% below | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OBV/PPR-IV HYDRATION 31 MIN-1 HR | $166.80 | $278.00 | — | 21% below | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION INITIAL 31-60 MIN | $166.80 | $278.00 | — | 21% below | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 WHC IV HYDRATION 31- 60 MINUTES | $228.00 | $380.00 | — | 8% above | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION 31 MINS-1 HR | $162.60 | $271.00 | — | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION INIT 31-60 MIN | $166.80 | $278.00 | — | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 OBV/PPR-IV HYDRATION 31 MIN-1 HR | $166.80 | $278.00 | — | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION INITIAL 31 MINS-1 HR | $166.80 | $278.00 | — | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION INITIAL 31-60 MIN | $166.80 | $278.00 | — | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION ONLY 31 MIN-1 HR | $166.80 | $278.00 | — | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 WHC IV HYDRATION 31- 60 MINUTES | $228.00 | $380.00 | — | — | 40% |
| IV infusion of a medicine, first hour CPT 96365 OBV/PPR-IV DRUGS 0-1 HR | $401.40 | $669.00 | — | 23% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 IV THERAPY INITIAL 0-1 HR | $401.40 | $669.00 | — | 23% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 IV DRUG THERAPY INITIAL 0-1 HRS | $401.40 | $669.00 | — | 23% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 IV DRUG INFUSION INITIAL 0-60 MIN | $401.40 | $669.00 | — | 23% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 IV INFUSION INITIAL UP TO 1 HR | $401.40 | $669.00 | — | 23% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 IV THERAPY 0-1HR | $401.40 | $669.00 | — | 23% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 IV DRUG INFUSION INITIAL 0-1 HR | $401.40 | $669.00 | — | 23% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 SPP IV DRUG INFUSION 0-1 HR 96365 | $401.40 | $669.00 | — | 23% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 IV DRUG INF 0-1 HR INIT THERAPEUTIC | $401.40 | $669.00 | — | 23% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 WHC IV DRUGS 0-1 HR | $401.40 | $669.00 | — | 23% above | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION INITIAL UP TO 1 HR | $401.40 | $669.00 | — | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV DRUG INF 0-1 HR INIT THERAPEUTIC | $401.40 | $669.00 | — | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 WHC IV DRUGS 0-1 HR | $401.40 | $669.00 | — | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 SPP IV DRUG INFUSION 0-1 HR 96365 | $401.40 | $669.00 | — | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV DRUG INFUSION INITIAL 0-1 HR | $401.40 | $669.00 | — | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY 0-1HR | $401.40 | $669.00 | — | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV DRUG INFUSION INITIAL 0-60 MIN | $401.40 | $669.00 | — | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV DRUG THERAPY INITIAL 0-1 HRS | $401.40 | $669.00 | — | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY INITIAL 0-1 HR | $401.40 | $669.00 | — | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 OBV/PPR-IV DRUGS 0-1 HR | $401.40 | $669.00 | — | — | 40% |
| IV push of a medicine, first drug CPT 96374 IV PUSH MED | $401.40 | $669.00 | — | 104% above | 40% |
| IV push of a medicine, first drug CPT 96374 IV drug push,init. </=15 | $401.40 | $669.00 | — | 104% above | 40% |
| IV push of a medicine, first drug CPT 96374 OBV/PPR-IV PUSH MED INITIAL DOSE | $401.40 | $669.00 | — | 104% above | 40% |
| IV push of a medicine, first drug CPT 96374 IV drug push,init.</=15" | $401.40 | $669.00 | — | 104% above | 40% |
| IV push of a medicine, first drug CPT 96374 IV PUSH MEDICATION - OP/OBSV | $401.40 | $669.00 | — | 104% above | 40% |
| IV push of a medicine, first drug CPT 96374 IV DRUG PUSH INITIAL | $401.40 | $669.00 | — | 104% above | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 IV drug push,init.</=15" | $401.40 | $669.00 | — | — | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 OBV/PPR-IV PUSH MED INITIAL DOSE | $401.40 | $669.00 | — | — | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 IV drug push,init. </=15 | $401.40 | $669.00 | — | — | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 IV PUSH MEDICATION - OP/OBSV | $401.40 | $669.00 | — | — | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 IV DRUG PUSH INITIAL | $401.40 | $669.00 | — | — | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 IV PUSH MED | $401.40 | $669.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IR RAD INJECT THERAPEUTIC SC/IM | $76.20 | $127.00 | — | 10% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION- MUSCLE/SUBCUT | $124.80 | $208.00 | — | 81% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER IM therapeutic/prophylactic injection | $124.80 | $208.00 | — | 81% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPUTIC/DX INJECTION | $124.80 | $208.00 | — | 81% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC INJECTION | $124.80 | $208.00 | — | 81% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 MEDICATION INJECTION (OP/OBSV) | $124.80 | $208.00 | — | 81% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 OBSV SC/IM INJECTION | $124.80 | $208.00 | — | 81% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION FACILITY CHG | $124.80 | $208.00 | — | 81% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IR RAD INJECT THERAPEUTIC SC/IM 96372 | $124.80 | $208.00 | — | 81% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 MEDICATION INJECT MP (IM/SQ) | $124.80 | $208.00 | — | 81% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION | $124.80 | $208.00 | — | 81% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 WELLS IM therapeutic/prophylactic inject | $124.80 | $208.00 | — | 81% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SC INJECTION | $124.80 | $208.00 | — | 81% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IR RAD INJECT THERAPEUTIC SC/IM | $76.20 | $127.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION- MUSCLE/SUBCUT | $124.80 | $208.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPUTIC/DX INJECTION | $124.80 | $208.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 WELLS IM therapeutic/prophylactic inject | $124.80 | $208.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IR RAD INJECT THERAPEUTIC SC/IM 96372 | $124.80 | $208.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC INJECTION | $124.80 | $208.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION FACILITY CHG | $124.80 | $208.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION | $124.80 | $208.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SC INJECTION | $124.80 | $208.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ER IM therapeutic/prophylactic injection | $124.80 | $208.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 MEDICATION INJECT MP (IM/SQ) | $124.80 | $208.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 OBSV SC/IM INJECTION | $124.80 | $208.00 | — | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 MEDICATION INJECTION (OP/OBSV) | $124.80 | $208.00 | — | — | 40% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 INITIAL DIAGNOSTIC EVALUATION | $165.00 | $275.00 | — | 23% below | 40% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 INITIAL DIAGNOSTIC EVALUATION | $165.00 | $275.00 | — | — | 40% |
| New patient office visit, about 30 minutes CPT 99203 ONCOLOGY CLINIC NEW PT LEVEL 3 | $118.80 | $198.00 | — | 17% below | 40% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE VST NEW LEVEL III | $188.40 | $314.00 | — | 31% above | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 ONCOLOGY CLINIC NEW PT LEVEL 3 | $118.80 | $198.00 | — | — | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VST NEW LEVEL III | $188.40 | $314.00 | — | — | 40% |
| New patient office visit, about 45 minutes CPT 99204 ONCOLOGY CLINIC NEW PT LEVEL 4 | $148.20 | $247.00 | — | 29% below | 40% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE VST NEW LEVEL IV | $241.20 | $402.00 | — | 15% above | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 ONCOLOGY CLINIC NEW PT LEVEL 4 | $148.20 | $247.00 | — | — | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE VST NEW LEVEL IV | $241.20 | $402.00 | — | — | 40% |
| New patient office visit, about 60 minutes CPT 99205 ONCOLOGY CLINIC NEW PT LEVEL 5 | $189.00 | $315.00 | — | 43% below | 40% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE VST NEW LEVEL V | $289.80 | $483.00 | — | 12% below | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 ONCOLOGY CLINIC NEW PT LEVEL 5 | $189.00 | $315.00 | — | — | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE VST NEW LEVEL V | $289.80 | $483.00 | — | — | 40% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 ONCOLOGY CLINIC NEW PT LEVEL 2 | $88.20 | $147.00 | — | at median | 40% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE VST NEW LEVEL II | $184.80 | $308.00 | — | 110% above | 40% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 ONCOLOGY CLINIC NEW PT LEVEL 2 | $88.20 | $147.00 | — | — | 40% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE VST NEW LEVEL II | $184.80 | $308.00 | — | — | 40% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRUTION THERAPY IND 15 MIN | $46.80 | $78.00 | — | 2% above | 40% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MEDICAL NUTRUTION THERAPY IND 15 MIN | $46.80 | $78.00 | — | — | 40% |
| Psychotherapy session, 30 minutes CPT 90832 PYSCHOTHERAPY 30 MIN W/WO FAMILY | $57.60 | $96.00 | — | 57% below | 40% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PYSCHOTHERAPY 30 MIN W/WO FAMILY | $57.60 | $96.00 | — | — | 40% |
| Psychotherapy session, 45 minutes CPT 90834 PYSCHOTHERAPY 45 MIN W/WO FAMILY | $84.60 | $141.00 | — | 51% below | 40% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PYSCHOTHERAPY 45 MIN W/WO FAMILY | $84.60 | $141.00 | — | — | 40% |
| Psychotherapy session, 60 minutes CPT 90837 PYSCHOTHERAPY 60 MIN W/WO FAMILY | $110.40 | $184.00 | — | 35% below | 40% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PYSCHOTHERAPY 60 MIN W/WO FAMILY | $110.40 | $184.00 | — | — | 40% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION E3DUCATION < 10 MIN | $30.60 | $51.00 | — | 23% above | 40% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHANGE SMOKING 3-10 MIN | $36.00 | $60.00 | — | 45% above | 40% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION E3DUCATION < 10 MIN | $30.60 | $51.00 | — | — | 40% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHANGE SMOKING 3-10 MIN | $36.00 | $60.00 | — | — | 40% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 ONCOLOGY CLINIC LEVEL V | $141.60 | $236.00 | — | 3% below | 40% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VST EST LEVEL V | $265.20 | $442.00 | — | 83% above | 40% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ONCOLOGY CLINIC LEVEL V | $141.60 | $236.00 | — | — | 40% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE VST EST LEVEL V | $265.20 | $442.00 | — | — | 40% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VST EST LEVEL III | $71.40 | $119.00 | — | 2% below | 40% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 ONCOLOGY CLINIC LEVEL III | $91.80 | $153.00 | — | 25% above | 40% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 NURSING LEVEL III | $500.40 | $834.00 | — | 584% above | 40% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE VST EST LEVEL III | $71.40 | $119.00 | — | — | 40% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ONCOLOGY CLINIC LEVEL III | $91.80 | $153.00 | — | — | 40% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 NURSING LEVEL III | $500.40 | $834.00 | — | — | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ONCOLOGY CLINIC LEVEL IV | $144.00 | $240.00 | — | 36% above | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VST EST LEVEL IV | $196.20 | $327.00 | — | 86% above | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ONCOLOGY CLINIC LEVEL IV | $144.00 | $240.00 | — | — | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE VST EST LEVEL IV | $196.20 | $327.00 | — | — | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 IR OUTPT EST VISIT LEVEL II 99212 | $46.80 | $78.00 | — | 17% below | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ONCOLOGY CLINIC LEVEL II | $77.40 | $129.00 | — | 38% above | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VST EST LEVEL II | $108.00 | $180.00 | — | 92% above | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 NURSING LEVEL II | $281.40 | $469.00 | — | 400% above | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 IR OUTPT EST VISIT LEVEL II 99212 | $46.80 | $78.00 | — | — | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ONCOLOGY CLINIC LEVEL II | $77.40 | $129.00 | — | — | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE VST EST LEVEL II | $108.00 | $180.00 | — | — | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 NURSING LEVEL II | $281.40 | $469.00 | — | — | 40% |
| Spirometry (breathing test) CPT 94010 KFP SPIROMETRY | $54.60 | $91.00 | — | 61% below | 40% |
| Spirometry (breathing test) CPT 94010 INCENTIVE SPIROMETRY | $78.00 | $130.00 | — | 45% below | 40% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY | $190.80 | $318.00 | — | 35% above | 40% |
| Spirometry (breathing test) inpatient CPT 94010 KFP SPIROMETRY | $54.60 | $91.00 | — | — | 40% |
| Spirometry (breathing test) inpatient CPT 94010 INCENTIVE SPIROMETRY | $78.00 | $130.00 | — | — | 40% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY | $190.80 | $318.00 | — | — | 40% |
| Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY W/ BRONCHODILATOR | $288.60 | $481.00 | — | 10% below | 40% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY W/ BRONCHODILATOR | $288.60 | $481.00 | — | — | 40% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY (THERAPEUTIC) | $234.00 | $390.00 | — | 51% above | 40% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY | $234.00 | $390.00 | — | 51% above | 40% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY (THERAPEUTIC) | $234.00 | $390.00 | — | — | 40% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY | $234.00 | $390.00 | — | — | 40% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Maine | Off list |
|---|---|---|---|---|---|
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 MODERNA COVID MRNA LNP 50 MCG | $258.00 | $430.00 | — | 61% above | 40% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SPIKEVAX VAC 50MCG/0.5ML PFS | $538.20 | $897.00 | — | 236% above | 40% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SPIKEVAX VAC 50MCG/0.25ML PFS | $538.20 | $897.00 | — | 236% above | 40% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 MODERNA COVID MRNA LNP 50 MCG | $258.00 | $430.00 | — | — | 40% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SPIKEVAX VAC 50MCG/0.5ML PFS | $538.20 | $897.00 | — | — | 40% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SPIKEVAX VAC 50MCG/0.25ML PFS | $538.20 | $897.00 | — | — | 40% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 PFIZER COVID VAC MRNA LNP 30MCG | $233.40 | $389.00 | — | — | 40% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 PFIZER COVID VAC MRNA LNP 30MCG | $233.40 | $389.00 | — | — | 40% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE SC | $162.60 | $271.00 | — | 5% above | 40% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE SC | $162.60 | $271.00 | — | — | 40% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV VACC 4-6 YR IM | $62.40 | $104.00 | — | at median | 40% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DIPH,PERTUS(ACEL),TET,POL (PF) VACCINE | $355.80 | $593.00 | — | 470% above | 40% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP-IPV VACC 4-6 YR IM | $62.40 | $104.00 | — | — | 40% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DIPH,PERTUS(ACEL),TET,POL (PF) VACCINE | $355.80 | $593.00 | — | — | 40% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP VACCINE <7 YRS IM | $25.80 | $43.00 | — | 9% above | 40% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP VACCINE <7 YRS IM | $25.80 | $43.00 | — | — | 40% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HEP B-DP(ACELL)T-POLIO VACCINE-PF | $529.20 | $882.00 | — | 345% above | 40% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HEP B-DP(ACELL)T-POLIO VACCINE-PF | $529.20 | $882.00 | — | — | 40% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-HIB-IP VACCINE IM | $90.60 | $151.00 | — | 34% above | 40% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DP(A)T-POLIO-HIB CONJ-TET (PF) VACCINE | $606.00 | $1,010.00 | — | 793% above | 40% |
| DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP-HIB-IP VACCINE IM | $90.60 | $151.00 | — | — | 40% |
| DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DP(A)T-POLIO-HIB CONJ-TET (PF) VACCINE | $606.00 | $1,010.00 | — | — | 40% |
| Flu shot, recombinant, egg-free (Flublok) CPT 90673 FLU VAC NO PRSV RIV3 | $60.00 | $100.00 | — | 8% below | 40% |
| Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 FLU VAC NO PRSV RIV3 | $60.00 | $100.00 | — | — | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACCINE | $21.00 | $35.00 | — | 5% below | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE NO PRESERV 3 & > | $21.00 | $35.00 | — | 5% below | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLULAVAL-TRI 90656 | $21.00 | $35.00 | — | 5% below | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACCINE | $21.00 | $35.00 | — | — | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLULAVAL-TRI 90656 | $21.00 | $35.00 | — | — | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE NO PRESERV 3 & > | $21.00 | $35.00 | — | — | 40% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV VACCINE 9 VALENT IM | $244.80 | $408.00 | — | 65% above | 40% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV VACCINE 9 VALENT IM | $244.80 | $408.00 | — | — | 40% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEP A/HEP B VACC ADULT IM | $183.60 | $306.00 | — | 43% above | 40% |
| Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEP A/HEP B VACC ADULT IM | $183.60 | $306.00 | — | — | 40% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE, ADULT IM | $64.80 | $108.00 | — | 34% below | 40% |
| Hepatitis A vaccine, adult dose CPT 90632 HAVRIX HEPATITIS A VACCINE 1ML SY | $497.70 | $829.50 | — | 408% above | 40% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE, ADULT IM | $64.80 | $108.00 | — | — | 40% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HAVRIX HEPATITIS A VACCINE 1ML SY | $497.70 | $829.50 | — | — | 40% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEP A VACC PED/ADOL 2 DOSE | $39.60 | $66.00 | — | 7% above | 40% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE 720U PEDI | $221.70 | $369.50 | — | 501% above | 40% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEP A VACC PED/ADOL 2 DOSE | $39.60 | $66.00 | — | — | 40% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VACCINE 720U PEDI | $221.70 | $369.50 | — | — | 40% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VACC, ADULT IM | $78.00 | $130.00 | — | 23% above | 40% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 ER HEP-B SERIES NON-EMP | $184.20 | $307.00 | — | 190% above | 40% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VACC, ADULT IM | $78.00 | $130.00 | — | — | 40% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 ER HEP-B SERIES NON-EMP | $184.20 | $307.00 | — | — | 40% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPB VACCINE 2 DOSE ADULT IM | $157.20 | $262.00 | — | 17% below | 40% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEPB VACCINE 2 DOSE ADULT IM | $157.20 | $262.00 | — | — | 40% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPB VACC PED/ADOL 3 DOSE IM | $34.80 | $58.00 | — | 1% below | 40% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPITITIS B VACCINE 5MCG/0.5ML SDV | $177.90 | $296.50 | — | 404% above | 40% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPB VACC PED/ADOL 3 DOSE IM | $34.80 | $58.00 | — | — | 40% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPITITIS B VACCINE 5MCG/0.5ML SDV | $177.90 | $296.50 | — | — | 40% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HIB VACCINE PRP-OMP IM | $33.60 | $56.00 | — | 2% above | 40% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HIB VACCINE PRP-OMP IM | $33.60 | $56.00 | — | — | 40% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIB VACCINE PRP-T IM | $64.20 | $107.00 | — | 224% above | 40% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HIB VACCINE PRP-T IM | $64.20 | $107.00 | — | — | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VAC NO PRSV INC ANTIG | $60.00 | $100.00 | — | 16% below | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VAC NO PRSV INC ANTIG 90662 | $60.00 | $100.00 | — | 16% below | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACCINE PF 4 VAL .5 ML | $60.00 | $100.00 | — | 16% below | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VACCINE PF 4 VAL .5 ML | $60.00 | $100.00 | — | — | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VAC NO PRSV INC ANTIG 90662 | $60.00 | $100.00 | — | — | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VAC NO PRSV INC ANTIG | $60.00 | $100.00 | — | — | 40% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE SC | $87.60 | $146.00 | — | 32% below | 40% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR VACCINE SC | $87.60 | $146.00 | — | — | 40% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MMRV VACCINE SC | $215.40 | $359.00 | — | 5% below | 40% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MEASLES,MUMPS,RUB,VARICEL(PF) VACCINE | $540.30 | $900.50 | — | 139% above | 40% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MMRV VACCINE SC | $215.40 | $359.00 | — | — | 40% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MEASLES,MUMPS,RUB,VARICEL(PF) VACCINE | $540.30 | $900.50 | — | — | 40% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENIGCCAL CONJUGATE VACCINE | $136.20 | $227.00 | — | 32% above | 40% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENIGCCAL CONJUGATE VACCINE | $136.20 | $227.00 | — | — | 40% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 BEXSERO | $237.60 | $396.00 | — | 23% above | 40% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 BEXSERO | $237.60 | $396.00 | — | — | 40% |
| Meningococcal B vaccine (Trumenba) CPT 90621 TRUMENBA | $171.00 | $285.00 | — | — | 40% |
| Meningococcal B vaccine (Trumenba) inpatient CPT 90621 TRUMENBA | $171.00 | $285.00 | — | — | 40% |
| Mpox and smallpox vaccine (Jynneos), 2-dose schedule CPT 90611 SMALLPOX MONKEYPOX VAC 0.5ML | $303.00 | $505.00 | — | — | 40% |
| Mpox and smallpox vaccine (Jynneos), 2-dose schedule inpatient CPT 90611 SMALLPOX MONKEYPOX VAC 0.5ML | $303.00 | $505.00 | — | — | 40% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL VACC 13 VAL IM | $228.00 | $380.00 | — | 28% below | 40% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOC 13-VAL CONJ-DIP CR (PF) VACCINE | $477.30 | $795.50 | — | 51% above | 40% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL VACC 13 VAL IM | $228.00 | $380.00 | — | — | 40% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOC 13-VAL CONJ-DIP CR (PF) VACCINE | $477.30 | $795.50 | — | — | 40% |
| Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 PCV15 VACCINE IM | $360.00 | $600.00 | — | — | 40% |
| Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 PCV15 VACCINE IM | $360.00 | $600.00 | — | — | 40% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE IM | $385.80 | $643.00 | — | at median | 40% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PCV20 VACCINE IM | $385.80 | $643.00 | — | — | 40% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 PCV21 VACCINE | $414.00 | $690.00 | — | 106% above | 40% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 PCV21 VACCINE | $414.00 | $690.00 | — | — | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 ERS PNEUMONIA SHOT | $90.60 | $151.00 | — | 6% below | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACCINE | $114.00 | $190.00 | — | 19% above | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 ERS PNEUMONIA SHOT | $90.60 | $151.00 | — | — | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACCINE | $114.00 | $190.00 | — | — | 40% |
| Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS IPV SC/IM | $43.20 | $72.00 | — | at median | 40% |
| Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOVIRUS IPV SC/IM | $43.20 | $72.00 | — | — | 40% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 RSV BEYFORTUS 1.0 ML | $525.60 | $876.00 | — | at median | 40% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 RSV BEYFORTUS 1.0 ML | $525.60 | $876.00 | — | — | 40% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 RSV BEYFORTUS 0.5 ML | $525.60 | $876.00 | — | — | 40% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 RSV BEYFORTUS 0.5 ML | $525.60 | $876.00 | — | — | 40% |
| Rabies vaccine, one dose CPT 90675 RABIIES VACCINE IM | $367.80 | $613.00 | — | 51% below | 40% |
| Rabies vaccine, one dose CPT 90675 WELLS RABIES VACCINE | $442.80 | $738.00 | — | 40% below | 40% |
| Rabies vaccine, one dose CPT 90675 ERS RABIES VACCINE | $442.80 | $738.00 | — | 40% below | 40% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIIES VACCINE IM | $367.80 | $613.00 | — | — | 40% |
| Rabies vaccine, one dose inpatient CPT 90675 WELLS RABIES VACCINE | $442.80 | $738.00 | — | — | 40% |
| Rabies vaccine, one dose inpatient CPT 90675 ERS RABIES VACCINE | $442.80 | $738.00 | — | — | 40% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTAVIRUS VACC 2 DOSE ORAL | $124.20 | $207.00 | — | 20% above | 40% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTAVIRUS VACCINE, LIVE ATT, 89-12 | $404.70 | $674.50 | — | 290% above | 40% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 ROTAVIRUS VACC 2 DOSE ORAL | $124.20 | $207.00 | — | — | 40% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 ROTAVIRUS VACCINE, LIVE ATT, 89-12 | $404.70 | $674.50 | — | — | 40% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTOVIRUS VACC 3 DOSE ORAL | $85.20 | $142.00 | — | 19% above | 40% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VACCINE LIVE, PENTA | $565.80 | $943.00 | — | 693% above | 40% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTOVIRUS VACC 3 DOSE ORAL | $85.20 | $142.00 | — | — | 40% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS VACCINE LIVE, PENTA | $565.80 | $943.00 | — | — | 40% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HZV VACC RECOMBINANT IM NJX | $206.40 | $344.00 | — | 140% above | 40% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HZV VACC RECOMBINANT IM NJX | $206.40 | $344.00 | — | — | 40% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACCINE NO PRSRV 7/> IM | $109.20 | $182.00 | — | 166% above | 40% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACCINE NO PRSRV 7/> IM | $109.20 | $182.00 | — | — | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE >7 YEARS OLD IM | $48.00 | $80.00 | — | 7% above | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE >7 YEARS OLD IM | $48.00 | $80.00 | — | — | 40% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VACCINE IM | $120.60 | $201.00 | — | 18% below | 40% |
| Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYPHOID VACCINE IM | $120.60 | $201.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 STATE SUPPLIED ADMINISTRATION | $12.90 | $21.50 | — | 27% below | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN | $15.00 | $25.00 | — | 15% below | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION OF FLU VACCINE | $15.00 | $25.00 | — | 15% below | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN FLU | $15.00 | $25.00 | — | 15% below | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATON OF FLU VACCINE | $15.00 | $25.00 | — | 15% below | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMINISTRATION | $35.40 | $59.00 | — | 101% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATITION ADMINISTRATION | $49.80 | $83.00 | — | 182% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION | $49.80 | $83.00 | — | 182% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINATION | $49.80 | $83.00 | — | 182% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vacc/Tox admin initial - 90471 | $49.80 | $83.00 | — | 182% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 STATE SUPPLIED ADMINISTRATION | $12.90 | $21.50 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMINISTRATION OF FLU VACCINE | $15.00 | $25.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMINISTRATON OF FLU VACCINE | $15.00 | $25.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN FLU | $15.00 | $25.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN | $15.00 | $25.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE ADMINISTRATION | $35.40 | $59.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION | $49.80 | $83.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vacc/Tox admin initial - 90471 | $49.80 | $83.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATITION ADMINISTRATION | $49.80 | $83.00 | — | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINATION | $49.80 | $83.00 | — | — | 40% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADDITIONAL STATE SUPPLIED ADMIN | $12.90 | $21.50 | — | 27% below | 40% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD FLU | $15.00 | $25.00 | — | 15% below | 40% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADM MULTIPLE VACCINE | $15.00 | $25.00 | — | 15% below | 40% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vacc/tox admin ea add 90472 | $47.40 | $79.00 | — | 169% above | 40% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADDITIONAL STATE SUPPLIED ADMIN | $12.90 | $21.50 | — | — | 40% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EACH ADD FLU | $15.00 | $25.00 | — | — | 40% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADM MULTIPLE VACCINE | $15.00 | $25.00 | — | — | 40% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vacc/tox admin ea add 90472 | $47.40 | $79.00 | — | — | 40% |
| Yellow fever vaccine, live CPT 90717 YELLOW FEVER VACCINE SUBQ | $129.00 | $215.00 | — | — | 40% |
| Yellow fever vaccine, live inpatient CPT 90717 YELLOW FEVER VACCINE SUBQ | $129.00 | $215.00 | — | — | 40% |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.
Source file: https://www.yorkhospital.com/download_file/view/b51e4a30-f2e2-4e69-a7d1-2ec25eeaa1d7/286