Monogahela Valley Hospital
Monogahela Valley Hospital in Monongahela, PA publishes cash prices for 337 common procedures listed here, from its own machine-readable price file updated Feb 2, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Pennsylvania median for 198 of 335 procedures and below it for 133. By typical cash price it ranks #60 of 108 Pennsylvania hospitals and #13 of 26 hospitals in the Pittsburgh, PA area, cheapest first. Select a procedure to compare it with other hospitals nearby.
1163 Country Club RD. Monongahela, PA 15063 Collected Sep 23, 2026 Source price file Check a bill from this hospital (724) 258-1000
Acute care hospital Nonprofit hospital Emergency department CMS star rating 1 of 5 CCN 390147 · CMS hospital register NPI 1912905548
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Monogahela Valley 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.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Pennsylvania | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT PANCREATIC PROTOCOL | $921.00 | $1,535.00 | $412.92–$1,881.14 | 51% below | 40% |
| Abdominal CT scan without and with contrast CPT 74170 CT ABD W/WO CONTRAST | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 31% below | 40% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT PANCREATIC PROTOCOL | $921.00 | $1,535.00 | $690.75 | — | 40% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABD W/WO CONTRAST | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| Abdominal X-ray, 2 views CPT 74019 PORTABLE ABDOMEN, 2 VIEWS | $192.60 | $321.00 | $86.35–$393.39 | 41% below | 40% |
| Abdominal X-ray, 2 views CPT 74019 OR PORT ABDOMEN, 2 VIEWS | $192.60 | $321.00 | $86.35–$393.39 | 41% below | 40% |
| Abdominal X-ray, 2 views CPT 74019 ABDOMEN, 2 VIEWS | $772.20 | $1,287.00 | $346.20–$1,577.22 | 136% above | 40% |
| Abdominal X-ray, 2 views inpatient CPT 74019 PORTABLE ABDOMEN, 2 VIEWS | $192.60 | $321.00 | $144.45 | — | 40% |
| Abdominal X-ray, 2 views inpatient CPT 74019 OR PORT ABDOMEN, 2 VIEWS | $192.60 | $321.00 | $144.45 | — | 40% |
| Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN, 2 VIEWS | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 PORTABLE ANKLE(ROUTINE)4V RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 76% above | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE(ROUTINE) 4 VIEW LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 76% above | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 PORTABLE ANKLE(ROUTINE)4V LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 76% above | 40% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE(ROUTINE) 4 VIEW RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 76% above | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE(ROUTINE) 4 VIEW RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE(ROUTINE) 4 VIEW LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 PORTABLE ANKLE(ROUTINE)4V LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 PORTABLE ANKLE(ROUTINE)4V RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 US (ABI) ART BILAT LOW LTD | $165.00 | $275.00 | $73.98–$337.01 | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ART UNI LOW-COMPLETE | $165.00 | $275.00 | $73.98–$337.01 | 63% below | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ART UNI UPPER COMPLETE | $165.00 | $275.00 | $73.98–$337.01 | 63% below | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ARTRL VASCULAR EX ANKLE | $936.60 | $1,561.00 | $419.91–$1,913.01 | 109% above | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 US (ABI) ART BILAT LOW LTD | $165.00 | $275.00 | $123.75 | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ART UNI UPPER COMPLETE | $165.00 | $275.00 | $123.75 | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ART UNI LOW-COMPLETE | $165.00 | $275.00 | $123.75 | — | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ARTRL VASCULAR EX ANKLE | $936.60 | $1,561.00 | $702.45 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UPPER EXT WO/CONTRAST RT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 35% below | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UPPER EXT WO/CONTRAST LT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 35% below | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPPER EXT WO/CONTRAST LT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPPER EXT WO/CONTRAST RT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 BARIUM SWALLOW/ESOPHAGUS | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 181% above | 40% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 BA/RHB SWALLOW | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 181% above | 40% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 BA/RHB SWALLOW | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 BARIUM SWALLOW/ESOPHAGUS | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN WHOLE BODY | $504.00 | $840.00 | $225.96–$1,029.42 | 59% below | 40% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE SCAN WHOLE BODY | $504.00 | $840.00 | $378.00 | — | 40% |
| Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE RT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 41% above | 40% |
| Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE LT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 41% above | 40% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE RT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE LT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 39% above | 40% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 39% above | 40% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABD&PELV W/O&W/DYE | $2,594.40 | $4,324.00 | $1,163.16–$5,299.06 | 13% below | 40% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ANGIO ABD&PELV W/O&W/DYE | $2,594.40 | $4,324.00 | $1,945.80 | — | 40% |
| CT angiography (CTA) of the head CPT 70496 CTA STROKE HEAD W/WO CONTRAST | $756.60 | $1,261.00 | $339.21–$1,545.36 | 56% below | 40% |
| CT angiography (CTA) of the head CPT 70496 CTA HEAD W/WO CONTRAST | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 24% below | 40% |
| CT angiography (CTA) of the head inpatient CPT 70496 CTA STROKE HEAD W/WO CONTRAST | $756.60 | $1,261.00 | $567.45 | — | 40% |
| CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD W/WO CONTRAST | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| CT angiography (CTA) of the neck CPT 70498 CTA STROKE NECK W/WO CONTRAST | $756.60 | $1,261.00 | $339.21–$1,545.36 | 55% below | 40% |
| CT angiography (CTA) of the neck CPT 70498 CTA NECK W/WO CONTRAST | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 23% below | 40% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CTA STROKE NECK W/WO CONTRAST | $756.60 | $1,261.00 | $567.45 | — | 40% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK W/WO CONTRAST | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST W/WO CONTRAST | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 33% below | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST W/WO CONTRAST | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CCTA W/WO DYE | $2,594.40 | $4,324.00 | $1,163.16–$5,299.06 | 31% above | 40% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CCTA W/WO DYE | $2,594.40 | $4,324.00 | $1,945.80 | — | 40% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT CALCIUM SCORING | $230.40 | $384.00 | $103.30–$470.59 | 30% above | 40% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HEART WO DYE; QUAL CALC | $639.60 | $1,066.00 | $286.75–$1,306.38 | 262% above | 40% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT CALCIUM SCORING | $230.40 | $384.00 | $172.80 | — | 40% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HEART WO DYE; QUAL CALC | $639.60 | $1,066.00 | $479.70 | — | 40% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS WO CONTRAST | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | 16% below | 40% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS WO CONTRAST | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ENTEROGRAPHY | $1,645.20 | $2,742.00 | $737.60–$3,360.32 | 45% below | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W CONTRAST | $2,594.40 | $4,324.00 | $1,163.16–$5,299.06 | 13% below | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ENTEROGRAPHY | $1,645.20 | $2,742.00 | $1,233.90 | — | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W CONTRAST | $2,594.40 | $4,324.00 | $1,945.80 | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT PELVIS WO & ABD W CONTST | $1,915.20 | $3,192.00 | $858.65–$3,911.80 | 36% below | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT PELVIS W & ABD W&WO CONTRAS | $1,915.20 | $3,192.00 | $858.65–$3,911.80 | 36% below | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT PELVIS W & ABD WO CONTRAST | $1,915.20 | $3,192.00 | $858.65–$3,911.80 | 36% below | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT PELVIS WO & ABD W&WO CONTST | $1,915.20 | $3,192.00 | $858.65–$3,911.80 | 36% below | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT PELVIS W&W/O & ABD W CONTRA | $1,915.20 | $3,192.00 | $858.65–$3,911.80 | 36% below | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT PELVIS W&W/O & ABD WO CONTR | $1,915.20 | $3,192.00 | $858.65–$3,911.80 | 36% below | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD & PELVIS W & WO CONTRAS | $2,594.40 | $4,324.00 | $1,163.16–$5,299.06 | 13% below | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT PELVIS W&W/O & ABD W CONTRA | $1,915.20 | $3,192.00 | $1,436.40 | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT PELVIS WO & ABD W CONTST | $1,915.20 | $3,192.00 | $1,436.40 | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT PELVIS WO & ABD W&WO CONTST | $1,915.20 | $3,192.00 | $1,436.40 | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT PELVIS W & ABD WO CONTRAST | $1,915.20 | $3,192.00 | $1,436.40 | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT PELVIS W & ABD W&WO CONTRAS | $1,915.20 | $3,192.00 | $1,436.40 | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT PELVIS W&W/O & ABD WO CONTR | $1,915.20 | $3,192.00 | $1,436.40 | — | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD & PELVIS W & WO CONTRAS | $2,594.40 | $4,324.00 | $1,945.80 | — | 40% |
| CT scan of the abdomen with contrast CPT 74160 CT ABD W/ CONTRAST | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 22% below | 40% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABD W/ CONTRAST | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| CT scan of the abdomen without contrast CPT 74150 CT ABD W/O CONTRAST | $772.20 | $1,287.00 | $346.20–$1,577.22 | 32% below | 40% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD W/O CONTRAST | $772.20 | $1,287.00 | $579.15 | — | 40% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL WO/CONTRAST | $772.20 | $1,287.00 | $346.20–$1,577.22 | 31% below | 40% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL WO/CONTRAST | $772.20 | $1,287.00 | $579.15 | — | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/STROKE W/O CONTRAST | $513.60 | $856.00 | $230.26–$1,049.03 | 53% below | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO/CONTRAST | $772.20 | $1,287.00 | $346.20–$1,577.22 | 29% below | 40% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/STROKE W/O CONTRAST | $513.60 | $856.00 | $385.20 | — | 40% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO/CONTRAST | $772.20 | $1,287.00 | $579.15 | — | 40% |
| CT scan of the head with contrast CPT 70460 CT HEAD W/CONTRAST | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 4% below | 40% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/CONTRAST | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD W/WO CONTRAST | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 23% below | 40% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/WO CONTRAST | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMB SPINE W/O CONTRAST | $991.20 | $1,652.00 | $444.39–$2,024.53 | 14% below | 40% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMB SPINE W/O CONTRAST | $991.20 | $1,652.00 | $743.40 | — | 40% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERV SPINE W/O CONTRAST | $972.60 | $1,621.00 | $436.05–$1,986.54 | 18% below | 40% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERV SPINE W/O CONTRAST | $972.60 | $1,621.00 | $729.45 | — | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 24% below | 40% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US CAROTID ART DUPLEX | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | 117% above | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US CAROTID ART DUPLEX | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| Chest CT scan without and with contrast CPT 71270 CT CHEST W/WO CONTRAST | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 20% below | 40% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST W/WO CONTRAST | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| Chest X-ray, 2 views CPT 71046 PORTABLE CHEST, 2 VIEWS | $112.80 | $188.00 | $50.57–$230.39 | 65% below | 40% |
| Chest X-ray, 2 views CPT 71046 OR PORT CHEST, 2 VIEWS | $112.80 | $188.00 | $50.57–$230.39 | 65% below | 40% |
| Chest X-ray, 2 views CPT 71046 CHEST, 2 VIEWS | $639.60 | $1,066.00 | $286.75–$1,306.38 | 98% above | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 PORTABLE CHEST, 2 VIEWS | $112.80 | $188.00 | $84.60 | — | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 OR PORT CHEST, 2 VIEWS | $112.80 | $188.00 | $84.60 | — | 40% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST, 2 VIEWS | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Chest X-ray, single view CPT 71045 OR PORT CHEST, 1 VIEW | $112.80 | $188.00 | $50.57–$230.39 | 40% below | 40% |
| Chest X-ray, single view CPT 71045 PORTABLE CHEST, 1 VIEW | $112.80 | $188.00 | $50.57–$230.39 | 40% below | 40% |
| Chest X-ray, single view CPT 71045 CHEST, 1 VIEW | $639.60 | $1,066.00 | $286.75–$1,306.38 | 239% above | 40% |
| Chest X-ray, single view inpatient CPT 71045 OR PORT CHEST, 1 VIEW | $112.80 | $188.00 | $84.60 | — | 40% |
| Chest X-ray, single view inpatient CPT 71045 PORTABLE CHEST, 1 VIEW | $112.80 | $188.00 | $84.60 | — | 40% |
| Chest X-ray, single view inpatient CPT 71045 CHEST, 1 VIEW | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 123% above | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 123% above | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE(RECHECK)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 123% above | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE(RECHECK)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 123% above | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 OR PORT CLAVICLE RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 123% above | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 PORTABLE CLAVICLE LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 123% above | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 OR PORT CLAVICLE LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 123% above | 40% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 PORTABLE CLAVICLE RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 123% above | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 PORTABLE CLAVICLE RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE(RECHECK)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE(RECHECK)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 PORTABLE CLAVICLE LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 OR PORT CLAVICLE RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 OR PORT CLAVICLE LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US KIDNEYS & AORTA | $772.20 | $1,287.00 | $346.20–$1,577.22 | 6% above | 40% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US KIDNEYS & AORTA | $772.20 | $1,287.00 | $579.15 | — | 40% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY | $202.80 | $338.00 | $90.92–$414.22 | 25% below | 40% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY | $202.80 | $338.00 | $152.10 | — | 40% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) one side CPT 77081 WRIST DEXA RIGHT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 254% above | 40% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) one side CPT 77081 WRIST DEXA LEFT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 254% above | 40% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient one side CPT 77081 WRIST DEXA LEFT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient one side CPT 77081 WRIST DEXA RIGHT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT LUNG CA LOW DOSE FOLLOWUP | $513.60 | $856.00 | $230.26–$1,049.03 | 53% below | 40% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT STERNUM(THORAX)WO CONTRAST | $513.60 | $856.00 | $230.26–$1,049.03 | 53% below | 40% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST | $513.60 | $856.00 | $230.26–$1,049.03 | 53% below | 40% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX W/O CONTRAST | $799.20 | $1,332.00 | $358.31–$1,632.37 | 27% below | 40% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTRAST | $513.60 | $856.00 | $385.20 | — | 40% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT STERNUM(THORAX)WO CONTRAST | $513.60 | $856.00 | $385.20 | — | 40% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT LUNG CA LOW DOSE FOLLOWUP | $513.60 | $856.00 | $385.20 | — | 40% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX W/O CONTRAST | $799.20 | $1,332.00 | $599.40 | — | 40% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT STERNUM W/ CONTRAST | $625.20 | $1,042.00 | $280.30–$1,276.97 | 56% below | 40% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/ CONTRAST | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 9% below | 40% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT STERNUM W/ CONTRAST | $625.20 | $1,042.00 | $468.90 | — | 40% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/ CONTRAST | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DX BILATERAL | $278.40 | $464.00 | $124.82–$568.63 | — | 40% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO POSTPROCEDURAL BILATERAL | $289.20 | $482.00 | $129.66–$590.69 | — | 40% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO PREPROCEDURAL BILATERAL | $708.00 | $1,180.00 | $317.42–$1,446.09 | — | 40% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO DX BILATERAL | $278.40 | $464.00 | $208.80 | — | 40% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO POSTPROCEDURAL BILATERAL | $289.20 | $482.00 | $216.90 | — | 40% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO PREPROCEDURAL BILATERAL | $708.00 | $1,180.00 | $531.00 | — | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO POSTPROCEDURAL LT | $217.80 | $363.00 | $97.65–$444.86 | 31% below | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO DX UNILATERAL RT | $217.80 | $363.00 | $97.65–$444.86 | 31% below | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO DX UNILATERAL LT | $217.80 | $363.00 | $97.65–$444.86 | 31% below | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO POSTPROCEDURAL RT | $217.80 | $363.00 | $97.65–$444.86 | 31% below | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO PREPROCEDURAL RT | $556.20 | $927.00 | $249.36–$1,136.04 | 76% above | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO PREPROCEDURAL LT | $556.20 | $927.00 | $249.36–$1,136.04 | 76% above | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO DX UNILATERAL RT | $217.80 | $363.00 | $163.35 | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO DX UNILATERAL LT | $217.80 | $363.00 | $163.35 | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO POSTPROCEDURAL RT | $217.80 | $363.00 | $163.35 | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO POSTPROCEDURAL LT | $217.80 | $363.00 | $163.35 | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO PREPROCEDURAL RT | $556.20 | $927.00 | $417.15 | — | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO PREPROCEDURAL LT | $556.20 | $927.00 | $417.15 | — | 40% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US DUPLEX BILAT LOWER ARTERIAL | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | — | 40% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US DUPLEX BILAT LOWER ARTERIAL | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS DUPLEX UPPER EXT-BILAT | $316.20 | $527.00 | $141.76–$645.84 | — | 40% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS DUPLEX LOWER EXT BILAT | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | — | 40% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 US VENOUS POST ABLATION F/U | $303.00 | $505.00 | $135.84–$618.88 | 65% below | 40% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 US VENOUS REFLUX STUDY LE | $316.20 | $527.00 | $141.76–$645.84 | 64% below | 40% |
| Duplex ultrasound of the leg veins, both legs one side CPT 93970 US VENOUS POST ABLATION F/U RT | $303.00 | $505.00 | $135.84–$618.88 | 65% below | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VENOUS DUPLEX UPPER EXT-BILAT | $316.20 | $527.00 | $237.15 | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VENOUS DUPLEX LOWER EXT BILAT | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US VENOUS POST ABLATION F/U | $303.00 | $505.00 | $227.25 | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US VENOUS REFLUX STUDY LE | $316.20 | $527.00 | $237.15 | — | 40% |
| Duplex ultrasound of the leg veins, both legs inpatient one side CPT 93970 US VENOUS POST ABLATION F/U RT | $303.00 | $505.00 | $227.25 | — | 40% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO REAL-TI M-MD | $3,982.80 | $6,638.00 | $1,785.62–$8,134.87 | 112% above | 40% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO REAL-TI M-MD | $3,982.80 | $6,638.00 | $2,987.10 | — | 40% |
| Elbow X-ray, 2 views one side CPT 73070 PORTABLE ELBOW(RECHECK) LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 110% above | 40% |
| Elbow X-ray, 2 views one side CPT 73070 PORTABLE ELBOW (2 VIEW) RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 110% above | 40% |
| Elbow X-ray, 2 views one side CPT 73070 ELBOW(2VIEW)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 110% above | 40% |
| Elbow X-ray, 2 views one side CPT 73070 OR PORT ELBOW (2 VIEW) RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 110% above | 40% |
| Elbow X-ray, 2 views one side CPT 73070 PORTABLE ELBOW(RECHECK) RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 110% above | 40% |
| Elbow X-ray, 2 views one side CPT 73070 OR PORT ELBOW(2VIEW)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 110% above | 40% |
| Elbow X-ray, 2 views one side CPT 73070 ELBOW(RECHECK)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 110% above | 40% |
| Elbow X-ray, 2 views one side CPT 73070 ELBOW(2VIEW)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 110% above | 40% |
| Elbow X-ray, 2 views one side CPT 73070 ELBOW(RECHECK)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 110% above | 40% |
| Elbow X-ray, 2 views one side CPT 73070 PORTABLE ELBOW(2VIEW)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 110% above | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW(2VIEW)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 OR PORT ELBOW (2 VIEW) RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 OR PORT ELBOW(2VIEW)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW(RECHECK)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW(RECHECK)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW(2VIEW)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 PORTABLE ELBOW(RECHECK) RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 PORTABLE ELBOW (2 VIEW) RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 PORTABLE ELBOW(RECHECK) LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 PORTABLE ELBOW(2VIEW)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW (ROUTINE)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 85% above | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 PORTABLE ELBOW (ROUTINE) RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 85% above | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW(ROUTINE)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 85% above | 40% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 PORTABLE ELBOW(ROUTINE) LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 85% above | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 PORTABLE ELBOW(ROUTINE) LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW(ROUTINE)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 PORTABLE ELBOW (ROUTINE) RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW (ROUTINE)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT PF,MID IN EAR WO/CONTRAST | $559.20 | $932.00 | $250.71–$1,142.17 | 49% below | 40% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT,SELLA WO/CONTRAST | $772.20 | $1,287.00 | $346.20–$1,577.22 | 29% below | 40% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT PF,MID IN EAR WO/CONTRAST | $559.20 | $932.00 | $419.40 | — | 40% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT,SELLA WO/CONTRAST | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES (ROUTINE) | $772.20 | $1,287.00 | $346.20–$1,577.22 | 88% above | 40% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES (ROUTINE) | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 PORTABLE FOREARM LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 128% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM(RECHECK)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 128% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM(RECHECK)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 128% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 128% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 OR PORT FOREARM RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 128% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 128% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 OR PORT FORARM LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 128% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 PORTABLE FOREARM RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 128% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 PORTABLE FOREARM(RECHECK) RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 128% above | 40% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 PORTABLE FOREARM(RECHECK) LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 128% above | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 OR PORT FOREARM RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 OR PORT FORARM LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 PORTABLE FOREARM(RECHECK) RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 PORTABLE FOREARM RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 PORTABLE FOREARM(RECHECK) LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 PORTABLE FOREARM LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM(RECHECK)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM(RECHECK)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SCAN | $2,919.00 | $4,865.00 | $1,308.69–$5,962.06 | 138% above | 40% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SCAN | $2,919.00 | $4,865.00 | $2,189.25 | — | 40% |
| Hand X-ray, 2 views one side CPT 73120 HAND RT (2 VIEW) | $772.20 | $1,287.00 | $346.20–$1,577.22 | 176% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 HAND LT (2 VIEW) | $772.20 | $1,287.00 | $346.20–$1,577.22 | 176% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 PORTABLE HAND LT (2 VIEW) | $772.20 | $1,287.00 | $346.20–$1,577.22 | 176% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 PORTABLE HAND(RECK) LT-2 VIEW | $772.20 | $1,287.00 | $346.20–$1,577.22 | 176% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 PORTABLE HAND RT (2 VIEW) | $772.20 | $1,287.00 | $346.20–$1,577.22 | 176% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 PORTABLE HAND(RECK) RT-2 VIEW | $772.20 | $1,287.00 | $346.20–$1,577.22 | 176% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 OR PORT HAND RT (2 VIEW) | $772.20 | $1,287.00 | $346.20–$1,577.22 | 176% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 OR PORT HAND LT (2 VIEW) | $772.20 | $1,287.00 | $346.20–$1,577.22 | 176% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 HAND(RECHECK)LT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 176% above | 40% |
| Hand X-ray, 2 views one side CPT 73120 HAND(RECHECK)RT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 176% above | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 PORTABLE HAND(RECK) LT-2 VIEW | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 OR PORT HAND RT (2 VIEW) | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 OR PORT HAND LT (2 VIEW) | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 PORTABLE HAND(RECK) RT-2 VIEW | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 PORTABLE HAND RT (2 VIEW) | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 PORTABLE HAND LT (2 VIEW) | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HAND LT (2 VIEW) | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HAND RT (2 VIEW) | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HAND(RECHECK)RT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HAND(RECHECK)LT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 PORTABLE OS CALCIS/HEEL LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 142% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 OS CALCIS/HEEL LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 142% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 OS CALCIS/HEEL RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 142% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 OR PORT OS CALCIS/HEEL LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 142% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 PORTABLE OS CALCIS/HEEL RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 142% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 OR PORT OS CALCIS/HEEL RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 142% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 OR PORT OS CALCIS/HEEL RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 PORTABLE OS CALCIS/HEEL RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 PORTABLE OS CALCIS/HEEL LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 OS CALCIS/HEEL RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 OS CALCIS/HEEL LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 OR PORT OS CALCIS/HEEL LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP STAGING 4OR> W/CPAP/BPAP | $1,582.80 | $2,638.00 | $709.62–$3,232.87 | 50% below | 40% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP STAGING 4OR> W/CPAP/BPAP | $1,582.80 | $2,638.00 | $1,187.10 | — | 40% |
| Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 60% above | 40% |
| Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 60% above | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 PORT KNEE 4 OR MORE VWS RT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 77% above | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 PORTABLE KNEE 4 OR MORE VWS LT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 77% above | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE/OBL/PAT/EREC RT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 77% above | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE/OBL/PAT/EREC LT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 77% above | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE 4 OR MORE VIEWS RT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 77% above | 40% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE 4 OR MORE VIEWS LT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 77% above | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE 4 OR MORE VIEWS RT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE 4 OR MORE VIEWS LT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 PORT KNEE 4 OR MORE VWS RT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE/OBL/PAT/EREC RT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE/OBL/PAT/EREC LT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 PORTABLE KNEE 4 OR MORE VWS LT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER EXT WO/CONTRAST RT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 27% below | 40% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER EXT WO/CONTRAST LT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 27% below | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER EXT WO/CONTRAST LT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER EXT WO/CONTRAST RT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LMTD | $181.80 | $303.00 | $81.51–$371.33 | 70% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US RUQ | $181.80 | $303.00 | $81.51–$371.33 | 70% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US RUQ PORT | $181.80 | $303.00 | $81.51–$371.33 | 70% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US LIVER PORT | $181.80 | $303.00 | $81.51–$371.33 | 70% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PANCREAS PORT | $181.80 | $303.00 | $81.51–$371.33 | 70% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US GB LIMITED PORT | $181.80 | $303.00 | $81.51–$371.33 | 70% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PANCREAS TC | $181.80 | $303.00 | $81.51–$371.33 | 70% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US GALLBLADDER TC | $181.80 | $303.00 | $81.51–$371.33 | 70% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US RLQ | $181.80 | $303.00 | $81.51–$371.33 | 70% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SPLEEN | $181.80 | $303.00 | $81.51–$371.33 | 70% below | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US LIVER TC | $772.20 | $1,287.00 | $346.20–$1,577.22 | 27% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LMTD | $181.80 | $303.00 | $136.35 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US PANCREAS PORT | $181.80 | $303.00 | $136.35 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US GALLBLADDER TC | $181.80 | $303.00 | $136.35 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US PANCREAS TC | $181.80 | $303.00 | $136.35 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US GB LIMITED PORT | $181.80 | $303.00 | $136.35 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US RLQ | $181.80 | $303.00 | $136.35 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US SPLEEN | $181.80 | $303.00 | $136.35 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US RUQ | $181.80 | $303.00 | $136.35 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US RUQ PORT | $181.80 | $303.00 | $136.35 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US LIVER PORT | $181.80 | $303.00 | $136.35 | — | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US LIVER TC | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US SOFT TISSUE GENERAL | $772.20 | $1,287.00 | $346.20–$1,577.22 | 96% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXTREMITIES RT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 96% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXTREMITIES LT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 96% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US AXILLA RT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 96% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US AXILLA LT | $772.20 | $1,287.00 | $346.20–$1,577.22 | 96% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US SOFT TISSUE GENERAL | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US AXILLA RT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXTREMITIES RT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US AXILLA LT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXTREMITIES LT | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG CA SCREENING LOW DOSE | $799.20 | $1,332.00 | $358.31–$1,632.37 | 102% above | 40% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG CA SCREENING LOW DOSE | $799.20 | $1,332.00 | $599.40 | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 PORTABLE LOWER LEG LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 92% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 OR PORT LOWER LEG RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 92% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 OR PORT LOWER LEG LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 92% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 PORTABLE LOWER LEG(RECHECK)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 92% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 PORTABLE LOWER LEG RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 92% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LOWER LEG(RECHECK)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 92% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LOWER LEG RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 92% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LOWER LEG LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 92% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LOWER LEG(RECHECK)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 92% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 PORTABLE LOWER LEG(RECHECK)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 92% above | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 PORTABLE LOWER LEG RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 PORTABLE LOWER LEG(RECHECK)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LOWER LEG RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LOWER LEG(RECHECK)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LOWER LEG(RECHECK)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 PORTABLE LOWER LEG LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 OR PORT LOWER LEG LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LOWER LEG LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 PORTABLE LOWER LEG(RECHECK)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 OR PORT LOWER LEG RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRV OF BRAIN W/O | $987.00 | $1,645.00 | $442.51–$2,015.95 | 45% below | 40% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | 2% below | 40% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV OF BRAIN W/O | $987.00 | $1,645.00 | $740.25 | — | 40% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| MRI of both breasts, without and then with contrast dye CPT 77049 MRI BREAST W & W/O (BI) | $1,944.00 | $3,240.00 | $871.56–$3,970.62 | at median | 40% |
| MRI of both breasts, without and then with contrast dye inpatient CPT 77049 MRI BREAST W & W/O (BI) | $1,944.00 | $3,240.00 | $1,458.00 | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI JOINT LOWER EXT RT W/O | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | 14% below | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI JOINT LOWER EXT LT W/O | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | 14% below | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI JOINT LOWER EXT RT W/O | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI JOINT LOWER EXT LT W/O | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI JOINT LOWER EXT LT W/&W/O | $2,594.40 | $4,324.00 | $1,163.16–$5,299.06 | 26% below | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI JOINT LOWER EXT RT W/&W/O | $2,594.40 | $4,324.00 | $1,163.16–$5,299.06 | 26% below | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI JOINT LOWER EXT LT W/&W/O | $2,594.40 | $4,324.00 | $1,945.80 | — | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI JOINT LOWER EXT RT W/&W/O | $2,594.40 | $4,324.00 | $1,945.80 | — | 40% |
| MRI of the abdomen without contrast CPT 74181 MRI MRCP | $1,176.00 | $1,960.00 | $527.24–$2,401.98 | 40% below | 40% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | 11% below | 40% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP | $1,176.00 | $1,960.00 | $882.00 | — | 40% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABD W/WO CONTRAST | $2,594.40 | $4,324.00 | $1,163.16–$5,299.06 | 26% below | 40% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABD W/WO CONTRAST | $2,594.40 | $4,324.00 | $1,945.80 | — | 40% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/IAC W/O CONT | $987.00 | $1,645.00 | $442.51–$2,015.95 | 46% below | 40% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN & PITUITARY W/O | $987.00 | $1,645.00 | $442.51–$2,015.95 | 46% below | 40% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | 4% below | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN/IAC W/O CONT | $987.00 | $1,645.00 | $740.25 | — | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN & PITUITARY W/O | $987.00 | $1,645.00 | $740.25 | — | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN & PITUITARY W & W/O | $1,776.00 | $2,960.00 | $796.24–$3,627.48 | 39% below | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/IAC W & W/O CONT | $1,776.00 | $2,960.00 | $796.24–$3,627.48 | 39% below | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO | $2,594.40 | $4,324.00 | $1,163.16–$5,299.06 | 11% below | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN/IAC W & W/O CONT | $1,776.00 | $2,960.00 | $1,332.00 | — | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN & PITUITARY W & W/O | $1,776.00 | $2,960.00 | $1,332.00 | — | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO | $2,594.40 | $4,324.00 | $1,945.80 | — | 40% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONT | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | 2% below | 40% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CONT | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR W/WO | $2,594.40 | $4,324.00 | $1,163.16–$5,299.06 | 21% below | 40% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR W/WO | $2,594.40 | $4,324.00 | $1,945.80 | — | 40% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | 15% below | 40% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE W/O | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERV W/WO | $2,594.40 | $4,324.00 | $1,163.16–$5,299.06 | 11% below | 40% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERV W/WO | $2,594.40 | $4,324.00 | $1,945.80 | — | 40% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE W/O CONT | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | at median | 40% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE W/O CONT | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W AND W/O CONTRAST | $2,594.40 | $4,324.00 | $1,163.16–$5,299.06 | 26% below | 40% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W AND W/O CONTRAST | $2,594.40 | $4,324.00 | $1,945.80 | — | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | 10% below | 40% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI JOINT UPPER EXT LT W/O | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | 17% below | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI JOINT UPPER EXT RT W/O | $1,755.60 | $2,926.00 | $787.09–$3,585.81 | 17% below | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI JOINT UPPER EXT RT W/O | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI JOINT UPPER EXT LT W/O | $1,755.60 | $2,926.00 | $1,316.70 | — | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERVICAL SPINE 4-5 VIEWS | $772.20 | $1,287.00 | $346.20–$1,577.22 | 75% above | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERVICAL SPINE 4-5 VIEWS | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK;W/CONTRAST | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 4% below | 40% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK;W/CONTRAST | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISS NECK;W/O CONTRAST | $772.20 | $1,287.00 | $346.20–$1,577.22 | 29% below | 40% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISS NECK;W/O CONTRAST | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Neck soft tissue X-ray CPT 70360 OR PORT NECK SOFT TISSUE | $112.80 | $188.00 | $50.57–$230.39 | 60% below | 40% |
| Neck soft tissue X-ray CPT 70360 PORTABLE NECK SOFT TISSUE | $112.80 | $188.00 | $50.57–$230.39 | 60% below | 40% |
| Neck soft tissue X-ray CPT 70360 NECK SOFT TISSUE | $639.60 | $1,066.00 | $286.75–$1,306.38 | 128% above | 40% |
| Neck soft tissue X-ray inpatient CPT 70360 PORTABLE NECK SOFT TISSUE | $112.80 | $188.00 | $84.60 | — | 40% |
| Neck soft tissue X-ray inpatient CPT 70360 OR PORT NECK SOFT TISSUE | $112.80 | $188.00 | $84.60 | — | 40% |
| Neck soft tissue X-ray inpatient CPT 70360 NECK SOFT TISSUE | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 SPECT MYOCARD MULTI | $9,483.00 | $15,805.00 | $4,251.54–$19,369.03 | 142% above | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 SPECT MYOCARD MULTI | $9,483.00 | $15,805.00 | $7,112.25 | — | 40% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 GALLIUM68 PET/CT SKULL-THIGH I | $3,618.00 | $6,030.00 | $1,622.07–$7,389.76 | 50% below | 40% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET W/CT, SKULL-THIGH(RESTAGE) | $3,618.00 | $6,030.00 | $1,622.07–$7,389.76 | 50% below | 40% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 GALLIUM68 PET/CT SKULL-THIGH R | $3,618.00 | $6,030.00 | $1,622.07–$7,389.76 | 50% below | 40% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET W/CT SKULL-THIGH(INITIAL) | $10,594.80 | $17,658.00 | $4,750.00–$21,639.88 | 46% above | 40% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 GALLIUM68 PET/CT SKULL-THIGH I | $3,618.00 | $6,030.00 | $2,713.50 | — | 40% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET W/CT, SKULL-THIGH(RESTAGE) | $3,618.00 | $6,030.00 | $2,713.50 | — | 40% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 GALLIUM68 PET/CT SKULL-THIGH R | $3,618.00 | $6,030.00 | $2,713.50 | — | 40% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET W/CT SKULL-THIGH(INITIAL) | $10,594.80 | $17,658.00 | $7,946.10 | — | 40% |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST | $772.20 | $1,287.00 | $346.20–$1,577.22 | 29% below | 40% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BLADDER | $772.20 | $1,287.00 | $346.20–$1,577.22 | 73% above | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US BLADDER | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS TC | $772.20 | $1,287.00 | $346.20–$1,577.22 | 33% above | 40% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS TC | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG > 14 WKS | $772.20 | $1,287.00 | $346.20–$1,577.22 | 26% above | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG > 14 WKS | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG < 14 WKS | $772.20 | $1,287.00 | $346.20–$1,577.22 | 38% above | 40% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG < 14 WKS | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREG LIMITED | $772.20 | $1,287.00 | $346.20–$1,577.22 | 45% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREG LIMITED | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 PORTABLE RIBS(UNILATERAL)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 90% above | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 PORT RIBS(UNILATERAL) LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 90% above | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIBS(UNILATERAL)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 90% above | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIBS(UNILATERAL)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 90% above | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 PORTABLE RIBS(UNILATERAL)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS(UNILATERAL)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS(UNILATERAL)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 PORT RIBS(UNILATERAL) LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS UNI LT W/PA CHEST | $772.20 | $1,287.00 | $346.20–$1,577.22 | 88% above | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS UNI RT W/PA CHEST | $772.20 | $1,287.00 | $346.20–$1,577.22 | 88% above | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS UNI RT W/PA CHEST | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS UNI LT W/PA CHEST | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Screening mammogram, both breasts both sides CPT 77067 MAMMO SCREEN BILATERAL | $585.60 | $976.00 | $262.54–$1,196.09 | — | 40% |
| Screening mammogram, both breasts CPT 77067 MAMMO SCREENING NO RX | $289.20 | $482.00 | $129.66–$590.69 | 12% above | 40% |
| Screening mammogram, both breasts CPT 77067 MAMMO SCREEN WALKIN | $585.60 | $976.00 | $262.54–$1,196.09 | 128% above | 40% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO SCREEN BILATERAL | $585.60 | $976.00 | $439.20 | — | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 MAMMO SCREENING NO RX | $289.20 | $482.00 | $216.90 | — | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 MAMMO SCREEN WALKIN | $585.60 | $976.00 | $439.20 | — | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER 2 VIEW RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER 2 VIEW LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER(RECHECK 2V)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER(RECHECK 2V)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 PORTABLE SHOULDER 2 VIEW LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 PORT SHOULDER(RECHECK 2V)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 PORTABLE SHOULDER 2 VIEW RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 PORT SHOULDER(RECHECK 2V)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 OR PORT SHOULDER 2 VIEW LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 OR PORT SHOULDER 2 VIEW RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER(RECHECK 2V)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 PORTABLE SHOULDER 2 VIEW LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 PORT SHOULDER(RECHECK 2V)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 PORTABLE SHOULDER 2 VIEW RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 PORT SHOULDER(RECHECK 2V)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 OR PORT SHOULDER 2 VIEW LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 OR PORT SHOULDER 2 VIEW RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER 2 VIEW LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER(RECHECK 2V)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER 2 VIEW RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES | $639.60 | $1,066.00 | $286.75–$1,306.38 | 51% above | 40% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Skull X-ray, fewer than 4 views CPT 70250 PORTABLE SKULL 2 VIEWS PARTIAL | $147.00 | $245.00 | $65.90–$300.25 | 59% below | 40% |
| Skull X-ray, fewer than 4 views CPT 70250 SKULL (2 VIEWS PARTIAL) | $772.20 | $1,287.00 | $346.20–$1,577.22 | 116% above | 40% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 PORTABLE SKULL 2 VIEWS PARTIAL | $147.00 | $245.00 | $110.25 | — | 40% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL (2 VIEWS PARTIAL) | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 SLEEP STAGING 4 OR > | $1,582.80 | $2,638.00 | $709.62–$3,232.87 | 54% below | 40% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 SLEEP STAGING 4 OR > | $1,582.80 | $2,638.00 | $1,187.10 | — | 40% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 STRESS TTE W CONTINUOUS ECT | $1,017.00 | $1,695.00 | $455.96–$2,077.22 | 44% below | 40% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 STRESS TTE W CONTINUOUS ECT | $1,017.00 | $1,695.00 | $762.75 | — | 40% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 RHB SWALLOWING STUDY | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 119% above | 40% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 RHB SWALLOWING STUDY | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 OR PORT FEMUR 2+ VIEWS RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 61% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 OR PORT FEMUR 2+ VIEWS LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 61% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 PORTABLE FEMUR 2+ VIEWS RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 61% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 PORTABLE FEMUR 2+ VIEWS LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 61% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR 2+ VIEWS RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 61% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR 2+ VIEWS LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 61% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 PORTABLE FEMUR 2+ VIEWS RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR 2+ VIEWS RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR 2+ VIEWS LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 OR PORT FEMUR 2+ VIEWS LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 PORTABLE FEMUR 2+ VIEWS LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 OR PORT FEMUR 2+ VIEWS RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT DORSAL SPINE WO/CONTRAST | $772.20 | $1,287.00 | $346.20–$1,577.22 | 34% below | 40% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT DORSAL SPINE WO/CONTRAST | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $772.20 | $1,287.00 | $346.20–$1,577.22 | 38% above | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Transvaginal ultrasound during pregnancy CPT 76817 US PREG TV < 14 WKS | $772.20 | $1,287.00 | $346.20–$1,577.22 | 40% above | 40% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREG TV < 14 WKS | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN PORTABLE | $185.40 | $309.00 | $83.12–$378.68 | 76% below | 40% |
| Ultrasound of the abdomen, complete CPT 76700 US ABD COMP | $772.20 | $1,287.00 | $346.20–$1,577.22 | 2% below | 40% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN PORTABLE | $185.40 | $309.00 | $139.05 | — | 40% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMP | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM TC | $772.20 | $1,287.00 | $346.20–$1,577.22 | 25% above | 40% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM TC | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID/NECK | $772.20 | $1,287.00 | $346.20–$1,577.22 | 35% above | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID/NECK | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 POST BARIATRIC UPPER GI | $327.60 | $546.00 | $146.87–$669.12 | 48% below | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI | $1,293.00 | $2,155.00 | $579.70–$2,640.95 | 106% above | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 POST BARIATRIC UPPER GI | $327.60 | $546.00 | $245.70 | — | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI | $1,293.00 | $2,155.00 | $969.75 | — | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 131% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 OR PORT HUMERUS LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 131% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 PORTABLE HUMERUS(RECHECK) RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 131% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 PORTABLE HUMERUS RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 131% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 PORTABLE HUMERUS(RECHECK) LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 131% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 OR PORT HUMERUS RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 131% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 PORTABLE HUMERUS LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 131% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS(RECHECK)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 131% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS(RECHECK)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 131% above | 40% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 131% above | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS(RECHECK)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS(RECHECK)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 PORTABLE HUMERUS LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 PORTABLE HUMERUS(RECHECK) LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 PORTABLE HUMERUS RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 PORTABLE HUMERUS(RECHECK) RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 OR PORT HUMERUS LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 OR PORT HUMERUS RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 DUP SCAN VEINS LTD MULT EXTR | $385.20 | $642.00 | $172.70–$786.77 | 40% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 DUP SCAN VEINS LTD UNI EXTR | $772.20 | $1,287.00 | $346.20–$1,577.22 | 21% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS DUP LOWER EXT RT | $210.60 | $351.00 | $94.42–$430.15 | 67% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS DUP LOWER EXT LT | $210.60 | $351.00 | $94.42–$430.15 | 67% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS DUP UPPER EXT RT | $210.60 | $351.00 | $94.42–$430.15 | 67% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS DUP UPPER EXT LT | $210.60 | $351.00 | $94.42–$430.15 | 67% below | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 DUP SCAN VEINS LTD MULT EXTR | $385.20 | $642.00 | $288.90 | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 DUP SCAN VEINS LTD UNI EXTR | $772.20 | $1,287.00 | $579.15 | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS DUP LOWER EXT LT | $210.60 | $351.00 | $157.95 | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS DUP LOWER EXT RT | $210.60 | $351.00 | $157.95 | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS DUP UPPER EXT RT | $210.60 | $351.00 | $157.95 | — | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS DUP UPPER EXT LT | $210.60 | $351.00 | $157.95 | — | 40% |
| Wrist X-ray, 2 views one side CPT 73100 OR PORT WRIST 2 VIEW RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 133% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 WRIST(RECHECK)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 133% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 WRIST(RECHECK)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 133% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 WRIST(2VIEW)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 133% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 WRIST(2VIEW)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 133% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 PORTABLE WRIST 2 VIEW LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 133% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 PORTABLE WRIST RECHECK LT-2V | $639.60 | $1,066.00 | $286.75–$1,306.38 | 133% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 PORTABLE WRIST 2 VIEW RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 133% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 PORTABLE WRIST RECHECK RT-2V | $639.60 | $1,066.00 | $286.75–$1,306.38 | 133% above | 40% |
| Wrist X-ray, 2 views one side CPT 73100 OR PORT WRIST 2 VIEW LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 133% above | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 OR PORT WRIST 2 VIEW RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 PORTABLE WRIST 2 VIEW RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 PORTABLE WRIST RECHECK RT-2V | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST(2VIEW)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST(RECHECK)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST(RECHECK)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST(2VIEW)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 PORTABLE WRIST 2 VIEW LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 PORTABLE WRIST RECHECK LT-2V | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 OR PORT WRIST 2 VIEW LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST(ROUTINE)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 99% above | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 PORTABLE WRIST ROUTINE RT-4V | $639.60 | $1,066.00 | $286.75–$1,306.38 | 99% above | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 PORTABLE WRIST ROUTINE LT-4V | $639.60 | $1,066.00 | $286.75–$1,306.38 | 99% above | 40% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST(ROUTINE)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 99% above | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST(ROUTINE)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 PORTABLE WRIST ROUTINE RT-4V | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 PORTABLE WRIST ROUTINE LT-4V | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST(ROUTINE)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 PORTABLE HIP UNI 2-3 VIEWS LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 80% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 OR PORT HIP UNI 2-3 VIEWS LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 80% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 OR PORT HIP UNI 2-3 VIEWS RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 80% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 PORTABLE HIP UNI 2-3 VIEWS RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 80% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIPS & PELVIS RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 80% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIPS & PELVIS LEFT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 80% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP UNI 2-3 VIEWS LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 80% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP UNI 2-3 VIEWS RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 80% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 OR PORT HIP UNI 2-3 VIEWS LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 PORTABLE HIP UNI 2-3 VIEWS LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP UNI 2-3 VIEWS RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP UNI 2-3 VIEWS LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIPS & PELVIS LEFT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 OR PORT HIP UNI 2-3 VIEWS RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIPS & PELVIS RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 PORTABLE HIP UNI 2-3 VIEWS RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the abdomen, 1 view CPT 74018 PORTABLE ABDOMEN, 1 VIEW | $112.80 | $188.00 | $50.57–$230.39 | 60% below | 40% |
| X-ray of the abdomen, 1 view CPT 74018 OR PORT ABDOMEN, 1 VIEW | $112.80 | $188.00 | $50.57–$230.39 | 60% below | 40% |
| X-ray of the abdomen, 1 view CPT 74018 ABDOMEN, 1 VIEW | $639.60 | $1,066.00 | $286.75–$1,306.38 | 128% above | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 OR PORT ABDOMEN, 1 VIEW | $112.80 | $188.00 | $84.60 | — | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 PORTABLE ABDOMEN, 1 VIEW | $112.80 | $188.00 | $84.60 | — | 40% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN, 1 VIEW | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 VIEW RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 VIEW LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE(2 VIEW)RECHECK LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE(2 VIEW)RECHECK RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 PORTABLE ANKLE 2V RECHECK LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 PORTABLE ANKLE 2 VIEW LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 PORTABLE ANKLE(2V)RECHECK RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 PORTABLE ANKLE 2 VIEW RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 OR PORT ANKLE 2 VIEWS LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| X-ray of the ankle, 2 views one side CPT 73600 OR PORT ANKLE 2 VIEWS RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 89% above | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 OR PORT ANKLE 2 VIEWS LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 VIEW LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE(2 VIEW)RECHECK LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 PORTABLE ANKLE(2V)RECHECK RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 PORTABLE ANKLE 2 VIEW RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 OR PORT ANKLE 2 VIEWS RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 VIEW RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 PORTABLE ANKLE 2V RECHECK LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 PORTABLE ANKLE 2 VIEW LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE(2 VIEW)RECHECK RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 THUMB LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 165% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 PORTABLE THUMB LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 165% above | 40% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 OR PORT FINGER LT 1 | $639.60 | $1,066.00 | $286.75–$1,306.38 | 165% above | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 PORTABLE THUMB LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 OR PORT FINGER LT 1 | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 THUMB LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, 2 views one side CPT 73620 FOOT(RECHECK)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 97% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 FOOT RT (2 VIEW) | $639.60 | $1,066.00 | $286.75–$1,306.38 | 97% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 FOOT LT (2 VIEW) | $639.60 | $1,066.00 | $286.75–$1,306.38 | 97% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 OR PORT FOOT LT (2 VIEW) | $639.60 | $1,066.00 | $286.75–$1,306.38 | 97% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 PORTABLE FOOT LT (2 VIEW) | $639.60 | $1,066.00 | $286.75–$1,306.38 | 97% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 PORTABLE FOOT(RECHECK) LT-2 V | $639.60 | $1,066.00 | $286.75–$1,306.38 | 97% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 PORTABLE FOOT RT (2 VIEW) | $639.60 | $1,066.00 | $286.75–$1,306.38 | 97% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 PORTABLE FOOT(RECK) RT-2V | $639.60 | $1,066.00 | $286.75–$1,306.38 | 97% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 OR PORT FOOT RT (2 VIEW) | $639.60 | $1,066.00 | $286.75–$1,306.38 | 97% above | 40% |
| X-ray of the foot, 2 views one side CPT 73620 FOOT(RECHECK)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 97% above | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 PORTABLE FOOT(RECHECK) LT-2 V | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT(RECHECK)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT(RECHECK)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT RT (2 VIEW) | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT LT (2 VIEW) | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 PORTABLE FOOT LT (2 VIEW) | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 PORTABLE FOOT RT (2 VIEW) | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 PORTABLE FOOT(RECK) RT-2V | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 OR PORT FOOT LT (2 VIEW) | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 OR PORT FOOT RT (2 VIEW) | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 PORTABLE FOOT RT-3 VIEW | $639.60 | $1,066.00 | $286.75–$1,306.38 | 75% above | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 75% above | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 75% above | 40% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 PORTABLE FOOT LT-3 VIEW | $639.60 | $1,066.00 | $286.75–$1,306.38 | 75% above | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 PORTABLE FOOT RT-3 VIEW | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 PORTABLE FOOT LT-3 VIEW | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 PORTABLE HAND RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 115% above | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 HAND LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 115% above | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 HAND RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 115% above | 40% |
| X-ray of the hand, 3 or more views one side CPT 73130 PORTABLE HAND LT-3 VIEW | $639.60 | $1,066.00 | $286.75–$1,306.38 | 115% above | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 PORTABLE HAND RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 PORTABLE HAND LT-3 VIEW | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE(2 VIEW)RECHECK RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 127% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE(2VIEW)LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 127% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE(2VIEW)RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 127% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 OR PORT KNEE(2 VIEW) RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 127% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 OR PORT KNEE(2VIEW) LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 127% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 PORTABLE KNEE(2VIEW)RECHECK RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 127% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 PORTABLE KNEE(2 VIEW) RT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 127% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 PORTABLE KNEE(2 V)RECHECK LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 127% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 PORTABLE KNEE(2VIEW) LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 127% above | 40% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE(2 VIEW)RECHECK LT | $639.60 | $1,066.00 | $286.75–$1,306.38 | 127% above | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 OR PORT KNEE(2VIEW) LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 OR PORT KNEE(2 VIEW) RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PORTABLE KNEE(2VIEW)RECHECK RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PORTABLE KNEE(2 VIEW) RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PORTABLE KNEE(2 V)RECHECK LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PORTABLE KNEE(2VIEW) LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE(2 VIEW)RECHECK RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE(2 VIEW)RECHECK LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE(2VIEW)RT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE(2VIEW)LT | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 PORTABLE LUMBAR (AP/LAT) | $147.00 | $245.00 | $65.90–$300.25 | 60% below | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 OR PORT LUMBAR (AP/LAT) | $147.00 | $245.00 | $65.90–$300.25 | 60% below | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR (AP/LAT) | $772.20 | $1,287.00 | $346.20–$1,577.22 | 112% above | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 PORTABLE LUMBAR (AP/LAT) | $147.00 | $245.00 | $110.25 | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 OR PORT LUMBAR (AP/LAT) | $147.00 | $245.00 | $110.25 | — | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR (AP/LAT) | $772.20 | $1,287.00 | $579.15 | — | 40% |
| X-ray of the lower back, 4 or more views CPT 72110 LUMBAR (ROUTINE) | $772.20 | $1,287.00 | $346.20–$1,577.22 | 70% above | 40% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR (ROUTINE) | $772.20 | $1,287.00 | $579.15 | — | 40% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 PORTABLE THORACIC SP 2 VIEW | $147.00 | $245.00 | $65.90–$300.25 | 60% below | 40% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 OR PORT THORACIC SP 2 VIEW | $147.00 | $245.00 | $65.90–$300.25 | 60% below | 40% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SP - 2 VIEW | $772.20 | $1,287.00 | $346.20–$1,577.22 | 111% above | 40% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 PORTABLE THORACIC SP 2 VIEW | $147.00 | $245.00 | $110.25 | — | 40% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 OR PORT THORACIC SP 2 VIEW | $147.00 | $245.00 | $110.25 | — | 40% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SP - 2 VIEW | $772.20 | $1,287.00 | $579.15 | — | 40% |
| X-ray of the nasal bones, 3 or more views CPT 70160 PORTABLE NASAL BONES | $112.80 | $188.00 | $50.57–$230.39 | 58% below | 40% |
| X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES | $639.60 | $1,066.00 | $286.75–$1,306.38 | 136% above | 40% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 PORTABLE NASAL BONES | $112.80 | $188.00 | $84.60 | — | 40% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 PORTABLE CERVICAL (AP/LAT) | $123.60 | $206.00 | $55.41–$252.45 | 63% below | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 C-SPINE OBLIQUE VIEWS ONLY | $123.60 | $206.00 | $55.41–$252.45 | 63% below | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 OR PORT CERVICAL (AP/LAT) | $123.60 | $206.00 | $55.41–$252.45 | 63% below | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL FLEX EXT | $123.60 | $206.00 | $55.41–$252.45 | 63% below | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 2-3 VIEWS | $639.60 | $1,066.00 | $286.75–$1,306.38 | 92% above | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 PORTABLE CERVICAL (AP/LAT) | $123.60 | $206.00 | $92.70 | — | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 OR PORT CERVICAL (AP/LAT) | $123.60 | $206.00 | $92.70 | — | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 C-SPINE OBLIQUE VIEWS ONLY | $123.60 | $206.00 | $92.70 | — | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL FLEX EXT | $123.60 | $206.00 | $92.70 | — | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE 2-3 VIEWS | $639.60 | $1,066.00 | $479.70 | — | 40% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 PORTABLE PELVIS | $147.00 | $245.00 | $65.90–$300.25 | 50% below | 40% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 OR PORT PELVIS | $147.00 | $245.00 | $65.90–$300.25 | 50% below | 40% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS | $772.20 | $1,287.00 | $346.20–$1,577.22 | 164% above | 40% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PORTABLE PELVIS | $147.00 | $245.00 | $110.25 | — | 40% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 OR PORT PELVIS | $147.00 | $245.00 | $110.25 | — | 40% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS | $772.20 | $1,287.00 | $579.15 | — | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM/COCCYX | $639.60 | $1,066.00 | $286.75–$1,306.38 | 91% above | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM/COCCYX | $639.60 | $1,066.00 | $479.70 | — | 40% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Pennsylvania | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ACTH-ADRENOCORTICOTROPIN | $272.40 | $454.00 | $122.13–$556.38 | 23% above | 40% |
| ACTH blood test inpatient CPT 82024 ACTH-ADRENOCORTICOTROPIN | $272.40 | $454.00 | $204.30 | — | 40% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT | $37.20 | $62.00 | $16.68–$75.98 | 2% above | 40% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT | $37.20 | $62.00 | $27.90 | — | 40% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT | $36.60 | $61.00 | $16.41–$74.76 | 1% above | 40% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT | $36.60 | $61.00 | $27.45 | — | 40% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $336.00 | $560.00 | $150.64–$686.28 | 8% above | 40% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL | $336.00 | $560.00 | $252.00 | — | 40% |
| Albumin blood test CPT 82040 ALBUMIN | $34.80 | $58.00 | $15.60–$71.08 | 9% above | 40% |
| Albumin blood test inpatient CPT 82040 ALBUMIN | $34.80 | $58.00 | $26.10 | — | 40% |
| Aldosterone blood test CPT 82088 ALDOSTERONE | $287.40 | $479.00 | $128.85–$587.01 | 38% above | 40% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE | $287.40 | $479.00 | $215.55 | — | 40% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE | $36.60 | $61.00 | $16.41–$74.76 | 1% above | 40% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE | $36.60 | $61.00 | $27.45 | — | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGY TESTING (EACH) | $36.60 | $61.00 | $16.41–$74.76 | 13% above | 40% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGY TESTING (EACH) | $36.60 | $61.00 | $27.45 | — | 40% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 TUMOR MARKER-ALPHA FETOPROTEIN | $35.40 | $59.00 | $15.87–$72.30 | 68% below | 40% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 TRIPLE SCREEN MATERNAL AFPM | $118.20 | $197.00 | $52.99–$241.42 | 7% above | 40% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 TUMOR MARKER-ALPHA FETOPROTEIN | $35.40 | $59.00 | $26.55 | — | 40% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 TRIPLE SCREEN MATERNAL AFPM | $118.20 | $197.00 | $88.65 | — | 40% |
| Ammonia blood test CPT 82140 AMMONIA | $102.60 | $171.00 | $46.00–$209.56 | 13% above | 40% |
| Ammonia blood test inpatient CPT 82140 AMMONIA | $102.60 | $171.00 | $76.95 | — | 40% |
| Amylase blood test CPT 82150 AMYLASE BODY FLUIDS | $20.40 | $34.00 | $9.15–$41.67 | 53% below | 40% |
| Amylase blood test CPT 82150 AMYLASE 2HR URINE | $20.40 | $34.00 | $9.15–$41.67 | 53% below | 40% |
| Amylase blood test CPT 82150 AMYLASE 24 HR URINE | $20.40 | $34.00 | $9.15–$41.67 | 53% below | 40% |
| Amylase blood test CPT 82150 AMYLASE | $45.60 | $76.00 | $20.44–$93.14 | 4% above | 40% |
| Amylase blood test inpatient CPT 82150 AMYLASE 2HR URINE | $20.40 | $34.00 | $15.30 | — | 40% |
| Amylase blood test inpatient CPT 82150 AMYLASE BODY FLUIDS | $20.40 | $34.00 | $15.30 | — | 40% |
| Amylase blood test inpatient CPT 82150 AMYLASE 24 HR URINE | $20.40 | $34.00 | $15.30 | — | 40% |
| Amylase blood test inpatient CPT 82150 AMYLASE | $45.60 | $76.00 | $34.20 | — | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY | $91.20 | $152.00 | $40.89–$186.28 | 7% above | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODY | $91.20 | $152.00 | $68.40 | — | 40% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTI NUCLEAR ANTIBODIES | $85.20 | $142.00 | $38.20–$174.02 | 15% above | 40% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTI NUCLEAR ANTIBODIES | $85.20 | $142.00 | $63.90 | — | 40% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP-B TYPE NATRIURETIC PEPTIDE | $276.60 | $461.00 | $124.01–$564.96 | 39% above | 40% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP-B TYPE NATRIURETIC PEPTIDE | $276.60 | $461.00 | $207.45 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 FLUID CULTURE | $16.80 | $28.00 | $7.53–$34.31 | 68% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE-PERITONEAL FLD/ABD CAV | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE WOUND | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE-BRON WASHING | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 GENITAL CULTURE | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE-THROAT | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE-NOSE | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE-IV CATH TIP | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE-TISSUE BX | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CSF CULTURE SPINAL FLUID | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE ABSCESS | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE DECUBITUS | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE SURGICAL SITE | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 PERI FLD BLD CULT | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE NASAL SINUS | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE-PERICARDIAL FLUID | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE-PLEURAL FLUID | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE-JOINT FLUID | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE-GALLBLADDER/BILE | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE-EAR | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE-EYE | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 RESP CULTURE | $22.80 | $38.00 | $10.22–$46.57 | 56% below | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 PERTUSSIS CULTURE | $60.60 | $101.00 | $27.17–$123.78 | 16% above | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 FLUID CULTURE | $16.80 | $28.00 | $12.60 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-PERITONEAL FLD/ABD CAV | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 GENITAL CULTURE | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 RESP CULTURE | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE WOUND | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CSF CULTURE SPINAL FLUID | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-NOSE | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-THROAT | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-BRON WASHING | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-EYE | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-EAR | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-IV CATH TIP | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-TISSUE BX | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-GALLBLADDER/BILE | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-JOINT FLUID | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-PLEURAL FLUID | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-PERICARDIAL FLUID | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE NASAL SINUS | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 PERI FLD BLD CULT | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE SURGICAL SITE | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE DECUBITUS | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE ABSCESS | $22.80 | $38.00 | $17.10 | — | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 PERTUSSIS CULTURE | $60.60 | $101.00 | $45.45 | — | 40% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $59.40 | $99.00 | $26.63–$121.32 | 23% below | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $59.40 | $99.00 | $44.55 | — | 40% |
| Bilirubin blood test, total CPT 82247 BODY FLUID TOTAL BILIRUBIN | $19.80 | $33.00 | $8.88–$40.44 | 38% below | 40% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL NEONATAL | $19.80 | $33.00 | $8.88–$40.44 | 38% below | 40% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL | $35.40 | $59.00 | $15.87–$72.30 | 11% above | 40% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL NEONATAL | $19.80 | $33.00 | $14.85 | — | 40% |
| Bilirubin blood test, total inpatient CPT 82247 BODY FLUID TOTAL BILIRUBIN | $19.80 | $33.00 | $14.85 | — | 40% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL | $35.40 | $59.00 | $26.55 | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 MUSCLE BIOPSY TC ONLY | $94.20 | $157.00 | $42.23–$192.40 | 47% below | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURG PATH GROSS/MICRO LEVEL IV | $388.20 | $647.00 | $174.04–$792.90 | 119% above | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MUSCLE BIOPSY TC ONLY | $94.20 | $157.00 | $70.65 | — | 40% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURG PATH GROSS/MICRO LEVEL IV | $388.20 | $647.00 | $291.15 | — | 40% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE | $72.60 | $121.00 | $32.55–$148.29 | 14% below | 40% |
| Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE | $72.60 | $121.00 | $54.45 | — | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD DRAW | $15.60 | $26.00 | $6.99–$31.86 | 4% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD DRAW | $15.60 | $26.00 | $11.70 | — | 40% |
| Blood glucose (sugar) test CPT 82947 VENOUS BLOOD GAS GLUCOSE | $13.20 | $22.00 | $5.92–$26.96 | 49% below | 40% |
| Blood glucose (sugar) test CPT 82947 ARTERIAL BLOOD GAS GLUCOSE | $13.20 | $22.00 | $5.92–$26.96 | 49% below | 40% |
| Blood glucose (sugar) test CPT 82947 ANES RANDOM GLUCOSE | $13.20 | $22.00 | $5.92–$26.96 | 49% below | 40% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE TEST FASTING | $27.60 | $46.00 | $12.37–$56.37 | 7% above | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 ANES RANDOM GLUCOSE | $13.20 | $22.00 | $9.90 | — | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 VENOUS BLOOD GAS GLUCOSE | $13.20 | $22.00 | $9.90 | — | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 ARTERIAL BLOOD GAS GLUCOSE | $13.20 | $22.00 | $9.90 | — | 40% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE TEST FASTING | $27.60 | $46.00 | $20.70 | — | 40% |
| Blood lead test CPT 83655 LEAD | $85.20 | $142.00 | $38.20–$174.02 | 9% above | 40% |
| Blood lead test inpatient CPT 83655 LEAD | $85.20 | $142.00 | $63.90 | — | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY TEST SERUM | $58.80 | $98.00 | $26.36–$120.10 | 17% above | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY TEST SERUM | $58.80 | $98.00 | $44.10 | — | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO TYPE | $21.00 | $35.00 | $9.42–$42.89 | 84% below | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO TYPE FORWARD | $150.60 | $251.00 | $67.52–$307.60 | 13% above | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO BLOOD TYPING ARC | $150.60 | $251.00 | $67.52–$307.60 | 13% above | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO TYPE | $21.00 | $35.00 | $15.75 | — | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO BLOOD TYPING ARC | $150.60 | $251.00 | $112.95 | — | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO TYPE FORWARD | $150.60 | $251.00 | $112.95 | — | 40% |
| Blood urea nitrogen (BUN) test CPT 84520 BUN PERIPHEAL | $13.20 | $22.00 | $5.92–$26.96 | 51% below | 40% |
| Blood urea nitrogen (BUN) test CPT 84520 BUN - ARTERIAL | $13.20 | $22.00 | $5.92–$26.96 | 51% below | 40% |
| Blood urea nitrogen (BUN) test CPT 84520 BUN VEINOUS | $13.20 | $22.00 | $5.92–$26.96 | 51% below | 40% |
| Blood urea nitrogen (BUN) test CPT 84520 BUN | $27.60 | $46.00 | $12.37–$56.37 | 2% above | 40% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN - ARTERIAL | $13.20 | $22.00 | $9.90 | — | 40% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN PERIPHEAL | $13.20 | $22.00 | $9.90 | — | 40% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN VEINOUS | $13.20 | $22.00 | $9.90 | — | 40% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN | $27.60 | $46.00 | $20.70 | — | 40% |
| C-peptide blood test CPT 84681 C-PEPTIDE | $147.00 | $245.00 | $65.90–$300.25 | 35% above | 40% |
| C-peptide blood test inpatient CPT 84681 C-PEPTIDE | $147.00 | $245.00 | $110.25 | — | 40% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN | $36.60 | $61.00 | $16.41–$74.76 | 2% above | 40% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN | $36.60 | $61.00 | $27.45 | — | 40% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED PROBE | $262.80 | $438.00 | $117.82–$536.77 | 27% above | 40% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF AMPLIFIED PROBE | $262.80 | $438.00 | $197.10 | — | 40% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA-19-9 | $147.00 | $245.00 | $65.90–$300.25 | 11% above | 40% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA-19-9 | $147.00 | $245.00 | $110.25 | — | 40% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA-125 | $147.00 | $245.00 | $65.90–$300.25 | 12% above | 40% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA-125 | $147.00 | $245.00 | $110.25 | — | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 | $361.80 | $603.00 | $162.21–$738.98 | 297% above | 40% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 | $361.80 | $603.00 | $271.35 | — | 40% |
| Calcium blood test, total CPT 82310 CALCIUM | $36.60 | $61.00 | $16.41–$74.76 | 9% above | 40% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM | $36.60 | $61.00 | $27.45 | — | 40% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CEA | $133.80 | $223.00 | $59.99–$273.29 | 13% above | 40% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA | $133.80 | $223.00 | $100.35 | — | 40% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER | $33.60 | $56.00 | $15.06–$68.63 | 60% below | 40% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER IGM | $90.60 | $151.00 | $40.62–$185.05 | 7% above | 40% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER | $33.60 | $56.00 | $25.20 | — | 40% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER IGM | $90.60 | $151.00 | $67.95 | — | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA BY DNA/PCR | $247.20 | $412.00 | $110.83–$504.91 | 26% above | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA BY DNA/PCR | $247.20 | $412.00 | $185.40 | — | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROF-LDL,HDL,CHOL,TRG | $94.20 | $157.00 | $42.23–$192.40 | 5% above | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROF-LDL,HDL,CHOL,TRG | $94.20 | $157.00 | $70.65 | — | 40% |
| Complete blood count (CBC) with differential CPT 85025 CBC AUTOMATED | $54.60 | $91.00 | $24.48–$111.52 | 7% above | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC AUTOMATED | $54.60 | $91.00 | $40.95 | — | 40% |
| Complete blood count (CBC), no differential CPT 85027 CBC | $45.60 | $76.00 | $20.44–$93.14 | 6% above | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC | $45.60 | $76.00 | $34.20 | — | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $74.40 | $124.00 | $33.36–$151.96 | 16% below | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $74.40 | $124.00 | $55.80 | — | 40% |
| Cortisol blood test, total CPT 82533 CORTISOL AM | $41.40 | $69.00 | $18.56–$84.56 | 60% below | 40% |
| Cortisol blood test, total CPT 82533 CORTISOL PM | $115.20 | $192.00 | $51.65–$235.30 | 12% above | 40% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL AM | $41.40 | $69.00 | $31.05 | — | 40% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL PM | $115.20 | $192.00 | $86.40 | — | 40% |
| Creatine kinase (CK) blood test, total CPT 82550 CPK, TOTAL | $45.60 | $76.00 | $20.44–$93.14 | 1% above | 40% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK, TOTAL | $45.60 | $76.00 | $34.20 | — | 40% |
| Creatinine blood test CPT 82565 CREATININE | $36.00 | $60.00 | $16.14–$73.53 | 7% above | 40% |
| Creatinine blood test inpatient CPT 82565 CREATININE | $36.00 | $60.00 | $27.00 | — | 40% |
| Cytomegalovirus (CMV) antibody test CPT 86644 CMV SCREEN | $37.80 | $63.00 | $16.95–$77.21 | 56% below | 40% |
| Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGALOVIRUS | $101.40 | $169.00 | $45.46–$207.11 | 17% above | 40% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV SCREEN | $37.80 | $63.00 | $28.35 | — | 40% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGALOVIRUS | $101.40 | $169.00 | $76.05 | — | 40% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S | $156.60 | $261.00 | $70.21–$319.86 | 17% above | 40% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S | $156.60 | $261.00 | $117.45 | — | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 BENZODIAZAPINES SCREEN | $173.40 | $289.00 | $77.74–$354.17 | 5% below | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DIRUETICS SCREEN, URINE | $173.40 | $289.00 | $77.74–$354.17 | 5% below | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 OXYCODONE SCREEN W CONFIRMATIO | $173.40 | $289.00 | $77.74–$354.17 | 5% below | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TOX MONITORING 6 | $173.40 | $289.00 | $77.74–$354.17 | 5% below | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 COCAINE SCREEN | $173.40 | $289.00 | $77.74–$354.17 | 5% below | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 METHADONE SCREEN | $173.40 | $289.00 | $77.74–$354.17 | 5% below | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 BUPRENORPHINE BY GCMS QUAL QD | $173.40 | $289.00 | $77.74–$354.17 | 5% below | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN NON TLC DEVICES | $438.00 | $730.00 | $196.37–$894.62 | 141% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN MULTIPLE CLASS-URI | $438.00 | $730.00 | $196.37–$894.62 | 141% above | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 COCAINE SCREEN | $173.40 | $289.00 | $130.05 | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 METHADONE SCREEN | $173.40 | $289.00 | $130.05 | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 BENZODIAZAPINES SCREEN | $173.40 | $289.00 | $130.05 | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DIRUETICS SCREEN, URINE | $173.40 | $289.00 | $130.05 | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 OXYCODONE SCREEN W CONFIRMATIO | $173.40 | $289.00 | $130.05 | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TOX MONITORING 6 | $173.40 | $289.00 | $130.05 | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 BUPRENORPHINE BY GCMS QUAL QD | $173.40 | $289.00 | $130.05 | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN MULTIPLE CLASS-URI | $438.00 | $730.00 | $328.50 | — | 40% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN NON TLC DEVICES | $438.00 | $730.00 | $328.50 | — | 40% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTES | $55.80 | $93.00 | $25.02–$113.97 | 6% above | 40% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTES | $55.80 | $93.00 | $41.85 | — | 40% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN BARR-VIRAL CAPSID | $127.80 | $213.00 | $57.30–$261.03 | 11% above | 40% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN BARR-VIRAL CAPSID | $127.80 | $213.00 | $95.85 | — | 40% |
| Estradiol blood test CPT 82670 ESTRADIOL TOTAL | $196.80 | $328.00 | $88.23–$401.96 | 18% above | 40% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL TOTAL | $196.80 | $328.00 | $147.60 | — | 40% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH | $130.80 | $218.00 | $58.64–$267.16 | 10% above | 40% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH | $130.80 | $218.00 | $98.10 | — | 40% |
| Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY CALPROTECTIN FECAL | $138.60 | $231.00 | $62.14–$283.09 | 7% above | 40% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 ASSAY CALPROTECTIN FECAL | $138.60 | $231.00 | $103.95 | — | 40% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $96.00 | $160.00 | $43.04–$196.08 | 11% above | 40% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN | $96.00 | $160.00 | $72.00 | — | 40% |
| Fibrinogen blood test CPT 85384 FIBRINOGEN | $68.40 | $114.00 | $30.67–$139.71 | 3% above | 40% |
| Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN | $68.40 | $114.00 | $51.30 | — | 40% |
| Folate (folic acid) blood test CPT 82746 FOLATE LEVEL | $103.80 | $173.00 | $46.54–$212.01 | 20% above | 40% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLATE LEVEL | $103.80 | $173.00 | $77.85 | — | 40% |
| Free T3 thyroid hormone test CPT 84481 FREE T3 | $119.40 | $199.00 | $53.53–$243.87 | 12% above | 40% |
| Free T3 thyroid hormone test inpatient CPT 84481 FREE T3 | $119.40 | $199.00 | $89.55 | — | 40% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 | $63.60 | $106.00 | $28.51–$129.90 | 6% above | 40% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4 | $63.60 | $106.00 | $47.70 | — | 40% |
| Free testosterone test CPT 84402 TESTOSTERONE FREE | $179.40 | $299.00 | $80.43–$366.42 | 12% above | 40% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE | $179.40 | $299.00 | $134.55 | — | 40% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 GAMMA GLUTAMYL TRNSTPTDSE | $51.00 | $85.00 | $22.86–$104.17 | 7% above | 40% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GAMMA GLUTAMYL TRNSTPTDSE | $51.00 | $85.00 | $38.25 | — | 40% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL | $190.80 | $318.00 | $85.54–$389.71 | 1% above | 40% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL | $190.80 | $318.00 | $143.10 | — | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GESTATIONAL DIAB SER BS | $15.00 | $25.00 | $6.72–$30.64 | 60% below | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 2HRPP | $33.60 | $56.00 | $15.06–$68.63 | 10% below | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GESTATIONAL DIAB SER BS | $15.00 | $25.00 | $11.25 | — | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 2HRPP | $33.60 | $56.00 | $25.20 | — | 40% |
| Glucose tolerance test, 3 samples CPT 82951 GLCS TLRNC GSTTN 3 SPEC | $35.40 | $59.00 | $15.87–$72.30 | 56% below | 40% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 2 HR | $35.40 | $59.00 | $15.87–$72.30 | 56% below | 40% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 3 SPEC | $90.60 | $151.00 | $40.62–$185.05 | 12% above | 40% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 2 HR | $35.40 | $59.00 | $26.55 | — | 40% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLCS TLRNC GSTTN 3 SPEC | $35.40 | $59.00 | $26.55 | — | 40% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 3 SPEC | $90.60 | $151.00 | $67.95 | — | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 G.C. BY DNA/PCR | $247.20 | $412.00 | $110.83–$504.91 | 34% above | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 G.C. BY DNA/PCR | $247.20 | $412.00 | $185.40 | — | 40% |
| H. pylori antibody blood test CPT 86677 AB; HELICOBACTER PYLORI | $118.80 | $198.00 | $53.26–$242.65 | 3% above | 40% |
| H. pylori antibody blood test inpatient CPT 86677 AB; HELICOBACTER PYLORI | $118.80 | $198.00 | $89.10 | — | 40% |
| H. pylori stool antigen test CPT 87338 HPYLORI, STOOL, EIA | $101.40 | $169.00 | $45.46–$207.11 | 5% above | 40% |
| H. pylori stool antigen test inpatient CPT 87338 HPYLORI, STOOL, EIA | $101.40 | $169.00 | $76.05 | — | 40% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA BY PCR | $600.00 | $1,000.00 | $269.00–$1,225.50 | 21% above | 40% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA BY PCR | $600.00 | $1,000.00 | $450.00 | — | 40% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV | $96.60 | $161.00 | $43.31–$197.31 | 6% below | 40% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV | $96.60 | $161.00 | $72.45 | — | 40% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1 & HIV-2 AB | $169.80 | $283.00 | $76.13–$346.82 | 20% above | 40% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG W/HIV-1 & HIV-2 AB | $169.80 | $283.00 | $127.35 | — | 40% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HI RISK TYPES, POOLED RSLT | $247.20 | $412.00 | $110.83–$504.91 | 19% above | 40% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HI RISK TYPES, POOLED RSLT | $247.20 | $412.00 | $185.40 | — | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOHEMOGLOBIN | $68.40 | $114.00 | $30.67–$139.71 | 34% above | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOHEMOGLOBIN | $68.40 | $114.00 | $51.30 | — | 40% |
| Hemoglobin blood test CPT 85018 HEMOGLOBIN | $16.80 | $28.00 | $7.53–$34.31 | 2% below | 40% |
| Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN | $16.80 | $28.00 | $12.60 | — | 40% |
| Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE TOTAL | $85.20 | $142.00 | $38.20–$174.02 | 1% above | 40% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE TOTAL | $85.20 | $142.00 | $63.90 | — | 40% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B ANTIBODY | $75.60 | $126.00 | $33.89–$154.41 | 3% above | 40% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B ANTIBODY | $75.60 | $126.00 | $56.70 | — | 40% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B ANTIGEN | $72.60 | $121.00 | $32.55–$148.29 | 4% above | 40% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B ANTIGEN | $72.60 | $121.00 | $54.45 | — | 40% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB SCRN | $100.80 | $168.00 | $45.19–$205.88 | 1% above | 40% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB SCRN | $100.80 | $168.00 | $75.60 | — | 40% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C-RNA,PCR QUANT | $301.80 | $503.00 | $135.31–$616.43 | 6% above | 40% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C-RNA,PCR QUANT | $301.80 | $503.00 | $226.35 | — | 40% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX I IGG | $34.80 | $58.00 | $15.60–$71.08 | 56% below | 40% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX I IGM | $93.00 | $155.00 | $41.70–$189.95 | 16% above | 40% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX I IGG | $34.80 | $58.00 | $26.10 | — | 40% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX I IGM | $93.00 | $155.00 | $69.75 | — | 40% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX II IGM | $52.20 | $87.00 | $23.40–$106.62 | 51% below | 40% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX II IGG | $136.20 | $227.00 | $61.06–$278.19 | 27% above | 40% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX II IGM | $52.20 | $87.00 | $39.15 | — | 40% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX II IGG | $136.20 | $227.00 | $102.15 | — | 40% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 CARDIO-C-REACTIVE PROTEIN | $91.20 | $152.00 | $40.89–$186.28 | 16% above | 40% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CARDIO-C-REACTIVE PROTEIN | $91.20 | $152.00 | $68.40 | — | 40% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE | $126.60 | $211.00 | $56.76–$258.58 | 6% above | 40% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE | $126.60 | $211.00 | $94.95 | — | 40% |
| Insulin blood test CPT 83525 INSULIN LEVEL | $80.40 | $134.00 | $36.05–$164.22 | 11% above | 40% |
| Insulin blood test inpatient CPT 83525 INSULIN LEVEL | $80.40 | $134.00 | $60.30 | — | 40% |
| Iron blood test (serum iron) CPT 83540 SERUM IRON | $45.60 | $76.00 | $20.44–$93.14 | at median | 40% |
| Iron blood test (serum iron) inpatient CPT 83540 SERUM IRON | $45.60 | $76.00 | $34.20 | — | 40% |
| Iron-binding capacity (TIBC) test CPT 83550 TIBC | $61.80 | $103.00 | $27.71–$126.23 | 3% above | 40% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 TIBC | $61.80 | $103.00 | $46.35 | — | 40% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $61.20 | $102.00 | $27.44–$125.00 | 11% below | 40% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $61.20 | $102.00 | $45.90 | — | 40% |
| LH (luteinizing hormone) test CPT 83002 LH | $130.80 | $218.00 | $58.64–$267.16 | 10% above | 40% |
| LH (luteinizing hormone) test inpatient CPT 83002 LH | $130.80 | $218.00 | $98.10 | — | 40% |
| Lactate (lactic acid) blood test CPT 83605 ARTERIAL BLOOD GAS LACTATE | $37.80 | $63.00 | $16.95–$77.21 | 51% below | 40% |
| Lactate (lactic acid) blood test CPT 83605 VENOUS BLOOD GAS LACTATE | $37.80 | $63.00 | $16.95–$77.21 | 51% below | 40% |
| Lactate (lactic acid) blood test CPT 83605 LACTIC ACID | $81.60 | $136.00 | $36.58–$166.67 | 6% above | 40% |
| Lactate (lactic acid) blood test inpatient CPT 83605 VENOUS BLOOD GAS LACTATE | $37.80 | $63.00 | $28.35 | — | 40% |
| Lactate (lactic acid) blood test inpatient CPT 83605 ARTERIAL BLOOD GAS LACTATE | $37.80 | $63.00 | $28.35 | — | 40% |
| Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID | $81.60 | $136.00 | $61.20 | — | 40% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH BODY FLUIDS | $16.20 | $27.00 | $7.26–$33.09 | 56% below | 40% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE DEHYDROGENASE | $42.60 | $71.00 | $19.10–$87.01 | 16% above | 40% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH BODY FLUIDS | $16.20 | $27.00 | $12.15 | — | 40% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE DEHYDROGENASE | $42.60 | $71.00 | $31.95 | — | 40% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $48.60 | $81.00 | $21.79–$99.27 | 4% above | 40% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE | $48.60 | $81.00 | $36.45 | — | 40% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $57.60 | $96.00 | $25.82–$117.65 | 26% below | 40% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $57.60 | $96.00 | $43.20 | — | 40% |
| Lyme disease antibody test CPT 86618 LYME DISEASE AB/REFLEX TO BLOT | $53.40 | $89.00 | $23.94–$109.07 | 44% below | 40% |
| Lyme disease antibody test CPT 86618 LYME DIS ABY SCREEN | $120.00 | $200.00 | $53.80–$245.10 | 27% above | 40% |
| Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB/REFLEX TO BLOT | $53.40 | $89.00 | $40.05 | — | 40% |
| Lyme disease antibody test inpatient CPT 86618 LYME DIS ABY SCREEN | $120.00 | $200.00 | $90.00 | — | 40% |
| Magnesium blood test CPT 83735 MAGNESIUM 24HR URINE | $18.00 | $30.00 | $8.07–$36.76 | 57% below | 40% |
| Magnesium blood test CPT 83735 MAGNESIUM | $47.40 | $79.00 | $21.25–$96.81 | 14% above | 40% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM 24HR URINE | $18.00 | $30.00 | $13.50 | — | 40% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM | $47.40 | $79.00 | $35.55 | — | 40% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA MEASLES IGG OR IGM | $25.80 | $43.00 | $11.57–$52.70 | 68% below | 40% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA MEASLES IGG | $90.60 | $151.00 | $40.62–$185.05 | 12% above | 40% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA MEASLES IGG OR IGM | $25.80 | $43.00 | $19.35 | — | 40% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA MEASLES IGG | $90.60 | $151.00 | $67.95 | — | 40% |
| Mono test (heterophile antibody, Monospot) CPT 86308 MONO TEST | $37.20 | $62.00 | $16.68–$75.98 | at median | 40% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO TEST | $37.20 | $62.00 | $27.90 | — | 40% |
| Mumps immunity blood test CPT 86735 MUMPS ANTIBODY | $91.80 | $153.00 | $41.16–$187.50 | 13% above | 40% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS ANTIBODY | $91.80 | $153.00 | $68.85 | — | 40% |
| Obstetric blood test panel CPT 80055 OBSTETRICAL PANEL | $337.20 | $562.00 | $151.18–$688.73 | 8% above | 40% |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRICAL PANEL | $337.20 | $562.00 | $252.90 | — | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 FREE PSA | $129.60 | $216.00 | $58.10–$264.71 | 14% above | 40% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 FREE PSA | $129.60 | $216.00 | $97.20 | — | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA DIAGNOSTIC | $129.60 | $216.00 | $58.10–$264.71 | 18% above | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA DIAGNOSTIC | $129.60 | $216.00 | $97.20 | — | 40% |
| Pap test (liquid-based, automated screening with review) CPT 88175 TL PAP W AUTO SCRN & MANUAL RS | $186.60 | $311.00 | $83.66–$381.13 | 128% above | 40% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 TL PAP W AUTO SCRN & MANUAL RS | $186.60 | $311.00 | $139.95 | — | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTO LIQUID BASE DIAGNOSTIC | $58.80 | $98.00 | $26.36–$120.10 | 4% below | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTO LIQUID SCREEN | $186.60 | $311.00 | $83.66–$381.13 | 205% above | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTO LIQUID BASE DIAGNOSTIC | $58.80 | $98.00 | $44.10 | — | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTO LIQUID SCREEN | $186.60 | $311.00 | $139.95 | — | 40% |
| Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT | $291.00 | $485.00 | $130.46–$594.37 | 33% above | 40% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT | $291.00 | $485.00 | $218.25 | — | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 H-PTT | $15.60 | $26.00 | $6.99–$31.86 | 62% below | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PART.THROMBOPLASTIN TIME | $42.60 | $71.00 | $19.10–$87.01 | 3% above | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 H-PTT | $15.60 | $26.00 | $11.70 | — | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PART.THROMBOPLASTIN TIME | $42.60 | $71.00 | $31.95 | — | 40% |
| Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS | $33.60 | $56.00 | $15.06–$68.63 | 3% above | 40% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS | $33.60 | $56.00 | $25.20 | — | 40% |
| Potassium blood test CPT 84132 VENOUS BLOOD GAS POTASSIUM | $15.00 | $25.00 | $6.72–$30.64 | 53% below | 40% |
| Potassium blood test CPT 84132 ARTERIAL BLOOD GAS POTASSIUM | $15.00 | $25.00 | $6.72–$30.64 | 53% below | 40% |
| Potassium blood test CPT 84132 POTASSIUM (K) | $33.60 | $56.00 | $15.06–$68.63 | 5% above | 40% |
| Potassium blood test inpatient CPT 84132 ARTERIAL BLOOD GAS POTASSIUM | $15.00 | $25.00 | $11.25 | — | 40% |
| Potassium blood test inpatient CPT 84132 VENOUS BLOOD GAS POTASSIUM | $15.00 | $25.00 | $11.25 | — | 40% |
| Potassium blood test inpatient CPT 84132 POTASSIUM (K) | $33.60 | $56.00 | $25.20 | — | 40% |
| Progesterone blood test CPT 84144 PROGESTERONE | $147.00 | $245.00 | $65.90–$300.25 | 7% above | 40% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE | $147.00 | $245.00 | $110.25 | — | 40% |
| Prolactin blood test CPT 84146 PROLACTIN | $136.80 | $228.00 | $61.33–$279.41 | 10% above | 40% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN | $136.80 | $228.00 | $102.60 | — | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME | $30.00 | $50.00 | $13.45–$61.28 | 5% above | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME | $30.00 | $50.00 | $22.50 | — | 40% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREPT SCREEN GPA | $116.40 | $194.00 | $52.19–$237.75 | 84% above | 40% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREPT SCREEN GPA | $116.40 | $194.00 | $87.30 | — | 40% |
| Renin blood test CPT 84244 RENIN | $154.80 | $258.00 | $69.40–$316.18 | 7% above | 40% |
| Renin blood test inpatient CPT 84244 RENIN | $154.80 | $258.00 | $116.10 | — | 40% |
| Rh blood typing CPT 86901 RH TYPE | $21.00 | $35.00 | $9.42–$42.89 | 63% below | 40% |
| Rh blood typing CPT 86901 BLOOD TYPING RH(D) ARC | $55.20 | $92.00 | $24.75–$112.75 | 3% below | 40% |
| Rh blood typing inpatient CPT 86901 RH TYPE | $21.00 | $35.00 | $15.75 | — | 40% |
| Rh blood typing inpatient CPT 86901 BLOOD TYPING RH(D) ARC | $55.20 | $92.00 | $41.40 | — | 40% |
| Rheumatoid factor (RF) test CPT 86431 QUAN RHEUM FACTOR | $40.20 | $67.00 | $18.02–$82.11 | 3% above | 40% |
| Rheumatoid factor (RF) test inpatient CPT 86431 QUAN RHEUM FACTOR | $40.20 | $67.00 | $30.15 | — | 40% |
| Rubella antibody test (immunity check) CPT 86762 AB; RUBELLA | $101.40 | $169.00 | $45.46–$207.11 | 20% above | 40% |
| Rubella antibody test (immunity check) inpatient CPT 86762 AB; RUBELLA | $101.40 | $169.00 | $76.05 | — | 40% |
| Sodium blood test CPT 84295 VENOUS BLOOD GAS SODIUM | $15.60 | $26.00 | $6.99–$31.86 | 52% below | 40% |
| Sodium blood test CPT 84295 BODY FLUID SODIUM | $15.60 | $26.00 | $6.99–$31.86 | 52% below | 40% |
| Sodium blood test CPT 84295 ARTERIAL BLOOD GAS SODIUM | $15.60 | $26.00 | $6.99–$31.86 | 52% below | 40% |
| Sodium blood test CPT 84295 SODIUM (NA) | $34.20 | $57.00 | $15.33–$69.85 | 6% above | 40% |
| Sodium blood test inpatient CPT 84295 BODY FLUID SODIUM | $15.60 | $26.00 | $11.70 | — | 40% |
| Sodium blood test inpatient CPT 84295 ARTERIAL BLOOD GAS SODIUM | $15.60 | $26.00 | $11.70 | — | 40% |
| Sodium blood test inpatient CPT 84295 VENOUS BLOOD GAS SODIUM | $15.60 | $26.00 | $11.70 | — | 40% |
| Sodium blood test inpatient CPT 84295 SODIUM (NA) | $34.20 | $57.00 | $25.65 | — | 40% |
| Stool ova and parasites exam CPT 87177 OVA AND PARASITES | $63.00 | $105.00 | $28.24–$128.68 | 7% above | 40% |
| Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES | $63.00 | $105.00 | $47.25 | — | 40% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD-GUIAC | $30.60 | $51.00 | $13.72–$62.50 | 50% above | 40% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD-GUIAC | $30.60 | $51.00 | $22.95 | — | 40% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLD FHG, QUAL,1-3 | $112.20 | $187.00 | $50.30–$229.17 | 212% above | 40% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLD FHG, QUAL,1-3 | $112.20 | $187.00 | $84.15 | — | 40% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM | $93.60 | $156.00 | $41.96–$191.18 | 25% above | 40% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM | $93.60 | $156.00 | $70.20 | — | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SEROLOGY (RPR) | $11.40 | $19.00 | $5.11–$23.28 | 59% below | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL CSF | $30.00 | $50.00 | $13.45–$61.28 | 7% above | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SEROLOGY (RPR) | $11.40 | $19.00 | $8.55 | — | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL CSF | $30.00 | $50.00 | $22.50 | — | 40% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST, CELL IMMUN MEASURE | $436.80 | $728.00 | $195.83–$892.16 | 41% above | 40% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST, CELL IMMUN MEASURE | $436.80 | $728.00 | $327.60 | — | 40% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE | $181.80 | $303.00 | $81.51–$371.33 | 12% above | 40% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE | $181.80 | $303.00 | $136.35 | — | 40% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL AB EACH | $37.80 | $63.00 | $16.95–$77.21 | 50% below | 40% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 ANTI THY PEROXIDASE ABY | $102.60 | $171.00 | $46.00–$209.56 | 36% above | 40% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL AB EACH | $37.80 | $63.00 | $28.35 | — | 40% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTI THY PEROXIDASE ABY | $102.60 | $171.00 | $76.95 | — | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $118.20 | $197.00 | $52.99–$241.42 | 18% above | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $118.20 | $197.00 | $88.65 | — | 40% |
| Total IgE blood test CPT 82785 IMMUNOGLOBULIN - IGE | $115.80 | $193.00 | $51.92–$236.52 | 12% above | 40% |
| Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN - IGE | $115.80 | $193.00 | $86.85 | — | 40% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL | $30.60 | $51.00 | $13.72–$62.50 | 1% above | 40% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL | $30.60 | $51.00 | $22.95 | — | 40% |
| Total thyroxine (T4) blood test CPT 84436 T4 TOTAL THYROXINE | $48.60 | $81.00 | $21.79–$99.27 | 8% above | 40% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4 TOTAL THYROXINE | $48.60 | $81.00 | $36.45 | — | 40% |
| Total triiodothyronine (T3) blood test CPT 84480 T3 TOTAL | $100.20 | $167.00 | $44.92–$204.66 | 3% above | 40% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 TOTAL | $100.20 | $167.00 | $75.15 | — | 40% |
| Transferrin blood test CPT 84466 TRANSFERRIN | $90.00 | $150.00 | $40.35–$183.82 | 5% above | 40% |
| Transferrin blood test inpatient CPT 84466 TRANSFERRIN | $90.00 | $150.00 | $67.50 | — | 40% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $294.00 | $490.00 | $131.81–$600.50 | 60% above | 40% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $294.00 | $490.00 | $220.50 | — | 40% |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES | $40.20 | $67.00 | $18.02–$82.11 | 1% above | 40% |
| Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES | $40.20 | $67.00 | $30.15 | — | 40% |
| Troponin test, quantitative CPT 84484 TROPONIN I | $88.20 | $147.00 | $39.54–$180.15 | 7% above | 40% |
| Troponin test, quantitative inpatient CPT 84484 TROPONIN I | $88.20 | $147.00 | $66.15 | — | 40% |
| Uric acid blood test CPT 84550 URIC ACID | $31.80 | $53.00 | $14.26–$64.95 | at median | 40% |
| Uric acid blood test inpatient CPT 84550 URIC ACID | $31.80 | $53.00 | $23.85 | — | 40% |
| Urinalysis with microscope exam, automated CPT 81001 AUTOM URINE DIP W MICRO | $35.40 | $59.00 | $15.87–$72.30 | 7% above | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 AUTOM URINE DIP W MICRO | $35.40 | $59.00 | $26.55 | — | 40% |
| Urinalysis with microscope exam, manual CPT 81000 CHS URINE DIPSTICK (NOT DOT) | $19.80 | $33.00 | $8.88–$40.44 | 33% below | 40% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 CHS URINE DIPSTICK (NOT DOT) | $19.80 | $33.00 | $14.85 | — | 40% |
| Urinalysis without microscope exam, automated CPT 81003 URINE AUTO W/O MICRO | $10.20 | $17.00 | $4.57–$20.83 | 43% below | 40% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS | $10.20 | $17.00 | $4.57–$20.83 | 43% below | 40% |
| Urinalysis without microscope exam, automated CPT 81003 HEMA-STIX URINE | $15.60 | $26.00 | $6.99–$31.86 | 13% below | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS | $10.20 | $17.00 | $7.65 | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINE AUTO W/O MICRO | $10.20 | $17.00 | $7.65 | — | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HEMA-STIX URINE | $15.60 | $26.00 | $11.70 | — | 40% |
| Urinalysis without microscope exam, manual CPT 81002 KETOSTIX KETONE | $24.60 | $41.00 | $11.03–$50.25 | 17% above | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 KETOSTIX KETONE | $24.60 | $41.00 | $18.45 | — | 40% |
| Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE | $65.40 | $109.00 | $29.32–$133.58 | 15% above | 40% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE | $65.40 | $109.00 | $49.05 | — | 40% |
| Urine microalbumin (albumin) test CPT 82043 ALBUMIN-MICRO 24' HR URINE | $16.20 | $27.00 | $7.26–$33.09 | 59% below | 40% |
| Urine microalbumin (albumin) test CPT 82043 MICRO ALBUMIN SPOT URINE | $40.80 | $68.00 | $18.29–$83.33 | 3% above | 40% |
| Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN-MICRO 24' HR URINE | $16.20 | $27.00 | $12.15 | — | 40% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICRO ALBUMIN SPOT URINE | $40.80 | $68.00 | $30.60 | — | 40% |
| Urine pregnancy test, read by color change CPT 81025 ANES URINE HCG | $23.40 | $39.00 | $10.49–$47.79 | 37% below | 40% |
| Urine pregnancy test, read by color change CPT 81025 ED URINE HCG | $23.40 | $39.00 | $10.49–$47.79 | 37% below | 40% |
| Urine pregnancy test, read by color change CPT 81025 URINE HCG | $60.60 | $101.00 | $27.17–$123.78 | 64% above | 40% |
| Urine pregnancy test, read by color change inpatient CPT 81025 ED URINE HCG | $23.40 | $39.00 | $17.55 | — | 40% |
| Urine pregnancy test, read by color change inpatient CPT 81025 ANES URINE HCG | $23.40 | $39.00 | $17.55 | — | 40% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE HCG | $60.60 | $101.00 | $45.45 | — | 40% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 | $106.20 | $177.00 | $47.61–$216.91 | 13% above | 40% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12 | $106.20 | $177.00 | $79.65 | — | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25 HYDROXY VIT D | $208.80 | $348.00 | $93.61–$426.47 | 40% above | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25 HYDROXY VIT D | $208.80 | $348.00 | $156.60 | — | 40% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 DIHYDROXY VIT D-1,25 | $271.20 | $452.00 | $121.59–$553.93 | 13% above | 40% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 DIHYDROXY VIT D-1,25 | $271.20 | $452.00 | $203.40 | — | 40% |
| Zinc blood test CPT 84630 ZINC | $80.40 | $134.00 | $36.05–$164.22 | 11% above | 40% |
| Zinc blood test inpatient CPT 84630 ZINC | $80.40 | $134.00 | $60.30 | — | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 MATERNAL MSHCG | $37.80 | $63.00 | $16.95–$77.21 | 58% below | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG SUBUNIT | $106.20 | $177.00 | $47.61–$216.91 | 19% above | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 MATERNAL MSHCG | $37.80 | $63.00 | $28.35 | — | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG SUBUNIT | $106.20 | $177.00 | $79.65 | — | 40% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Pennsylvania | Off list |
|---|---|---|---|---|---|
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 BREAST STRTC BX INIT LESION RT | $11,769.00 | $19,615.00 | $5,276.44–$24,038.18 | 201% above | 40% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 BREAST STRTC BX INIT LESION LT | $11,769.00 | $19,615.00 | $5,276.44–$24,038.18 | 201% above | 40% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 BREAST STRTC BX INIT LESION RT | $11,769.00 | $19,615.00 | $8,826.75 | — | 40% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 BREAST STRTC BX INIT LESION LT | $11,769.00 | $19,615.00 | $8,826.75 | — | 40% |
| Broken foot (metatarsal) treatment without surgery or setting one side CPT 28470 CL METARSAL FX; WO MANIP LT | $1,742.40 | $2,904.00 | $781.18–$3,558.85 | 235% above | 40% |
| Broken foot (metatarsal) treatment without surgery or setting one side CPT 28470 CL TX METARSAL FX;WO MANIP RT | $1,742.40 | $2,904.00 | $781.18–$3,558.85 | 235% above | 40% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient one side CPT 28470 CL METARSAL FX; WO MANIP LT | $1,742.40 | $2,904.00 | $1,306.80 | — | 40% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient one side CPT 28470 CL TX METARSAL FX;WO MANIP RT | $1,742.40 | $2,904.00 | $1,306.80 | — | 40% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION/DEFIBRILLATION | $762.60 | $1,271.00 | $341.90–$1,557.61 | 48% below | 40% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT | $4,753.20 | $7,922.00 | $2,131.02–$9,708.41 | 224% above | 40% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION/DEFIBRILLATION | $762.60 | $1,271.00 | $571.95 | — | 40% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTRIC EXT | $4,753.20 | $7,922.00 | $3,564.90 | — | 40% |
| Coronary stent placement, one artery CPT 92928 PERC CORONARY BMS SINGLE | $82,375.20 | $137,292.00 | $36,931.55–$168,251.35 | 306% above | 40% |
| Coronary stent placement, one artery inpatient CPT 92928 PERC CORONARY BMS SINGLE | $82,375.20 | $137,292.00 | $61,781.40 | — | 40% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION BENIG LESION/WART | $1,443.60 | $2,406.00 | $647.21–$2,948.55 | 237% above | 40% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION BENIG LESION/WART | $1,443.60 | $2,406.00 | $1,082.70 | — | 40% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV | $6,466.80 | $10,778.00 | $2,899.28–$13,208.44 | 349% above | 40% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERT F JNT L/S 1 LEV | $6,466.80 | $10,778.00 | $4,850.10 | — | 40% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HYSTEROSALPINGOGRAPHY INJ PRO | $296.40 | $494.00 | $132.89–$605.40 | 23% below | 40% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HYSTEROSALPINGOGRAPHY INJ PRO | $296.40 | $494.00 | $222.30 | — | 40% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I & D OF ABSCESS | $693.60 | $1,156.00 | $310.96–$1,416.68 | 36% above | 40% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I & D ABSCESS SIMPLE | $1,443.60 | $2,406.00 | $647.21–$2,948.55 | 183% above | 40% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D OF ABSCESS | $693.60 | $1,156.00 | $520.20 | — | 40% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D ABSCESS SIMPLE | $1,443.60 | $2,406.00 | $1,082.70 | — | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION TENDON OR LIGAMENT | $712.80 | $1,188.00 | $319.57–$1,455.89 | 25% above | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ. TENDON SHEATH/TRIGGER | $2,144.40 | $3,574.00 | $961.41–$4,379.94 | 276% above | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) one side CPT 20550 US LONG OF HEAD BICEPS INJ LT | $2,144.40 | $3,574.00 | $961.41–$4,379.94 | 276% above | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) one side CPT 20550 US LONG HEAD OF BICEPS INJ RT | $2,144.40 | $3,574.00 | $961.41–$4,379.94 | 276% above | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION TENDON OR LIGAMENT | $712.80 | $1,188.00 | $534.60 | — | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ. TENDON SHEATH/TRIGGER | $2,144.40 | $3,574.00 | $1,608.30 | — | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient one side CPT 20550 US LONG OF HEAD BICEPS INJ LT | $2,144.40 | $3,574.00 | $1,608.30 | — | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient one side CPT 20550 US LONG HEAD OF BICEPS INJ RT | $2,144.40 | $3,574.00 | $1,608.30 | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJECTION PROC, THER MAJ JOINT | $2,144.40 | $3,574.00 | $961.41–$4,379.94 | 358% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 CT DRAIN/INJ MAJOR JNT/BURSA | $2,144.40 | $3,574.00 | $961.41–$4,379.94 | 358% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 USDRAIN/INJ MAJOR JNT/BURSA RT | $2,144.40 | $3,574.00 | $961.41–$4,379.94 | 358% above | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJECTION PROC, THER MAJ JOINT | $2,144.40 | $3,574.00 | $1,608.30 | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 CT DRAIN/INJ MAJOR JNT/BURSA | $2,144.40 | $3,574.00 | $1,608.30 | — | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 USDRAIN/INJ MAJOR JNT/BURSA RT | $2,144.40 | $3,574.00 | $1,608.30 | — | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS-INTERMED JO | $67.80 | $113.00 | $30.40–$138.48 | 81% below | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ INTERM JNT/BURSA | $2,144.40 | $3,574.00 | $961.41–$4,379.94 | 506% above | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS-INTERMED JO | $67.80 | $113.00 | $50.85 | — | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ INTERM JNT/BURSA | $2,144.40 | $3,574.00 | $1,608.30 | — | 40% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJECT SM JNT/BURSA | $2,144.40 | $3,574.00 | $961.41–$4,379.94 | 422% above | 40% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJECT SM JNT/BURSA | $2,144.40 | $3,574.00 | $1,608.30 | — | 40% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CT GUIDED NERVE BLOCK-LUMBAR | $6,472.80 | $10,788.00 | $2,901.97–$13,220.69 | 238% above | 40% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 CT GUIDED NERVE BLOCK-LUMBAR | $6,472.80 | $10,788.00 | $4,854.60 | — | 40% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE,PART/COMP | $712.80 | $1,188.00 | $319.57–$1,455.89 | 51% above | 40% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE;ONE | $1,443.60 | $2,406.00 | $647.21–$2,948.55 | 206% above | 40% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE,PART/COMP | $712.80 | $1,188.00 | $534.60 | — | 40% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE;ONE | $1,443.60 | $2,406.00 | $1,082.70 | — | 40% |
| Paracentesis with imaging guidance CPT 49083 US PARACENTESIS W ALBUMIN | $1,677.60 | $2,796.00 | $752.12–$3,426.50 | at median | 40% |
| Paracentesis with imaging guidance CPT 49083 US PARACENTESIS | $1,677.60 | $2,796.00 | $752.12–$3,426.50 | at median | 40% |
| Paracentesis with imaging guidance CPT 49083 CT PARACENTESIS | $1,677.60 | $2,796.00 | $752.12–$3,426.50 | at median | 40% |
| Paracentesis with imaging guidance CPT 49083 PARACENTESIS | $6,810.00 | $11,350.00 | $3,053.15–$13,909.42 | 304% above | 40% |
| Paracentesis with imaging guidance inpatient CPT 49083 CT PARACENTESIS | $1,677.60 | $2,796.00 | $1,258.20 | — | 40% |
| Paracentesis with imaging guidance inpatient CPT 49083 US PARACENTESIS | $1,677.60 | $2,796.00 | $1,258.20 | — | 40% |
| Paracentesis with imaging guidance inpatient CPT 49083 US PARACENTESIS W ALBUMIN | $1,677.60 | $2,796.00 | $1,258.20 | — | 40% |
| Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS | $6,810.00 | $11,350.00 | $5,107.50 | — | 40% |
| Prostate biopsy CPT 55700 US PROSTATE BX | $14,880.00 | $24,800.00 | $6,671.20–$30,392.40 | 288% above | 40% |
| Prostate biopsy inpatient CPT 55700 US PROSTATE BX | $14,880.00 | $24,800.00 | $11,160.00 | — | 40% |
| Removal of a foreign object under the skin, simple CPT 10120 REMOVAL FB,SUBQ TISSUE, SIMPLE | $712.80 | $1,188.00 | $319.57–$1,455.89 | 31% above | 40% |
| Removal of a foreign object under the skin, simple CPT 10120 I & R FB SIMPLE | $2,902.20 | $4,837.00 | $1,301.15–$5,927.74 | 434% above | 40% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVAL FB,SUBQ TISSUE, SIMPLE | $712.80 | $1,188.00 | $534.60 | — | 40% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 I & R FB SIMPLE | $2,902.20 | $4,837.00 | $2,176.65 | — | 40% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) one side CPT 50590 UNILATERAL LITHOTRIPSY | $8,163.60 | $13,606.00 | $3,660.01–$16,674.15 | 23% above | 40% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient one side CPT 50590 UNILATERAL LITHOTRIPSY | $8,163.60 | $13,606.00 | $6,122.70 | — | 40% |
| Short arm splint (forearm and hand) CPT 29125 SHORT ARM SPLINT STATIC | $63.00 | $105.00 | $28.24–$128.68 | 80% below | 40% |
| Short arm splint (forearm and hand) CPT 29125 FABRICATE THUMB SPICA SPLINT | $106.20 | $177.00 | $47.61–$216.91 | 66% below | 40% |
| Short arm splint (forearm and hand) CPT 29125 SHORT ARM SPLINT | $936.60 | $1,561.00 | $419.91–$1,913.01 | 197% above | 40% |
| Short arm splint (forearm and hand) inpatient CPT 29125 SHORT ARM SPLINT STATIC | $63.00 | $105.00 | $47.25 | — | 40% |
| Short arm splint (forearm and hand) inpatient CPT 29125 FABRICATE THUMB SPICA SPLINT | $106.20 | $177.00 | $79.65 | — | 40% |
| Short arm splint (forearm and hand) inpatient CPT 29125 SHORT ARM SPLINT | $936.60 | $1,561.00 | $702.45 | — | 40% |
| Short leg splint (calf to foot) CPT 29515 SHORT LEG SPLINT | $73.80 | $123.00 | $33.09–$150.74 | 84% below | 40% |
| Short leg splint (calf to foot) inpatient CPT 29515 SHORT LEG SPLINT | $73.80 | $123.00 | $55.35 | — | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR WOUND SIMPLE <2.5CM | $1,443.60 | $2,406.00 | $647.21–$2,948.55 | 181% above | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 TRNK,SCLP,NK,EXT.;2.5CM OR < | $1,443.60 | $2,406.00 | $647.21–$2,948.55 | 181% above | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPAIR WOUND SIMPLE <2.5CM | $1,443.60 | $2,406.00 | $1,082.70 | — | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 TRNK,SCLP,NK,EXT.;2.5CM OR < | $1,443.60 | $2,406.00 | $1,082.70 | — | 40% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION | $2,902.20 | $4,837.00 | $1,301.15–$5,927.74 | 341% above | 40% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION | $2,902.20 | $4,837.00 | $2,176.65 | — | 40% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES | $1,443.60 | $2,406.00 | $647.21–$2,948.55 | 155% above | 40% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES | $1,443.60 | $2,406.00 | $1,082.70 | — | 40% |
| Thoracentesis with imaging guidance CPT 32555 THORA W IMAG REMVE FLUID/DRAIN | $1,425.60 | $2,376.00 | $639.14–$2,911.79 | 3% below | 40% |
| Thoracentesis with imaging guidance one side CPT 32555 CT THORA W/TUBE THERAPUTIC LT | $1,425.60 | $2,376.00 | $639.14–$2,911.79 | 3% below | 40% |
| Thoracentesis with imaging guidance one side CPT 32555 CT CHEST TUBE/PNEUMO LT | $1,425.60 | $2,376.00 | $639.14–$2,911.79 | 3% below | 40% |
| Thoracentesis with imaging guidance one side CPT 32555 US THORACENTESIS LT | $1,425.60 | $2,376.00 | $639.14–$2,911.79 | 3% below | 40% |
| Thoracentesis with imaging guidance one side CPT 32555 US THORACENTESIS RT | $1,425.60 | $2,376.00 | $639.14–$2,911.79 | 3% below | 40% |
| Thoracentesis with imaging guidance one side CPT 32555 CT THORACENTESIS RT | $1,425.60 | $2,376.00 | $639.14–$2,911.79 | 3% below | 40% |
| Thoracentesis with imaging guidance one side CPT 32555 CT THORA W/TUBE THERAPUTIC RT | $1,425.60 | $2,376.00 | $639.14–$2,911.79 | 3% below | 40% |
| Thoracentesis with imaging guidance one side CPT 32555 CT CHEST TUBE/PNEUMO RT | $1,425.60 | $2,376.00 | $639.14–$2,911.79 | 3% below | 40% |
| Thoracentesis with imaging guidance one side CPT 32555 CT THORACENTESIS LT | $1,425.60 | $2,376.00 | $639.14–$2,911.79 | 3% below | 40% |
| Thoracentesis with imaging guidance inpatient CPT 32555 THORA W IMAG REMVE FLUID/DRAIN | $1,425.60 | $2,376.00 | $1,069.20 | — | 40% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 CT THORA W/TUBE THERAPUTIC RT | $1,425.60 | $2,376.00 | $1,069.20 | — | 40% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 CT THORACENTESIS RT | $1,425.60 | $2,376.00 | $1,069.20 | — | 40% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 CT CHEST TUBE/PNEUMO RT | $1,425.60 | $2,376.00 | $1,069.20 | — | 40% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 CT THORACENTESIS LT | $1,425.60 | $2,376.00 | $1,069.20 | — | 40% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 CT THORA W/TUBE THERAPUTIC LT | $1,425.60 | $2,376.00 | $1,069.20 | — | 40% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 CT CHEST TUBE/PNEUMO LT | $1,425.60 | $2,376.00 | $1,069.20 | — | 40% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 US THORACENTESIS RT | $1,425.60 | $2,376.00 | $1,069.20 | — | 40% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 US THORACENTESIS LT | $1,425.60 | $2,376.00 | $1,069.20 | — | 40% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT, 1/2 MUSCL | $712.80 | $1,188.00 | $319.57–$1,455.89 | 32% above | 40% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ;SINGLE/MULTIPLE 1-2 MUSCLE | $2,144.40 | $3,574.00 | $961.41–$4,379.94 | 297% above | 40% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT, 1/2 MUSCL | $712.80 | $1,188.00 | $534.60 | — | 40% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ;SINGLE/MULTIPLE 1-2 MUSCLE | $2,144.40 | $3,574.00 | $1,608.30 | — | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BREAST BX INITIAL LESION RT | $11,769.00 | $19,615.00 | $5,276.44–$24,038.18 | 228% above | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BREAST BX INITIAL LESION LT | $11,769.00 | $19,615.00 | $5,276.44–$24,038.18 | 228% above | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US BREAST BX INITIAL LESION LT | $11,769.00 | $19,615.00 | $8,826.75 | — | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US BREAST BX INITIAL LESION RT | $11,769.00 | $19,615.00 | $8,826.75 | — | 40% |
| Vein ablation, radiofrequency, first vein one side CPT 36475 US ENDOVENOUS RF ABLATION LT | $22,863.00 | $38,105.00 | $10,250.25–$46,697.68 | 144% above | 40% |
| Vein ablation, radiofrequency, first vein one side CPT 36475 US ENDOVENOUS RF ABLATION RT | $22,863.00 | $38,105.00 | $10,250.25–$46,697.68 | 144% above | 40% |
| Vein ablation, radiofrequency, first vein inpatient one side CPT 36475 US ENDOVENOUS RF ABLATION RT | $22,863.00 | $38,105.00 | $17,147.25 | — | 40% |
| Vein ablation, radiofrequency, first vein inpatient one side CPT 36475 US ENDOVENOUS RF ABLATION LT | $22,863.00 | $38,105.00 | $17,147.25 | — | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT;SKIN AND SUBQ | $964.80 | $1,608.00 | $432.55–$1,970.60 | 10% below | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRID;SKIN/SUBCUTANEOUS | $2,902.20 | $4,837.00 | $1,301.15–$5,927.74 | 169% above | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT;SKIN AND SUBQ | $964.80 | $1,608.00 | $723.60 | — | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRID;SKIN/SUBCUTANEOUS | $2,902.20 | $4,837.00 | $2,176.65 | — | 40% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Pennsylvania | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSIONS(ALL BLOOD/BLOOD | $3,175.80 | $5,293.00 | $1,423.82–$6,486.57 | 237% above | 40% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION | $3,175.80 | $5,293.00 | $1,423.82–$6,486.57 | 237% above | 40% |
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION, BLOOD OR BLD COMP | $3,175.80 | $5,293.00 | $1,423.82–$6,486.57 | 237% above | 40% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSIONS(ALL BLOOD/BLOOD | $3,175.80 | $5,293.00 | $2,381.85 | — | 40% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION | $3,175.80 | $5,293.00 | $2,381.85 | — | 40% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION, BLOOD OR BLD COMP | $3,175.80 | $5,293.00 | $2,381.85 | — | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SVN & OR MDI INITIAL TX | $1,477.20 | $2,462.00 | $662.28–$3,017.18 | 562% above | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SVN & OR MDI INITIAL TX | $1,477.20 | $2,462.00 | $1,107.90 | — | 40% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION TECH 1 HR | $2,409.60 | $4,016.00 | $1,080.30–$4,921.61 | 233% above | 40% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION TECH 1 HR | $2,409.60 | $4,016.00 | $1,807.20 | — | 40% |
| Critical care, first 30 to 74 minutes CPT 99291 ED CRITICAL CARE UP TO 74MIN | $6,120.60 | $10,201.00 | $2,744.07–$12,501.33 | 226% above | 40% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 ED CRITICAL CARE UP TO 74MIN | $6,120.60 | $10,201.00 | $4,590.45 | — | 40% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE & DROWSY W PORTABLE | $437.40 | $729.00 | $196.10–$893.39 | 42% below | 40% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY | $2,262.00 | $3,770.00 | $1,014.13–$4,620.14 | 197% above | 40% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE & DROWSY W PORTABLE | $437.40 | $729.00 | $328.05 | — | 40% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE AND DROWSY | $2,262.00 | $3,770.00 | $1,696.50 | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 REPEAT EKG ER | $110.40 | $184.00 | $49.50–$225.49 | 37% below | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TC | $431.40 | $719.00 | $193.41–$881.13 | 147% above | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 REPEAT EKG ER | $110.40 | $184.00 | $82.80 | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM TC | $431.40 | $719.00 | $323.55 | — | 40% |
| Electroconvulsive therapy (ECT), one session CPT 90870 ECT | $3,854.40 | $6,424.00 | $1,728.06–$7,872.61 | 205% above | 40% |
| Electroconvulsive therapy (ECT), one session inpatient CPT 90870 ECT | $3,854.40 | $6,424.00 | $2,890.80 | — | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY ROOM LEVEL 1 | $639.60 | $1,066.00 | $286.75–$1,306.38 | 110% above | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENCY ROOM LEVEL 1 | $639.60 | $1,066.00 | $479.70 | — | 40% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY ROOM LEVEL 2 | $1,150.20 | $1,917.00 | $515.67–$2,349.28 | 140% above | 40% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY ROOM LEVEL 2 | $1,150.20 | $1,917.00 | $862.65 | — | 40% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY ROOM LEVEL 3 | $2,011.20 | $3,352.00 | $901.69–$4,107.88 | 170% above | 40% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY ROOM LEVEL 3 | $2,011.20 | $3,352.00 | $1,508.40 | — | 40% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY ROOM LEVEL 4 | $3,093.00 | $5,155.00 | $1,386.70–$6,317.45 | 153% above | 40% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY ROOM LEVEL 4 | $3,093.00 | $5,155.00 | $2,319.75 | — | 40% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY ROOM LEVEL 5 | $4,453.20 | $7,422.00 | $1,996.52–$9,095.66 | 179% above | 40% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY ROOM LEVEL 5 | $4,453.20 | $7,422.00 | $3,339.90 | — | 40% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 NUCLEAR EXERCISE STRESS TEST | $441.00 | $735.00 | $197.72–$900.74 | 53% below | 40% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 LEXISCAN STRESS TEST | $441.00 | $735.00 | $197.72–$900.74 | 53% below | 40% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 TREADMILL | $441.00 | $735.00 | $197.72–$900.74 | 53% below | 40% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 DOBUTAMINE STRESS TEST | $2,262.00 | $3,770.00 | $1,014.13–$4,620.14 | 139% above | 40% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 NUCLEAR EXERCISE STRESS TEST | $441.00 | $735.00 | $330.75 | — | 40% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TREADMILL | $441.00 | $735.00 | $330.75 | — | 40% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 LEXISCAN STRESS TEST | $441.00 | $735.00 | $330.75 | — | 40% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 DOBUTAMINE STRESS TEST | $2,262.00 | $3,770.00 | $1,696.50 | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INF,INITIAL | $268.20 | $447.00 | $120.24–$547.80 | 38% below | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION, INIT | $268.20 | $447.00 | $120.24–$547.80 | 38% below | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INF, INITIAL | $363.00 | $605.00 | $162.74–$741.43 | 17% below | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT | $363.00 | $605.00 | $162.74–$741.43 | 17% below | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION, INIT | $268.20 | $447.00 | $201.15 | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INF,INITIAL | $268.20 | $447.00 | $201.15 | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT | $363.00 | $605.00 | $272.25 | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INF, INITIAL | $363.00 | $605.00 | $272.25 | — | 40% |
| IV infusion of a medicine, first hour CPT 96365 IV THERAPY 1ST HOUR | $1,530.60 | $2,551.00 | $686.22–$3,126.25 | 240% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT | $1,530.60 | $2,551.00 | $686.22–$3,126.25 | 240% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 IV THERAPY NON CHEMO 1ST HOUR | $1,530.60 | $2,551.00 | $686.22–$3,126.25 | 240% above | 40% |
| IV infusion of a medicine, first hour CPT 96365 NON-CHEMO ADMIN 1ST HOUR | $1,530.60 | $2,551.00 | $686.22–$3,126.25 | 240% above | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY 1ST HOUR | $1,530.60 | $2,551.00 | $1,147.95 | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY NON CHEMO 1ST HOUR | $1,530.60 | $2,551.00 | $1,147.95 | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 NON-CHEMO ADMIN 1ST HOUR | $1,530.60 | $2,551.00 | $1,147.95 | — | 40% |
| IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT | $1,530.60 | $2,551.00 | $1,147.95 | — | 40% |
| IV push of a medicine, first drug CPT 96374 MEDICATION INJECTION (IV PUSH) | $363.00 | $605.00 | $162.74–$741.43 | 11% above | 40% |
| IV push of a medicine, first drug CPT 96374 IV MEDICATION PUSH | $363.00 | $605.00 | $162.74–$741.43 | 11% above | 40% |
| IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IV PUSH | $363.00 | $605.00 | $162.74–$741.43 | 11% above | 40% |
| IV push of a medicine, first drug CPT 96374 NON CHEMO IV PUSH | $363.00 | $605.00 | $162.74–$741.43 | 11% above | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 MEDICATION INJECTION (IV PUSH) | $363.00 | $605.00 | $272.25 | — | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 IV MEDICATION PUSH | $363.00 | $605.00 | $272.25 | — | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 THER/PROPH/DIAG INJ IV PUSH | $363.00 | $605.00 | $272.25 | — | 40% |
| IV push of a medicine, first drug inpatient CPT 96374 NON CHEMO IV PUSH | $363.00 | $605.00 | $272.25 | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ INJECTION | $12.00 | $20.00 | $5.38–$24.51 | 90% below | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 NON CHEMO INJ; SQ, IM | $90.00 | $150.00 | $40.35–$183.82 | 27% below | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/M | $517.20 | $862.00 | $231.88–$1,056.38 | 319% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION, SQ, IM | $517.20 | $862.00 | $231.88–$1,056.38 | 319% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM | $517.20 | $862.00 | $231.88–$1,056.38 | 319% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 MEDICATION INJECTION SQ OR IM | $517.20 | $862.00 | $231.88–$1,056.38 | 319% above | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ INJECTION | $12.00 | $20.00 | $9.00 | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 NON CHEMO INJ; SQ, IM | $90.00 | $150.00 | $67.50 | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/M | $517.20 | $862.00 | $387.90 | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 MEDICATION INJECTION SQ OR IM | $517.20 | $862.00 | $387.90 | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM | $517.20 | $862.00 | $387.90 | — | 40% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION, SQ, IM | $517.20 | $862.00 | $387.90 | — | 40% |
| New patient office visit, about 30 minutes CPT 99203 O/P OFF VISIT NEW PT DETAILED | $81.00 | $135.00 | $36.32–$165.44 | 66% below | 40% |
| New patient office visit, about 30 minutes CPT 99203 LOW <30 MINUTES | $190.20 | $317.00 | $85.27–$388.48 | 20% below | 40% |
| New patient office visit, about 30 minutes CPT 99203 NEW PT LOW <30 MINUTES | $190.20 | $317.00 | $85.27–$388.48 | 20% below | 40% |
| New patient office visit, about 30 minutes CPT 99203 LEVEL III NEW PATIENT | $190.20 | $317.00 | $85.27–$388.48 | 20% below | 40% |
| New patient office visit, about 30 minutes CPT 99203 LEVEL III NEW PATIENT-30 MIN | $301.80 | $503.00 | $135.31–$616.43 | 26% above | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 O/P OFF VISIT NEW PT DETAILED | $81.00 | $135.00 | $60.75 | — | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 LOW <30 MINUTES | $190.20 | $317.00 | $142.65 | — | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PT LOW <30 MINUTES | $190.20 | $317.00 | $142.65 | — | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 LEVEL III NEW PATIENT | $190.20 | $317.00 | $142.65 | — | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 LEVEL III NEW PATIENT-30 MIN | $301.80 | $503.00 | $226.35 | — | 40% |
| New patient office visit, about 45 minutes CPT 99204 O/P OFF VISIT NEW PT MOD COMP | $81.00 | $135.00 | $36.32–$165.44 | 73% below | 40% |
| New patient office visit, about 45 minutes CPT 99204 MODERATE <45 MINUTES | $199.80 | $333.00 | $89.58–$408.09 | 33% below | 40% |
| New patient office visit, about 45 minutes CPT 99204 LEVEL IV NEW PATIENT | $199.80 | $333.00 | $89.58–$408.09 | 33% below | 40% |
| New patient office visit, about 45 minutes CPT 99204 LEVEL IV NEW PATIENT-45 MIN | $307.80 | $513.00 | $138.00–$628.68 | 3% above | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 O/P OFF VISIT NEW PT MOD COMP | $81.00 | $135.00 | $60.75 | — | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 MODERATE <45 MINUTES | $199.80 | $333.00 | $149.85 | — | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 LEVEL IV NEW PATIENT | $199.80 | $333.00 | $149.85 | — | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 LEVEL IV NEW PATIENT-45 MIN | $307.80 | $513.00 | $230.85 | — | 40% |
| New patient office visit, about 60 minutes CPT 99205 NEW PT HIGHLYCOMPLEX OFFICE S | $87.60 | $146.00 | $39.27–$178.92 | 83% below | 40% |
| New patient office visit, about 60 minutes CPT 99205 HIGH >45 MINUTES | $219.60 | $366.00 | $98.45–$448.53 | 58% below | 40% |
| New patient office visit, about 60 minutes CPT 99205 LEVEL V NEW PATIENT | $219.60 | $366.00 | $98.45–$448.53 | 58% below | 40% |
| New patient office visit, about 60 minutes CPT 99205 LEVEL V NEW PATIENT-60 MIN | $314.40 | $524.00 | $140.96–$642.16 | 40% below | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 NEW PT HIGHLYCOMPLEX OFFICE S | $87.60 | $146.00 | $65.70 | — | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 LEVEL V NEW PATIENT | $219.60 | $366.00 | $164.70 | — | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HIGH >45 MINUTES | $219.60 | $366.00 | $164.70 | — | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 LEVEL V NEW PATIENT-60 MIN | $314.40 | $524.00 | $235.80 | — | 40% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PT EXPANDED OFFICE SVC | $81.00 | $135.00 | $36.32–$165.44 | 56% below | 40% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 LEVEL 1 NEW PATIENT-10 MIN | $184.80 | $308.00 | $82.85–$377.45 | 1% above | 40% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 LEVEL 1 NEW PATIENT | $184.80 | $308.00 | $82.85–$377.45 | 1% above | 40% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 STRAIGHT FORWARD <20 MINUTES | $188.40 | $314.00 | $84.47–$384.81 | 3% above | 40% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 LEVEL II NEW PATIENT | $188.40 | $314.00 | $84.47–$384.81 | 3% above | 40% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 LEVEL II NEW PATIENT-20 MIN | $298.20 | $497.00 | $133.69–$609.07 | 63% above | 40% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PT EXPANDED OFFICE SVC | $81.00 | $135.00 | $60.75 | — | 40% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 LEVEL 1 NEW PATIENT-10 MIN | $184.80 | $308.00 | $138.60 | — | 40% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 LEVEL 1 NEW PATIENT | $184.80 | $308.00 | $138.60 | — | 40% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 LEVEL II NEW PATIENT | $188.40 | $314.00 | $141.30 | — | 40% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 STRAIGHT FORWARD <20 MINUTES | $188.40 | $314.00 | $141.30 | — | 40% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 LEVEL II NEW PATIENT-20 MIN | $298.20 | $497.00 | $223.65 | — | 40% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 OP MNT INITIAL CONSULT EA 15MI | $213.60 | $356.00 | $95.76–$436.28 | 324% above | 40% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 OP MNT INIT CON 15 MIN VIRTUAL | $213.60 | $356.00 | $95.76–$436.28 | 324% above | 40% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 OP MNT INITIAL CONSULT EA 15MI | $213.60 | $356.00 | $160.20 | — | 40% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 OP MNT INIT CON 15 MIN VIRTUAL | $213.60 | $356.00 | $160.20 | — | 40% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 O/P OFF VISIT EST PT COMPLX | $81.00 | $135.00 | $36.32–$165.44 | 70% below | 40% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 RN VISIT-EST PT COMPLEX-40 MIN | $199.80 | $333.00 | $89.58–$408.09 | 27% below | 40% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 LEVEL V ESTABLISHED PATIENT | $199.80 | $333.00 | $89.58–$408.09 | 27% below | 40% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PT HIGH >40 MIN | $199.80 | $333.00 | $89.58–$408.09 | 27% below | 40% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PT HIGH > 40 MINUTES | $199.80 | $333.00 | $89.58–$408.09 | 27% below | 40% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 O/P OFF VISIT EST PT COMPLX | $81.00 | $135.00 | $60.75 | — | 40% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PT HIGH > 40 MINUTES | $199.80 | $333.00 | $149.85 | — | 40% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 RN VISIT-EST PT COMPLEX-40 MIN | $199.80 | $333.00 | $149.85 | — | 40% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 LEVEL V ESTABLISHED PATIENT | $199.80 | $333.00 | $149.85 | — | 40% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PT HIGH >40 MIN | $199.80 | $333.00 | $149.85 | — | 40% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT DETAILED OFFICE SVC | $81.00 | $135.00 | $36.32–$165.44 | 56% below | 40% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 LEVEL III ESTABLISHED PATIENT | $190.20 | $317.00 | $85.27–$388.48 | 3% above | 40% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT LOW <15 MIN | $190.20 | $317.00 | $85.27–$388.48 | 3% above | 40% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT LOW <15 MINUTES | $190.20 | $317.00 | $85.27–$388.48 | 3% above | 40% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 RN VISIT-EST PT MODERATE-15 MN | $190.20 | $317.00 | $85.27–$388.48 | 3% above | 40% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PT DETAILED OFFICE SVC | $81.00 | $135.00 | $60.75 | — | 40% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PT LOW <15 MIN | $190.20 | $317.00 | $142.65 | — | 40% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 LEVEL III ESTABLISHED PATIENT | $190.20 | $317.00 | $142.65 | — | 40% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 RN VISIT-EST PT MODERATE-15 MN | $190.20 | $317.00 | $142.65 | — | 40% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PT LOW <15 MINUTES | $190.20 | $317.00 | $142.65 | — | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 O/P OFF VISIT PT MOD COMPLX | $81.00 | $135.00 | $36.32–$165.44 | 60% below | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 LEVEL IV ESTABLISHED PATIENT | $193.20 | $322.00 | $86.62–$394.61 | 4% below | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 RN EST PT COMPREHENSIVE-25 MIN | $193.20 | $322.00 | $86.62–$394.61 | 4% below | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PT MODERATE < 25 MINUTES | $193.20 | $322.00 | $86.62–$394.61 | 4% below | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PT MODERATE <25 MIN | $193.20 | $322.00 | $86.62–$394.61 | 4% below | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 O/P OFF VISIT PT MOD COMPLX | $81.00 | $135.00 | $60.75 | — | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PT MODERATE <25 MIN | $193.20 | $322.00 | $144.90 | — | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 LEVEL IV ESTABLISHED PATIENT | $193.20 | $322.00 | $144.90 | — | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 RN EST PT COMPREHENSIVE-25 MIN | $193.20 | $322.00 | $144.90 | — | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PT MODERATE < 25 MINUTES | $193.20 | $322.00 | $144.90 | — | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 O/P OFF VISIT EST PT EXPANDED | $81.00 | $135.00 | $36.32–$165.44 | 50% below | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 RN EST PT EXPANDED PROB-10 MIN | $188.40 | $314.00 | $84.47–$384.81 | 16% above | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 LEVEL II ESTABLISHED PATIENT | $188.40 | $314.00 | $84.47–$384.81 | 16% above | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT STRAIGHT FORWARD <10MIN | $188.40 | $314.00 | $84.47–$384.81 | 16% above | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT STRAIGHTFORWARD <10MIN | $188.40 | $314.00 | $84.47–$384.81 | 16% above | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 O/P OFF VISIT EST PT EXPANDED | $81.00 | $135.00 | $60.75 | — | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PT STRAIGHTFORWARD <10MIN | $188.40 | $314.00 | $141.30 | — | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 LEVEL II ESTABLISHED PATIENT | $188.40 | $314.00 | $141.30 | — | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 RN EST PT EXPANDED PROB-10 MIN | $188.40 | $314.00 | $141.30 | — | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PT STRAIGHT FORWARD <10MIN | $188.40 | $314.00 | $141.30 | — | 40% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY | $455.40 | $759.00 | $204.17–$930.15 | 51% above | 40% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY | $455.40 | $759.00 | $341.55 | — | 40% |
| Spirometry before and after a bronchodilator CPT 94060 BRONCHOSPASM PRE/POST DILATOR | $455.40 | $759.00 | $204.17–$930.15 | 30% below | 40% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHOSPASM PRE/POST DILATOR | $455.40 | $759.00 | $341.55 | — | 40% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Pennsylvania | Off list |
|---|---|---|---|---|---|
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 FLUAD TRIVALENT VACCINE | $102.00 | $170.00 | $45.73–$208.34 | 39% below | 40% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 FLUAD 2019 2020 SYRINGE | $162.60 | $271.00 | $72.90–$332.11 | 3% below | 40% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 FLUAD TRIVALENT VACCINE | $102.00 | $170.00 | $76.50 | — | 40% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 FLUAD 2019 2020 SYRINGE | $162.60 | $271.00 | $121.95 | — | 40% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VACCINE(VARIVAX)1350 | $310.80 | $518.00 | $139.34–$634.81 | 51% above | 40% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VACCINE(VARIVAX)1350 | $310.80 | $518.00 | $233.10 | — | 40% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 INFANRIX PFS 0.5ML | $48.00 | $80.00 | $21.52–$98.04 | 40% above | 40% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 INFANRIX PFS 0.5ML | $48.00 | $80.00 | $36.00 | — | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VACCINE-PF SYRINGE | $34.20 | $57.00 | $15.33–$69.85 | 49% below | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUVIRIN VACCINE PFS 45MCG/.5M | $34.20 | $57.00 | $15.33–$69.85 | 49% below | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUARIX VACCINE 0.5ML SYRINGE | $34.20 | $57.00 | $15.33–$69.85 | 49% below | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUZONE ('24-'25) 0.5ML SYRING | $44.40 | $74.00 | $19.91–$90.69 | 33% below | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUZONE ('25-'26) 0.5ML | $48.00 | $80.00 | $21.52–$98.04 | 28% below | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUVIRIN VACCINE PFS 45MCG/.5M | $34.20 | $57.00 | $25.65 | — | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUARIX VACCINE 0.5ML SYRINGE | $34.20 | $57.00 | $25.65 | — | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VACCINE-PF SYRINGE | $34.20 | $57.00 | $25.65 | — | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUZONE ('24-'25) 0.5ML SYRING | $44.40 | $74.00 | $33.30 | — | 40% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUZONE ('25-'26) 0.5ML | $48.00 | $80.00 | $36.00 | — | 40% |
| Hepatitis A vaccine, adult dose CPT 90632 CHS HEPATITIS A VACCINE & ADMI | $46.20 | $77.00 | $20.71–$94.36 | 48% below | 40% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE (VAQTA) | $247.80 | $413.00 | $111.10–$506.13 | 178% above | 40% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 CHS HEPATITIS A VACCINE & ADMI | $46.20 | $77.00 | $34.65 | — | 40% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE (VAQTA) | $247.80 | $413.00 | $185.85 | — | 40% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 VAQTA 25 UNITS/0.5 ML VIAL | $102.60 | $171.00 | $46.00–$209.56 | 38% above | 40% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 VAQTA 25 UNITS/0.5 ML VIAL | $102.60 | $171.00 | $76.95 | — | 40% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 CHS HEPATITIS B VACCINE & ADMI | $39.00 | $65.00 | $17.48–$79.66 | 53% below | 40% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE | $39.00 | $65.00 | $17.48–$79.66 | 53% below | 40% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE | $39.00 | $65.00 | $29.25 | — | 40% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 CHS HEPATITIS B VACCINE & ADMI | $39.00 | $65.00 | $29.25 | — | 40% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 ENGERIX-B 10MCG/0.5ML | $153.00 | $255.00 | $68.60–$312.50 | 223% above | 40% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 ENGERIX-B SDV P/F 20MCG/ML | $1,645.20 | $2,742.00 | $737.60–$3,360.32 | 3371% above | 40% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 ENGERIX-B 10MCG/0.5ML | $153.00 | $255.00 | $114.75 | — | 40% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 ENGERIX-B SDV P/F 20MCG/ML | $1,645.20 | $2,742.00 | $1,233.90 | — | 40% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIBERIX SDV 0.85ML/DIL | $33.00 | $55.00 | $14.80–$67.40 | 5% above | 40% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HIBERIX SDV 0.85ML/DIL | $33.00 | $55.00 | $24.75 | — | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZO HIGH DSE ('25-'26) 0.5ML | $132.00 | $220.00 | $59.18–$269.61 | 51% above | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZO HIGH DSE ('24-'25) 0.5ML | $157.80 | $263.00 | $70.75–$322.31 | 81% above | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZO HIGH DSE ('25-'26) 0.5ML | $132.00 | $220.00 | $99.00 | — | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZO HIGH DSE ('24-'25) 0.5ML | $157.80 | $263.00 | $118.35 | — | 40% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENVEO VACCINE A-C-Y 135 DIP V | $174.00 | $290.00 | $78.01–$355.40 | 86% above | 40% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENVEO VACCINE A-C-Y 135 DIP V | $174.00 | $290.00 | $130.50 | — | 40% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 BEXSERO PFS 1 IU 0.5ML | $254.40 | $424.00 | $114.06–$519.61 | 32% above | 40% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 BEXSERO PFS 1 IU 0.5ML | $254.40 | $424.00 | $190.80 | — | 40% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR 13 PFS 0.5 ML | $439.80 | $733.00 | $197.18–$898.29 | 205% above | 40% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PREVNAR 13 PFS 0.5 ML | $439.80 | $733.00 | $329.85 | — | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACCINE | $26.40 | $44.00 | $11.84–$53.92 | 79% below | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOVAX VACCINE | $153.00 | $255.00 | $68.60–$312.50 | 19% above | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACCINE | $26.40 | $44.00 | $19.80 | — | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOVAX VACCINE | $153.00 | $255.00 | $114.75 | — | 40% |
| Rabies vaccine, one dose CPT 90675 RABAVERT RABIES VACCINE VIAL | $898.20 | $1,497.00 | $402.69–$1,834.57 | 50% above | 40% |
| Rabies vaccine, one dose CPT 90675 IMOVAX RABIES VACCINE 2.5IU | $1,002.60 | $1,671.00 | $449.50–$2,047.81 | 68% above | 40% |
| Rabies vaccine, one dose inpatient CPT 90675 RABAVERT RABIES VACCINE VIAL | $898.20 | $1,497.00 | $673.65 | — | 40% |
| Rabies vaccine, one dose inpatient CPT 90675 IMOVAX RABIES VACCINE 2.5IU | $1,002.60 | $1,671.00 | $751.95 | — | 40% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TENIVAC TETANUS DIP. TOXOID | $70.20 | $117.00 | $31.47–$143.38 | 26% above | 40% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TENIVAC TETANUS DIP. TOXOID | $70.20 | $117.00 | $52.65 | — | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP (ADACEL) VACCINE | $49.80 | $83.00 | $22.33–$101.72 | 11% below | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 CHS TDAP VACCINE & ADMIN | $49.80 | $83.00 | $22.33–$101.72 | 11% below | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH,PERTUSS,ADELL TETANUS | $99.60 | $166.00 | $44.65–$203.43 | 78% above | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX VACCINE VIAL 0.5ML | $122.40 | $204.00 | $54.88–$250.00 | 118% above | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP (ADACEL) VACCINE | $49.80 | $83.00 | $37.35 | — | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 CHS TDAP VACCINE & ADMIN | $49.80 | $83.00 | $37.35 | — | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTH,PERTUSS,ADELL TETANUS | $99.60 | $166.00 | $74.70 | — | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 BOOSTRIX VACCINE VIAL 0.5ML | $122.40 | $204.00 | $91.80 | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADM;ONE | $87.60 | $146.00 | $39.27–$178.92 | 37% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADM INJ | $517.20 | $862.00 | $231.88–$1,056.38 | 712% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 INJ IM HEPATITIS B;NO MD | $517.20 | $862.00 | $231.88–$1,056.38 | 712% above | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADM;ONE | $87.60 | $146.00 | $65.70 | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADM INJ | $517.20 | $862.00 | $387.90 | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 INJ IM HEPATITIS B;NO MD | $517.20 | $862.00 | $387.90 | — | 40% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUN ADMIN EACH ADD | $53.40 | $89.00 | $23.94–$109.07 | 99% above | 40% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN ADMIN EACH ADD | $53.40 | $89.00 | $40.05 | — | 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.phhealthcare.org/download/?id=14847