Hospital

Northern Light Sebasticook Valley Hospital

Listed in its price file as “Sebasticook Valley Health”.

Northern Light Sebasticook Valley Hospital in Pittsfield, ME publishes cash prices for 383 common procedures listed here, from its own machine-readable price file updated Mar 30, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Maine median for 364 of 380 procedures and above it for 9. By typical cash price it ranks #7 of 28 Maine hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

447 Main St, Pittsfield, ME 04967 Collected Sep 23, 2026 Source price file Check a bill from this hospital (207) 487-5141

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CMS star rating 2 of 5 CCN 201313 · CMS hospital register NPI 1457461477

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

Northern Light Sebasticook 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 Maine	Off list
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W/ AND W/O CONTRAST	$614.72	$1,808.00	$687.04–$1,808.00	56% below	66%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/ AND W/O CONTRAST	$614.72	$1,808.00	$1,175.20–$1,808.00	—	66%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN COMPLETE	$165.92	$488.00	$185.44–$488.00	32% below	66%
Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN COMPLETE	$165.92	$488.00	$317.20–$488.00	—	66%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE MIN 3 VIEWS LT	$144.84	$426.00	$161.88–$426.00	32% below	66%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE MIN 3 VIEWS RT	$144.84	$426.00	$161.88–$426.00	32% below	66%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE MIN 3 VIEWS LT	$144.84	$426.00	$276.90–$426.00	—	66%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE MIN 3 VIEWS RT	$144.84	$426.00	$276.90–$426.00	—	66%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 PVR SINGLE LEVEL	$78.88	$232.00	$88.16–$232.00	46% below	66%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 PVR SINGLE LEVEL	$78.88	$232.00	$150.80–$232.00	—	66%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT EXTREMITY UPPER RT	$434.52	$1,278.00	$485.64–$1,278.00	62% below	66%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT EXTREMITY UPPER LT	$434.52	$1,278.00	$485.64–$1,278.00	62% below	66%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT EXTREMITY UPPER LT	$434.52	$1,278.00	$830.70–$1,278.00	—	66%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT EXTREMITY UPPER RT	$434.52	$1,278.00	$830.70–$1,278.00	—	66%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS	$279.14	$821.00	$311.98–$821.00	21% below	66%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGUS	$279.14	$821.00	$533.65–$821.00	—	66%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN	$610.98	$1,797.00	$682.86–$1,797.00	48% below	66%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE SCAN	$610.98	$1,797.00	$1,168.05–$1,797.00	—	66%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST SONO COMPLETE LT	$166.94	$491.00	$186.58–$491.00	18% below	66%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST SONO COMPLETE RT	$166.94	$491.00	$186.58–$491.00	18% below	66%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST SONO COMPLETE LT	$166.94	$491.00	$319.15–$491.00	—	66%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST SONO COMPLETE RT	$166.94	$491.00	$319.15–$491.00	—	66%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST SONO LMTD RT	$138.04	$406.00	$154.28–$406.00	41% below	66%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST SONO LMTD LT	$138.04	$406.00	$154.28–$406.00	41% below	66%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST SONO LMTD LT	$138.04	$406.00	$263.90–$406.00	—	66%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST SONO LMTD RT	$138.04	$406.00	$263.90–$406.00	—	66%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABDOM/PELVIS W/WO CONTRAST	$1,149.54	$3,381.00	$1,284.78–$3,381.00	25% below	66%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT VENOGRAM ABD/PELV W/WO CONT	$1,149.54	$3,381.00	$1,284.78–$3,381.00	25% below	66%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABDOM/PELVIS W/WO CONTRAST	$1,149.54	$3,381.00	$2,197.65–$3,381.00	—	66%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT VENOGRAM ABD/PELV W/WO CONT	$1,149.54	$3,381.00	$2,197.65–$3,381.00	—	66%
CT angiography (CTA) of the head CPT 70496 CT CTA HEAD W & W/O CONTRAST	$757.86	$2,229.00	$847.02–$2,229.00	51% below	66%
CT angiography (CTA) of the head inpatient CPT 70496 CT CTA HEAD W & W/O CONTRAST	$757.86	$2,229.00	$1,448.85–$2,229.00	—	66%
CT angiography (CTA) of the neck CPT 70498 CTA NECK W & W/O CONTRAST	$943.50	$2,775.00	$1,054.50–$2,775.00	40% below	66%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK W & W/O CONTRAST	$943.50	$2,775.00	$1,803.75–$2,775.00	—	66%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT CTA CHEST W & W/O CONTRAS	$1,255.28	$3,692.00	$1,402.96–$3,692.00	32% below	66%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT CTA CHEST W & W/O CONTRAS	$1,255.28	$3,692.00	$2,399.80–$3,692.00	—	66%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT CORONARY CALCIUM SCORING	$131.24	$386.00	$146.68–$386.00	at median	66%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT CORONARY CALCIUM SCORING	$131.24	$386.00	$250.90–$386.00	—	66%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOM & PELVIS W/O CONTRAST	$1,227.74	$3,611.00	$1,372.18–$3,611.00	12% below	66%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOM & PELVIS W/O CONTRAST	$1,227.74	$3,611.00	$2,347.15–$3,611.00	—	66%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOM&PELVIS WITH CONRAST	$1,540.20	$4,530.00	$1,721.40–$4,530.00	23% below	66%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOM&PELVIS WITH CONRAST	$1,540.20	$4,530.00	$2,944.50–$4,530.00	—	66%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOM & PELVIS W &WO CON	$1,739.78	$5,117.00	$1,944.46–$5,117.00	21% below	66%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOM & PELVIS W &WO CON	$1,739.78	$5,117.00	$3,326.05–$5,117.00	—	66%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN WITH CONTRAST	$544.68	$1,602.00	$608.76–$1,602.00	51% below	66%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN WITH CONTRAST	$544.68	$1,602.00	$1,041.30–$1,602.00	—	66%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$440.64	$1,296.00	$492.48–$1,296.00	48% below	66%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$440.64	$1,296.00	$842.40–$1,296.00	—	66%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXIOFACIAL W/O CONTRAST	$460.70	$1,355.00	$514.90–$1,355.00	48% below	66%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXIOFACIAL W/O CONTRAST	$460.70	$1,355.00	$880.75–$1,355.00	—	66%
CT scan of the head or brain, no contrast dye CPT 70450 CT BRAIN	$582.76	$1,714.00	$651.32–$1,714.00	41% below	66%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT BRAIN	$582.76	$1,714.00	$1,114.10–$1,714.00	—	66%
CT scan of the head with contrast CPT 70460 CT BRAIN W/CONTRAST	$604.18	$1,777.00	$675.26–$1,777.00	43% below	66%
CT scan of the head with contrast inpatient CPT 70460 CT BRAIN W/CONTRAST	$604.18	$1,777.00	$1,155.05–$1,777.00	—	66%
CT scan of the head without and with contrast CPT 70470 CT BRAIN WITH & W/O CONTRAST	$721.82	$2,123.00	$806.74–$2,123.00	51% below	66%
CT scan of the head without and with contrast inpatient CPT 70470 CT BRAIN WITH & W/O CONTRAST	$721.82	$2,123.00	$1,379.95–$2,123.00	—	66%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SPINE LUMBAR	$473.96	$1,394.00	$529.72–$1,394.00	52% below	66%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT SPINE LUMBAR	$473.96	$1,394.00	$906.10–$1,394.00	—	66%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SPINE CERVICAL	$507.96	$1,494.00	$567.72–$1,494.00	48% below	66%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT SPINE CERVICAL	$507.96	$1,494.00	$971.10–$1,494.00	—	66%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST	$607.92	$1,788.00	$679.44–$1,788.00	39% below	66%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST	$607.92	$1,788.00	$1,162.20–$1,788.00	—	66%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 CAROTID ARTERY SONOGRAM BILAT	$371.96	$1,094.00	$415.72–$1,094.00	—	66%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 CAROTID ARTERY SONOGRAM BILAT	$371.96	$1,094.00	$711.10–$1,094.00	—	66%
Chest CT scan without and with contrast CPT 71270 CT CHEST W/ AND W/O CONTRAST	$1,127.10	$3,315.00	$1,259.70–$3,315.00	34% below	66%
Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST W/ AND W/O CONTRAST	$1,127.10	$3,315.00	$2,154.75–$3,315.00	—	66%
Chest X-ray, 2 views CPT 71046 CXR, 2 V W/FLUORO	$158.78	$467.00	$177.46–$467.00	25% below	66%
Chest X-ray, 2 views CPT 71046 CHEST,TWO VIEWS	$158.78	$467.00	$177.46–$467.00	25% below	66%
Chest X-ray, 2 views CPT 71046 CHEST SPECIAL VIEWS	$158.78	$467.00	$177.46–$467.00	25% below	66%
Chest X-ray, 2 views inpatient CPT 71046 CHEST,TWO VIEWS	$158.78	$467.00	$303.55–$467.00	—	66%
Chest X-ray, 2 views inpatient CPT 71046 CHEST SPECIAL VIEWS	$158.78	$467.00	$303.55–$467.00	—	66%
Chest X-ray, 2 views inpatient CPT 71046 CXR, 2 V W/FLUORO	$158.78	$467.00	$303.55–$467.00	—	66%
Chest X-ray, single view CPT 71045 CHEST, SINGLE VIEW	$138.04	$406.00	$154.28–$406.00	31% below	66%
Chest X-ray, single view inpatient CPT 71045 CHEST, SINGLE VIEW	$138.04	$406.00	$263.90–$406.00	—	66%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE XRAY	$138.04	$406.00	$154.28–$406.00	37% below	66%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE XRAY LT	$138.04	$406.00	$154.28–$406.00	37% below	66%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE XRAY	$138.04	$406.00	$263.90–$406.00	—	66%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE XRAY LT	$138.04	$406.00	$263.90–$406.00	—	66%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 ABD RETROPERITINEAL, FULL	$261.80	$770.00	$292.60–$770.00	42% below	66%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 ABD RETROPERITINEAL, FULL	$261.80	$770.00	$500.50–$770.00	—	66%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA BONE DENSITOM	$166.94	$491.00	$186.58–$491.00	33% below	66%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA BONE DENSITOM	$166.94	$491.00	$319.15–$491.00	—	66%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 OB PREG COMPLETE	$351.22	$1,033.00	$392.54–$1,033.00	15% below	66%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 OB PREG COMPLETE	$351.22	$1,033.00	$671.45–$1,033.00	—	66%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST	$608.26	$1,789.00	$679.82–$1,789.00	35% below	66%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTRAST	$608.26	$1,789.00	$1,162.85–$1,789.00	—	66%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CONTRAST	$919.70	$2,705.00	$1,027.90–$2,705.00	29% below	66%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CONTRAST	$919.70	$2,705.00	$1,758.25–$2,705.00	—	66%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIGITAL DIAG BILAT	$180.54	$531.00	$201.78–$531.00	—	66%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO DIGITAL DIAG BILAT	$180.54	$531.00	$345.15–$531.00	—	66%
Diagnostic mammogram, one breast one side CPT 77065 DX MAMMO INCL CAD UNI-RT	$106.42	$313.00	$118.94–$313.00	32% below	66%
Diagnostic mammogram, one breast one side CPT 77065 DX MAMMO INCL CAD UNI-LT	$106.42	$313.00	$118.94–$313.00	32% below	66%
Diagnostic mammogram, one breast inpatient one side CPT 77065 DX MAMMO INCL CAD UNI-LT	$106.42	$313.00	$203.45–$313.00	—	66%
Diagnostic mammogram, one breast inpatient one side CPT 77065 DX MAMMO INCL CAD UNI-RT	$106.42	$313.00	$203.45–$313.00	—	66%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US EXTREM ARTERY LOWER COMP	$371.96	$1,094.00	$415.72–$1,094.00	at median	66%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US EXTREM ARTERY LOWER COMP	$371.96	$1,094.00	$711.10–$1,094.00	—	66%
Duplex ultrasound of the leg veins, both legs CPT 93970 EXT VEINS COMPLETE	$371.96	$1,094.00	$415.72–$1,094.00	28% below	66%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 EXT VEINS COMPLETE	$371.96	$1,094.00	$711.10–$1,094.00	—	66%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO INTERPRETATION	$837.08	$2,462.00	$935.56–$2,462.00	23% below	66%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 EV/EC ECHOCARDIOGRAPHY	$837.08	$2,462.00	$935.56–$2,462.00	23% below	66%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO INTERPRETATION	$837.08	$2,462.00	$1,600.30–$2,462.00	—	66%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 EV/EC ECHOCARDIOGRAPHY	$837.08	$2,462.00	$1,600.30–$2,462.00	—	66%
Elbow X-ray, 2 views one side CPT 73070 ELBOW LT 2 VIEWS	$91.46	$269.00	$102.22–$269.00	58% below	66%
Elbow X-ray, 2 views one side CPT 73070 ELBOW RT 2 VIEWS	$91.46	$269.00	$102.22–$269.00	58% below	66%
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW LT 2 VIEWS	$91.46	$269.00	$174.85–$269.00	—	66%
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW RT 2 VIEWS	$91.46	$269.00	$174.85–$269.00	—	66%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW MIN 3 VIEWS RT	$137.70	$405.00	$153.90–$405.00	37% below	66%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW MIN 3 VIEWS LT	$137.70	$405.00	$153.90–$405.00	37% below	66%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW MIN 3 VIEWS RT	$137.70	$405.00	$263.25–$405.00	—	66%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW MIN 3 VIEWS LT	$137.70	$405.00	$263.25–$405.00	—	66%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT, EAR, SELLA	$472.60	$1,390.00	$528.20–$1,390.00	52% below	66%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT, EAR, SELLA	$472.60	$1,390.00	$903.50–$1,390.00	—	66%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL/ORBIT MIN 3 VIEWS	$142.80	$420.00	$159.60–$420.00	38% below	66%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL/ORBIT MIN 3 VIEWS	$142.80	$420.00	$273.00–$420.00	—	66%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM RT 2 VIEWS	$138.04	$406.00	$154.28–$406.00	35% below	66%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM LT 2 VIEWS	$138.04	$406.00	$154.28–$406.00	35% below	66%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM LT 2 VIEWS	$138.04	$406.00	$263.90–$406.00	—	66%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM RT 2 VIEWS	$138.04	$406.00	$263.90–$406.00	—	66%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SCAN	$625.94	$1,841.00	$699.58–$1,841.00	37% below	66%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SCAN	$625.94	$1,841.00	$1,196.65–$1,841.00	—	66%
Hand X-ray, 2 views one side CPT 73120 HAND 2 VIEWS LT	$155.38	$457.00	$173.66–$457.00	27% below	66%
Hand X-ray, 2 views one side CPT 73120 HAND 2 VIEWS RT	$155.38	$457.00	$173.66–$457.00	27% below	66%
Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 VIEWS RT	$155.38	$457.00	$297.05–$457.00	—	66%
Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 VIEWS LT	$155.38	$457.00	$297.05–$457.00	—	66%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL MIN 2 VIEWS RT	$100.30	$295.00	$112.10–$295.00	52% below	66%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL MIN 2 VIEWS LT	$100.30	$295.00	$112.10–$295.00	52% below	66%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL MIN 2 VIEWS LT	$100.30	$295.00	$191.75–$295.00	—	66%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL MIN 2 VIEWS RT	$100.30	$295.00	$191.75–$295.00	—	66%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HOME SLEEP STUD	$237.32	$698.00	$265.24–$698.00	15% below	66%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HOME SLEEP STUD	$237.32	$698.00	$453.70–$698.00	—	66%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRPHY STG 4+ PARAMTRS	$1,586.10	$4,665.00	$1,772.70–$4,665.00	9% below	66%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRPHY STG 4+ PARAMTRS	$1,586.10	$4,665.00	$3,032.25–$4,665.00	—	66%
Knee X-ray, 3 views one side CPT 73562 KNEE MIN 3 VIEWS RT	$138.04	$406.00	$154.28–$406.00	39% below	66%
Knee X-ray, 3 views one side CPT 73562 KNEE MIN 3 VIEWS LT	$138.04	$406.00	$154.28–$406.00	39% below	66%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE MIN 3 VIEWS RT	$138.04	$406.00	$263.90–$406.00	—	66%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE MIN 3 VIEWS LT	$138.04	$406.00	$263.90–$406.00	—	66%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE MIN 4 VIEWS RT	$166.94	$491.00	$186.58–$491.00	34% below	66%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE MIN 4 VIEWS LT	$166.94	$491.00	$186.58–$491.00	34% below	66%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE MIN 4 VIEWS RT	$166.94	$491.00	$319.15–$491.00	—	66%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE MIN 4 VIEWS LT	$166.94	$491.00	$319.15–$491.00	—	66%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT EXTREMITY LOWER RT	$452.54	$1,331.00	$505.78–$1,331.00	57% below	66%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT EXTREMITY LOWER LT	$452.54	$1,331.00	$505.78–$1,331.00	57% below	66%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT EXTREMITY LOWER RT	$452.54	$1,331.00	$865.15–$1,331.00	—	66%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT EXTREMITY LOWER LT	$452.54	$1,331.00	$865.15–$1,331.00	—	66%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC POCUS GALLBLADDER	$227.46	$669.00	$254.22–$669.00	7% below	66%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ABDOMEN, LIMITED	$227.46	$669.00	$254.22–$669.00	7% below	66%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC POCUS ABDOMEN	$227.46	$669.00	$254.22–$669.00	7% below	66%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ABDOMEN, LIMITED	$227.46	$669.00	$434.85–$669.00	—	66%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC POCUS ABDOMEN	$227.46	$669.00	$434.85–$669.00	—	66%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC POCUS GALLBLADDER	$227.46	$669.00	$434.85–$669.00	—	66%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US JNT/NON VASC EXT LTD	$166.94	$491.00	$186.58–$491.00	at median	66%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT NON-VASC LIMITED RT	$166.94	$491.00	$186.58–$491.00	at median	66%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC POCUS MSK/SOFT TISSUE RT	$166.94	$491.00	$186.58–$491.00	at median	66%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC POCUS MSK/SOFT TISSUE LT	$166.94	$491.00	$186.58–$491.00	at median	66%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT NON-VASC LIMITED LT	$166.94	$491.00	$186.58–$491.00	at median	66%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US JNT/NON VASC EXT LTD	$166.94	$491.00	$319.15–$491.00	—	66%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT NON-VASC LIMITED LT	$166.94	$491.00	$319.15–$491.00	—	66%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC POCUS MSK/SOFT TISSUE LT	$166.94	$491.00	$319.15–$491.00	—	66%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC POCUS MSK/SOFT TISSUE RT	$166.94	$491.00	$319.15–$491.00	—	66%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT NON-VASC LIMITED RT	$166.94	$491.00	$319.15–$491.00	—	66%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG SCREENING LOW DOSE	$166.94	$491.00	$186.58–$491.00	26% below	66%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG SCREENING LOW DOSE	$166.94	$491.00	$319.15–$491.00	—	66%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LEG RT 2 VIEWS	$138.04	$406.00	$154.28–$406.00	35% below	66%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LEG LT 2 VIEWS	$138.04	$406.00	$154.28–$406.00	35% below	66%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LEG LT 2 VIEWS	$138.04	$406.00	$263.90–$406.00	—	66%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LEG RT 2 VIEWS	$138.04	$406.00	$263.90–$406.00	—	66%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRAST	$657.22	$1,933.00	$734.54–$1,933.00	63% below	66%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CONTRAST	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST RT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST LT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST RT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST LT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST RT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST LT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTR LIMITED RT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTR LIMITED LT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST LT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST RT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST LT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTR LIMITED RT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTR LIMITED LT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST RT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST LT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST RT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W&W/O CONTRAST LT	$1,114.18	$3,277.00	$1,245.26–$3,277.00	57% below	66%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W&W/O CONTRAST RT	$1,114.18	$3,277.00	$1,245.26–$3,277.00	57% below	66%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W & W/O CONTRAST LT	$1,114.18	$3,277.00	$1,245.26–$3,277.00	57% below	66%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W & W/O CONTRAST RT	$1,114.18	$3,277.00	$1,245.26–$3,277.00	57% below	66%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W & W/O CONTRAST LT	$1,114.18	$3,277.00	$1,245.26–$3,277.00	57% below	66%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W & W/O CONTRAST RT	$1,114.18	$3,277.00	$1,245.26–$3,277.00	57% below	66%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W & W/O CONTRAST RT	$1,114.18	$3,277.00	$2,130.05–$3,277.00	—	66%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W&W/O CONTRAST LT	$1,114.18	$3,277.00	$2,130.05–$3,277.00	—	66%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W&W/O CONTRAST RT	$1,114.18	$3,277.00	$2,130.05–$3,277.00	—	66%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W & W/O CONTRAST LT	$1,114.18	$3,277.00	$2,130.05–$3,277.00	—	66%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W & W/O CONTRAST LT	$1,114.18	$3,277.00	$2,130.05–$3,277.00	—	66%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W & W/O CONTRAST RT	$1,114.18	$3,277.00	$2,130.05–$3,277.00	—	66%
MRI of the abdomen without contrast CPT 74181 MRI MRCP WITHOUT CONTRAST	$657.22	$1,933.00	$734.54–$1,933.00	62% below	66%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN	$657.22	$1,933.00	$734.54–$1,933.00	62% below	66%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP WITHOUT CONTRAST	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/WO CONTRAST	$835.38	$2,457.00	$933.66–$2,457.00	62% below	66%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/WO CONTRAST	$835.38	$2,457.00	$1,597.05–$2,457.00	—	66%
MRI of the brain, no contrast dye CPT 70551 MRI HEAD	$657.22	$1,933.00	$734.54–$1,933.00	54% below	66%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI HEAD	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of the brain, with and without contrast dye CPT 70553 MRI HEAD W/WO CONTRAST	$835.04	$2,456.00	$933.28–$2,456.00	62% below	66%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI HEAD W/WO CONTRAST	$835.04	$2,456.00	$1,596.40–$2,456.00	—	66%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE	$628.66	$1,849.00	$702.62–$1,849.00	56% below	66%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE	$628.66	$1,849.00	$1,201.85–$1,849.00	—	66%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/WO CONT	$835.38	$2,457.00	$933.66–$2,457.00	64% below	66%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/WO CONT	$835.38	$2,457.00	$1,597.05–$2,457.00	—	66%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE	$657.22	$1,933.00	$734.54–$1,933.00	54% below	66%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W/WO CONT	$835.38	$2,457.00	$933.66–$2,457.00	59% below	66%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE W/WO CONT	$835.38	$2,457.00	$1,597.05–$2,457.00	—	66%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE	$636.48	$1,872.00	$711.36–$1,872.00	55% below	66%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE	$636.48	$1,872.00	$1,216.80–$1,872.00	—	66%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/WO CONTRAST	$998.58	$2,937.00	$1,116.06–$2,937.00	57% below	66%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/WO CONTRAST	$998.58	$2,937.00	$1,909.05–$2,937.00	—	66%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS	$657.22	$1,933.00	$734.54–$1,933.00	58% below	66%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONTRAST LT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONTRAST RT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONTRAST LT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONTRAST RT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONTRAST LT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONTRAST RT	$657.22	$1,933.00	$734.54–$1,933.00	56% below	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW W/O CONTRAST LT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW W/O CONTRAST RT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER W/O CONTRAST LT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER W/O CONTRAST RT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST W/O CONTRAST LT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST W/O CONTRAST RT	$657.22	$1,933.00	$1,256.45–$1,933.00	—	66%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERVICAL SPINE 4 OR 5 VIEWS	$166.94	$491.00	$186.58–$491.00	43% below	66%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERVICAL SPINE 4 OR 5 VIEWS	$166.94	$491.00	$319.15–$491.00	—	66%
Neck soft tissue CT scan with contrast CPT 70491 CT NECK W/CONTRAST	$586.16	$1,724.00	$655.12–$1,724.00	54% below	66%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK W/CONTRAST	$586.16	$1,724.00	$1,120.60–$1,724.00	—	66%
Neck soft tissue CT scan without contrast CPT 70490 CT NECK	$414.12	$1,218.00	$462.84–$1,218.00	59% below	66%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK	$414.12	$1,218.00	$791.70–$1,218.00	—	66%
Neck soft tissue X-ray CPT 70360 NASOPHARYNX/NECK SOFT TISSUE	$135.66	$399.00	$151.62–$399.00	35% below	66%
Neck soft tissue X-ray inpatient CPT 70360 NASOPHARYNX/NECK SOFT TISSUE	$135.66	$399.00	$259.35–$399.00	—	66%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 PERSANTINE NUCLEAR STRESS TEST	$1,736.72	$5,108.00	$1,941.04–$5,108.00	16% below	66%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM STRESS IMAGE INTERP	$1,736.72	$5,108.00	$1,941.04–$5,108.00	16% below	66%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MYOCARDIAL PERFUSION IMAGING	$1,736.72	$5,108.00	$1,941.04–$5,108.00	16% below	66%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 LEXISCAN NUC STRESS TEST	$1,736.72	$5,108.00	$1,941.04–$5,108.00	16% below	66%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 DOBUTAMINE NUCLEAR STRESS TEST	$1,736.72	$5,108.00	$1,941.04–$5,108.00	16% below	66%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 TREADMILL NUCLEAR STRESS TEST	$1,736.72	$5,108.00	$1,941.04–$5,108.00	16% below	66%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 ADENOSINE NUCLEAR STRESS TEST	$1,736.72	$5,108.00	$1,941.04–$5,108.00	16% below	66%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 PERSANTINE NUCLEAR STRESS TEST	$1,736.72	$5,108.00	$3,320.20–$5,108.00	—	66%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM STRESS IMAGE INTERP	$1,736.72	$5,108.00	$3,320.20–$5,108.00	—	66%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 TREADMILL NUCLEAR STRESS TEST	$1,736.72	$5,108.00	$3,320.20–$5,108.00	—	66%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 DOBUTAMINE NUCLEAR STRESS TEST	$1,736.72	$5,108.00	$3,320.20–$5,108.00	—	66%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 ADENOSINE NUCLEAR STRESS TEST	$1,736.72	$5,108.00	$3,320.20–$5,108.00	—	66%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYOCARDIAL PERFUSION IMAGING	$1,736.72	$5,108.00	$3,320.20–$5,108.00	—	66%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 LEXISCAN NUC STRESS TEST	$1,736.72	$5,108.00	$3,320.20–$5,108.00	—	66%
Pelvic CT scan without contrast CPT 72192 CT PELVIS	$464.44	$1,366.00	$519.08–$1,366.00	51% below	66%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS	$464.44	$1,366.00	$887.90–$1,366.00	—	66%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC POCUS PST VOID RESIDL BLADR	$141.10	$415.00	$157.70–$415.00	19% below	66%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 PELVIS SONO, LIMITED	$141.10	$415.00	$157.70–$415.00	19% below	66%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 PELVIS SONO, LIMITED	$141.10	$415.00	$269.75–$415.00	—	66%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC POCUS PST VOID RESIDL BLADR	$141.10	$415.00	$269.75–$415.00	—	66%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PELVIC SONOGRAM	$233.24	$686.00	$260.68–$686.00	41% below	66%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 PELVIC SONOGRAM	$233.24	$686.00	$445.90–$686.00	—	66%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OBSTETRICAL ULTRASOUND	$247.86	$729.00	$277.02–$729.00	44% below	66%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OBSTETRICAL ULTRASOUND	$247.86	$729.00	$473.85–$729.00	—	66%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 PREG<14WKS TRANSABDOMINAL	$175.78	$517.00	$196.46–$517.00	43% below	66%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 PREG<14WKS TRANSABDOMINAL	$175.78	$517.00	$336.05–$517.00	—	66%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC POCUS PREGNANT TRANSABDOML	$166.94	$491.00	$186.58–$491.00	13% below	66%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB PREGNANCY LIMITED	$166.94	$491.00	$186.58–$491.00	13% below	66%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB PREGNANCY LIMITED	$166.94	$491.00	$319.15–$491.00	—	66%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC POCUS PREGNANT TRANSABDOML	$166.94	$491.00	$319.15–$491.00	—	66%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS 2 VIEWS RT	$138.04	$406.00	$154.28–$406.00	40% below	66%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS 2 VIEWS LT	$138.04	$406.00	$154.28–$406.00	40% below	66%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS 2 VIEWS LT	$138.04	$406.00	$263.90–$406.00	—	66%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS 2 VIEWS RT	$138.04	$406.00	$263.90–$406.00	—	66%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS W/CHEST MIN 3 V LT	$166.94	$491.00	$186.58–$491.00	49% below	66%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS W/CHEST MIN 3 V RT	$166.94	$491.00	$186.58–$491.00	49% below	66%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS W/CHEST MIN 3 V RT	$166.94	$491.00	$319.15–$491.00	—	66%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS W/CHEST MIN 3 V LT	$166.94	$491.00	$319.15–$491.00	—	66%
Screening mammogram, both breasts both sides CPT 77067 MAMMO DIGITAL SCREEN BILAT	$149.60	$440.00	$167.20–$440.00	—	66%
Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO DIGITAL SCREEN BILAT	$149.60	$440.00	$286.00–$440.00	—	66%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER XRAY MIN 2 VIEWS LT	$142.46	$419.00	$159.22–$419.00	38% below	66%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER XRAY MIN 2 VIEWS RT	$142.46	$419.00	$159.22–$419.00	38% below	66%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER XRAY MIN 2 VIEWS LT	$142.46	$419.00	$272.35–$419.00	—	66%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER XRAY MIN 2 VIEWS RT	$142.46	$419.00	$272.35–$419.00	—	66%
Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES MIN 3 VIEWS	$124.10	$365.00	$138.70–$365.00	45% below	66%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES MIN 3 VIEWS	$124.10	$365.00	$237.25–$365.00	—	66%
Skull X-ray, fewer than 4 views CPT 70250 SKULL < 4 VIEWS	$107.10	$315.00	$119.70–$315.00	51% below	66%
Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL < 4 VIEWS	$107.10	$315.00	$204.75–$315.00	—	66%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY 4 > PARAMETERS	$1,586.10	$4,665.00	$1,772.70–$4,665.00	3% below	66%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY 4 > PARAMETERS	$1,586.10	$4,665.00	$3,032.25–$4,665.00	—	66%
Swallow study (modified barium swallow, video X-ray) CPT 74230 MODIFIED BARIUM SWALLOW W/ST	$246.50	$725.00	$275.50–$725.00	44% below	66%
Swallow study (modified barium swallow, video X-ray) CPT 74230 BARIUM SWALLOW W/VIDEO	$246.50	$725.00	$275.50–$725.00	44% below	66%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 MODIFIED BARIUM SWALLOW W/ST	$246.50	$725.00	$471.25–$725.00	—	66%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 BARIUM SWALLOW W/VIDEO	$246.50	$725.00	$471.25–$725.00	—	66%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR MINIMUM 2 VIEWS RIGHT	$138.04	$406.00	$154.28–$406.00	35% below	66%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR MINIMUM 2 VIEWS LEFT	$138.04	$406.00	$154.28–$406.00	35% below	66%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR MINIMUM 2 VIEWS LEFT	$138.04	$406.00	$263.90–$406.00	—	66%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR MINIMUM 2 VIEWS RIGHT	$138.04	$406.00	$263.90–$406.00	—	66%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT SPINE THORACIC	$464.10	$1,365.00	$518.70–$1,365.00	56% below	66%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT SPINE THORACIC	$464.10	$1,365.00	$887.25–$1,365.00	—	66%
Toe X-ray, 2 or more views one side CPT 73660 TOE 2/4 VIEWS RT	$122.40	$360.00	$136.80–$360.00	32% below	66%
Toe X-ray, 2 or more views one side CPT 73660 TOE 2/4 VIEWS LT	$122.40	$360.00	$136.80–$360.00	32% below	66%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE 2/4 VIEWS LT	$122.40	$360.00	$234.00–$360.00	—	66%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE 2/4 VIEWS RT	$122.40	$360.00	$234.00–$360.00	—	66%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL SONO	$193.46	$569.00	$216.22–$569.00	48% below	66%
Transvaginal pelvic ultrasound CPT 76830 HC POCUS NON-PREGNT TRNSVAGNL	$193.46	$569.00	$216.22–$569.00	48% below	66%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC POCUS NON-PREGNT TRNSVAGNL	$193.46	$569.00	$369.85–$569.00	—	66%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL SONO	$193.46	$569.00	$369.85–$569.00	—	66%
Transvaginal ultrasound during pregnancy CPT 76817 HC POCUS PREGNANT TRANSVAGINAL	$166.94	$491.00	$186.58–$491.00	46% below	66%
Transvaginal ultrasound during pregnancy CPT 76817 OB PREG TANSVAGINAL	$166.94	$491.00	$186.58–$491.00	46% below	66%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 OB PREG TANSVAGINAL	$166.94	$491.00	$319.15–$491.00	—	66%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC POCUS PREGNANT TRANSVAGINAL	$166.94	$491.00	$319.15–$491.00	—	66%
Ultrasound of the abdomen, complete CPT 76700 ABDOMINAL SONOGRAM	$273.02	$803.00	$305.14–$803.00	42% below	66%
Ultrasound of the abdomen, complete inpatient CPT 76700 ABDOMINAL SONOGRAM	$273.02	$803.00	$521.95–$803.00	—	66%
Ultrasound of the scrotum and testicles CPT 76870 TESTICULAR SONOGRAM	$229.84	$676.00	$256.88–$676.00	50% below	66%
Ultrasound of the scrotum and testicles inpatient CPT 76870 TESTICULAR SONOGRAM	$229.84	$676.00	$439.40–$676.00	—	66%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 NECK/HEAD SONOGRAM	$202.64	$596.00	$226.48–$596.00	50% below	66%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 NECK/HEAD SONOGRAM	$202.64	$596.00	$387.40–$596.00	—	66%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 GI SERIES W/O KUB	$279.14	$821.00	$311.98–$821.00	36% below	66%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 GI SERIES W/O KUB	$279.14	$821.00	$533.65–$821.00	—	66%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS MIN 2 VIEWS LT	$138.04	$406.00	$154.28–$406.00	33% below	66%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS MIN 2 VIEWS RT	$138.04	$406.00	$154.28–$406.00	33% below	66%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS MIN 2 VIEWS LT	$138.04	$406.00	$263.90–$406.00	—	66%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS MIN 2 VIEWS RT	$138.04	$406.00	$263.90–$406.00	—	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC POCUS FOCUSED DVT STUDY	$251.60	$740.00	$281.20–$740.00	49% below	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 EXT VEINS UNILAT RT	$251.60	$740.00	$281.20–$740.00	49% below	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 EXT VEINS UNILAT LT	$251.60	$740.00	$281.20–$740.00	49% below	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC POCUS FOCUSED DVT STUDY RT	$251.60	$740.00	$281.20–$740.00	49% below	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 EXT VEINS UNILAT RT	$251.60	$740.00	$481.00–$740.00	—	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC POCUS FOCUSED DVT STUDY	$251.60	$740.00	$481.00–$740.00	—	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 EXT VEINS UNILAT LT	$251.60	$740.00	$481.00–$740.00	—	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC POCUS FOCUSED DVT STUDY RT	$251.60	$740.00	$481.00–$740.00	—	66%
Wrist X-ray, 2 views one side CPT 73100 WRIST LT 2 VIEWS	$134.30	$395.00	$150.10–$395.00	41% below	66%
Wrist X-ray, 2 views one side CPT 73100 WRIST RT 2 VIEWS	$134.30	$395.00	$150.10–$395.00	41% below	66%
Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST LT 2 VIEWS	$134.30	$395.00	$256.75–$395.00	—	66%
Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST RT 2 VIEWS	$134.30	$395.00	$256.75–$395.00	—	66%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST MIN 3 VIEWS RT	$138.04	$406.00	$154.28–$406.00	37% below	66%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST MIN 3 VIEWS LT	$138.04	$406.00	$154.28–$406.00	37% below	66%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST MIN 3 VIEWS RT	$138.04	$406.00	$263.90–$406.00	—	66%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST MIN 3 VIEWS LT	$138.04	$406.00	$263.90–$406.00	—	66%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP 2-3 VIEWS W/PELVIS RIGHT	$138.04	$406.00	$154.28–$406.00	32% below	66%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP 2-3 VIEWS W/PELVIS LEFT	$138.04	$406.00	$154.28–$406.00	32% below	66%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP 2-3 VIEWS W/PELVIS RIGHT	$138.04	$406.00	$263.90–$406.00	—	66%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP 2-3 VIEWS W/PELVIS LEFT	$138.04	$406.00	$263.90–$406.00	—	66%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN SINGLE VIEW	$137.70	$405.00	$153.90–$405.00	35% below	66%
X-ray of the abdomen, 1 view CPT 74018 XR SITZ MOTILITY STUDY	$137.70	$405.00	$153.90–$405.00	35% below	66%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR SITZ MOTILITY STUDY	$137.70	$405.00	$263.25–$405.00	—	66%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN SINGLE VIEW	$137.70	$405.00	$263.25–$405.00	—	66%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE RT 2 VIEWS	$138.04	$406.00	$154.28–$406.00	33% below	66%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE LT 2 VIEWS	$138.04	$406.00	$154.28–$406.00	33% below	66%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE RT 2 VIEWS	$138.04	$406.00	$263.90–$406.00	—	66%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE LT 2 VIEWS	$138.04	$406.00	$263.90–$406.00	—	66%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER MIN 2 VIEWS LT	$128.18	$377.00	$143.26–$377.00	35% below	66%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER MIN 2 VIEWS RT	$128.18	$377.00	$143.26–$377.00	35% below	66%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER MIN 2 VIEWS LT	$128.18	$377.00	$245.05–$377.00	—	66%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER MIN 2 VIEWS RT	$128.18	$377.00	$245.05–$377.00	—	66%
X-ray of the foot, 2 views one side CPT 73620 FOOT RT 2 VIEWS	$138.04	$406.00	$154.28–$406.00	32% below	66%
X-ray of the foot, 2 views one side CPT 73620 FOOT LT 2 VIEWS	$138.04	$406.00	$154.28–$406.00	32% below	66%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT LT 2 VIEWS	$138.04	$406.00	$263.90–$406.00	—	66%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT RT 2 VIEWS	$138.04	$406.00	$263.90–$406.00	—	66%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT MIN 3 VIEWS RT	$144.84	$426.00	$161.88–$426.00	32% below	66%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT MIN 3 VIEWS LT	$144.84	$426.00	$161.88–$426.00	32% below	66%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT MIN 3 VIEWS LT	$144.84	$426.00	$276.90–$426.00	—	66%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT MIN 3 VIEWS RT	$144.84	$426.00	$276.90–$426.00	—	66%
X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 VIEWS RT	$163.20	$480.00	$182.40–$480.00	26% below	66%
X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 VIEWS LT	$163.20	$480.00	$182.40–$480.00	26% below	66%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 VIEWS RT	$163.20	$480.00	$312.00–$480.00	—	66%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 VIEWS LT	$163.20	$480.00	$312.00–$480.00	—	66%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1-2 VIEWS RT	$133.62	$393.00	$149.34–$393.00	39% below	66%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1-2 VIEWS LT	$133.62	$393.00	$149.34–$393.00	39% below	66%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1-2 VIEWS RT	$133.62	$393.00	$255.45–$393.00	—	66%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1-2 VIEWS LT	$133.62	$393.00	$255.45–$393.00	—	66%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE 2 VIEWS	$166.94	$491.00	$186.58–$491.00	32% below	66%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR SPINE 2 VIEWS	$166.94	$491.00	$319.15–$491.00	—	66%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE MIN 4 VIEWS	$192.44	$566.00	$215.08–$566.00	40% below	66%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPINE MIN 4 VIEWS	$192.44	$566.00	$367.90–$566.00	—	66%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2 VIEWS	$166.94	$491.00	$186.58–$491.00	27% below	66%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE 2 VIEWS	$166.94	$491.00	$319.15–$491.00	—	66%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONE MIN 3 VIEWS	$138.04	$406.00	$154.28–$406.00	39% below	66%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONE MIN 3 VIEWS	$138.04	$406.00	$263.90–$406.00	—	66%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 3 VIEWS OR LESS	$138.04	$406.00	$154.28–$406.00	35% below	66%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE 3 VIEWS OR LESS	$138.04	$406.00	$263.90–$406.00	—	66%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 OR 2 VIEWS	$97.92	$288.00	$109.44–$288.00	54% below	66%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1 OR 2 VIEWS	$97.92	$288.00	$187.20–$288.00	—	66%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM / CCOCYX	$138.04	$406.00	$154.28–$406.00	39% below	66%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM / CCOCYX	$138.04	$406.00	$263.90–$406.00	—	66%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
ACTH blood test CPT 82024 ACTH/LAB	$110.84	$326.00	$123.88–$326.00	31% below	66%
ACTH blood test inpatient CPT 82024 ACTH/LAB	$110.84	$326.00	$211.90–$326.00	—	66%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 FIBROMETER ALT	$24.14	$71.00	$26.98–$71.00	28% below	66%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT (ALT) LAB	$24.14	$71.00	$26.98–$71.00	28% below	66%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINOTRANSFERASE-Q	$24.14	$71.00	$26.98–$71.00	28% below	66%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 FIBROSURE ALT	$24.14	$71.00	$26.98–$71.00	28% below	66%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 FIBROMETER ALT	$24.14	$71.00	$46.15–$71.00	—	66%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT (ALT) LAB	$24.14	$71.00	$46.15–$71.00	—	66%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINOTRANSFERASE-Q	$24.14	$71.00	$46.15–$71.00	—	66%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 FIBROSURE ALT	$24.14	$71.00	$46.15–$71.00	—	66%
AST (aspartate aminotransferase) enzyme test CPT 84450 FIBROMETER AST	$20.74	$61.00	$23.18–$61.00	33% below	66%
AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT (AST) LAB	$20.74	$61.00	$23.18–$61.00	33% below	66%
AST (aspartate aminotransferase) enzyme test CPT 84450 ASPARTATE AMINOTRANSFERASE-Q	$20.74	$61.00	$23.18–$61.00	33% below	66%
AST (aspartate aminotransferase) enzyme test CPT 84450 FIBROSURE AST	$20.74	$61.00	$23.18–$61.00	33% below	66%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 FIBROMETER AST	$20.74	$61.00	$39.65–$61.00	—	66%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT (AST) LAB	$20.74	$61.00	$39.65–$61.00	—	66%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 ASPARTATE AMINOTRANSFERASE-Q	$20.74	$61.00	$39.65–$61.00	—	66%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 FIBROSURE AST	$20.74	$61.00	$39.65–$61.00	—	66%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PAN	$102.34	$301.00	$114.38–$301.00	36% below	66%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PAN	$102.34	$301.00	$195.65–$301.00	—	66%
Albumin blood test CPT 82040 ALBUMIN LEVEL-Q	$22.10	$65.00	$24.70–$65.00	4% below	66%
Albumin blood test CPT 82040 ALBUMIN, SERUM	$22.10	$65.00	$24.70–$65.00	4% below	66%
Albumin blood test CPT 82040 ALBUMIN/LAB	$22.10	$65.00	$24.70–$65.00	4% below	66%
Albumin blood test inpatient CPT 82040 ALBUMIN LEVEL-Q	$22.10	$65.00	$42.25–$65.00	—	66%
Albumin blood test inpatient CPT 82040 ALBUMIN/LAB	$22.10	$65.00	$42.25–$65.00	—	66%
Albumin blood test inpatient CPT 82040 ALBUMIN, SERUM	$22.10	$65.00	$42.25–$65.00	—	66%
Aldosterone blood test CPT 82088 ALDOSTERONE, URINE	$115.26	$339.00	$128.82–$339.00	26% below	66%
Aldosterone blood test CPT 82088 ALDOSTERONE/LAB	$115.26	$339.00	$128.82–$339.00	26% below	66%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE/LAB	$115.26	$339.00	$220.35–$339.00	—	66%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE, URINE	$115.26	$339.00	$220.35–$339.00	—	66%
Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE-Q	$17.34	$51.00	$19.38–$51.00	37% below	66%
Alkaline phosphatase (ALP) blood test CPT 84075 BONE SPECIFIC ALKALINE PHOS	$17.34	$51.00	$19.38–$51.00	37% below	66%
Alkaline phosphatase (ALP) blood test CPT 84075 ALK PHOS ISO,TOTAL	$17.34	$51.00	$19.38–$51.00	37% below	66%
Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE	$17.34	$51.00	$19.38–$51.00	37% below	66%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALK PHOS ISO,TOTAL	$17.34	$51.00	$33.15–$51.00	—	66%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE-Q	$17.34	$51.00	$33.15–$51.00	—	66%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE	$17.34	$51.00	$33.15–$51.00	—	66%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 BONE SPECIFIC ALKALINE PHOS	$17.34	$51.00	$33.15–$51.00	—	66%
Allergy blood test, specific IgE, per allergen CPT 86003 RAST ALLERGENS EACH	$23.46	$69.00	$26.22–$69.00	2% above	66%
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT ALLERGEN	$23.46	$69.00	$26.22–$69.00	2% above	66%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST ALLERGENS EACH	$23.46	$69.00	$44.85–$69.00	—	66%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PEANUT ALLERGEN	$23.46	$69.00	$44.85–$69.00	—	66%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP,TUMOR MARKER/LAB	$32.98	$97.00	$36.86–$97.00	50% below	66%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN	$32.98	$97.00	$36.86–$97.00	50% below	66%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP PROFILE 4	$32.98	$97.00	$36.86–$97.00	50% below	66%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP,TUMOR MARKER/LAB	$32.98	$97.00	$63.05–$97.00	—	66%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN	$32.98	$97.00	$63.05–$97.00	—	66%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP PROFILE 4	$32.98	$97.00	$63.05–$97.00	—	66%
Ammonia blood test CPT 82140 STONE ANALYSIS AMMONIA	$44.54	$131.00	$49.78–$131.00	51% below	66%
Ammonia blood test CPT 82140 AMMONIA/LAB	$44.54	$131.00	$49.78–$131.00	51% below	66%
Ammonia blood test inpatient CPT 82140 AMMONIA/LAB	$44.54	$131.00	$85.15–$131.00	—	66%
Ammonia blood test inpatient CPT 82140 STONE ANALYSIS AMMONIA	$44.54	$131.00	$85.15–$131.00	—	66%
Amylase blood test CPT 82150 AMYLASE,SERUM/LAB	$32.98	$97.00	$36.86–$97.00	21% below	66%
Amylase blood test CPT 82150 AMYLASE, BODY FLUID	$32.98	$97.00	$36.86–$97.00	21% below	66%
Amylase blood test CPT 82150 AMYLASE LEVEL-Q	$32.98	$97.00	$36.86–$97.00	21% below	66%
Amylase blood test CPT 82150 AMYLASE BODY FLUID-Q	$32.98	$97.00	$36.86–$97.00	21% below	66%
Amylase blood test CPT 82150 AMYLASE LEVEL RANDOM URINE-Q	$32.98	$97.00	$36.86–$97.00	21% below	66%
Amylase blood test CPT 82150 AMYLASE ISOENZYMES	$32.98	$97.00	$36.86–$97.00	21% below	66%
Amylase blood test CPT 82150 AMYLASE URINE/LAB	$32.98	$97.00	$36.86–$97.00	21% below	66%
Amylase blood test inpatient CPT 82150 AMYLASE LEVEL-Q	$32.98	$97.00	$63.05–$97.00	—	66%
Amylase blood test inpatient CPT 82150 AMYLASE LEVEL RANDOM URINE-Q	$32.98	$97.00	$63.05–$97.00	—	66%
Amylase blood test inpatient CPT 82150 AMYLASE, BODY FLUID	$32.98	$97.00	$63.05–$97.00	—	66%
Amylase blood test inpatient CPT 82150 AMYLASE,SERUM/LAB	$32.98	$97.00	$63.05–$97.00	—	66%
Amylase blood test inpatient CPT 82150 AMYLASE URINE/LAB	$32.98	$97.00	$63.05–$97.00	—	66%
Amylase blood test inpatient CPT 82150 AMYLASE ISOENZYMES	$32.98	$97.00	$63.05–$97.00	—	66%
Amylase blood test inpatient CPT 82150 AMYLASE BODY FLUID-Q	$32.98	$97.00	$63.05–$97.00	—	66%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRIC PEPTIDE AB IGG	$59.16	$174.00	$66.12–$174.00	17% below	66%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRIC PEPTIDE AB IGG	$59.16	$174.00	$113.10–$174.00	—	66%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA (FBR)	$40.46	$119.00	$45.22–$119.00	26% below	66%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY	$40.46	$119.00	$45.22–$119.00	26% below	66%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA/LAB	$40.46	$119.00	$45.22–$119.00	26% below	66%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA/LAB	$40.46	$119.00	$77.35–$119.00	—	66%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODY	$40.46	$119.00	$77.35–$119.00	—	66%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA (FBR)	$40.46	$119.00	$77.35–$119.00	—	66%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-TYPE NATRIURETIC PEPTIDE	$69.36	$204.00	$77.52–$204.00	56% below	66%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-TYPE NATRIURETIC PEPTIDE	$69.36	$204.00	$132.60–$204.00	—	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, ROUTINE/LAB	$35.36	$104.00	$39.52–$104.00	35% below	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 GENITAL CULTURE	$35.36	$104.00	$39.52–$104.00	35% below	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 GENITAL CULTURE	$35.36	$104.00	$67.60–$104.00	—	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, ROUTINE/LAB	$35.36	$104.00	$67.60–$104.00	—	66%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PAN	$64.94	$191.00	$72.58–$191.00	17% below	66%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL-Q	$64.94	$191.00	$72.58–$191.00	17% below	66%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PAN	$64.94	$191.00	$124.15–$191.00	—	66%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL-Q	$64.94	$191.00	$124.15–$191.00	—	66%
Bilirubin blood test, total CPT 82247 BILIRUBIN, TOTAL	$22.10	$65.00	$24.70–$65.00	29% below	66%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL-Q	$22.10	$65.00	$24.70–$65.00	29% below	66%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL-Q	$22.10	$65.00	$42.25–$65.00	—	66%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN, TOTAL	$22.10	$65.00	$42.25–$65.00	—	66%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURG PATH LEVEL 4	$104.38	$307.00	$116.66–$307.00	25% below	66%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 CYTOLOGY CELL BLOCK	$104.38	$307.00	$116.66–$307.00	25% below	66%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURG PATH LEVEL 4	$104.38	$307.00	$199.55–$307.00	—	66%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 CYTOLOGY CELL BLOCK	$104.38	$307.00	$199.55–$307.00	—	66%
Blood culture for bacteria CPT 87040 BLOOD CULTURE	$73.10	$215.00	$81.70–$215.00	14% below	66%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE	$73.10	$215.00	$139.75–$215.00	—	66%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD DRAW/LAB	$8.16	$24.00	$9.12–$24.00	42% below	66%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE	$8.16	$24.00	$9.12–$24.00	42% below	66%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 RH ROUTINE VENIPUNCTURE	$8.16	$24.00	$9.12–$24.00	42% below	66%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD DRAW/LAB	$8.16	$24.00	$15.60–$24.00	—	66%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE	$8.16	$24.00	$15.60–$24.00	—	66%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 RH ROUTINE VENIPUNCTURE	$8.16	$24.00	$15.60–$24.00	—	66%
Blood glucose (sugar) test CPT 82947 FIBROSURE GLUCOSE	$19.72	$58.00	$22.04–$58.00	15% below	66%
Blood glucose (sugar) test CPT 82947 GLUCOSE,SERUM/LAB	$19.72	$58.00	$22.04–$58.00	15% below	66%
Blood glucose (sugar) test CPT 82947 ISTAT GLUCUSOE	$19.72	$58.00	$22.04–$58.00	15% below	66%
Blood glucose (sugar) test CPT 82947 GLUCOSE LEVEL-Q	$19.72	$58.00	$22.04–$58.00	15% below	66%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE LEVEL-Q	$19.72	$58.00	$37.70–$58.00	—	66%
Blood glucose (sugar) test inpatient CPT 82947 FIBROSURE GLUCOSE	$19.72	$58.00	$37.70–$58.00	—	66%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE,SERUM/LAB	$19.72	$58.00	$37.70–$58.00	—	66%
Blood glucose (sugar) test inpatient CPT 82947 ISTAT GLUCUSOE	$19.72	$58.00	$37.70–$58.00	—	66%
Blood lead test CPT 83655 LEAD,INDUSTRIAL EXP	$30.60	$90.00	$34.20–$90.00	32% below	66%
Blood lead test CPT 83655 LEAD, URINE	$30.60	$90.00	$34.20–$90.00	32% below	66%
Blood lead test CPT 83655 LEAD, BLOOD/LAB	$30.60	$90.00	$34.20–$90.00	32% below	66%
Blood lead test CPT 83655 LEAD, WHOLE BLOOD	$30.60	$90.00	$34.20–$90.00	32% below	66%
Blood lead test inpatient CPT 83655 LEAD, BLOOD/LAB	$30.60	$90.00	$58.50–$90.00	—	66%
Blood lead test inpatient CPT 83655 LEAD, WHOLE BLOOD	$30.60	$90.00	$58.50–$90.00	—	66%
Blood lead test inpatient CPT 83655 LEAD, URINE	$30.60	$90.00	$58.50–$90.00	—	66%
Blood lead test inpatient CPT 83655 LEAD,INDUSTRIAL EXP	$30.60	$90.00	$58.50–$90.00	—	66%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY TEST	$31.62	$93.00	$35.34–$93.00	27% below	66%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 BETA HCG QUALITATIVE-Q	$31.62	$93.00	$35.34–$93.00	27% below	66%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 BETA HCG QUALITATIVE-Q	$31.62	$93.00	$60.45–$93.00	—	66%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY TEST	$31.62	$93.00	$60.45–$93.00	—	66%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO TYPE	$61.88	$182.00	$69.16–$182.00	25% above	66%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ARC ABO CHARGE	$61.88	$182.00	$69.16–$182.00	25% above	66%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ARC ABO CHARGE	$61.88	$182.00	$118.30–$182.00	—	66%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO TYPE	$61.88	$182.00	$118.30–$182.00	—	66%
Blood urea nitrogen (BUN) test CPT 84520 FIBROMETER BUN	$11.22	$33.00	$12.54–$33.00	55% below	66%
Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN (BUN)-Q	$11.22	$33.00	$12.54–$33.00	55% below	66%
Blood urea nitrogen (BUN) test CPT 84520 ISTAT BUN	$11.22	$33.00	$12.54–$33.00	55% below	66%
Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN,BF	$11.22	$33.00	$12.54–$33.00	55% below	66%
Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN/LAB	$11.22	$33.00	$12.54–$33.00	55% below	66%
Blood urea nitrogen (BUN) test inpatient CPT 84520 ISTAT BUN	$11.22	$33.00	$21.45–$33.00	—	66%
Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN,BF	$11.22	$33.00	$21.45–$33.00	—	66%
Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN/LAB	$11.22	$33.00	$21.45–$33.00	—	66%
Blood urea nitrogen (BUN) test inpatient CPT 84520 FIBROMETER BUN	$11.22	$33.00	$21.45–$33.00	—	66%
Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN (BUN)-Q	$11.22	$33.00	$21.45–$33.00	—	66%
C-peptide blood test CPT 84681 C-PEPTIDE REACTIVITY	$51.68	$152.00	$57.76–$152.00	26% below	66%
C-peptide blood test CPT 84681 C PEPTIDE/LAB	$51.68	$152.00	$57.76–$152.00	26% below	66%
C-peptide blood test inpatient CPT 84681 C PEPTIDE/LAB	$51.68	$152.00	$98.80–$152.00	—	66%
C-peptide blood test inpatient CPT 84681 C-PEPTIDE REACTIVITY	$51.68	$152.00	$98.80–$152.00	—	66%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN MG/L-Q	$30.94	$91.00	$34.58–$91.00	17% below	66%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN	$30.94	$91.00	$34.58–$91.00	17% below	66%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$30.94	$91.00	$34.58–$91.00	17% below	66%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN	$30.94	$91.00	$59.15–$91.00	—	66%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$30.94	$91.00	$59.15–$91.00	—	66%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN MG/L-Q	$30.94	$91.00	$59.15–$91.00	—	66%
C. difficile toxin gene test (stool PCR) CPT 87493 C-DIFFIICILE AMPLIFIED PROBE	$60.18	$177.00	$67.26–$177.00	41% below	66%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C-DIFFIICILE AMPLIFIED PROBE	$60.18	$177.00	$115.05–$177.00	—	66%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$44.20	$130.00	$49.40–$130.00	32% below	66%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$44.20	$130.00	$84.50–$130.00	—	66%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA, 125	$50.66	$149.00	$56.62–$149.00	41% below	66%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA, 125	$50.66	$149.00	$96.85–$149.00	—	66%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$45.90	$135.00	$51.30–$135.00	48% below	66%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID CEPHEID	$45.90	$135.00	$51.30–$135.00	48% below	66%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID CEPHEID	$45.90	$135.00	$87.75–$135.00	—	66%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$45.90	$135.00	$87.75–$135.00	—	66%
Calcium blood test, total CPT 82310 CALCIUM/LAB	$18.02	$53.00	$20.14–$53.00	36% below	66%
Calcium blood test, total CPT 82310 CALCIUM LEVEL TOTAL-Q	$18.02	$53.00	$20.14–$53.00	36% below	66%
Calcium blood test, total inpatient CPT 82310 CALCIUM/LAB	$18.02	$53.00	$34.45–$53.00	—	66%
Calcium blood test, total inpatient CPT 82310 CALCIUM LEVEL TOTAL-Q	$18.02	$53.00	$34.45–$53.00	—	66%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA/LAB	$52.02	$153.00	$58.14–$153.00	41% below	66%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA/LAB	$52.02	$153.00	$99.45–$153.00	—	66%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA-ZOSTER ABY	$38.76	$114.00	$43.32–$114.00	20% below	66%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER IGG	$38.76	$114.00	$43.32–$114.00	20% below	66%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER IGM	$38.76	$114.00	$43.32–$114.00	20% below	66%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER IGM	$38.76	$114.00	$74.10–$114.00	—	66%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA-ZOSTER ABY	$38.76	$114.00	$74.10–$114.00	—	66%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER IGG	$38.76	$114.00	$74.10–$114.00	—	66%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA DIRECT/LAB	$40.46	$119.00	$45.22–$119.00	44% below	66%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA DIRECT/LAB	$40.46	$119.00	$77.35–$119.00	—	66%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$45.90	$135.00	$51.30–$135.00	38% below	66%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$45.90	$135.00	$87.75–$135.00	—	66%
Complete blood count (CBC) with differential CPT 85025 CBC/AUTO DIFF	$41.48	$122.00	$46.36–$122.00	12% below	66%
Complete blood count (CBC) with differential CPT 85025 CBC WITH DIFF-Q	$41.48	$122.00	$46.36–$122.00	12% below	66%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH DIFF-Q	$41.48	$122.00	$79.30–$122.00	—	66%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC/AUTO DIFF	$41.48	$122.00	$79.30–$122.00	—	66%
Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFFERENTIAL-Q	$23.80	$70.00	$26.60–$70.00	23% below	66%
Complete blood count (CBC), no differential CPT 85027 HEMOGRAM	$23.80	$70.00	$26.60–$70.00	23% below	66%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC WITHOUT DIFFERENTIAL-Q	$23.80	$70.00	$45.50–$70.00	—	66%
Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM	$23.80	$70.00	$45.50–$70.00	—	66%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PAN	$96.56	$284.00	$107.92–$284.00	8% below	66%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANL-Q	$96.56	$284.00	$107.92–$284.00	8% below	66%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANL-Q	$96.56	$284.00	$184.60–$284.00	—	66%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PAN	$96.56	$284.00	$184.60–$284.00	—	66%
Cortisol blood test, total CPT 82533 ACTH STIMULATION	$41.82	$123.00	$46.74–$123.00	40% below	66%
Cortisol blood test, total CPT 82533 CORTISOL PEDS COSYNTROPIN TEST	$41.82	$123.00	$46.74–$123.00	40% below	66%
Cortisol blood test, total CPT 82533 CORTISOL,PLASMA/LAB	$41.82	$123.00	$46.74–$123.00	40% below	66%
Cortisol blood test, total CPT 82533 CORTISOL, SALIVA	$41.82	$123.00	$46.74–$123.00	40% below	66%
Cortisol blood test, total CPT 82533 CORTISOL/LAB	$41.82	$123.00	$46.74–$123.00	40% below	66%
Cortisol blood test, total inpatient CPT 82533 CORTISOL/LAB	$41.82	$123.00	$79.95–$123.00	—	66%
Cortisol blood test, total inpatient CPT 82533 ACTH STIMULATION	$41.82	$123.00	$79.95–$123.00	—	66%
Cortisol blood test, total inpatient CPT 82533 CORTISOL,PLASMA/LAB	$41.82	$123.00	$79.95–$123.00	—	66%
Cortisol blood test, total inpatient CPT 82533 CORTISOL, SALIVA	$41.82	$123.00	$79.95–$123.00	—	66%
Cortisol blood test, total inpatient CPT 82533 CORTISOL PEDS COSYNTROPIN TEST	$41.82	$123.00	$79.95–$123.00	—	66%
Creatine kinase (CK) blood test, total CPT 82550 CK, TOTAL	$23.12	$68.00	$25.84–$68.00	49% below	66%
Creatine kinase (CK) blood test, total CPT 82550 TOTAL CK (ARUP)	$23.12	$68.00	$25.84–$68.00	49% below	66%
Creatine kinase (CK) blood test, total CPT 82550 CREATINE KINASE TOTAL-Q	$23.12	$68.00	$25.84–$68.00	49% below	66%
Creatine kinase (CK) blood test, total CPT 82550 CPK/LAB	$23.12	$68.00	$25.84–$68.00	49% below	66%
Creatine kinase (CK) blood test, total inpatient CPT 82550 TOTAL CK (ARUP)	$23.12	$68.00	$44.20–$68.00	—	66%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CREATINE KINASE TOTAL-Q	$23.12	$68.00	$44.20–$68.00	—	66%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK/LAB	$23.12	$68.00	$44.20–$68.00	—	66%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CK, TOTAL	$23.12	$68.00	$44.20–$68.00	—	66%
Creatinine blood test CPT 82565 ISTAT CREATININE	$12.58	$37.00	$14.06–$37.00	56% below	66%
Creatinine blood test CPT 82565 CREATININE, SERUM	$12.58	$37.00	$14.06–$37.00	56% below	66%
Creatinine blood test CPT 82565 CREATININE SERUM-Q	$12.58	$37.00	$14.06–$37.00	56% below	66%
Creatinine blood test inpatient CPT 82565 CREATININE, SERUM	$12.58	$37.00	$24.05–$37.00	—	66%
Creatinine blood test inpatient CPT 82565 CREATININE SERUM-Q	$12.58	$37.00	$24.05–$37.00	—	66%
Creatinine blood test inpatient CPT 82565 ISTAT CREATININE	$12.58	$37.00	$24.05–$37.00	—	66%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV ANTIBODY, IGG	$35.02	$103.00	$39.14–$103.00	44% below	66%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV IGG	$35.02	$103.00	$39.14–$103.00	44% below	66%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV ANTIBODY, IGG	$35.02	$103.00	$66.95–$103.00	—	66%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV IGG	$35.02	$103.00	$66.95–$103.00	—	66%
D-dimer blood test (blood clot marker) CPT 85379 D DIMER	$45.22	$133.00	$50.54–$133.00	37% below	66%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D DIMER	$45.22	$133.00	$86.45–$133.00	—	66%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE/LAB	$41.48	$122.00	$46.36–$122.00	54% below	66%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE/LAB	$41.48	$122.00	$79.30–$122.00	—	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ETHANOL LEVEL URINE-Q	$41.82	$123.00	$46.74–$123.00	57% below	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG URINE SCREEN RAPID	$87.38	$257.00	$97.66–$257.00	10% below	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN 9 PANEL W REFLEX	$87.38	$257.00	$97.66–$257.00	10% below	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ETHYL GLUCURONIDE URINE	$87.38	$257.00	$97.66–$257.00	10% below	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE DRUG SCREEN	$87.38	$257.00	$97.66–$257.00	10% below	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN URINE COMP	$149.60	$440.00	$167.20–$440.00	54% above	66%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ETHANOL LEVEL URINE-Q	$41.82	$123.00	$79.95–$123.00	—	66%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN 9 PANEL W REFLEX	$87.38	$257.00	$167.05–$257.00	—	66%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE DRUG SCREEN	$87.38	$257.00	$167.05–$257.00	—	66%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ETHYL GLUCURONIDE URINE	$87.38	$257.00	$167.05–$257.00	—	66%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG URINE SCREEN RAPID	$87.38	$257.00	$167.05–$257.00	—	66%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN URINE COMP	$149.60	$440.00	$286.00–$440.00	—	66%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL	$33.66	$99.00	$37.62–$99.00	33% below	66%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYES-Q	$33.66	$99.00	$37.62–$99.00	33% below	66%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYES-Q	$33.66	$99.00	$64.35–$99.00	—	66%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL	$33.66	$99.00	$64.35–$99.00	—	66%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV AB V.CAPSID AG	$41.48	$122.00	$46.36–$122.00	32% below	66%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV AB V.CAPSID AG	$41.48	$122.00	$79.30–$122.00	—	66%
Estradiol blood test CPT 82670 ESTRADIOL/LAB	$94.86	$279.00	$106.02–$279.00	7% below	66%
Estradiol blood test inpatient CPT 82670 ESTRADIOL/LAB	$94.86	$279.00	$181.35–$279.00	—	66%
FSH (follicle-stimulating hormone) test CPT 83001 FSH/LAB	$57.46	$169.00	$64.22–$169.00	28% below	66%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH/LAB	$57.46	$169.00	$109.85–$169.00	—	66%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN	$94.86	$279.00	$106.02–$279.00	38% below	66%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN	$94.86	$279.00	$181.35–$279.00	—	66%
Ferritin blood test (iron stores) CPT 82728 FIBROSURE FERRITIN	$46.92	$138.00	$52.44–$138.00	37% below	66%
Ferritin blood test (iron stores) CPT 82728 FERRITIN/LAB	$46.92	$138.00	$52.44–$138.00	37% below	66%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN/LAB	$46.92	$138.00	$89.70–$138.00	—	66%
Ferritin blood test (iron stores) inpatient CPT 82728 FIBROSURE FERRITIN	$46.92	$138.00	$89.70–$138.00	—	66%
Fibrinogen blood test CPT 85384 FIBRINOGEN, ACTIVITY	$34.34	$101.00	$38.38–$101.00	43% below	66%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN, ACTIVITY	$34.34	$101.00	$65.65–$101.00	—	66%
Folate (folic acid) blood test CPT 82746 FOLATE,SERUM/LAB	$31.28	$92.00	$34.96–$92.00	58% below	66%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE,SERUM/LAB	$31.28	$92.00	$59.80–$92.00	—	66%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$61.20	$180.00	$68.40–$180.00	29% below	66%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE	$61.20	$180.00	$117.00–$180.00	—	66%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE DIRECT DIALYSIS	$53.04	$156.00	$59.28–$156.00	11% below	66%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4/LAB	$53.04	$156.00	$59.28–$156.00	11% below	66%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE DIRECT DIALYSIS	$53.04	$156.00	$101.40–$156.00	—	66%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4/LAB	$53.04	$156.00	$101.40–$156.00	—	66%
Free testosterone test CPT 84402 TESTOSTERONE, FREE	$62.90	$185.00	$70.30–$185.00	38% below	66%
Free testosterone test CPT 84402 TESTOSTERONE FREE LC-MS/MS	$62.90	$185.00	$70.30–$185.00	38% below	66%
Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE	$62.90	$185.00	$120.25–$185.00	—	66%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE LC-MS/MS	$62.90	$185.00	$120.25–$185.00	—	66%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT/LAB	$32.64	$96.00	$36.48–$96.00	27% below	66%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 FIBROMETER GGT	$32.64	$96.00	$36.48–$96.00	27% below	66%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GAMMA GLUTAMYL TRANSFERASE-Q	$32.64	$96.00	$36.48–$96.00	27% below	66%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT/LAB	$32.64	$96.00	$62.40–$96.00	—	66%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 FIBROMETER GGT	$32.64	$96.00	$62.40–$96.00	—	66%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GAMMA GLUTAMYL TRANSFERASE-Q	$32.64	$96.00	$62.40–$96.00	—	66%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 30" GLUCOSE/LAB	$27.20	$80.00	$30.40–$80.00	27% below	66%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST DOSE	$27.20	$80.00	$30.40–$80.00	27% below	66%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST DOSE	$27.20	$80.00	$52.00–$80.00	—	66%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 30" GLUCOSE/LAB	$27.20	$80.00	$52.00–$80.00	—	66%
Glucose tolerance test, 3 samples CPT 82951 LACTOSE TOLERANCE TEST-Q	$49.64	$146.00	$55.48–$146.00	22% below	66%
Glucose tolerance test, 3 samples CPT 82951 LACTOSE TOLERANCE	$49.64	$146.00	$55.48–$146.00	22% below	66%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOL. GEST.	$49.64	$146.00	$55.48–$146.00	22% below	66%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOL. HYPOGLY	$49.64	$146.00	$55.48–$146.00	22% below	66%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOL. ROUTINE	$49.64	$146.00	$55.48–$146.00	22% below	66%
Glucose tolerance test, 3 samples inpatient CPT 82951 LACTOSE TOLERANCE	$49.64	$146.00	$94.90–$146.00	—	66%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOL. GEST.	$49.64	$146.00	$94.90–$146.00	—	66%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOL. HYPOGLY	$49.64	$146.00	$94.90–$146.00	—	66%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOL. ROUTINE	$49.64	$146.00	$94.90–$146.00	—	66%
Glucose tolerance test, 3 samples inpatient CPT 82951 LACTOSE TOLERANCE TEST-Q	$49.64	$146.00	$94.90–$146.00	—	66%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC DIRECT/LAB	$41.82	$123.00	$46.74–$123.00	37% below	66%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC DIRECT/LAB	$41.82	$123.00	$79.95–$123.00	—	66%
H. pylori antibody blood test CPT 86677 H PYLORI ANTIBODY	$52.70	$155.00	$58.90–$155.00	31% below	66%
H. pylori antibody blood test inpatient CPT 86677 H PYLORI ANTIBODY	$52.70	$155.00	$100.75–$155.00	—	66%
H. pylori stool antigen test CPT 87338 HELICOBACTER PYLORI AG FECAL	$90.44	$266.00	$101.08–$266.00	21% below	66%
H. pylori stool antigen test inpatient CPT 87338 HELICOBACTER PYLORI AG FECAL	$90.44	$266.00	$172.90–$266.00	—	66%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA QUANT BDNA	$155.72	$458.00	$174.04–$458.00	32% below	66%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA QUANT/PCR	$155.72	$458.00	$174.04–$458.00	32% below	66%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA QUANT/PCR	$155.72	$458.00	$297.70–$458.00	—	66%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA QUANT BDNA	$155.72	$458.00	$297.70–$458.00	—	66%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1 AND HIV-2 ANTIBODY	$30.94	$91.00	$34.58–$91.00	32% below	66%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1 AND HIV-2 ANTIBODY	$30.94	$91.00	$59.15–$91.00	—	66%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV COMBO ANTIGEN/ANTIBODY REF	$22.10	$65.00	$24.70–$65.00	53% below	66%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV -1,2 COMBO, AG/AB ELISA	$22.10	$65.00	$24.70–$65.00	53% below	66%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV COMBO ANTIGEN/ANTIBODY REF	$22.10	$65.00	$42.25–$65.00	—	66%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV -1,2 COMBO, AG/AB ELISA	$22.10	$65.00	$42.25–$65.00	—	66%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV DNA PROBE	$48.96	$144.00	$54.72–$144.00	32% below	66%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV DNA PROBE	$48.96	$144.00	$93.60–$144.00	—	66%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSALATED HGB/LAB	$38.76	$114.00	$43.32–$114.00	26% below	66%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSALATED HGB/LAB	$38.76	$114.00	$74.10–$114.00	—	66%
Hemoglobin blood test CPT 85018 HEMOGLOBIN-Q	$8.50	$25.00	$9.50–$25.00	44% below	66%
Hemoglobin blood test CPT 85018 HEMOGLOBIN/LAB	$8.50	$25.00	$9.50–$25.00	44% below	66%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN/LAB	$8.50	$25.00	$16.25–$25.00	—	66%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN-Q	$8.50	$25.00	$16.25–$25.00	—	66%
Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B ABY, TOT	$39.44	$116.00	$44.08–$116.00	35% below	66%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B ABY, TOT	$39.44	$116.00	$75.40–$116.00	—	66%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ABY	$35.36	$104.00	$39.52–$104.00	30% below	66%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE ABY	$35.36	$104.00	$67.60–$104.00	—	66%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B ANTIGEN	$33.66	$99.00	$37.62–$99.00	31% below	66%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B ANTIGEN	$33.66	$99.00	$64.35–$99.00	—	66%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ABY	$48.28	$142.00	$53.96–$142.00	34% below	66%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ABY	$48.28	$142.00	$92.30–$142.00	—	66%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C RNA, QUANT	$123.42	$363.00	$137.94–$363.00	28% below	66%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C RNA, QUANT	$123.42	$363.00	$235.95–$363.00	—	66%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1	$35.02	$103.00	$39.14–$103.00	34% below	66%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE 1	$35.02	$103.00	$66.95–$103.00	—	66%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2	$46.92	$138.00	$52.44–$138.00	34% below	66%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE 2	$46.92	$138.00	$89.70–$138.00	—	66%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP HIGH SENSITIVITY Q	$32.30	$95.00	$36.10–$95.00	38% below	66%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP HIGH SENSITIVITY	$32.30	$95.00	$36.10–$95.00	38% below	66%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP-HIGH SENSITIVITY-Q	$32.30	$95.00	$36.10–$95.00	38% below	66%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP-HIGH SENSITIVITY-Q	$32.30	$95.00	$61.75–$95.00	—	66%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP HIGH SENSITIVITY	$32.30	$95.00	$61.75–$95.00	—	66%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP HIGH SENSITIVITY Q	$32.30	$95.00	$61.75–$95.00	—	66%
Homocysteine blood test CPT 83090 HOMOCYSTEINE	$79.56	$234.00	$88.92–$234.00	9% above	66%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE	$79.56	$234.00	$152.10–$234.00	—	66%
Insulin blood test CPT 83525 INSULIN/LAB	$47.26	$139.00	$52.82–$139.00	27% below	66%
Insulin blood test inpatient CPT 83525 INSULIN/LAB	$47.26	$139.00	$90.35–$139.00	—	66%
Iron blood test (serum iron) CPT 83540 IRON/LAB	$26.52	$78.00	$29.64–$78.00	29% below	66%
Iron blood test (serum iron) CPT 83540 IRON	$26.52	$78.00	$29.64–$78.00	29% below	66%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$26.52	$78.00	$50.70–$78.00	—	66%
Iron blood test (serum iron) inpatient CPT 83540 IRON/LAB	$26.52	$78.00	$50.70–$78.00	—	66%
Iron-binding capacity (TIBC) test CPT 83550 IBC/LAB	$24.14	$71.00	$26.98–$71.00	40% below	66%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IBC/LAB	$24.14	$71.00	$46.15–$71.00	—	66%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$34.68	$102.00	$38.76–$102.00	48% below	66%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL-Q	$34.68	$102.00	$38.76–$102.00	48% below	66%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL-Q	$34.68	$102.00	$66.30–$102.00	—	66%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$34.68	$102.00	$66.30–$102.00	—	66%
LH (luteinizing hormone) test CPT 83002 LH/LAB	$42.84	$126.00	$47.88–$126.00	50% below	66%
LH (luteinizing hormone) test inpatient CPT 83002 LH/LAB	$42.84	$126.00	$81.90–$126.00	—	66%
Lactate (lactic acid) blood test CPT 83605 CSF LACTIC ACID/LAB	$30.26	$89.00	$33.82–$89.00	48% below	66%
Lactate (lactic acid) blood test CPT 83605 ISTAT LACTATE	$30.26	$89.00	$33.82–$89.00	48% below	66%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID/LAB	$30.26	$89.00	$33.82–$89.00	48% below	66%
Lactate (lactic acid) blood test inpatient CPT 83605 CSF LACTIC ACID/LAB	$30.26	$89.00	$57.85–$89.00	—	66%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID/LAB	$30.26	$89.00	$57.85–$89.00	—	66%
Lactate (lactic acid) blood test inpatient CPT 83605 ISTAT LACTATE	$30.26	$89.00	$57.85–$89.00	—	66%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH,SERUM/LAB	$15.64	$46.00	$17.48–$46.00	57% below	66%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH,SPINAL FLUID/LAB	$15.64	$46.00	$17.48–$46.00	57% below	66%
Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE DEHYDROGENASE (LDH)-Q	$15.64	$46.00	$17.48–$46.00	57% below	66%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH,BODY FLUID/LAB	$15.64	$46.00	$17.48–$46.00	57% below	66%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH BODY FLUID-Q	$15.64	$46.00	$17.48–$46.00	57% below	66%
Lactate dehydrogenase (LDH) blood test CPT 83615 TOTAL LD (ARUP)	$15.64	$46.00	$17.48–$46.00	57% below	66%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 TOTAL LD (ARUP)	$15.64	$46.00	$29.90–$46.00	—	66%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE DEHYDROGENASE (LDH)-Q	$15.64	$46.00	$29.90–$46.00	—	66%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH BODY FLUID-Q	$15.64	$46.00	$29.90–$46.00	—	66%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH,SERUM/LAB	$15.64	$46.00	$29.90–$46.00	—	66%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH,SPINAL FLUID/LAB	$15.64	$46.00	$29.90–$46.00	—	66%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH,BODY FLUID/LAB	$15.64	$46.00	$29.90–$46.00	—	66%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE/LAB	$31.62	$93.00	$35.34–$93.00	31% below	66%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE LEVEL-Q	$31.62	$93.00	$35.34–$93.00	31% below	66%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE/LAB	$31.62	$93.00	$60.45–$93.00	—	66%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE LEVEL-Q	$31.62	$93.00	$60.45–$93.00	—	66%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL-Q	$49.64	$146.00	$55.48–$146.00	40% below	66%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PAN	$49.64	$146.00	$55.48–$146.00	40% below	66%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PAN	$49.64	$146.00	$94.90–$146.00	—	66%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL-Q	$49.64	$146.00	$94.90–$146.00	—	66%
Lyme disease antibody test CPT 86618 LYME DISEASE CSF	$37.74	$111.00	$42.18–$111.00	51% below	66%
Lyme disease antibody test CPT 86618 LYME DIS TITER/LAB	$37.74	$111.00	$42.18–$111.00	51% below	66%
Lyme disease antibody test inpatient CPT 86618 LYME DIS TITER/LAB	$37.74	$111.00	$72.15–$111.00	—	66%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE CSF	$37.74	$111.00	$72.15–$111.00	—	66%
Magnesium blood test CPT 83735 MAGNESIUM URINE RANDOM COLCT-Q	$34.68	$102.00	$38.76–$102.00	14% below	66%
Magnesium blood test CPT 83735 MAGNESIUM LEVEL-Q	$34.68	$102.00	$38.76–$102.00	14% below	66%
Magnesium blood test CPT 83735 MAGNESIUM URINE TIMED-Q	$34.68	$102.00	$38.76–$102.00	14% below	66%
Magnesium blood test CPT 83735 MAGNESIUM/LAB	$34.68	$102.00	$38.76–$102.00	14% below	66%
Magnesium blood test CPT 83735 URINE MAGNESIUM/LAB	$34.68	$102.00	$38.76–$102.00	14% below	66%
Magnesium blood test CPT 83735 MAGNESIUM RBC'S	$34.68	$102.00	$38.76–$102.00	14% below	66%
Magnesium blood test CPT 83735 STONE ANALYSIS MAGNESIUM	$34.68	$102.00	$38.76–$102.00	14% below	66%
Magnesium blood test inpatient CPT 83735 MAGNESIUM LEVEL-Q	$34.68	$102.00	$66.30–$102.00	—	66%
Magnesium blood test inpatient CPT 83735 MAGNESIUM/LAB	$34.68	$102.00	$66.30–$102.00	—	66%
Magnesium blood test inpatient CPT 83735 URINE MAGNESIUM/LAB	$34.68	$102.00	$66.30–$102.00	—	66%
Magnesium blood test inpatient CPT 83735 MAGNESIUM URINE TIMED-Q	$34.68	$102.00	$66.30–$102.00	—	66%
Magnesium blood test inpatient CPT 83735 MAGNESIUM RBC'S	$34.68	$102.00	$66.30–$102.00	—	66%
Magnesium blood test inpatient CPT 83735 MAGNESIUM URINE RANDOM COLCT-Q	$34.68	$102.00	$66.30–$102.00	—	66%
Magnesium blood test inpatient CPT 83735 STONE ANALYSIS MAGNESIUM	$34.68	$102.00	$66.30–$102.00	—	66%
Measles (rubeola) antibody test CPT 86765 RUBEOLA SCREEN/LAB	$29.24	$86.00	$32.68–$86.00	17% below	66%
Measles (rubeola) antibody test CPT 86765 MEASLES (RUBEOLA ANTIBODY IGM	$29.24	$86.00	$32.68–$86.00	17% below	66%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA SCREEN/LAB	$29.24	$86.00	$55.90–$86.00	—	66%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES (RUBEOLA ANTIBODY IGM	$29.24	$86.00	$55.90–$86.00	—	66%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE AB SCRN	$23.12	$68.00	$25.84–$68.00	36% below	66%
Mono test (heterophile antibody, Monospot) CPT 86308 INFECTIOUS MONO/LAB	$23.12	$68.00	$25.84–$68.00	36% below	66%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 INFECTIOUS MONO/LAB	$23.12	$68.00	$44.20–$68.00	—	66%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE AB SCRN	$23.12	$68.00	$44.20–$68.00	—	66%
Mumps immunity blood test CPT 86735 MUMPS IGM	$37.06	$109.00	$41.42–$109.00	at median	66%
Mumps immunity blood test CPT 86735 MUMPS IGG	$37.06	$109.00	$41.42–$109.00	at median	66%
Mumps immunity blood test inpatient CPT 86735 MUMPS IGM	$37.06	$109.00	$70.85–$109.00	—	66%
Mumps immunity blood test inpatient CPT 86735 MUMPS IGG	$37.06	$109.00	$70.85–$109.00	—	66%
Obstetric blood test panel CPT 80055 PRENATAL PROFILE	$165.58	$487.00	$185.06–$487.00	16% above	66%
Obstetric blood test panel inpatient CPT 80055 PRENATAL PROFILE	$165.58	$487.00	$316.55–$487.00	—	66%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE	$55.42	$163.00	$61.94–$163.00	40% below	66%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, FREE	$55.42	$163.00	$105.95–$163.00	—	66%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL (PART OF PSA FREE)	$49.98	$147.00	$55.86–$147.00	30% below	66%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPE-AG/LAB	$49.98	$147.00	$55.86–$147.00	30% below	66%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL (PART OF PSA FREE)	$49.98	$147.00	$95.55–$147.00	—	66%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SPE-AG/LAB	$49.98	$147.00	$95.55–$147.00	—	66%
Pap test (liquid-based, automated screening with review) CPT 88175 THIN PREP TEST IMAGIN	$26.86	$79.00	$30.02–$79.00	58% below	66%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 THIN PREP TEST IMAGIN	$26.86	$79.00	$51.35–$79.00	—	66%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 SUREPATH PAP	$37.40	$110.00	$41.80–$110.00	47% below	66%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 SUREPATH PAP	$37.40	$110.00	$71.50–$110.00	—	66%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT	$52.02	$153.00	$58.14–$153.00	47% below	66%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT	$52.02	$153.00	$99.45–$153.00	—	66%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT SUBSTITUTION, EA	$28.56	$84.00	$31.92–$84.00	34% below	66%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL	$28.56	$84.00	$31.92–$84.00	34% below	66%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT/LAB	$28.56	$84.00	$31.92–$84.00	34% below	66%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT SUBSTITUTION, EA	$28.56	$84.00	$54.60–$84.00	—	66%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT/LAB	$28.56	$84.00	$54.60–$84.00	—	66%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL	$28.56	$84.00	$54.60–$84.00	—	66%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS LEVEL-Q	$13.94	$41.00	$15.58–$41.00	50% below	66%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS/LAB	$13.94	$41.00	$15.58–$41.00	50% below	66%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS/LAB	$13.94	$41.00	$26.65–$41.00	—	66%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS LEVEL-Q	$13.94	$41.00	$26.65–$41.00	—	66%
Potassium blood test CPT 84132 POTASSIUM,SERUM/LAB	$13.60	$40.00	$15.20–$40.00	44% below	66%
Potassium blood test CPT 84132 POTASSIUM LEVEL-Q	$13.60	$40.00	$15.20–$40.00	44% below	66%
Potassium blood test CPT 84132 ISTAT POTASSIUM	$13.60	$40.00	$15.20–$40.00	44% below	66%
Potassium blood test inpatient CPT 84132 POTASSIUM,SERUM/LAB	$13.60	$40.00	$26.00–$40.00	—	66%
Potassium blood test inpatient CPT 84132 ISTAT POTASSIUM	$13.60	$40.00	$26.00–$40.00	—	66%
Potassium blood test inpatient CPT 84132 POTASSIUM LEVEL-Q	$13.60	$40.00	$26.00–$40.00	—	66%
Progesterone blood test CPT 84144 PROGESTERONE/LAB	$62.56	$184.00	$69.92–$184.00	30% below	66%
Progesterone blood test inpatient CPT 84144 PROGESTERONE/LAB	$62.56	$184.00	$119.60–$184.00	—	66%
Prolactin blood test CPT 84146 PROLACTIN DILUTION STUDY	$59.50	$175.00	$66.50–$175.00	21% below	66%
Prolactin blood test CPT 84146 PROLACTIN/LAB	$59.50	$175.00	$66.50–$175.00	21% below	66%
Prolactin blood test inpatient CPT 84146 PROLACTIN DILUTION STUDY	$59.50	$175.00	$113.75–$175.00	—	66%
Prolactin blood test inpatient CPT 84146 PROLACTIN/LAB	$59.50	$175.00	$113.75–$175.00	—	66%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME/LAB	$15.98	$47.00	$17.86–$47.00	46% below	66%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME/LAB	$15.98	$47.00	$30.55–$47.00	—	66%
Rapid flu test (influenza antigen) CPT 87804 RAPID FLU TEST	$18.02	$53.00	$20.14–$53.00	77% below	66%
Rapid flu test (influenza antigen) inpatient CPT 87804 RAPID FLU TEST	$18.02	$53.00	$34.45–$53.00	—	66%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP TEST	$17.34	$51.00	$19.38–$51.00	56% below	66%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 RAPID STREP SCREEN	$17.34	$51.00	$19.38–$51.00	56% below	66%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 RH STREP A ASSAY RAPID STREP	$21.42	$63.00	$23.94–$63.00	45% below	66%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RAPID STREP SCREEN	$17.34	$51.00	$33.15–$51.00	—	66%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP TEST	$17.34	$51.00	$33.15–$51.00	—	66%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RH STREP A ASSAY RAPID STREP	$21.42	$63.00	$40.95–$63.00	—	66%
Renin blood test CPT 84244 RENIN 1/LAB	$53.72	$158.00	$60.04–$158.00	27% below	66%
Renin blood test inpatient CPT 84244 RENIN 1/LAB	$53.72	$158.00	$102.70–$158.00	—	66%
Rh blood typing CPT 86901 ARC RH TYPE CHARGE	$29.92	$88.00	$33.44–$88.00	18% below	66%
Rh blood typing CPT 86901 RH TYPE	$29.92	$88.00	$33.44–$88.00	18% below	66%
Rh blood typing inpatient CPT 86901 RH TYPE	$29.92	$88.00	$57.20–$88.00	—	66%
Rh blood typing inpatient CPT 86901 ARC RH TYPE CHARGE	$29.92	$88.00	$57.20–$88.00	—	66%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT	$24.48	$72.00	$27.36–$72.00	27% below	66%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR	$24.48	$72.00	$27.36–$72.00	27% below	66%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT	$24.48	$72.00	$46.80–$72.00	—	66%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR	$24.48	$72.00	$46.80–$72.00	—	66%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG	$33.32	$98.00	$37.24–$98.00	34% below	66%
Rubella antibody test (immunity check) CPT 86762 RUBELLA TITER/LAB	$33.32	$98.00	$37.24–$98.00	34% below	66%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA TITER/LAB	$33.32	$98.00	$63.70–$98.00	—	66%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGG	$33.32	$98.00	$63.70–$98.00	—	66%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE (ESR)-Q	$26.18	$77.00	$29.26–$77.00	12% below	66%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE (ESR)-Q	$26.18	$77.00	$50.05–$77.00	—	66%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS DAHL	$23.46	$69.00	$26.22–$69.00	72% below	66%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SPERM MORPHOLOGY	$23.46	$69.00	$26.22–$69.00	72% below	66%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANALYSIS DAHL	$23.46	$69.00	$44.85–$69.00	—	66%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SPERM MORPHOLOGY	$23.46	$69.00	$44.85–$69.00	—	66%
Sodium blood test CPT 84295 SODIUM LEVEL-Q	$12.92	$38.00	$14.44–$38.00	46% below	66%
Sodium blood test CPT 84295 SODIUM,SERUM/LAB	$12.92	$38.00	$14.44–$38.00	46% below	66%
Sodium blood test CPT 84295 ISTAT SODIUM	$12.92	$38.00	$14.44–$38.00	46% below	66%
Sodium blood test inpatient CPT 84295 SODIUM,SERUM/LAB	$12.92	$38.00	$24.70–$38.00	—	66%
Sodium blood test inpatient CPT 84295 ISTAT SODIUM	$12.92	$38.00	$24.70–$38.00	—	66%
Sodium blood test inpatient CPT 84295 SODIUM LEVEL-Q	$12.92	$38.00	$24.70–$38.00	—	66%
Stool ova and parasites exam CPT 87177 OVA & PARASITE COMP	$21.42	$63.00	$23.94–$63.00	42% below	66%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITE COMP	$21.42	$63.00	$40.95–$63.00	—	66%
Stool test for hidden blood (guaiac FOBT) CPT 82270 RH HEMOCCULT	$11.56	$34.00	$12.92–$34.00	44% below	66%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD ANNUAL SCREEN	$11.56	$34.00	$12.92–$34.00	44% below	66%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 RH HEMOCCULT	$11.56	$34.00	$22.10–$34.00	—	66%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD ANNUAL SCREEN	$11.56	$34.00	$22.10–$34.00	—	66%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC ASSAY TEST FOR BLOOD FECAL	$25.16	$74.00	$28.12–$74.00	38% below	66%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 ST BLD 11MM	$25.16	$74.00	$28.12–$74.00	38% below	66%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC ASSAY TEST FOR BLOOD FECAL	$25.16	$74.00	$48.10–$74.00	—	66%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 ST BLD 11MM	$25.16	$74.00	$48.10–$74.00	—	66%
Syphilis antibody test (Treponema pallidum) CPT 86780 RPR-FTA-ABS/LAB	$35.36	$104.00	$39.52–$104.00	34% below	66%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 RPR-FTA-ABS/LAB	$35.36	$104.00	$67.60–$104.00	—	66%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL/LAB	$20.74	$61.00	$23.18–$61.00	34% below	66%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR/LAB	$20.74	$61.00	$23.18–$61.00	34% below	66%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR/LAB	$20.74	$61.00	$39.65–$61.00	—	66%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL/LAB	$20.74	$61.00	$39.65–$61.00	—	66%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB GOLD TB QUANTIFERON GOLD	$70.72	$208.00	$79.04–$208.00	40% below	66%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB GOLD TB QUANTIFERON GOLD	$70.72	$208.00	$135.20–$208.00	—	66%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE/LAB	$75.82	$223.00	$84.74–$223.00	17% below	66%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE FREE & TOTAL	$75.82	$223.00	$84.74–$223.00	17% below	66%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE/LAB	$75.82	$223.00	$144.95–$223.00	—	66%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE FREE & TOTAL	$75.82	$223.00	$144.95–$223.00	—	66%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER-KIDNEY MICROSOME AB IGG	$58.82	$173.00	$65.74–$173.00	31% below	66%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID AUTOANTIBODY	$58.82	$173.00	$65.74–$173.00	31% below	66%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID AUTOANTIBODY	$58.82	$173.00	$112.45–$173.00	—	66%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER-KIDNEY MICROSOME AB IGG	$58.82	$173.00	$112.45–$173.00	—	66%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH/LAB	$54.40	$160.00	$60.80–$160.00	30% below	66%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH/LAB	$54.40	$160.00	$104.00–$160.00	—	66%
Total IgE blood test CPT 82785 IGE	$58.48	$172.00	$65.36–$172.00	8% below	66%
Total IgE blood test inpatient CPT 82785 IGE	$58.48	$172.00	$111.80–$172.00	—	66%
Total cholesterol blood test CPT 82465 CHOLESTEROL/LAB	$23.46	$69.00	$26.22–$69.00	4% below	66%
Total cholesterol blood test CPT 82465 CHOLESTEROL TOTAL-Q	$23.46	$69.00	$26.22–$69.00	4% below	66%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL/LAB	$23.46	$69.00	$44.85–$69.00	—	66%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL TOTAL-Q	$23.46	$69.00	$44.85–$69.00	—	66%
Total thyroxine (T4) blood test CPT 84436 T4/LAB	$34.00	$100.00	$38.00–$100.00	30% below	66%
Total thyroxine (T4) blood test inpatient CPT 84436 T4/LAB	$34.00	$100.00	$65.00–$100.00	—	66%
Total triiodothyronine (T3) blood test CPT 84480 T3 TOTAL	$45.90	$135.00	$51.30–$135.00	45% below	66%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 TOTAL	$45.90	$135.00	$87.75–$135.00	—	66%
Transferrin blood test CPT 84466 TRANSFERRIN/LAB	$24.48	$72.00	$27.36–$72.00	58% below	66%
Transferrin blood test CPT 84466 TRANSFERRIN	$24.48	$72.00	$27.36–$72.00	58% below	66%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN/LAB	$24.48	$72.00	$46.80–$72.00	—	66%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$24.48	$72.00	$46.80–$72.00	—	66%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS BY PCR	$49.30	$145.00	$55.10–$145.00	45% below	66%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS BY PCR	$49.30	$145.00	$94.25–$145.00	—	66%
Triglycerides blood test CPT 84478 TRIGLYCERIDES/LAB	$30.60	$90.00	$34.20–$90.00	31% below	66%
Triglycerides blood test CPT 84478 BODY FLUID TRIG	$30.60	$90.00	$34.20–$90.00	31% below	66%
Triglycerides blood test inpatient CPT 84478 BODY FLUID TRIG	$30.60	$90.00	$58.50–$90.00	—	66%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES/LAB	$30.60	$90.00	$58.50–$90.00	—	66%
Troponin test, quantitative CPT 84484 TROPONIN T HS (RANDOM)-Q	$76.50	$225.00	$85.50–$225.00	4% below	66%
Troponin test, quantitative CPT 84484 TROPONIN	$76.50	$225.00	$85.50–$225.00	4% below	66%
Troponin test, quantitative inpatient CPT 84484 TROPONIN	$76.50	$225.00	$146.25–$225.00	—	66%
Troponin test, quantitative inpatient CPT 84484 TROPONIN T HS (RANDOM)-Q	$76.50	$225.00	$146.25–$225.00	—	66%
Uric acid blood test CPT 84550 URIC ACID-Q	$13.60	$40.00	$15.20–$40.00	56% below	66%
Uric acid blood test CPT 84550 URIC ACID,SERUM/LAB	$13.60	$40.00	$15.20–$40.00	56% below	66%
Uric acid blood test inpatient CPT 84550 URIC ACID,SERUM/LAB	$13.60	$40.00	$26.00–$40.00	—	66%
Uric acid blood test inpatient CPT 84550 URIC ACID-Q	$13.60	$40.00	$26.00–$40.00	—	66%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS/AUTO/MIC	$15.98	$47.00	$17.86–$47.00	53% below	66%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS REFLEX TO CULTURE-Q	$15.98	$47.00	$17.86–$47.00	53% below	66%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS REFLEX TO CULTURE-Q	$15.98	$47.00	$30.55–$47.00	—	66%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS/AUTO/MIC	$15.98	$47.00	$30.55–$47.00	—	66%
Urinalysis without microscope exam, automated CPT 81003 URINE PH/LAB	$12.58	$37.00	$14.06–$37.00	42% below	66%
Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITY/LAB	$12.58	$37.00	$14.06–$37.00	42% below	66%
Urinalysis without microscope exam, automated CPT 81003 URINE SCREEN AUTOMATED	$12.58	$37.00	$14.06–$37.00	42% below	66%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS W/MICROSCOPIC-Q	$12.58	$37.00	$14.06–$37.00	42% below	66%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS MACROSCOPIC-Q	$12.58	$37.00	$14.06–$37.00	42% below	66%
Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITY URINE-Q	$12.58	$37.00	$14.06–$37.00	42% below	66%
Urinalysis without microscope exam, automated CPT 81003 PH URINE-Q	$12.58	$37.00	$14.06–$37.00	42% below	66%
Urinalysis without microscope exam, automated CPT 81003 UA MACROSCOPIC	$12.58	$37.00	$14.06–$37.00	42% below	66%
Urinalysis without microscope exam, automated CPT 81003 URINE SCREEN/LAB	$12.58	$37.00	$14.06–$37.00	42% below	66%
Urinalysis without microscope exam, automated CPT 81003 RH URINALYSIS AUTO W/O SCOPE	$12.92	$38.00	$14.44–$38.00	40% below	66%
Urinalysis without microscope exam, automated inpatient CPT 81003 SPECIFIC GRAVITY URINE-Q	$12.58	$37.00	$24.05–$37.00	—	66%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS MACROSCOPIC-Q	$12.58	$37.00	$24.05–$37.00	—	66%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS W/MICROSCOPIC-Q	$12.58	$37.00	$24.05–$37.00	—	66%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA MACROSCOPIC	$12.58	$37.00	$24.05–$37.00	—	66%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE SCREEN/LAB	$12.58	$37.00	$24.05–$37.00	—	66%
Urinalysis without microscope exam, automated inpatient CPT 81003 PH URINE-Q	$12.58	$37.00	$24.05–$37.00	—	66%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE SCREEN AUTOMATED	$12.58	$37.00	$24.05–$37.00	—	66%
Urinalysis without microscope exam, automated inpatient CPT 81003 SPECIFIC GRAVITY/LAB	$12.58	$37.00	$24.05–$37.00	—	66%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE PH/LAB	$12.58	$37.00	$24.05–$37.00	—	66%
Urinalysis without microscope exam, automated inpatient CPT 81003 RH URINALYSIS AUTO W/O SCOPE	$12.92	$38.00	$24.70–$38.00	—	66%
Urinalysis without microscope exam, manual CPT 81002 RH UA NONAUTO W/O SCOPE	$4.76	$14.00	$5.32–$14.00	70% below	66%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS MANUAL TEST	$9.18	$27.00	$10.26–$27.00	42% below	66%
Urinalysis without microscope exam, manual CPT 81002 RH URINALYSIS, MANUAL TEST	$9.18	$27.00	$10.26–$27.00	42% below	66%
Urinalysis without microscope exam, manual CPT 81002 URINE SUGAR/LAB	$9.18	$27.00	$10.26–$27.00	42% below	66%
Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK	$9.18	$27.00	$10.26–$27.00	42% below	66%
Urinalysis without microscope exam, manual inpatient CPT 81002 RH UA NONAUTO W/O SCOPE	$4.76	$14.00	$9.10–$14.00	—	66%
Urinalysis without microscope exam, manual inpatient CPT 81002 RH URINALYSIS, MANUAL TEST	$9.18	$27.00	$17.55–$27.00	—	66%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK	$9.18	$27.00	$17.55–$27.00	—	66%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS MANUAL TEST	$9.18	$27.00	$17.55–$27.00	—	66%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE SUGAR/LAB	$9.18	$27.00	$17.55–$27.00	—	66%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/LAB	$31.62	$93.00	$35.34–$93.00	51% below	66%
Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE/LAB	$31.62	$93.00	$60.45–$93.00	—	66%
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN URINE TIMED-Q	$44.88	$132.00	$50.16–$132.00	12% below	66%
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN, URINE	$44.88	$132.00	$50.16–$132.00	12% below	66%
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN URINE RNDM CLCT-Q	$44.88	$132.00	$50.16–$132.00	12% below	66%
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN, URINE	$44.88	$132.00	$85.80–$132.00	—	66%
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN URINE RNDM CLCT-Q	$44.88	$132.00	$85.80–$132.00	—	66%
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN URINE TIMED-Q	$44.88	$132.00	$85.80–$132.00	—	66%
Urine pregnancy test, read by color change CPT 81025 BETA HCG QUALITATIVE URINE-Q	$21.08	$62.00	$23.56–$62.00	25% below	66%
Urine pregnancy test, read by color change CPT 81025 RH URINE PREGNANCY TEST	$21.08	$62.00	$23.56–$62.00	25% below	66%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST,URINE	$21.08	$62.00	$23.56–$62.00	25% below	66%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST	$21.08	$62.00	$23.56–$62.00	25% below	66%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$21.08	$62.00	$23.56–$62.00	25% below	66%
Urine pregnancy test, read by color change inpatient CPT 81025 RH URINE PREGNANCY TEST	$21.08	$62.00	$40.30–$62.00	—	66%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST,URINE	$21.08	$62.00	$40.30–$62.00	—	66%
Urine pregnancy test, read by color change inpatient CPT 81025 BETA HCG QUALITATIVE URINE-Q	$21.08	$62.00	$40.30–$62.00	—	66%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST	$21.08	$62.00	$40.30–$62.00	—	66%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST	$21.08	$62.00	$40.30–$62.00	—	66%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 REFLEX	$38.76	$114.00	$43.32–$114.00	55% below	66%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12/LAB	$40.80	$120.00	$45.60–$120.00	52% below	66%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 REFLEX	$38.76	$114.00	$74.10–$114.00	—	66%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12/LAB	$40.80	$120.00	$78.00–$120.00	—	66%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D2 & D3 LCMS	$61.20	$180.00	$68.40–$180.00	46% below	66%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25/LAB	$61.20	$180.00	$68.40–$180.00	46% below	66%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25-HYDROXY VIT	$61.20	$180.00	$68.40–$180.00	46% below	66%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D2 & D3 LCMS	$61.20	$180.00	$117.00–$180.00	—	66%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25-HYDROXY VIT	$61.20	$180.00	$117.00–$180.00	—	66%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25/LAB	$61.20	$180.00	$117.00–$180.00	—	66%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D 1.25/LAB	$90.78	$267.00	$101.46–$267.00	31% below	66%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D 1.25/LAB	$90.78	$267.00	$173.55–$267.00	—	66%
Zinc blood test CPT 84630 ZINC/LAB	$32.98	$97.00	$36.86–$97.00	22% below	66%
Zinc blood test CPT 84630 ZINC, RED BLOOD CELLS	$32.98	$97.00	$36.86–$97.00	22% below	66%
Zinc blood test inpatient CPT 84630 ZINC, RED BLOOD CELLS	$32.98	$97.00	$63.05–$97.00	—	66%
Zinc blood test inpatient CPT 84630 ZINC/LAB	$32.98	$97.00	$63.05–$97.00	—	66%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG-BETA SUBUNIT/LAB	$52.02	$153.00	$58.14–$153.00	36% below	66%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG QUANTITATIVE SERUM-Q	$52.02	$153.00	$58.14–$153.00	36% below	66%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BHCG	$52.02	$153.00	$58.14–$153.00	36% below	66%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG-BETA SUBUNIT/LAB	$52.02	$153.00	$99.45–$153.00	—	66%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BHCG	$52.02	$153.00	$99.45–$153.00	—	66%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG QUANTITATIVE SERUM-Q	$52.02	$153.00	$99.45–$153.00	—	66%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC CLSD TX DISTAL FIB FX	$256.36	$754.00	$286.52–$754.00	7% below	66%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 RH CLSD TX DISTAL FIB FX	$486.88	$1,432.00	$544.16–$1,432.00	76% above	66%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC CLSD TX DISTAL FIB FX	$256.36	$754.00	$490.10–$754.00	—	66%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 RH CLSD TX DISTAL FIB FX	$486.88	$1,432.00	$930.80–$1,432.00	—	66%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE	$221.68	$652.00	$247.76–$652.00	9% below	66%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC CLOSED TX MT FX	$221.68	$652.00	$247.76–$652.00	9% below	66%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 TREAT METATARSAL FRACTURE	$221.68	$652.00	$423.80–$652.00	—	66%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC CLOSED TX MT FX	$221.68	$652.00	$423.80–$652.00	—	66%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE	$377.06	$1,109.00	$421.42–$1,109.00	23% below	66%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT	$377.06	$1,109.00	$421.42–$1,109.00	23% below	66%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTRIC EXT	$377.06	$1,109.00	$421.42–$1,109.00	23% below	66%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTRIC EXT	$377.06	$1,109.00	$720.85–$1,109.00	—	66%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTIVE	$377.06	$1,109.00	$720.85–$1,109.00	—	66%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTRIC EXT	$377.06	$1,109.00	$720.85–$1,109.00	—	66%
Cervical biopsy CPT 57500 BX CERVIX FACILITY	$116.28	$342.00	$129.96–$342.00	68% below	66%
Cervical biopsy inpatient CPT 57500 BX CERVIX FACILITY	$116.28	$342.00	$222.30–$342.00	—	66%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC TREAT FRACTURE RADIUS/ULNA	$211.14	$621.00	$235.98–$621.00	29% below	66%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC TREAT FRACTURE RADIUS/ULNA	$211.14	$621.00	$403.65–$621.00	—	66%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 COLPOSCOPY W/BIOPSY	$112.20	$330.00	$125.40–$330.00	46% below	66%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 COLPOSCOPY W/BIOPSY	$112.20	$330.00	$214.50–$330.00	—	66%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOSCOPY PROF	$136.68	$402.00	$152.76–$402.00	75% below	66%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC CYSTOSCOPY PROF	$136.68	$402.00	$261.30–$402.00	—	66%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DESTROY BENIGN-PREMAL	$66.98	$197.00	$74.86–$197.00	27% below	66%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DESTROY BENIGN LESION	$66.98	$197.00	$74.86–$197.00	27% below	66%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DESTRUCT PREMALIG LESION 1	$66.98	$197.00	$74.86–$197.00	27% below	66%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DESTROY BENIGN-PREMAL	$66.98	$197.00	$128.05–$197.00	—	66%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DESTRUCT PREMALIG LESION 1	$66.98	$197.00	$128.05–$197.00	—	66%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DESTROY BENIGN LESION	$66.98	$197.00	$128.05–$197.00	—	66%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVAL IMPACT EAR WAX	$34.00	$100.00	$38.00–$100.00	32% below	66%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC RMVL IMPACTED EAR WAX UNI	$34.00	$100.00	$38.00–$100.00	32% below	66%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$34.00	$100.00	$38.00–$100.00	32% below	66%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI	$34.00	$100.00	$65.00–$100.00	—	66%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC RMVL IMPACTED EAR WAX UNI	$34.00	$100.00	$65.00–$100.00	—	66%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVAL IMPACT EAR WAX	$34.00	$100.00	$65.00–$100.00	—	66%
Earwax removal with instruments, one ear CPT 69210 HC REMOVAL CERUMEN	$37.40	$110.00	$41.80–$110.00	36% below	66%
Earwax removal with instruments, one ear CPT 69210 HC ER RMV IMPACTED EAR WAX UNI	$37.40	$110.00	$41.80–$110.00	36% below	66%
Earwax removal with instruments, one ear inpatient CPT 69210 HC ER RMV IMPACTED EAR WAX UNI	$37.40	$110.00	$71.50–$110.00	—	66%
Earwax removal with instruments, one ear inpatient CPT 69210 HC REMOVAL CERUMEN	$37.40	$110.00	$71.50–$110.00	—	66%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BX FACILITY	$89.76	$264.00	$100.32–$264.00	55% below	66%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BX FACILITY	$89.76	$264.00	$171.60–$264.00	—	66%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ FACET JT LUM/SAC 1ST LEV	$533.80	$1,570.00	$596.60–$1,570.00	46% below	66%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ FACET JT LUM/SAC 1ST LEV	$533.80	$1,570.00	$1,020.50–$1,570.00	—	66%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HYSTEROSALPINGOGRAM INJECTION	$91.80	$270.00	$102.60–$270.00	73% below	66%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HYSTEROSALPINGOGRAM INJECTION	$91.80	$270.00	$175.50–$270.00	—	66%
IUD insertion (the device itself billed separately) CPT 58300 INSERT IUD FACILITY	$46.58	$137.00	$52.06–$137.00	72% below	66%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT IUD FACILITY	$46.58	$137.00	$89.05–$137.00	—	66%
Incision and drainage of a simple or single skin abscess CPT 10060 HC DRAINAGE OF SKIN ABSCESS	$106.42	$313.00	$118.94–$313.00	33% below	66%
Incision and drainage of a simple or single skin abscess CPT 10060 HC ER I&D ABSCESS SIMP	$106.42	$313.00	$118.94–$313.00	33% below	66%
Incision and drainage of a simple or single skin abscess CPT 10060 HC ABSCESS/PARONYCHIA	$106.42	$313.00	$118.94–$313.00	33% below	66%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I & D ABSCESS SIMPLE	$106.42	$313.00	$118.94–$313.00	33% below	66%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC DRAINAGE OF SKIN ABSCESS	$106.42	$313.00	$203.45–$313.00	—	66%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC ABSCESS/PARONYCHIA	$106.42	$313.00	$203.45–$313.00	—	66%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I & D ABSCESS SIMPLE	$106.42	$313.00	$203.45–$313.00	—	66%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC ER I&D ABSCESS SIMP	$106.42	$313.00	$203.45–$313.00	—	66%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ SING TENDON SHTH FACILITY	$61.88	$182.00	$69.16–$182.00	67% below	66%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ TEND/LIG/TRIGGER/CYST	$61.88	$182.00	$69.16–$182.00	67% below	66%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ TEND/LIG/TRIGGER/CYST	$61.88	$182.00	$118.30–$182.00	—	66%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ SING TENDON SHTH FACILITY	$61.88	$182.00	$118.30–$182.00	—	66%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC DRN/INJ JNT/BRSA WO US RT	$61.20	$180.00	$68.40–$180.00	77% below	66%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC DRN/INJ JNT/BRSA WO US LT	$61.20	$180.00	$68.40–$180.00	77% below	66%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC DRN/INJ JNT/BRSA WO US RT	$61.20	$180.00	$117.00–$180.00	—	66%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC DRN/INJ JNT/BRSA WO US LT	$61.20	$180.00	$117.00–$180.00	—	66%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION DRUG DLVR IMPLANT	$105.74	$311.00	$118.18–$311.00	8% below	66%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 XRB INJ INTERMED JOINT	$49.30	$145.00	$55.10–$145.00	73% below	66%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ER ARTHROCENTESIS INTERMED	$49.30	$145.00	$55.10–$145.00	73% below	66%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCEN INTERM JT FACILITY	$49.30	$145.00	$55.10–$145.00	73% below	66%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRN/INJ MED JNT/BURSA WO US	$49.30	$145.00	$55.10–$145.00	73% below	66%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ER ARTHROCENTESIS INTERMED	$49.30	$145.00	$94.25–$145.00	—	66%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 XRB INJ INTERMED JOINT	$49.30	$145.00	$94.25–$145.00	—	66%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC DRN/INJ MED JNT/BURSA WO US	$49.30	$145.00	$94.25–$145.00	—	66%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCEN INTERM JT FACILITY	$49.30	$145.00	$94.25–$145.00	—	66%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC INJ/ASP SMALL JOINT	$44.54	$131.00	$49.78–$131.00	78% below	66%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ARTHROCENTESIS SM JT W/O US	$44.54	$131.00	$49.78–$131.00	78% below	66%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCEN SMALL JT FAC	$44.54	$131.00	$49.78–$131.00	78% below	66%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ER ARTHROCENTESIS SMALL	$44.54	$131.00	$49.78–$131.00	78% below	66%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ARTHROCENTESIS SM JT W/O US	$44.54	$131.00	$85.15–$131.00	—	66%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCEN SMALL JT FAC	$44.54	$131.00	$85.15–$131.00	—	66%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC INJ/ASP SMALL JOINT	$44.54	$131.00	$85.15–$131.00	—	66%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ER ARTHROCENTESIS SMALL	$44.54	$131.00	$85.15–$131.00	—	66%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC RPR INTER WND <2.5CM SATE	$210.12	$618.00	$234.84–$618.00	27% below	66%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC INTMD RPR S/A/T/EXT 2.5CM/<	$210.12	$618.00	$234.84–$618.00	27% below	66%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC INTMD RPR S/A/T/EXT 2.5CM/<	$210.12	$618.00	$401.70–$618.00	—	66%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC RPR INTER WND <2.5CM SATE	$210.12	$618.00	$401.70–$618.00	—	66%
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ INTERLAMINAR LUMBAR/SAC	$941.80	$2,770.00	$1,052.60–$2,770.00	1% above	66%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ INTERLAMINAR LUMBAR/SAC	$941.80	$2,770.00	$1,800.50–$2,770.00	—	66%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 XR INJ FORAMEN EPIDURAL L/S	$171.36	$504.00	$191.52–$504.00	82% below	66%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 XR INJ FORAMEN EPIDURAL L/S	$171.36	$504.00	$327.60–$504.00	—	66%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BNGN 0.5CM LESS FACILITY	$56.78	$167.00	$63.46–$167.00	67% below	66%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BNGN 0.5CM LESS FACILITY	$56.78	$167.00	$108.55–$167.00	—	66%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXC FACE-MM B9+MARG 0.5CM/<	$86.70	$255.00	$96.90–$255.00	68% below	66%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC EXC FACE-MM B9+MARG 0.5CM/<	$86.70	$255.00	$165.75–$255.00	—	66%
Nail removal (partial or complete), one nail CPT 11730 HC NAIL AVULSION TEMPORARY	$57.12	$168.00	$63.84–$168.00	56% below	66%
Nail removal (partial or complete), one nail CPT 11730 HC ER REMOVAL OF NAIL PLATE	$57.12	$168.00	$63.84–$168.00	56% below	66%
Nail removal (partial or complete), one nail CPT 11730 HC REMOVAL OF NAIL PLATE	$57.12	$168.00	$63.84–$168.00	56% below	66%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC REMOVAL OF NAIL PLATE	$57.12	$168.00	$109.20–$168.00	—	66%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC ER REMOVAL OF NAIL PLATE	$57.12	$168.00	$109.20–$168.00	—	66%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC NAIL AVULSION TEMPORARY	$57.12	$168.00	$109.20–$168.00	—	66%
Occipital nerve block (injection for headaches) CPT 64405 HC N BLOCK INJ OCCIPITAL	$96.56	$284.00	$107.92–$284.00	68% below	66%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC N BLOCK INJ OCCIPITAL	$96.56	$284.00	$184.60–$284.00	—	66%
Paracentesis with imaging guidance CPT 49083 HC ABD PARACENTESIS W/IMAGING	$703.80	$2,070.00	$786.60–$2,070.00	14% below	66%
Paracentesis with imaging guidance CPT 49083 US GUIDED PARACENTESIS	$703.80	$2,070.00	$786.60–$2,070.00	14% below	66%
Paracentesis with imaging guidance inpatient CPT 49083 US GUIDED PARACENTESIS	$703.80	$2,070.00	$1,345.50–$2,070.00	—	66%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABD PARACENTESIS W/IMAGING	$703.80	$2,070.00	$1,345.50–$2,070.00	—	66%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC NAIL AVULSION PERM	$194.82	$573.00	$217.74–$573.00	41% below	66%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL FACILITY	$194.82	$573.00	$217.74–$573.00	41% below	66%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC ER NAIL EXCISION PART/COMP	$194.82	$573.00	$217.74–$573.00	41% below	66%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL FACILITY	$194.82	$573.00	$372.45–$573.00	—	66%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC ER NAIL EXCISION PART/COMP	$194.82	$573.00	$372.45–$573.00	—	66%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC NAIL AVULSION PERM	$194.82	$573.00	$372.45–$573.00	—	66%
Removal of a breast lump, open surgery CPT 19120 HC REMOVAL BREAST LESION	$243.78	$717.00	$272.46–$717.00	83% below	66%
Removal of a breast lump, open surgery inpatient CPT 19120 HC REMOVAL BREAST LESION	$243.78	$717.00	$466.05–$717.00	—	66%
Removal of a foreign object under the skin, simple CPT 10120 HC ER REMOVE FOREIGN BODY	$96.56	$284.00	$107.92–$284.00	58% below	66%
Removal of a foreign object under the skin, simple CPT 10120 HC INC&RMVL FB SUBQ TISS SMPL	$96.56	$284.00	$107.92–$284.00	58% below	66%
Removal of a foreign object under the skin, simple CPT 10120 HC INC REM FB SUBCUT	$96.56	$284.00	$107.92–$284.00	58% below	66%
Removal of a foreign object under the skin, simple CPT 10120 HC INC & REM FB SUBCUT	$96.56	$284.00	$107.92–$284.00	58% below	66%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC ER REMOVE FOREIGN BODY	$96.56	$284.00	$184.60–$284.00	—	66%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INC REM FB SUBCUT	$96.56	$284.00	$184.60–$284.00	—	66%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INC&RMVL FB SUBQ TISS SMPL	$96.56	$284.00	$184.60–$284.00	—	66%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INC & REM FB SUBCUT	$96.56	$284.00	$184.60–$284.00	—	66%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 HC COLON CANCER SCREEN	$907.80	$2,670.00	$1,014.60–$2,670.00	9% below	66%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 HC COLON CANCER SCREEN	$907.80	$2,670.00	$1,735.50–$2,670.00	—	66%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HC COLORECTAL SCREENING	$907.80	$2,670.00	$1,014.60–$2,670.00	12% below	66%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 HC COLORECTAL SCREENING	$907.80	$2,670.00	$1,735.50–$2,670.00	—	66%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 HC LITHOTRPSY EXTRA SHOCK WAVE	$2,582.98	$7,597.00	$2,886.86–$7,597.00	at median	66%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 HC LITHOTRPSY EXTRA SHOCK WAVE	$2,582.98	$7,597.00	$4,938.05–$7,597.00	—	66%
Short arm cast (elbow to hand) CPT 29075 HC CAST APPL SHRT ARM ELB-FING	$63.92	$188.00	$71.44–$188.00	64% below	66%
Short arm cast (elbow to hand) CPT 29075 OT SHORT ARM CAST	$63.92	$188.00	$71.44–$188.00	64% below	66%
Short arm cast (elbow to hand) inpatient CPT 29075 HC CAST APPL SHRT ARM ELB-FING	$63.92	$188.00	$122.20–$188.00	—	66%
Short arm cast (elbow to hand) inpatient CPT 29075 OT SHORT ARM CAST	$63.92	$188.00	$122.20–$188.00	—	66%
Short arm splint (forearm and hand) CPT 29125 OT SHORT ARM SPLINT	$86.02	$253.00	$96.14–$253.00	25% below	66%
Short arm splint (forearm and hand) CPT 29125 APP SHORT ARM SPLINT FAC	$86.02	$253.00	$96.14–$253.00	25% below	66%
Short arm splint (forearm and hand) CPT 29125 PTA APPL SPL SHORT STATIC FH	$86.02	$253.00	$96.14–$253.00	25% below	66%
Short arm splint (forearm and hand) CPT 29125 PT APPL SPLINT SHORT STATIC FH	$86.02	$253.00	$96.14–$253.00	25% below	66%
Short arm splint (forearm and hand) CPT 29125 HC ER SPLINT ARM SHORT	$86.02	$253.00	$96.14–$253.00	25% below	66%
Short arm splint (forearm and hand) inpatient CPT 29125 HC ER SPLINT ARM SHORT	$86.02	$253.00	$164.45–$253.00	—	66%
Short arm splint (forearm and hand) inpatient CPT 29125 APP SHORT ARM SPLINT FAC	$86.02	$253.00	$164.45–$253.00	—	66%
Short arm splint (forearm and hand) inpatient CPT 29125 PTA APPL SPL SHORT STATIC FH	$86.02	$253.00	$164.45–$253.00	—	66%
Short arm splint (forearm and hand) inpatient CPT 29125 PT APPL SPLINT SHORT STATIC FH	$86.02	$253.00	$164.45–$253.00	—	66%
Short arm splint (forearm and hand) inpatient CPT 29125 OT SHORT ARM SPLINT	$86.02	$253.00	$164.45–$253.00	—	66%
Short leg splint (calf to foot) CPT 29515 HC APPLICATION SHORT LEG SPLNT	$86.02	$253.00	$96.14–$253.00	32% below	66%
Short leg splint (calf to foot) CPT 29515 PT APPL SPLINT SHORT LEG	$86.02	$253.00	$96.14–$253.00	32% below	66%
Short leg splint (calf to foot) CPT 29515 HC ER SPLINT LEG SHORT	$86.02	$253.00	$96.14–$253.00	32% below	66%
Short leg splint (calf to foot) CPT 29515 PTA APPL SPLINT SHORT LEG	$86.02	$253.00	$96.14–$253.00	32% below	66%
Short leg splint (calf to foot) one side CPT 29515 PTA SPLINT APPL SHORT LEG LT	$86.02	$253.00	$96.14–$253.00	32% below	66%
Short leg splint (calf to foot) one side CPT 29515 PTA SPLINT APPL SHORT LEG RT	$86.02	$253.00	$96.14–$253.00	32% below	66%
Short leg splint (calf to foot) inpatient CPT 29515 PTA APPL SPLINT SHORT LEG	$86.02	$253.00	$164.45–$253.00	—	66%
Short leg splint (calf to foot) inpatient CPT 29515 HC APPLICATION SHORT LEG SPLNT	$86.02	$253.00	$164.45–$253.00	—	66%
Short leg splint (calf to foot) inpatient CPT 29515 HC ER SPLINT LEG SHORT	$86.02	$253.00	$164.45–$253.00	—	66%
Short leg splint (calf to foot) inpatient CPT 29515 PT APPL SPLINT SHORT LEG	$86.02	$253.00	$164.45–$253.00	—	66%
Short leg splint (calf to foot) inpatient one side CPT 29515 PTA SPLINT APPL SHORT LEG RT	$86.02	$253.00	$164.45–$253.00	—	66%
Short leg splint (calf to foot) inpatient one side CPT 29515 PTA SPLINT APPL SHORT LEG LT	$86.02	$253.00	$164.45–$253.00	—	66%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC RPR S/N/AX/GEN/TRNK 2.5CM/<	$126.14	$371.00	$140.98–$371.00	15% below	66%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC RPR SUPER WND <2.5CM SNAGT	$126.14	$371.00	$140.98–$371.00	15% below	66%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC RPR S/N/AX/GEN/TRNK 2.5CM/<	$126.14	$371.00	$241.15–$371.00	—	66%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC RPR SUPER WND <2.5CM SNAGT	$126.14	$371.00	$241.15–$371.00	—	66%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BX SKIN SINGLE LESION	$70.04	$206.00	$78.28–$206.00	73% below	66%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BX SKIN SNGL LESION	$70.04	$206.00	$78.28–$206.00	73% below	66%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BX SKIN SNGL LESION	$70.04	$206.00	$133.90–$206.00	—	66%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BX SKIN SINGLE LESION	$70.04	$206.00	$133.90–$206.00	—	66%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC EXC TR-EXT MAL+MARG 0.5/<	$103.70	$305.00	$115.90–$305.00	68% below	66%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC EXC TR-EXT MAL+MARG 0.5/<	$103.70	$305.00	$198.25–$305.00	—	66%
Skin tag removal, up to 15 tags CPT 11200 HC SSA REM SKIN TAGS UP TO 15	$66.30	$195.00	$74.10–$195.00	49% below	66%
Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL SKIN TAGS UP TO 15	$66.30	$195.00	$74.10–$195.00	49% below	66%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC REMOVAL SKIN TAGS UP TO 15	$66.30	$195.00	$126.75–$195.00	—	66%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC SSA REM SKIN TAGS UP TO 15	$66.30	$195.00	$126.75–$195.00	—	66%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC RPR S/N/AX/GN/TRNK2.6-7.5CM	$149.26	$439.00	$166.82–$439.00	20% below	66%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC RPR S/N/AX/GN/TRNK2.6-7.5CM	$149.26	$439.00	$285.35–$439.00	—	66%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC RPR F/E/E/N/L/M 2.5 CM/<	$153.00	$450.00	$171.00–$450.00	7% below	66%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC RPR F/E/E/N/L/M 2.5 CM/<	$153.00	$450.00	$292.50–$450.00	—	66%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BX SKIN SNGL LES	$53.72	$158.00	$60.04–$158.00	73% below	66%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BX SKIN SNGL LES	$53.72	$158.00	$102.70–$158.00	—	66%
Thoracentesis with imaging guidance CPT 32555 US GUIDED THORACENTESIS	$594.32	$1,748.00	$664.24–$1,748.00	12% below	66%
Thoracentesis with imaging guidance inpatient CPT 32555 US GUIDED THORACENTESIS	$594.32	$1,748.00	$1,136.20–$1,748.00	—	66%
Trigger point injections, 1 or 2 muscles CPT 20552 HC ER INJ TRIGGR PNT 1-2 MUSCL	$46.58	$137.00	$52.06–$137.00	76% below	66%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ 1 OR 2 MUSCLE GROUPS	$46.58	$137.00	$52.06–$137.00	76% below	66%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC ER INJ TRIGGR PNT 1-2 MUSCL	$46.58	$137.00	$89.05–$137.00	—	66%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ 1 OR 2 MUSCLE GROUPS	$46.58	$137.00	$89.05–$137.00	—	66%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 BX BREAST 1ST LESION US IMG-LT	$1,141.72	$3,358.00	$1,276.04–$3,358.00	17% below	66%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 BX BREAST 1ST LESION US IMG-RT	$1,141.72	$3,358.00	$1,276.04–$3,358.00	17% below	66%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 BX BREAST 1ST LESION US IMG-LT	$1,141.72	$3,358.00	$2,182.70–$3,358.00	—	66%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 BX BREAST 1ST LESION US IMG-RT	$1,141.72	$3,358.00	$2,182.70–$3,358.00	—	66%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY	$194.48	$572.00	$217.36–$572.00	62% below	66%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY	$194.48	$572.00	$371.80–$572.00	—	66%
Wart removal, up to 14 warts CPT 17110 DESCRUCTION UP TO 14 FAC	$93.16	$274.00	$104.12–$274.00	45% below	66%
Wart removal, up to 14 warts CPT 17110 HC ER DEST CHMO/CRYOS LES1-14	$93.16	$274.00	$104.12–$274.00	45% below	66%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCT LESIONS 1-14	$93.16	$274.00	$104.12–$274.00	45% below	66%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCT LES 1-14	$93.16	$274.00	$104.12–$274.00	45% below	66%
Wart removal, up to 14 warts inpatient CPT 17110 DESCRUCTION UP TO 14 FAC	$93.16	$274.00	$178.10–$274.00	—	66%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCT LESIONS 1-14	$93.16	$274.00	$178.10–$274.00	—	66%
Wart removal, up to 14 warts inpatient CPT 17110 HC ER DEST CHMO/CRYOS LES1-14	$93.16	$274.00	$178.10–$274.00	—	66%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCT LES 1-14	$93.16	$274.00	$178.10–$274.00	—	66%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD PRODUCT ADMINISTRATION	$351.22	$1,033.00	$392.54–$1,033.00	28% below	66%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD PRODUCT ADMIN	$351.22	$1,033.00	$392.54–$1,033.00	28% below	66%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD PRODUCT ADMIN	$351.22	$1,033.00	$671.45–$1,033.00	—	66%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD PRODUCT ADMINISTRATION	$351.22	$1,033.00	$671.45–$1,033.00	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TREATMENT	$227.80	$670.00	$254.60–$670.00	24% above	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC SPUTUM INDUCTION	$227.80	$670.00	$254.60–$670.00	24% above	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INITIAL NEBULIZER TX	$227.80	$670.00	$254.60–$670.00	24% above	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INITIAL NEB W/MEDICATION	$227.80	$670.00	$254.60–$670.00	24% above	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$227.80	$670.00	$254.60–$670.00	24% above	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$227.80	$670.00	$435.50–$670.00	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INITIAL NEBULIZER TX	$227.80	$670.00	$435.50–$670.00	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL TREATMENT	$227.80	$670.00	$435.50–$670.00	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INITIAL NEB W/MEDICATION	$227.80	$670.00	$435.50–$670.00	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC SPUTUM INDUCTION	$227.80	$670.00	$435.50–$670.00	—	66%
Chemotherapy IV infusion, first hour CPT 96413 IV INFUS COMPLEX DRUG TO1HR	$277.78	$817.00	$310.46–$817.00	29% below	66%
Chemotherapy IV infusion, first hour inpatient CPT 96413 IV INFUS COMPLEX DRUG TO1HR	$277.78	$817.00	$531.05–$817.00	—	66%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE E.R. 1 HOUR	$636.48	$1,872.00	$711.36–$1,872.00	38% below	66%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE E.R. 1 HOUR	$636.48	$1,872.00	$1,216.80–$1,872.00	—	66%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING ONLY	$93.16	$274.00	$104.12–$274.00	17% below	66%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 RH EKG TRACING ONLY	$93.16	$274.00	$104.12–$274.00	17% below	66%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 RH ELECTROCARDIOGRAM TRACING	$108.46	$319.00	$121.22–$319.00	4% below	66%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING ONLY	$93.16	$274.00	$178.10–$274.00	—	66%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 LEVEL I	$73.44	$216.00	$82.08–$216.00	29% below	66%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 LEVEL I	$73.44	$216.00	$140.40–$216.00	—	66%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 LEVEL II	$142.12	$418.00	$158.84–$418.00	32% below	66%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 LEVEL II	$142.12	$418.00	$271.70–$418.00	—	66%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 LEVEL III	$254.66	$749.00	$284.62–$749.00	24% below	66%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 LEVEL III	$254.66	$749.00	$486.85–$749.00	—	66%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 LEVEL IV	$415.48	$1,222.00	$464.36–$1,222.00	32% below	66%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 LEVEL IV	$415.48	$1,222.00	$794.30–$1,222.00	—	66%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 LEVEL V	$689.86	$2,029.00	$771.02–$2,029.00	30% below	66%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 LEVEL V	$689.86	$2,029.00	$1,318.85–$2,029.00	—	66%
Exercise stress test, tracing only, the hospital charge CPT 93017 NM CV STRESS TEST	$387.60	$1,140.00	$433.20–$1,140.00	33% below	66%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST	$387.60	$1,140.00	$433.20–$1,140.00	33% below	66%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 NM CV STRESS TEST	$387.60	$1,140.00	$741.00–$1,140.00	—	66%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS TEST	$387.60	$1,140.00	$741.00–$1,140.00	—	66%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION 1ST HOUR	$117.30	$345.00	$131.10–$345.00	44% below	66%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV THERAPY HYDRATION 1ST HR	$117.30	$345.00	$131.10–$345.00	44% below	66%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYDRATION	$117.30	$345.00	$131.10–$345.00	44% below	66%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION UP TO 1ST HR	$117.30	$345.00	$131.10–$345.00	44% below	66%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION HYDRATION	$117.30	$345.00	$224.25–$345.00	—	66%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION 1ST HOUR	$117.30	$345.00	$224.25–$345.00	—	66%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION UP TO 1ST HR	$117.30	$345.00	$224.25–$345.00	—	66%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV THERAPY HYDRATION 1ST HR	$117.30	$345.00	$224.25–$345.00	—	66%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION 1ST HOUR	$325.72	$958.00	$364.04–$958.00	at median	66%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION INITIAL 1 HR	$325.72	$958.00	$364.04–$958.00	at median	66%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION 1ST HOUR EST	$325.72	$958.00	$364.04–$958.00	at median	66%
IV infusion of a medicine, first hour CPT 96365 IV INFUSTION 1ST HOUR	$325.72	$958.00	$364.04–$958.00	at median	66%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSTION 1ST HOUR	$325.72	$958.00	$622.70–$958.00	—	66%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION INITIAL 1 HR	$325.72	$958.00	$622.70–$958.00	—	66%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION 1ST HOUR	$325.72	$958.00	$622.70–$958.00	—	66%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION 1ST HOUR EST	$325.72	$958.00	$622.70–$958.00	—	66%
IV push of a medicine, first drug CPT 96374 INJECTION IV PUSH	$325.72	$958.00	$364.04–$958.00	65% above	66%
IV push of a medicine, first drug CPT 96374 INJECTION IV PUSH DRUG	$325.72	$958.00	$364.04–$958.00	65% above	66%
IV push of a medicine, first drug inpatient CPT 96374 INJECTION IV PUSH	$325.72	$958.00	$622.70–$958.00	—	66%
IV push of a medicine, first drug inpatient CPT 96374 INJECTION IV PUSH DRUG	$325.72	$958.00	$622.70–$958.00	—	66%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC THER/PROPH/DIAG INJ SC/IM	$101.66	$299.00	$113.62–$299.00	47% above	66%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM/ANTIBIOTIC	$107.10	$315.00	$119.70–$315.00	55% above	66%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 RH THERA DIAGNOSTIC INJECTION	$107.10	$315.00	$119.70–$315.00	55% above	66%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION SQ/IM	$107.10	$315.00	$119.70–$315.00	55% above	66%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC INJECTION SQ OR IM	$107.10	$315.00	$119.70–$315.00	55% above	66%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM ANTIBIOTIC	$107.10	$315.00	$119.70–$315.00	55% above	66%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC INJECTION	$107.10	$315.00	$119.70–$315.00	55% above	66%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERA INJECT SUBCU OR IM FAC	$107.10	$315.00	$119.70–$315.00	55% above	66%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC THER/PROPH/DIAG INJ SC/IM	$101.66	$299.00	$194.35–$299.00	—	66%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERA INJECT SUBCU OR IM FAC	$107.10	$315.00	$204.75–$315.00	—	66%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC INJECTION	$107.10	$315.00	$204.75–$315.00	—	66%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM/ANTIBIOTIC	$107.10	$315.00	$204.75–$315.00	—	66%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC INJECTION SQ OR IM	$107.10	$315.00	$204.75–$315.00	—	66%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM ANTIBIOTIC	$107.10	$315.00	$204.75–$315.00	—	66%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION SQ/IM	$107.10	$315.00	$204.75–$315.00	—	66%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NRV CNDJ TEST 7-8 STUDIES	$184.96	$544.00	$206.72–$544.00	14% below	66%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NRV CNDJ TST 7-8 STUDIES	$184.96	$544.00	$206.72–$544.00	14% below	66%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC NRV CNDJ TST 7-8 STUDIES	$184.96	$544.00	$353.60–$544.00	—	66%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NRV CNDJ TEST 7-8 STUDIES	$184.96	$544.00	$353.60–$544.00	—	66%
Neuromuscular re-education, 15 minutes CPT 97112 OTA NEUROMUSCULAR RE-ED .25	$52.36	$154.00	$58.52–$154.00	47% below	66%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-ED .25	$52.36	$154.00	$58.52–$154.00	47% below	66%
Neuromuscular re-education, 15 minutes CPT 97112 PTA NEUROMUSCULAR RE-ED .25	$52.36	$154.00	$58.52–$154.00	47% below	66%
Neuromuscular re-education, 15 minutes CPT 97112 SP NEUROMUSCULAR RE-ED 15 MINS	$52.36	$154.00	$58.52–$154.00	47% below	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 SP NEUROMUSCULAR RE-ED 15 MINS	$52.36	$154.00	$100.10–$154.00	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PTA NEUROMUSCULAR RE-ED .25	$52.36	$154.00	$100.10–$154.00	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-ED .25	$52.36	$154.00	$100.10–$154.00	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OTA NEUROMUSCULAR RE-ED .25	$52.36	$154.00	$100.10–$154.00	—	66%
New patient office visit, about 30 minutes CPT 99203 HC NEW PT OV LEVEL III	$63.58	$187.00	$71.06–$187.00	56% below	66%
New patient office visit, about 30 minutes CPT 99203 HC INITIAL VISIT LEVEL III	$63.58	$187.00	$71.06–$187.00	56% below	66%
New patient office visit, about 45 minutes CPT 99204 HC INITIAL VISIT LEVEL IV	$86.70	$255.00	$96.90–$255.00	59% below	66%
New patient office visit, about 45 minutes CPT 99204 HC NEW PT OV LEVEL IV	$86.70	$255.00	$96.90–$255.00	59% below	66%
New patient office visit, about 60 minutes CPT 99205 HC INITIAL VISIT LEVEL V	$152.66	$449.00	$170.62–$449.00	54% below	66%
New patient office visit, about 60 minutes CPT 99205 HC NEW PT OV LEVEL V	$152.66	$449.00	$170.62–$449.00	54% below	66%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC NEW PT OV LEVEL II	$54.06	$159.00	$60.42–$159.00	39% below	66%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC INITIAL VISIT LEVEL II	$54.06	$159.00	$60.42–$159.00	39% below	66%
Occupational therapy evaluation, low complexity CPT 97165 OT EVALUATION, LOW	$151.64	$446.00	$169.48–$446.00	32% below	66%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVALUATION, LOW	$151.64	$446.00	$289.90–$446.00	—	66%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 LYMPHEDEMA EVALUATION, HIGH	$166.94	$491.00	$186.58–$491.00	40% below	66%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVALUATION, HIGH	$166.94	$491.00	$186.58–$491.00	40% below	66%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 LYMPHEDEMA EVALUATION, HIGH	$166.94	$491.00	$319.15–$491.00	—	66%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVALUATION, HIGH	$166.94	$491.00	$319.15–$491.00	—	66%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 LYMPHEDEMA EVALUATION, LOW	$151.64	$446.00	$169.48–$446.00	32% below	66%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVALUATION, LOW	$151.64	$446.00	$169.48–$446.00	32% below	66%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 LYMPHEDEMA EVALUATION, LOW	$151.64	$446.00	$289.90–$446.00	—	66%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVALUATION, LOW	$151.64	$446.00	$289.90–$446.00	—	66%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 LYMPHEDEMA EVALUATION, MOD	$159.12	$468.00	$177.84–$468.00	41% below	66%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVALUATION, MODERATE	$159.12	$468.00	$177.84–$468.00	41% below	66%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVALUATION, MODERATE	$159.12	$468.00	$304.20–$468.00	—	66%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 LYMPHEDEMA EVALUATION, MOD	$159.12	$468.00	$304.20–$468.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 LYMPHEDEMA MANUAL THERAPY .25	$48.62	$143.00	$54.34–$143.00	51% below	66%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OTA MANUAL THERAPY .25	$48.62	$143.00	$54.34–$143.00	51% below	66%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY .25	$48.62	$143.00	$54.34–$143.00	51% below	66%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PTA MANUAL THERAPY .25	$48.62	$143.00	$54.34–$143.00	51% below	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY .25	$48.62	$143.00	$92.95–$143.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 LYMPHEDEMA MANUAL THERAPY .25	$48.62	$143.00	$92.95–$143.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PTA MANUAL THERAPY .25	$48.62	$143.00	$92.95–$143.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OTA MANUAL THERAPY .25	$48.62	$143.00	$92.95–$143.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE .25	$44.88	$132.00	$50.16–$132.00	34% below	66%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OTA THERAPEUTIC EXERCISE .25	$44.88	$132.00	$50.16–$132.00	34% below	66%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 SP THERAPEUTIC EXER 15 MINS	$44.88	$132.00	$50.16–$132.00	34% below	66%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPUTIC EXERCISE .25 HR	$44.88	$132.00	$50.16–$132.00	34% below	66%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 LYMPHEDEMA THERPUTC EXRCSE .25	$44.88	$132.00	$50.16–$132.00	34% below	66%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PTA THERAPUTIC EXERCISE .25 HR	$44.88	$132.00	$50.16–$132.00	34% below	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 LYMPHEDEMA THERPUTC EXRCSE .25	$44.88	$132.00	$85.80–$132.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 SP THERAPEUTIC EXER 15 MINS	$44.88	$132.00	$85.80–$132.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OTA THERAPEUTIC EXERCISE .25	$44.88	$132.00	$85.80–$132.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE .25	$44.88	$132.00	$85.80–$132.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PTA THERAPUTIC EXERCISE .25 HR	$44.88	$132.00	$85.80–$132.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPUTIC EXERCISE .25 HR	$44.88	$132.00	$85.80–$132.00	—	66%
Preventive checkup, new patient aged 18–39 CPT 99385 HC NP PREV 18-39 YR	$20.74	$61.00	$23.18–$61.00	86% below	66%
Preventive checkup, new patient aged 18–39 CPT 99385 HC NP PREV 18-39YR	$20.74	$61.00	$23.18–$61.00	86% below	66%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC NP PREV 18-39 YR	$20.74	$61.00	$39.65–$61.00	—	66%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC NP PREV 18-39YR	$20.74	$61.00	$39.65–$61.00	—	66%
Preventive checkup, new patient aged 40–64 CPT 99386 HC NP PREV 40-64YR	$24.48	$72.00	$27.36–$72.00	86% below	66%
Preventive checkup, new patient aged 40–64 CPT 99386 HC NP PREV 40-64 YR	$24.48	$72.00	$27.36–$72.00	86% below	66%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC NP PREV 40-64YR	$24.48	$72.00	$46.80–$72.00	—	66%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC NP PREV 40-64 YR	$24.48	$72.00	$46.80–$72.00	—	66%
Preventive checkup, new patient aged 65 or older CPT 99387 HC NP PREV 65+	$26.86	$79.00	$30.02–$79.00	78% below	66%
Preventive checkup, new patient aged 65 or older CPT 99387 HC NP PREV 60 PLUS	$26.86	$79.00	$30.02–$79.00	78% below	66%
Preventive checkup, new patient aged 65 or older CPT 99387 HC NP PREV 65 PLUS	$26.86	$79.00	$30.02–$79.00	78% below	66%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC NP PREV 65 PLUS	$26.86	$79.00	$51.35–$79.00	—	66%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC NP PREV 60 PLUS	$26.86	$79.00	$51.35–$79.00	—	66%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC NP PREV 65+	$26.86	$79.00	$51.35–$79.00	—	66%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC EST PREV 18-39YR	$19.04	$56.00	$21.28–$56.00	84% below	66%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC EST PREV 18-39 YR	$19.04	$56.00	$21.28–$56.00	84% below	66%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC EST PREV 18-39YR	$19.04	$56.00	$36.40–$56.00	—	66%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC EST PREV 18-39 YR	$19.04	$56.00	$36.40–$56.00	—	66%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC EST PREV 40-64YR	$20.74	$61.00	$23.18–$61.00	82% below	66%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC EST PREV 40-64 YR	$20.74	$61.00	$23.18–$61.00	82% below	66%
Preventive checkup, returning patient aged 40–64 CPT 99396 RH TM PREV VISIT EST AGE 40-64	$146.54	$431.00	$163.78–$431.00	30% above	66%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC EST PREV 40-64 YR	$20.74	$61.00	$39.65–$61.00	—	66%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC EST PREV 40-64YR	$20.74	$61.00	$39.65–$61.00	—	66%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 RH TM PREV VISIT EST AGE 40-64	$146.54	$431.00	$280.15–$431.00	—	66%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC EST PREV 65+	$21.76	$64.00	$24.32–$64.00	86% below	66%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC EST PREV 65 PLUS	$21.76	$64.00	$24.32–$64.00	86% below	66%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC EST PREV 65+	$21.76	$64.00	$41.60–$64.00	—	66%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC EST PREV 65 PLUS	$21.76	$64.00	$41.60–$64.00	—	66%
Psychotherapy session, 30 minutes CPT 90832 HC PSYTX W/PATIENT 30 MINUTES	$52.70	$155.00	$58.90–$155.00	61% below	66%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYTX W/PATIENT 30 MINUTES	$52.70	$155.00	$100.75–$155.00	—	66%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC TOBACCO USE COUNSEL 3-10MIN	$16.66	$49.00	$18.62–$49.00	33% below	66%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN	$16.66	$49.00	$18.62–$49.00	33% below	66%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN	$16.66	$49.00	$31.85–$49.00	—	66%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC TOBACCO USE COUNSEL 3-10MIN	$16.66	$49.00	$31.85–$49.00	—	66%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 LEVEL V	$116.62	$343.00	$130.34–$343.00	20% below	66%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PHARMACIST CONSULT FACILITY V	$116.62	$343.00	$130.34–$343.00	20% below	66%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 FACILITY LEVEL V ESTAB	$116.62	$343.00	$130.34–$343.00	20% below	66%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC ESTAB VISIT LEVEL V	$116.62	$343.00	$130.34–$343.00	20% below	66%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC EST PT OV LEVEL V	$116.62	$343.00	$130.34–$343.00	20% below	66%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTABLISHED VISIT-LEVEL V	$116.62	$343.00	$130.34–$343.00	20% below	66%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 VISIT FACILITY LEVEL V EST	$116.62	$343.00	$130.34–$343.00	20% below	66%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 LEVEL III	$58.48	$172.00	$65.36–$172.00	20% below	66%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTABLISHED VISIT-LEVEL III	$58.48	$172.00	$65.36–$172.00	20% below	66%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 FACILITY LEVEL III ESTAB	$58.48	$172.00	$65.36–$172.00	20% below	66%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC ESTAB VISIT LEVEL III	$58.48	$172.00	$65.36–$172.00	20% below	66%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PHARMACIST CONSULT FAC III	$58.48	$172.00	$65.36–$172.00	20% below	66%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC EST PT OV LEVEL III	$58.48	$172.00	$65.36–$172.00	20% below	66%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 VISIT FACILITY LEVEL III EST	$58.48	$172.00	$65.36–$172.00	20% below	66%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTABLISHED VISIT-LEVEL IV	$76.84	$226.00	$85.88–$226.00	27% below	66%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PHARMACIST CONSULT FACILITY IV	$76.84	$226.00	$85.88–$226.00	27% below	66%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC EST PT OV LEVEL IV	$76.84	$226.00	$85.88–$226.00	27% below	66%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC ESTAB VISIT LEVEL IV	$76.84	$226.00	$85.88–$226.00	27% below	66%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 FACILITY LEVEL IV ESTAB	$76.84	$226.00	$85.88–$226.00	27% below	66%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 VISIT FACILITY LEVEL IV EST	$76.84	$226.00	$85.88–$226.00	27% below	66%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 VISIT FACILITY LEVEL II EST	$45.22	$133.00	$50.54–$133.00	20% below	66%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PHARMACIST CONSULT FACILITY II	$45.22	$133.00	$50.54–$133.00	20% below	66%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC EST PT OV LEVEL II	$45.22	$133.00	$50.54–$133.00	20% below	66%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC ESTAB VISIT LEVEL II	$45.22	$133.00	$50.54–$133.00	20% below	66%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 FACILITY LEVEL II ESTAB	$45.22	$133.00	$50.54–$133.00	20% below	66%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTABLISHED VISIT-LEVEL II	$45.22	$133.00	$50.54–$133.00	20% below	66%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 LEVEL II	$45.22	$133.00	$50.54–$133.00	20% below	66%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HC OFFICE CONSULT LVL 3 NEW	$25.84	$76.00	$28.88–$76.00	43% below	66%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HC OFFICE CONSULT LVL 3 EST	$25.84	$76.00	$28.88–$76.00	43% below	66%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC OFFICE CONSULT LVL 4 EST	$34.68	$102.00	$38.76–$102.00	46% below	66%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC OFFICE CONSULT LVL 4 NEW	$34.68	$102.00	$38.76–$102.00	46% below	66%
Speech and language evaluation CPT 92523 SPEECH SOUND LANG COMPREHEN	$203.66	$599.00	$227.62–$599.00	37% below	66%
Speech and language evaluation inpatient CPT 92523 SPEECH SOUND LANG COMPREHEN	$203.66	$599.00	$389.35–$599.00	—	66%
Speech therapy session, individual CPT 92507 SPEECH THERAPY TREATMENT	$111.18	$327.00	$124.26–$327.00	32% below	66%
Speech therapy session, individual inpatient CPT 92507 SPEECH THERAPY TREATMENT	$111.18	$327.00	$212.55–$327.00	—	66%
Spirometry (breathing test) CPT 94010 PULM FUNCTION TST (SPIROMETRY)	$120.02	$353.00	$134.14–$353.00	15% below	66%
Spirometry (breathing test) inpatient CPT 94010 PULM FUNCTION TST (SPIROMETRY)	$120.02	$353.00	$229.45–$353.00	—	66%
Spirometry before and after a bronchodilator CPT 94060 PRE/POST PULM FUNCTION TEST	$265.54	$781.00	$296.78–$781.00	17% below	66%
Spirometry before and after a bronchodilator CPT 94060 RH PRE/POST PULM FUNCTION TEST	$265.54	$781.00	$296.78–$781.00	17% below	66%
Spirometry before and after a bronchodilator CPT 94060 PULM REHAB PFT PRE/POST	$265.54	$781.00	$296.78–$781.00	17% below	66%
Spirometry before and after a bronchodilator inpatient CPT 94060 PULM REHAB PFT PRE/POST	$265.54	$781.00	$507.65–$781.00	—	66%
Spirometry before and after a bronchodilator inpatient CPT 94060 PRE/POST PULM FUNCTION TEST	$265.54	$781.00	$507.65–$781.00	—	66%
Spirometry before and after a bronchodilator inpatient CPT 94060 RH PRE/POST PULM FUNCTION TEST	$265.54	$781.00	$507.65–$781.00	—	66%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITY .25 ST	$59.84	$176.00	$66.88–$176.00	48% below	66%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITY .25 HR	$59.84	$176.00	$66.88–$176.00	48% below	66%
Therapeutic activities (functional training), 15 minutes CPT 97530 PTA THERAPEUTC ACTIVITY .25 HR	$59.84	$176.00	$66.88–$176.00	48% below	66%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITY .25	$59.84	$176.00	$66.88–$176.00	48% below	66%
Therapeutic activities (functional training), 15 minutes CPT 97530 OTA THERAPEUTIC ACTIVITY .25	$59.84	$176.00	$66.88–$176.00	48% below	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITY .25 HR	$59.84	$176.00	$114.40–$176.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITY .25 ST	$59.84	$176.00	$114.40–$176.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OTA THERAPEUTIC ACTIVITY .25	$59.84	$176.00	$114.40–$176.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITY .25	$59.84	$176.00	$114.40–$176.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PTA THERAPEUTC ACTIVITY .25 HR	$59.84	$176.00	$114.40–$176.00	—	66%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPUTIC PHLEBOTOMY	$104.04	$306.00	$116.28–$306.00	33% below	66%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPUTIC PHLEBOTOMY	$104.04	$306.00	$198.90–$306.00	—	66%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SPIKEVAX PF (CVX 312) 0.5 ML	$91.12	$268.00	$101.84–$268.00	43% below	66%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SPIKEVAX PF (CVX 312) 0.5 ML	$91.12	$268.00	$174.20–$268.00	—	66%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 RH VARICELLA PURCHASED	$102.73	$302.15	$114.82–$302.15	34% below	66%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA PURCHASED	$102.73	$302.15	$114.82–$302.15	34% below	66%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 RH VARICELLA VACCINE	$102.73	$302.15	$114.82–$302.15	34% below	66%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 RH VARICELLA PURCHASED	$102.73	$302.15	$196.40–$302.15	—	66%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA PURCHASED	$102.73	$302.15	$196.40–$302.15	—	66%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 RH VARICELLA VACCINE	$102.73	$302.15	$196.40–$302.15	—	66%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP PURCHASED	$21.71	$63.84	$24.26–$63.84	8% below	66%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 RH DTAP PURCHASED	$21.71	$63.84	$24.26–$63.84	8% below	66%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 RH DTAP PURCHASED	$21.71	$63.84	$41.50–$63.84	—	66%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP PURCHASED	$21.71	$63.84	$41.50–$63.84	—	66%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DIP/HAEM/PERT/TET./POLIO	$67.83	$199.49	$75.81–$199.49	at median	66%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 PENTACEL PURCHASED	$67.83	$199.49	$75.81–$199.49	at median	66%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 RH PENTACEL PURCHASED	$67.83	$199.49	$75.81–$199.49	at median	66%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 RH PENTACEL PURCHASED	$67.83	$199.49	$129.67–$199.49	—	66%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 PENTACEL PURCHASED	$67.83	$199.49	$129.67–$199.49	—	66%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DIP/HAEM/PERT/TET./POLIO	$67.83	$199.49	$129.67–$199.49	—	66%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VAC PF 0.5ML TIV PF	$13.21	$38.85	$14.76–$38.85	40% below	66%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VAC PF 0.5ML TIV PF	$13.21	$38.85	$25.25–$38.85	—	66%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 RH HPV PURCHASED	$172.64	$507.75	$192.94–$507.75	16% above	66%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT PURCHASED	$172.64	$507.75	$192.94–$507.75	16% above	66%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 H PAPILLOMA VACCINE	$172.64	$507.75	$192.94–$507.75	16% above	66%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 RH HPV PURCHASED	$172.64	$507.75	$330.04–$507.75	—	66%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV 9-VALENT PURCHASED	$172.64	$507.75	$330.04–$507.75	—	66%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 H PAPILLOMA VACCINE	$172.64	$507.75	$330.04–$507.75	—	66%
Hepatitis A vaccine, adult dose CPT 90632 HEP A ADULT PURCHASED	$50.74	$149.24	$56.71–$149.24	48% below	66%
Hepatitis A vaccine, adult dose CPT 90632 RH HEPATITIS A VACCINE ADULT	$50.74	$149.24	$56.71–$149.24	48% below	66%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS-A(HAVRIX) VAC(ADULT)	$55.36	$162.82	$61.87–$162.82	44% below	66%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEP A ADULT PURCHASED	$50.74	$149.24	$97.01–$149.24	—	66%
Hepatitis A vaccine, adult dose inpatient CPT 90632 RH HEPATITIS A VACCINE ADULT	$50.74	$149.24	$97.01–$149.24	—	66%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS-A(HAVRIX) VAC(ADULT)	$55.36	$162.82	$105.83–$162.82	—	66%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 RH HEP A PEDIA PURCHASED	$23.25	$68.37	$25.98–$68.37	37% below	66%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEP A PEDIA PURCHASED	$23.25	$68.37	$25.98–$68.37	37% below	66%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS-A VAC(PEDS) 0.5ML	$25.14	$73.95	$28.10–$73.95	32% below	66%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 RH HEP A PEDIA PURCHASED	$23.25	$68.37	$44.44–$68.37	—	66%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEP A PEDIA PURCHASED	$23.25	$68.37	$44.44–$68.37	—	66%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS-A VAC(PEDS) 0.5ML	$25.14	$73.95	$48.07–$73.95	—	66%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B ADULT PURCHASED	$42.47	$124.92	$47.47–$124.92	33% below	66%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 RH HEP B ADULT	$42.47	$124.92	$47.47–$124.92	33% below	66%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 RH HEP B ADULT	$42.47	$124.92	$81.20–$124.92	—	66%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B ADULT PURCHASED	$42.47	$124.92	$81.20–$124.92	—	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 ENGERIX-B INJ 10MCG/0.5ML	$17.10	$50.28	$19.11–$50.28	52% below	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B VACCINE CHILD	$17.10	$50.30	$19.11–$50.30	52% below	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B CHILD PURCHASED	$17.10	$50.30	$19.11–$50.30	52% below	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 RH HEP B CHILD PURCHASED	$17.10	$50.30	$19.11–$50.30	52% below	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B VACCINE IM	$17.10	$50.30	$19.11–$50.30	52% below	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 RECOMBIVAX-HB PED VAC	$17.93	$52.74	$20.04–$52.74	49% below	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 RH HEP B CHILD PURCHASED	$17.10	$50.30	$32.70–$50.30	—	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B CHILD PURCHASED	$17.10	$50.30	$32.70–$50.30	—	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B VACCINE IM	$17.10	$50.30	$32.70–$50.30	—	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B VACCINE CHILD	$17.10	$50.30	$32.70–$50.30	—	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 ENGERIX-B INJ 10MCG/0.5ML	$17.10	$50.28	$32.68–$50.28	—	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 RECOMBIVAX-HB PED VAC	$17.93	$52.74	$34.28–$52.74	—	66%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 ACTHIB VACCINE INJ	$8.62	$25.35	$9.63–$25.35	56% below	66%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIB PURCHASED	$11.64	$34.23	$13.01–$34.23	41% below	66%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 RH HIB PURCHASED	$11.64	$34.23	$13.01–$34.23	41% below	66%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 ACTHIB VACCINE INJ	$8.62	$25.35	$16.48–$25.35	—	66%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HIB PURCHASED	$11.64	$34.23	$22.25–$34.23	—	66%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 RH HIB PURCHASED	$11.64	$34.23	$22.25–$34.23	—	66%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VAC-PFHIGHDOSE65YRS+	$47.06	$138.42	$52.60–$138.42	34% below	66%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VAC-PFHIGHDOSE65YRS+	$47.06	$138.42	$89.97–$138.42	—	66%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR PURCHASED	$57.50	$169.13	$64.27–$169.13	55% below	66%
MMR vaccine (measles, mumps and rubella), live CPT 90707 RH MMR PURCHASED	$57.50	$169.13	$64.27–$169.13	55% below	66%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 RH MMR PURCHASED	$57.50	$169.13	$109.93–$169.13	—	66%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR PURCHASED	$57.50	$169.13	$109.93–$169.13	—	66%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL (CON) VAC INJ	$90.98	$267.58	$101.68–$267.58	12% below	66%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 RH MENINGOCOCCAL CONJUGATE VAC	$94.94	$279.23	$106.11–$279.23	8% below	66%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 RH MENIGOCOCAL PURCHASED	$94.94	$279.23	$106.11–$279.23	8% below	66%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENIGOCOCAL PURCHASED	$94.94	$279.23	$106.11–$279.23	8% below	66%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL (CON) VAC INJ	$90.98	$267.58	$173.93–$267.58	—	66%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 RH MENINGOCOCCAL CONJUGATE VAC	$94.94	$279.23	$181.50–$279.23	—	66%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 RH MENIGOCOCAL PURCHASED	$94.94	$279.23	$181.50–$279.23	—	66%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENIGOCOCAL PURCHASED	$94.94	$279.23	$181.50–$279.23	—	66%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 RH MENINGOCOCCAL B	$135.31	$397.98	$151.23–$397.98	30% below	66%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B	$135.31	$397.98	$151.23–$397.98	30% below	66%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B	$135.31	$397.98	$258.69–$397.98	—	66%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 RH MENINGOCOCCAL B	$135.31	$397.98	$258.69–$397.98	—	66%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR-20	$162.72	$478.58	$181.86–$478.58	58% below	66%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 RH PREVNAR-20	$162.72	$478.58	$181.86–$478.58	58% below	66%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20 INJ	$168.02	$494.19	$187.79–$494.19	56% below	66%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20 VALENT 0.5ML	$168.02	$494.19	$187.79–$494.19	56% below	66%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR-20	$162.72	$478.58	$311.08–$478.58	—	66%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 RH PREVNAR-20	$162.72	$478.58	$311.08–$478.58	—	66%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20 VALENT 0.5ML	$168.02	$494.19	$321.22–$494.19	—	66%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20 INJ	$168.02	$494.19	$321.22–$494.19	—	66%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 PNEUMOCOCCAL 21-(CVX 327)	$184.43	$542.43	$206.12–$542.43	8% below	66%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 PNEUMOCOCCAL 21-(CVX 327)	$184.43	$542.43	$352.58–$542.43	—	66%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACCINE INJ	$75.24	$221.29	$84.09–$221.29	22% below	66%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACCINE INJ	$75.24	$221.29	$143.84–$221.29	—	66%
Polio vaccine, inactivated (IPV) CPT 90713 RH IPV POLIO PURCHASED	$24.82	$72.99	$27.74–$72.99	43% below	66%
Polio vaccine, inactivated (IPV) CPT 90713 IPV POLIO PURCHASED	$24.82	$72.99	$27.74–$72.99	43% below	66%
Polio vaccine, inactivated (IPV) CPT 90713 RH IPV	$24.82	$72.99	$27.74–$72.99	43% below	66%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 RH IPV POLIO PURCHASED	$24.82	$72.99	$47.44–$72.99	—	66%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 IPV POLIO PURCHASED	$24.82	$72.99	$47.44–$72.99	—	66%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 RH IPV	$24.82	$72.99	$47.44–$72.99	—	66%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV VACCINE PREF BIVALENT IM	$164.29	$483.21	$183.62–$483.21	11% below	66%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV VACCINE PREF BIVALENT IM	$164.29	$483.21	$314.09–$483.21	—	66%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS PURCHASED	$59.80	$175.89	$66.84–$175.89	16% below	66%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 RH ROTAVIRUS PURCHASED	$59.80	$175.89	$66.84–$175.89	16% below	66%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS PURCHASED	$59.80	$175.89	$114.33–$175.89	—	66%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 RH ROTAVIRUS PURCHASED	$59.80	$175.89	$114.33–$175.89	—	66%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 DIPTH-TETANUS TOXOID 0.5ML INJ	$17.98	$52.89	$20.10–$52.89	56% below	66%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIP TOX 5UN/2UN/0.5ML	$25.90	$76.19	$28.95–$76.19	37% below	66%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 DIPTH-TETANUS TOXOID 0.5ML INJ	$17.98	$52.89	$34.38–$52.89	—	66%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIP TOX 5UN/2UN/0.5ML	$25.90	$76.19	$49.52–$76.19	—	66%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 RH TDAP 7 PLUS PURC	$28.16	$82.83	$31.48–$82.83	37% below	66%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP 7 PLUS PURC	$28.16	$82.83	$31.48–$82.83	37% below	66%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP 7 PLUS PURC	$28.16	$82.83	$53.84–$82.83	—	66%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 RH TDAP 7 PLUS PURC	$28.16	$82.83	$53.84–$82.83	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 RH IMMUN ADMIN STATE SUPP DRUG	$7.34	$21.58	$8.20–$21.58	58% below	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUN ADMIN STATE SUPPLY DRUG	$7.34	$21.58	$8.20–$21.58	58% below	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VAC_S ADMIN INFLUENZA VACCINE	$23.80	$70.00	$26.60–$70.00	35% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IM INJECTION	$23.80	$70.00	$26.60–$70.00	35% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INFLUENZA VACCINE	$23.80	$70.00	$26.60–$70.00	35% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN PNEUMO VACCINE	$23.80	$70.00	$26.60–$70.00	35% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HEP B ADMINISTRATION	$23.80	$70.00	$26.60–$70.00	35% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 RH HEP B ADMINISTRATION	$23.80	$70.00	$26.60–$70.00	35% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 RH TETANUS IM ST SUPPLIED	$23.80	$70.00	$26.60–$70.00	35% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 RH IMMUNIZATION ADMINISTRATION	$23.80	$70.00	$26.60–$70.00	35% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 RH ADMIN PNEUMO VACCINE	$23.80	$70.00	$26.60–$70.00	35% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 RH ADMIN INFLUENZA VACCINE	$23.80	$70.00	$26.60–$70.00	35% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION IMMUNIZATION	$23.80	$70.00	$26.60–$70.00	35% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN SQ/IM	$23.80	$70.00	$26.60–$70.00	35% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 RH ADMIN HEPATITIS B VAC	$27.88	$82.00	$31.16–$82.00	58% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 RH ADMIN PNEUMOCOCCAL VAC	$27.88	$82.00	$31.16–$82.00	58% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 RH ADMIN INFLUENZA VIRUS VAC	$27.88	$82.00	$31.16–$82.00	58% above	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUN ADMIN STATE SUPPLY DRUG	$7.34	$21.58	$14.03–$21.58	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 RH IMMUN ADMIN STATE SUPP DRUG	$7.34	$21.58	$14.03–$21.58	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 RH ADMIN PNEUMO VACCINE	$23.80	$70.00	$45.50–$70.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VAC_S ADMIN INFLUENZA VACCINE	$23.80	$70.00	$45.50–$70.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HEP B ADMINISTRATION	$23.80	$70.00	$45.50–$70.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN PNEUMO VACCINE	$23.80	$70.00	$45.50–$70.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN INFLUENZA VACCINE	$23.80	$70.00	$45.50–$70.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMINISTRATION IMMUNIZATION	$23.80	$70.00	$45.50–$70.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 RH HEP B ADMINISTRATION	$23.80	$70.00	$45.50–$70.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 RH TETANUS IM ST SUPPLIED	$23.80	$70.00	$45.50–$70.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 RH IMMUNIZATION ADMINISTRATION	$23.80	$70.00	$45.50–$70.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 RH ADMIN INFLUENZA VACCINE	$23.80	$70.00	$45.50–$70.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IM INJECTION	$23.80	$70.00	$45.50–$70.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN SQ/IM	$23.80	$70.00	$45.50–$70.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 RH ADMIN HEPATITIS B VAC	$27.88	$82.00	$53.30–$82.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 RH ADMIN PNEUMOCOCCAL VAC	$27.88	$82.00	$53.30–$82.00	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 RH ADMIN INFLUENZA VIRUS VAC	$27.88	$82.00	$53.30–$82.00	—	66%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 RH IMMUN ADMIN STATE SUPP ADD	$7.34	$21.58	$8.20–$21.58	58% below	66%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUN ADMIN STATE SUPPLY ADD	$7.34	$21.58	$8.20–$21.58	58% below	66%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUN INJECTION ADDL	$8.16	$24.00	$9.12–$24.00	54% below	66%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IM INJECTION ADD	$8.16	$24.00	$9.12–$24.00	54% below	66%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IM INJECTION ADD'L	$8.16	$24.00	$9.12–$24.00	54% below	66%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 RH IMMUNIZ ADMIN EACH ADD'L	$8.16	$24.00	$9.12–$24.00	54% below	66%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 RH IMMUN ADMIN STATE SUPP ADD	$7.34	$21.58	$14.03–$21.58	—	66%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN ADMIN STATE SUPPLY ADD	$7.34	$21.58	$14.03–$21.58	—	66%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 RH IMMUNIZ ADMIN EACH ADD'L	$8.16	$24.00	$15.60–$24.00	—	66%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN INJECTION ADDL	$8.16	$24.00	$15.60–$24.00	—	66%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IM INJECTION ADD'L	$8.16	$24.00	$15.60–$24.00	—	66%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IM INJECTION ADD	$8.16	$24.00	$15.60–$24.00	—	66%

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://northernlighthealth.org/NLH/media/Price-Transparency/010263628_Sebasticook-Valley-hospital_standardcharges.csv