Northern Light CA Dean Hospital
Listed in its price file as “Charles A. Dean Memorial Hospital”.
Northern Light CA Dean Hospital in Greenville, ME publishes cash prices for 335 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 188 of 333 procedures and above it for 125. By typical cash price it ranks #12 of 28 Maine hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.
364 Pritham Ave Greenville, ME 04441 Collected Sep 23, 2026 Source price file Check a bill from this hospital (207) 695-5209
Critical access hospital (rural, 25 beds or fewer) Government-owned hospital No emergency department CCN 201301 · CMS hospital register NPI 1659388213
Financial assistance
Public hospital: ask for its charity care or sliding-scale discount
Northern Light CA Dean Hospital is government-owned (CMS register). The federal financial assistance rules for nonprofit hospitals do not always apply to public ones, but many public hospitals run charity care or sliding-scale discounts for uninsured and low-income patients. Ask the billing office for its financial assistance or charity care policy and application before you pay. Letters you can copy.
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 | $904.00 | $1,808.00 | $1,157.12–$1,808.00 | 35% below | 50% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/ AND W/O CONTRAST | $904.00 | $1,808.00 | $1,175.20–$1,808.00 | — | 50% |
| Abdominal X-ray, 2 views CPT 74019 ABDOMEN COMPLETE SERIES | $244.00 | $488.00 | $312.32–$488.00 | at median | 50% |
| Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN COMPLETE SERIES | $244.00 | $488.00 | $317.20–$488.00 | — | 50% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE MIN 3 VIEWS LT | $213.00 | $426.00 | $272.64–$426.00 | at median | 50% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE MIN 3 VIEWS RT | $213.00 | $426.00 | $272.64–$426.00 | at median | 50% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE MIN 3 VIEWS LT | $213.00 | $426.00 | $276.90–$426.00 | — | 50% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE MIN 3 VIEWS RT | $213.00 | $426.00 | $276.90–$426.00 | — | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 PULSE VOLUME RECORDER TESTING | $116.00 | $232.00 | $148.48–$232.00 | 21% below | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ABI DOPPLER STUDY F | $116.00 | $232.00 | $148.48–$232.00 | 21% below | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ABI DOPPLER STUDY | $116.00 | $232.00 | $148.48–$232.00 | 21% below | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ABI DOPPLER STUDY MA ONLY | $116.00 | $232.00 | $148.48–$232.00 | 21% below | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ABI DOPPLER STUDY MA ONLY | $116.00 | $232.00 | $150.80–$232.00 | — | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ABI DOPPLER STUDY | $116.00 | $232.00 | $150.80–$232.00 | — | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ABI DOPPLER STUDY F | $116.00 | $232.00 | $150.80–$232.00 | — | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 PULSE VOLUME RECORDER TESTING | $116.00 | $232.00 | $150.80–$232.00 | — | 50% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT EXTREMITY UPPER RT | $639.00 | $1,278.00 | $817.92–$1,278.00 | 44% below | 50% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT EXTREMITY UPPER LT | $639.00 | $1,278.00 | $817.92–$1,278.00 | 44% below | 50% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT EXTREMITY UPPER RT | $639.00 | $1,278.00 | $830.70–$1,278.00 | — | 50% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT EXTREMITY UPPER LT | $639.00 | $1,278.00 | $830.70–$1,278.00 | — | 50% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST SONOGRAM | $203.00 | $406.00 | $259.84–$406.00 | 14% below | 50% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST SONOGRAM | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| CT angiography (CTA) of the head CPT 70496 HC CT CTA HEAD W &W/O CONTRAST | $1,189.00 | $2,378.00 | $1,521.92–$2,378.00 | 23% below | 50% |
| CT angiography (CTA) of the head inpatient CPT 70496 HC CT CTA HEAD W &W/O CONTRAST | $1,189.00 | $2,378.00 | $1,545.70–$2,378.00 | — | 50% |
| CT angiography (CTA) of the neck CPT 70498 HC CTA NECK W & W/O CONTRAST | $1,453.50 | $2,907.00 | $1,860.48–$2,907.00 | 8% below | 50% |
| CT angiography (CTA) of the neck inpatient CPT 70498 HC CTA NECK W & W/O CONTRAST | $1,453.50 | $2,907.00 | $1,889.55–$2,907.00 | — | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST W/CONTRAST | $1,846.00 | $3,692.00 | $2,362.88–$3,692.00 | 1% above | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST W/CONTRAST | $1,846.00 | $3,692.00 | $2,399.80–$3,692.00 | — | 50% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PEL W/O CONTRAST | $1,805.50 | $3,611.00 | $2,311.04–$3,611.00 | 30% above | 50% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PEL W/O CONTRAST | $1,805.50 | $3,611.00 | $2,347.15–$3,611.00 | — | 50% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PEL WITH CONTRAST | $2,265.00 | $4,530.00 | $2,899.20–$4,530.00 | 13% above | 50% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PEL WITH CONTRAST | $2,265.00 | $4,530.00 | $2,944.50–$4,530.00 | — | 50% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PEL W/O & WITH CONTRAST | $2,558.50 | $5,117.00 | $3,274.88–$5,117.00 | 16% above | 50% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD/PEL W/O & WITH CONTRAST | $2,558.50 | $5,117.00 | $3,326.05–$5,117.00 | — | 50% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN WITH CONTRAST | $801.00 | $1,602.00 | $1,025.28–$1,602.00 | 28% below | 50% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN WITH CONTRAST | $801.00 | $1,602.00 | $1,041.30–$1,602.00 | — | 50% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST | $648.00 | $1,296.00 | $829.44–$1,296.00 | 23% below | 50% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST | $648.00 | $1,296.00 | $842.40–$1,296.00 | — | 50% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXIOFACIAL W/O CONTRAST | $677.50 | $1,355.00 | $867.20–$1,355.00 | 23% below | 50% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXIOFACIAL W/O CONTRAST | $677.50 | $1,355.00 | $880.75–$1,355.00 | — | 50% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT BRAIN | $857.00 | $1,714.00 | $1,096.96–$1,714.00 | 13% below | 50% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT BRAIN | $857.00 | $1,714.00 | $1,114.10–$1,714.00 | — | 50% |
| CT scan of the head with contrast CPT 70460 CT BRAIN W/CONTRAST | $888.50 | $1,777.00 | $1,137.28–$1,777.00 | 16% below | 50% |
| CT scan of the head with contrast inpatient CPT 70460 CT BRAIN W/CONTRAST | $888.50 | $1,777.00 | $1,155.05–$1,777.00 | — | 50% |
| CT scan of the head without and with contrast CPT 70470 CT BRAIN WITH & W/O CONTRAST | $1,061.50 | $2,123.00 | $1,358.72–$2,123.00 | 27% below | 50% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT BRAIN WITH & W/O CONTRAST | $1,061.50 | $2,123.00 | $1,379.95–$2,123.00 | — | 50% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE | $697.00 | $1,394.00 | $892.16–$1,394.00 | 29% below | 50% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE | $697.00 | $1,394.00 | $906.10–$1,394.00 | — | 50% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SPINE CERVICAL | $747.00 | $1,494.00 | $956.16–$1,494.00 | 24% below | 50% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT SPINE CERVICAL | $747.00 | $1,494.00 | $971.10–$1,494.00 | — | 50% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST | $894.00 | $1,788.00 | $1,144.32–$1,788.00 | 11% below | 50% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST | $894.00 | $1,788.00 | $1,162.20–$1,788.00 | — | 50% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID BILATERAL | $547.00 | $1,094.00 | $700.16–$1,094.00 | — | 50% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID BILATERAL | $547.00 | $1,094.00 | $711.10–$1,094.00 | — | 50% |
| Chest CT scan without and with contrast CPT 71270 CT CHEST W/ AND W/O CONTRAST | $1,657.50 | $3,315.00 | $2,121.60–$3,315.00 | 3% below | 50% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST W/ AND W/O CONTRAST | $1,657.50 | $3,315.00 | $2,154.75–$3,315.00 | — | 50% |
| Chest X-ray, 2 views CPT 71046 CHEST SPECIAL VWS (EG, LAT. DE | $233.50 | $467.00 | $298.88–$467.00 | 10% above | 50% |
| Chest X-ray, 2 views CPT 71046 CHEST,TWO VIEWS | $233.50 | $467.00 | $298.88–$467.00 | 10% above | 50% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST SPECIAL VWS (EG, LAT. DE | $233.50 | $467.00 | $303.55–$467.00 | — | 50% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST,TWO VIEWS | $233.50 | $467.00 | $303.55–$467.00 | — | 50% |
| Chest X-ray, single view CPT 71045 CHEST, SINGLE VIEW | $203.00 | $406.00 | $259.84–$406.00 | 1% above | 50% |
| Chest X-ray, single view inpatient CPT 71045 CHEST, SINGLE VIEW | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE XRAY LT | $203.00 | $406.00 | $259.84–$406.00 | 7% below | 50% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE XRAY | $203.00 | $406.00 | $259.84–$406.00 | 7% below | 50% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE XRAY | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE XRAY LT | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US ABD RETROPERITONEAL TOTAL | $385.00 | $770.00 | $492.80–$770.00 | 15% below | 50% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US ABD RETROPERITONEAL TOTAL | $385.00 | $770.00 | $500.50–$770.00 | — | 50% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITOMETRY AXIAL | $245.50 | $491.00 | $314.24–$491.00 | 2% below | 50% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITOMETRY AXIAL | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB PREG SONOGRAM COMPLETE | $516.50 | $1,033.00 | $661.12–$1,033.00 | 25% above | 50% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB PREG SONOGRAM COMPLETE | $516.50 | $1,033.00 | $671.45–$1,033.00 | — | 50% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST | $894.50 | $1,789.00 | $1,144.96–$1,789.00 | 5% below | 50% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTRAST | $894.50 | $1,789.00 | $1,162.85–$1,789.00 | — | 50% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CONTRAST | $1,352.50 | $2,705.00 | $1,731.20–$2,705.00 | 5% above | 50% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CONTRAST | $1,352.50 | $2,705.00 | $1,758.25–$2,705.00 | — | 50% |
| Diagnostic mammogram, one breast CPT 77065 MAMMO DIGITAL DIAGNOSTIC UNI | $156.50 | $313.00 | $200.32–$313.00 | 1% below | 50% |
| Diagnostic mammogram, one breast inpatient CPT 77065 MAMMO DIGITAL DIAGNOSTIC UNI | $156.50 | $313.00 | $203.45–$313.00 | — | 50% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 US EXTREMITY ARTERY LOWER CMPL | $547.00 | $1,094.00 | $700.16–$1,094.00 | 47% above | 50% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US EXTREMITY ARTERY LOWER CMPL | $547.00 | $1,094.00 | $711.10–$1,094.00 | — | 50% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 US DUPLEX EXTREMITY VEINS CMPL | $547.00 | $1,094.00 | $700.16–$1,094.00 | 6% above | 50% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US DUPLEX EXTREMITY VEINS CMPL | $547.00 | $1,094.00 | $711.10–$1,094.00 | — | 50% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHOCARDIOGRAM COMPLETE | $1,231.00 | $2,462.00 | $1,575.68–$2,462.00 | 13% above | 50% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHOCARDIOGRAM COMPLETE | $1,231.00 | $2,462.00 | $1,600.30–$2,462.00 | — | 50% |
| Elbow X-ray, 2 views one side CPT 73070 ELBOW RT 2 VIEWS | $134.50 | $269.00 | $172.16–$269.00 | 38% below | 50% |
| Elbow X-ray, 2 views one side CPT 73070 ELBOW LT 2 VIEWS | $134.50 | $269.00 | $172.16–$269.00 | 38% below | 50% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW LT 2 VIEWS | $134.50 | $269.00 | $174.85–$269.00 | — | 50% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW RT 2 VIEWS | $134.50 | $269.00 | $174.85–$269.00 | — | 50% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW MIN 3 VIEWS RT | $202.50 | $405.00 | $259.20–$405.00 | 8% below | 50% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW MIN 3 VIEWS LT | $202.50 | $405.00 | $259.20–$405.00 | 8% below | 50% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW MIN 3 VIEWS LT | $202.50 | $405.00 | $263.25–$405.00 | — | 50% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW MIN 3 VIEWS RT | $202.50 | $405.00 | $263.25–$405.00 | — | 50% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT, EAR, SELLA | $695.00 | $1,390.00 | $889.60–$1,390.00 | 29% below | 50% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT, EAR, SELLA | $695.00 | $1,390.00 | $903.50–$1,390.00 | — | 50% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL/ORBIT MIN 3 V | $210.00 | $420.00 | $268.80–$420.00 | 8% below | 50% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL/ORBIT MIN 3 V | $210.00 | $420.00 | $273.00–$420.00 | — | 50% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM RT 2 VIEWS | $203.00 | $406.00 | $259.84–$406.00 | 4% below | 50% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM LT 2 VIEWS | $203.00 | $406.00 | $259.84–$406.00 | 4% below | 50% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM LT 2 VIEWS | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM RT 2 VIEWS | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Hand X-ray, 2 views one side CPT 73120 HAND 2 VIEWS LT | $228.50 | $457.00 | $292.48–$457.00 | 8% above | 50% |
| Hand X-ray, 2 views one side CPT 73120 HAND 2 VIEWS RT | $228.50 | $457.00 | $292.48–$457.00 | 8% above | 50% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 VIEWS LT | $228.50 | $457.00 | $297.05–$457.00 | — | 50% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 VIEWS RT | $228.50 | $457.00 | $297.05–$457.00 | — | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL MIN 2 VIEWS RT | $147.50 | $295.00 | $188.80–$295.00 | 29% below | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL MIN 2 VIEWS LT | $147.50 | $295.00 | $188.80–$295.00 | 29% below | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL MIN 2 VIEWS LT | $147.50 | $295.00 | $191.75–$295.00 | — | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL MIN 2 VIEWS RT | $147.50 | $295.00 | $191.75–$295.00 | — | 50% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT&RESP EFFT F | $349.00 | $698.00 | $446.72–$698.00 | 26% above | 50% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATT&RESP EFFT F | $349.00 | $698.00 | $453.70–$698.00 | — | 50% |
| Knee X-ray, 3 views one side CPT 73562 KNEE MIN 3 VIEWS LT | $203.00 | $406.00 | $259.84–$406.00 | 11% below | 50% |
| Knee X-ray, 3 views one side CPT 73562 KNEE MIN 3 VIEWS RT | $203.00 | $406.00 | $259.84–$406.00 | 11% below | 50% |
| Knee X-ray, 3 views inpatient one side CPT 73562 KNEE MIN 3 VIEWS RT | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Knee X-ray, 3 views inpatient one side CPT 73562 KNEE MIN 3 VIEWS LT | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE MIN 4 VIEWS RT | $245.50 | $491.00 | $314.24–$491.00 | 3% below | 50% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE MIN 4 VIEWS LT | $245.50 | $491.00 | $314.24–$491.00 | 3% below | 50% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE MIN 4 VIEWS LT | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE MIN 4 VIEWS RT | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT EXTREMITY LOWER LT | $665.50 | $1,331.00 | $851.84–$1,331.00 | 37% below | 50% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT EXTREMITY LOWER RT | $665.50 | $1,331.00 | $851.84–$1,331.00 | 37% below | 50% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT EXTREMITY LOWER LT | $665.50 | $1,331.00 | $865.15–$1,331.00 | — | 50% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT EXTREMITY LOWER RT | $665.50 | $1,331.00 | $865.15–$1,331.00 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC POCUS ABDOMEN | $334.50 | $669.00 | $428.16–$669.00 | 37% above | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC ECHO EXAM OF ABDOMEN | $334.50 | $669.00 | $428.16–$669.00 | 37% above | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED | $334.50 | $669.00 | $428.16–$669.00 | 37% above | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC POCUS GALLBLADDER | $334.50 | $669.00 | $428.16–$669.00 | 37% above | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC POCUS GALLBLADDER | $334.50 | $669.00 | $434.85–$669.00 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC ECHO EXAM OF ABDOMEN | $334.50 | $669.00 | $434.85–$669.00 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED | $334.50 | $669.00 | $434.85–$669.00 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC POCUS ABDOMEN | $334.50 | $669.00 | $434.85–$669.00 | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT NON-VASC LIMITED RT | $245.50 | $491.00 | $314.24–$491.00 | 47% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT NON-VASC LIMITED LT | $245.50 | $491.00 | $314.24–$491.00 | 47% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC POCUS MSK/SOFT TISSUE LT | $245.50 | $491.00 | $314.24–$491.00 | 47% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC POCUS MSK/SOFT TISSUE RT | $245.50 | $491.00 | $314.24–$491.00 | 47% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT NON-VASC LIMITED RT | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT NON-VASC LIMITED LT | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC POCUS MSK/SOFT TISSUE LT | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC POCUS MSK/SOFT TISSUE RT | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG SCREENING LOW DOSE | $245.50 | $491.00 | $314.24–$491.00 | 9% above | 50% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG SCREENING LOW DOSE | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LEG LT 2 VIEWS | $203.00 | $406.00 | $259.84–$406.00 | 5% below | 50% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LEG RT 2 VIEWS | $203.00 | $406.00 | $259.84–$406.00 | 5% below | 50% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LEG LT 2 VIEWS | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LEG RT 2 VIEWS | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERVICAL SPINE MIN 4 VWS | $245.50 | $491.00 | $314.24–$491.00 | 17% below | 50% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERVICAL SPINE MIN 4 VWS | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Neck soft tissue CT scan with contrast CPT 70491 CT NECK W/CONTRAST | $862.00 | $1,724.00 | $1,103.36–$1,724.00 | 33% below | 50% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK W/CONTRAST | $862.00 | $1,724.00 | $1,120.60–$1,724.00 | — | 50% |
| Neck soft tissue CT scan without contrast CPT 70490 CT NECK | $609.00 | $1,218.00 | $779.52–$1,218.00 | 39% below | 50% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK | $609.00 | $1,218.00 | $791.70–$1,218.00 | — | 50% |
| Neck soft tissue X-ray CPT 70360 NASOPHARYNX/NECK SOFT TISSUE | $199.50 | $399.00 | $255.36–$399.00 | 5% below | 50% |
| Neck soft tissue X-ray inpatient CPT 70360 NASOPHARYNX/NECK SOFT TISSUE | $199.50 | $399.00 | $259.35–$399.00 | — | 50% |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS | $683.00 | $1,366.00 | $874.24–$1,366.00 | 28% below | 50% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS | $683.00 | $1,366.00 | $887.90–$1,366.00 | — | 50% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC POCUS POST VOID RESID BLADR | $207.50 | $415.00 | $265.60–$415.00 | 19% above | 50% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIMITED | $207.50 | $415.00 | $265.60–$415.00 | 19% above | 50% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC POCUS POST VOID RESID BLADR | $207.50 | $415.00 | $269.75–$415.00 | — | 50% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LIMITED | $207.50 | $415.00 | $269.75–$415.00 | — | 50% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS SONOGRAM | $343.00 | $686.00 | $439.04–$686.00 | 13% below | 50% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIS NON-OBSTETRC CMPL | $343.00 | $686.00 | $439.04–$686.00 | 13% below | 50% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIS NON-OBSTETRC CMPL | $343.00 | $686.00 | $445.90–$686.00 | — | 50% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS SONOGRAM | $343.00 | $686.00 | $445.90–$686.00 | — | 50% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OBSTETRICAL ULTRASOUND | $364.50 | $729.00 | $466.56–$729.00 | 17% below | 50% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OBSTETRICAL ULTRASOUND | $364.50 | $729.00 | $473.85–$729.00 | — | 50% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG <14WKS TRANSABDOMINAL | $258.50 | $517.00 | $330.88–$517.00 | 17% below | 50% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG <14WKS TRANSABDOMINAL | $258.50 | $517.00 | $336.05–$517.00 | — | 50% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB PREG SONOGRAM LIMITED | $245.50 | $491.00 | $314.24–$491.00 | 27% above | 50% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC POCUS PREGNANT TRANSABDOM | $245.50 | $491.00 | $314.24–$491.00 | 27% above | 50% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB PREG SONOGRAM LIMITED | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC POCUS PREGNANT TRANSABDOM | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNILATERAL 2 VIEWS LT | $203.00 | $406.00 | $259.84–$406.00 | 12% below | 50% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNILATERAL 2 VIEWS RT | $203.00 | $406.00 | $259.84–$406.00 | 12% below | 50% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNILATERAL 2 VIEWS RT | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNILATERAL 2 VIEWS LT | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS UNI W/CHEST MIN 3 V LT | $245.50 | $491.00 | $314.24–$491.00 | 25% below | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS UNI W/CHEST MIN 3 V RT | $245.50 | $491.00 | $314.24–$491.00 | 25% below | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS UNI W/CHEST MIN 3 V LT | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS UNI W/CHEST MIN 3 V RT | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Screening mammogram, both breasts both sides CPT 77067 MAMMO DIGITAL SCREENING BILAT | $274.00 | $548.00 | $350.72–$548.00 | — | 50% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO DIGITAL SCREENING BILAT | $274.00 | $548.00 | $356.20–$548.00 | — | 50% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER XRAY MIN 2 VIEWS RT | $209.50 | $419.00 | $268.16–$419.00 | 8% below | 50% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER XRAY MIN 2 VIEWS LT | $209.50 | $419.00 | $268.16–$419.00 | 8% below | 50% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER XRAY MIN 2 VIEWS LT | $209.50 | $419.00 | $272.35–$419.00 | — | 50% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER XRAY MIN 2 VIEWS RT | $209.50 | $419.00 | $272.35–$419.00 | — | 50% |
| Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES MIN 3 VIEWS | $182.50 | $365.00 | $233.60–$365.00 | 20% below | 50% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES MIN 3 VIEWS | $182.50 | $365.00 | $237.25–$365.00 | — | 50% |
| Skull X-ray, fewer than 4 views CPT 70250 SKULL < 4 VIEWS | $157.50 | $315.00 | $201.60–$315.00 | 27% below | 50% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL < 4 VIEWS | $157.50 | $315.00 | $204.75–$315.00 | — | 50% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR RT 2 VIEWS | $203.00 | $406.00 | $259.84–$406.00 | 4% below | 50% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR LT 2 VIEWS | $203.00 | $406.00 | $259.84–$406.00 | 4% below | 50% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR LT 2 VIEWS | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR RT 2 VIEWS | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE | $682.50 | $1,365.00 | $873.60–$1,365.00 | 36% below | 50% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE | $682.50 | $1,365.00 | $887.25–$1,365.00 | — | 50% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE 2/4 VIEWS LT | $180.00 | $360.00 | $230.40–$360.00 | at median | 50% |
| Toe X-ray, 2 or more views one side CPT 73660 TOE 2/4 VIEWS RT | $180.00 | $360.00 | $230.40–$360.00 | at median | 50% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE 2/4 VIEWS LT | $180.00 | $360.00 | $234.00–$360.00 | — | 50% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE 2/4 VIEWS RT | $180.00 | $360.00 | $234.00–$360.00 | — | 50% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL SONOGRAM | $284.50 | $569.00 | $364.16–$569.00 | 24% below | 50% |
| Transvaginal pelvic ultrasound CPT 76830 HC POCUS NON-PREGNANT TRANSVAG | $284.50 | $569.00 | $364.16–$569.00 | 24% below | 50% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC POCUS NON-PREGNANT TRANSVAG | $284.50 | $569.00 | $369.85–$569.00 | — | 50% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL SONOGRAM | $284.50 | $569.00 | $369.85–$569.00 | — | 50% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC POCUS PREGNANT TRANSVAGINAL | $245.50 | $491.00 | $314.24–$491.00 | 21% below | 50% |
| Transvaginal ultrasound during pregnancy CPT 76817 US OB PREG SONO TRANSVAGINAL | $245.50 | $491.00 | $314.24–$491.00 | 21% below | 50% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB PREG SONO TRANSVAGINAL | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC POCUS PREGNANT TRANSVAGINAL | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN SONOGRAM | $401.50 | $803.00 | $513.92–$803.00 | 15% below | 50% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN SONOGRAM | $401.50 | $803.00 | $521.95–$803.00 | — | 50% |
| Ultrasound of the scrotum and testicles CPT 76870 US TESTICULAR SONOGRAM | $338.00 | $676.00 | $432.64–$676.00 | 27% below | 50% |
| Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM & CONTENTS | $338.00 | $676.00 | $432.64–$676.00 | 27% below | 50% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM & CONTENTS | $338.00 | $676.00 | $439.40–$676.00 | — | 50% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US TESTICULAR SONOGRAM | $338.00 | $676.00 | $439.40–$676.00 | — | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US NECK/HEAD SONOGRAM | $298.00 | $596.00 | $381.44–$596.00 | 26% below | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US NECK/HEAD SONOGRAM | $298.00 | $596.00 | $387.40–$596.00 | — | 50% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS MIN 2 VIEWS LT | $203.00 | $406.00 | $259.84–$406.00 | 2% below | 50% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS MIN 2 VIEWS RT | $203.00 | $406.00 | $259.84–$406.00 | 2% below | 50% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS MIN 2 VIEWS RT | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS MIN 2 VIEWS LT | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC POCUS FOCUSED DVT STUDY RT | $370.00 | $740.00 | $473.60–$740.00 | 25% below | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC POCUS FOCUSED DVT STUDY LT | $370.00 | $740.00 | $473.60–$740.00 | 25% below | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC POCUS FOCUSED DVT STUDY LT | $370.00 | $740.00 | $481.00–$740.00 | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC POCUS FOCUSED DVT STUDY RT | $370.00 | $740.00 | $481.00–$740.00 | — | 50% |
| Wrist X-ray, 2 views one side CPT 73100 WRIST LT 2 VIEWS | $197.50 | $395.00 | $252.80–$395.00 | 13% below | 50% |
| Wrist X-ray, 2 views one side CPT 73100 WRIST RT 2 VIEWS | $197.50 | $395.00 | $252.80–$395.00 | 13% below | 50% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST LT 2 VIEWS | $197.50 | $395.00 | $256.75–$395.00 | — | 50% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST RT 2 VIEWS | $197.50 | $395.00 | $256.75–$395.00 | — | 50% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST MIN 3 VIEWS LT | $203.00 | $406.00 | $259.84–$406.00 | 7% below | 50% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST MIN 3 VIEWS RT | $203.00 | $406.00 | $259.84–$406.00 | 7% below | 50% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST MIN 3 VIEWS RT | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST MIN 3 VIEWS LT | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP MIN 2 VIEWS RT | $203.00 | $406.00 | $259.84–$406.00 | at median | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP MIN 2 VIEWS LT | $203.00 | $406.00 | $259.84–$406.00 | at median | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP MIN 2 VIEWS RT | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP MIN 2 VIEWS LT | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| X-ray of the abdomen, 1 view CPT 74018 XR SITZ MOTILITY STUDY | $202.50 | $405.00 | $259.20–$405.00 | 4% below | 50% |
| X-ray of the abdomen, 1 view CPT 74018 ABDOMEN SINGLE VIEW | $202.50 | $405.00 | $259.20–$405.00 | 4% below | 50% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 XR SITZ MOTILITY STUDY | $202.50 | $405.00 | $263.25–$405.00 | — | 50% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN SINGLE VIEW | $202.50 | $405.00 | $263.25–$405.00 | — | 50% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE LT 2 VIEWS | $203.00 | $406.00 | $259.84–$406.00 | 2% below | 50% |
| X-ray of the ankle, 2 views one side CPT 73600 ANKLE RT 2 VIEWS | $203.00 | $406.00 | $259.84–$406.00 | 2% below | 50% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE LT 2 VIEWS | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE RT 2 VIEWS | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER MIN 2 VIEWS RT | $188.50 | $377.00 | $241.28–$377.00 | 4% below | 50% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER MIN 2 VIEWS LT | $188.50 | $377.00 | $241.28–$377.00 | 4% below | 50% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER MIN 2 VIEWS LT | $188.50 | $377.00 | $245.05–$377.00 | — | 50% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER MIN 2 VIEWS RT | $188.50 | $377.00 | $245.05–$377.00 | — | 50% |
| X-ray of the foot, 2 views one side CPT 73620 FOOT LT 2 VIEWS | $203.00 | $406.00 | $259.84–$406.00 | at median | 50% |
| X-ray of the foot, 2 views one side CPT 73620 FOOT RT 2 VIEWS | $203.00 | $406.00 | $259.84–$406.00 | at median | 50% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT RT 2 VIEWS | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT LT 2 VIEWS | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT MIN 3 VIEWS RT | $213.00 | $426.00 | $272.64–$426.00 | at median | 50% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT MIN 3 VIEWS LT | $213.00 | $426.00 | $272.64–$426.00 | at median | 50% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT MIN 3 VIEWS RT | $213.00 | $426.00 | $276.90–$426.00 | — | 50% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT MIN 3 VIEWS LT | $213.00 | $426.00 | $276.90–$426.00 | — | 50% |
| X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 VIEWS RT | $240.00 | $480.00 | $307.20–$480.00 | 9% above | 50% |
| X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 VIEWS LT | $240.00 | $480.00 | $307.20–$480.00 | 9% above | 50% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 VIEWS LT | $240.00 | $480.00 | $312.00–$480.00 | — | 50% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 VIEWS RT | $240.00 | $480.00 | $312.00–$480.00 | — | 50% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1-2 VIEWS RT | $196.50 | $393.00 | $251.52–$393.00 | 10% below | 50% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1-2 VIEWS LT | $196.50 | $393.00 | $251.52–$393.00 | 10% below | 50% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1-2 VIEWS LT | $196.50 | $393.00 | $255.45–$393.00 | — | 50% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1-2 VIEWS RT | $196.50 | $393.00 | $255.45–$393.00 | — | 50% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE 2 VIEWS | $245.50 | $491.00 | $314.24–$491.00 | at median | 50% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR SPINE 2 VIEWS | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE MIN 4 VIEWS | $283.00 | $566.00 | $362.24–$566.00 | 12% below | 50% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPINE MIN 4 VIEWS | $283.00 | $566.00 | $367.90–$566.00 | — | 50% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2 VIEWS | $245.50 | $491.00 | $314.24–$491.00 | 8% above | 50% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE 2 VIEWS | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONE MIN 3 | $203.00 | $406.00 | $259.84–$406.00 | 11% below | 50% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONE MIN 3 | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 C-SPINE 2 OR 3 VIEWS | $203.00 | $406.00 | $259.84–$406.00 | 4% below | 50% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 C-SPINE 2 OR 3 VIEWS | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 OR 2 VIEWS | $144.00 | $288.00 | $184.32–$288.00 | 32% below | 50% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1 OR 2 VIEWS | $144.00 | $288.00 | $187.20–$288.00 | — | 50% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM / CCOCYX | $203.00 | $406.00 | $259.84–$406.00 | 11% below | 50% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM / CCOCYX | $203.00 | $406.00 | $263.90–$406.00 | — | 50% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Maine | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ADENOCORTICOTROPIC HORMONES | $163.00 | $326.00 | $208.64–$326.00 | 2% above | 50% |
| ACTH blood test inpatient CPT 82024 ADENOCORTICOTROPIC HORMONES | $163.00 | $326.00 | $211.90–$326.00 | — | 50% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINOTRANSFERASE-Q | $34.00 | $68.00 | $43.52–$68.00 | 1% above | 50% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 FIBROMETER ALT | $35.50 | $71.00 | $45.44–$71.00 | 5% above | 50% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT (ALT) LAB | $35.50 | $71.00 | $45.44–$71.00 | 5% above | 50% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 FIBROSURE ALT | $35.50 | $71.00 | $45.44–$71.00 | 5% above | 50% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINOTRANSFERASE-Q | $34.00 | $68.00 | $44.20–$68.00 | — | 50% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 FIBROSURE ALT | $35.50 | $71.00 | $46.15–$71.00 | — | 50% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT (ALT) LAB | $35.50 | $71.00 | $46.15–$71.00 | — | 50% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 FIBROMETER ALT | $35.50 | $71.00 | $46.15–$71.00 | — | 50% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 ASPARTATE AMINOTRANSFERASE-Q | $29.00 | $58.00 | $37.12–$58.00 | 6% below | 50% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 FIBROSURE AST | $30.50 | $61.00 | $39.04–$61.00 | 1% below | 50% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 FIBROMETER AST | $30.50 | $61.00 | $39.04–$61.00 | 1% below | 50% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT (AST) LAB | $30.50 | $61.00 | $39.04–$61.00 | 1% below | 50% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 ASPARTATE AMINOTRANSFERASE-Q | $29.00 | $58.00 | $37.70–$58.00 | — | 50% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 FIBROSURE AST | $30.50 | $61.00 | $39.65–$61.00 | — | 50% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 FIBROMETER AST | $30.50 | $61.00 | $39.65–$61.00 | — | 50% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT (AST) LAB | $30.50 | $61.00 | $39.65–$61.00 | — | 50% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS ACUTE PROFILE | $150.50 | $301.00 | $192.64–$301.00 | 6% below | 50% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS ACUTE PROFILE | $150.50 | $301.00 | $195.65–$301.00 | — | 50% |
| Albumin blood test CPT 82040 ALBUMIN LEVEL-Q | $31.00 | $62.00 | $39.68–$62.00 | 35% above | 50% |
| Albumin blood test CPT 82040 ALBUMIN/LAB | $32.50 | $65.00 | $41.60–$65.00 | 42% above | 50% |
| Albumin blood test CPT 82040 ALBUMIN SERUM | $32.50 | $65.00 | $41.60–$65.00 | 42% above | 50% |
| Albumin blood test inpatient CPT 82040 ALBUMIN LEVEL-Q | $31.00 | $62.00 | $40.30–$62.00 | — | 50% |
| Albumin blood test inpatient CPT 82040 ALBUMIN SERUM | $32.50 | $65.00 | $42.25–$65.00 | — | 50% |
| Albumin blood test inpatient CPT 82040 ALBUMIN/LAB | $32.50 | $65.00 | $42.25–$65.00 | — | 50% |
| Aldosterone blood test CPT 82088 ALDOSTERONE | $169.50 | $339.00 | $216.96–$339.00 | 8% above | 50% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE | $169.50 | $339.00 | $220.35–$339.00 | — | 50% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE-Q | $24.50 | $49.00 | $31.36–$49.00 | 11% below | 50% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALKPHOSPHATASE CHARGE | $25.50 | $51.00 | $32.64–$51.00 | 7% below | 50% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE | $25.50 | $51.00 | $32.64–$51.00 | 7% below | 50% |
| Alkaline phosphatase (ALP) blood test CPT 84075 BONE SPECIFIC ALKALINE PHOS | $25.50 | $51.00 | $32.64–$51.00 | 7% below | 50% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE-Q | $24.50 | $49.00 | $31.85–$49.00 | — | 50% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 BONE SPECIFIC ALKALINE PHOS | $25.50 | $51.00 | $33.15–$51.00 | — | 50% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKPHOSPHATASE CHARGE | $25.50 | $51.00 | $33.15–$51.00 | — | 50% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE | $25.50 | $51.00 | $33.15–$51.00 | — | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 RAST ALLERGENS EACH | $34.50 | $69.00 | $44.16–$69.00 | 50% above | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST ALLERGENS EACH | $34.50 | $69.00 | $44.85–$69.00 | — | 50% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN | $82.50 | $165.00 | $105.60–$165.00 | 25% above | 50% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFP, TUMOR MARKER/LAB | $82.50 | $165.00 | $105.60–$165.00 | 25% above | 50% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFP PROFILE 4 | $82.50 | $165.00 | $105.60–$165.00 | 25% above | 50% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN | $82.50 | $165.00 | $107.25–$165.00 | — | 50% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP, TUMOR MARKER/LAB | $82.50 | $165.00 | $107.25–$165.00 | — | 50% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP PROFILE 4 | $82.50 | $165.00 | $107.25–$165.00 | — | 50% |
| Ammonia blood test CPT 82140 STONE ANALYSIS AMMONIA | $65.50 | $131.00 | $83.84–$131.00 | 28% below | 50% |
| Ammonia blood test CPT 82140 AMMONIA/LAB | $65.50 | $131.00 | $83.84–$131.00 | 28% below | 50% |
| Ammonia blood test inpatient CPT 82140 AMMONIA/LAB | $65.50 | $131.00 | $85.15–$131.00 | — | 50% |
| Ammonia blood test inpatient CPT 82140 STONE ANALYSIS AMMONIA | $65.50 | $131.00 | $85.15–$131.00 | — | 50% |
| Amylase blood test CPT 82150 AMYLASE BODY FLUID-Q | $48.50 | $97.00 | $62.08–$97.00 | 17% above | 50% |
| Amylase blood test CPT 82150 URINE AMYLASE | $48.50 | $97.00 | $62.08–$97.00 | 17% above | 50% |
| Amylase blood test CPT 82150 AMYLASE,SERUM/LAB | $48.50 | $97.00 | $62.08–$97.00 | 17% above | 50% |
| Amylase blood test CPT 82150 AMYLASE BODY FLUID | $48.50 | $97.00 | $62.08–$97.00 | 17% above | 50% |
| Amylase blood test CPT 82150 AMYLASE LEVEL-Q | $48.50 | $97.00 | $62.08–$97.00 | 17% above | 50% |
| Amylase blood test CPT 82150 AMYLASE LEVEL RANDOM URINE-Q | $48.50 | $97.00 | $62.08–$97.00 | 17% above | 50% |
| Amylase blood test inpatient CPT 82150 AMYLASE LEVEL RANDOM URINE-Q | $48.50 | $97.00 | $63.05–$97.00 | — | 50% |
| Amylase blood test inpatient CPT 82150 URINE AMYLASE | $48.50 | $97.00 | $63.05–$97.00 | — | 50% |
| Amylase blood test inpatient CPT 82150 AMYLASE,SERUM/LAB | $48.50 | $97.00 | $63.05–$97.00 | — | 50% |
| Amylase blood test inpatient CPT 82150 AMYLASE BODY FLUID-Q | $48.50 | $97.00 | $63.05–$97.00 | — | 50% |
| Amylase blood test inpatient CPT 82150 AMYLASE LEVEL-Q | $48.50 | $97.00 | $63.05–$97.00 | — | 50% |
| Amylase blood test inpatient CPT 82150 AMYLASE BODY FLUID | $48.50 | $97.00 | $63.05–$97.00 | — | 50% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULINATED PEPTIDE | $87.00 | $174.00 | $111.36–$174.00 | 22% above | 50% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULINATED PEPTIDE | $87.00 | $174.00 | $113.10–$174.00 | — | 50% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA/LAB | $59.50 | $119.00 | $76.16–$119.00 | 8% above | 50% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY | $59.50 | $119.00 | $76.16–$119.00 | 8% above | 50% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA/LAB | $59.50 | $119.00 | $77.35–$119.00 | — | 50% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODY | $59.50 | $119.00 | $77.35–$119.00 | — | 50% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-TYPE NATRIURETIC PEPTIDE | $102.00 | $204.00 | $130.56–$204.00 | 35% below | 50% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-TYPE NATRIURETIC PEPTIDE | $102.00 | $204.00 | $132.60–$204.00 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, ROUTINE/LAB | $73.00 | $146.00 | $93.44–$146.00 | 35% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 GENITAL CULTURE | $73.00 | $146.00 | $93.44–$146.00 | 35% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, ROUTINE/LAB | $73.00 | $146.00 | $94.90–$146.00 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 GENITAL CULTURE | $73.00 | $146.00 | $94.90–$146.00 | — | 50% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL-Q | $91.00 | $182.00 | $116.48–$182.00 | 17% above | 50% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PAN | $95.50 | $191.00 | $122.24–$191.00 | 22% above | 50% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL-Q | $91.00 | $182.00 | $118.30–$182.00 | — | 50% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PAN | $95.50 | $191.00 | $124.15–$191.00 | — | 50% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL-Q | $31.00 | $62.00 | $39.68–$62.00 | at median | 50% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN, TOTAL | $32.50 | $65.00 | $41.60–$65.00 | 5% above | 50% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL-Q | $31.00 | $62.00 | $40.30–$62.00 | — | 50% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN, TOTAL | $32.50 | $65.00 | $42.25–$65.00 | — | 50% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV SURGICAL PATHOLOGY | $153.50 | $307.00 | $196.48–$307.00 | 11% above | 50% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATHOLOGY LEVEL 4 | $153.50 | $307.00 | $196.48–$307.00 | 11% above | 50% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATHOLOGY LEVEL 4 | $153.50 | $307.00 | $199.55–$307.00 | — | 50% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV SURGICAL PATHOLOGY | $153.50 | $307.00 | $199.55–$307.00 | — | 50% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE | $107.50 | $215.00 | $137.60–$215.00 | 26% above | 50% |
| Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE | $107.50 | $215.00 | $139.75–$215.00 | — | 50% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD DRAW/LAB | $12.00 | $24.00 | $15.36–$24.00 | 15% below | 50% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE | $12.00 | $24.00 | $15.36–$24.00 | 15% below | 50% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC VENIPUNCTURE | $17.50 | $35.00 | $22.40–$35.00 | 24% above | 50% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD DRAW/LAB | $12.00 | $24.00 | $15.60–$24.00 | — | 50% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC VENIPUNCTURE | $17.50 | $35.00 | $22.75–$35.00 | — | 50% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE LEVEL-Q | $31.00 | $62.00 | $39.68–$62.00 | 34% above | 50% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE,SERUM/LAB | $32.50 | $65.00 | $41.60–$65.00 | 40% above | 50% |
| Blood glucose (sugar) test CPT 82947 FIBROSURE GLUCOSE | $32.50 | $65.00 | $41.60–$65.00 | 40% above | 50% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE LEVEL-Q | $31.00 | $62.00 | $40.30–$62.00 | — | 50% |
| Blood glucose (sugar) test inpatient CPT 82947 FIBROSURE GLUCOSE | $32.50 | $65.00 | $42.25–$65.00 | — | 50% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE,SERUM/LAB | $32.50 | $65.00 | $42.25–$65.00 | — | 50% |
| Blood lead test CPT 83655 HEAVY METAL PANEL URINE | $45.00 | $90.00 | $57.60–$90.00 | at median | 50% |
| Blood lead test CPT 83655 LEAD, BLOOD/LAB | $45.00 | $90.00 | $57.60–$90.00 | at median | 50% |
| Blood lead test CPT 83655 LEAD INDUSTRIAL EXP | $45.00 | $90.00 | $57.60–$90.00 | at median | 50% |
| Blood lead test CPT 83655 LEAD, WHOLE BLOOD | $45.00 | $90.00 | $57.60–$90.00 | at median | 50% |
| Blood lead test inpatient CPT 83655 LEAD, BLOOD/LAB | $45.00 | $90.00 | $58.50–$90.00 | — | 50% |
| Blood lead test inpatient CPT 83655 HEAVY METAL PANEL URINE | $45.00 | $90.00 | $58.50–$90.00 | — | 50% |
| Blood lead test inpatient CPT 83655 LEAD, WHOLE BLOOD | $45.00 | $90.00 | $58.50–$90.00 | — | 50% |
| Blood lead test inpatient CPT 83655 LEAD INDUSTRIAL EXP | $45.00 | $90.00 | $58.50–$90.00 | — | 50% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 BETA HCG QUALITATIVE-Q | $44.50 | $89.00 | $56.96–$89.00 | 3% above | 50% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY TEST, SERUM QUAL | $46.50 | $93.00 | $59.52–$93.00 | 8% above | 50% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 BETA HCG QUALITATIVE-Q | $44.50 | $89.00 | $57.85–$89.00 | — | 50% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY TEST, SERUM QUAL | $46.50 | $93.00 | $60.45–$93.00 | — | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO TYPE | $91.00 | $182.00 | $116.48–$182.00 | 84% above | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO TYPE | $91.00 | $182.00 | $118.30–$182.00 | — | 50% |
| Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN (BUN)-Q | $15.50 | $31.00 | $19.84–$31.00 | 38% below | 50% |
| Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN | $16.50 | $33.00 | $21.12–$33.00 | 35% below | 50% |
| Blood urea nitrogen (BUN) test CPT 84520 FIBROMETER BUN | $16.50 | $33.00 | $21.12–$33.00 | 35% below | 50% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN (BUN)-Q | $15.50 | $31.00 | $20.15–$31.00 | — | 50% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 FIBROMETER BUN | $16.50 | $33.00 | $21.45–$33.00 | — | 50% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN | $16.50 | $33.00 | $21.45–$33.00 | — | 50% |
| C-peptide blood test CPT 84681 C-PEPTIDE REACTIVITY | $76.00 | $152.00 | $97.28–$152.00 | 8% above | 50% |
| C-peptide blood test inpatient CPT 84681 C-PEPTIDE REACTIVITY | $76.00 | $152.00 | $98.80–$152.00 | — | 50% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN MG/L-Q | $38.50 | $77.00 | $49.28–$77.00 | 4% above | 50% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REATIVE PROTEIN | $40.50 | $81.00 | $51.84–$81.00 | 9% above | 50% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $40.50 | $81.00 | $51.84–$81.00 | 9% above | 50% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN MG/L-Q | $38.50 | $77.00 | $50.05–$77.00 | — | 50% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REATIVE PROTEIN | $40.50 | $81.00 | $52.65–$81.00 | — | 50% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN | $40.50 | $81.00 | $52.65–$81.00 | — | 50% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C-DIFFIICILE AMPLIFIED PROBE | $88.50 | $177.00 | $113.28–$177.00 | 14% below | 50% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C-DIFFIICILE AMPLIFIED PROBE | $88.50 | $177.00 | $115.05–$177.00 | — | 50% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 | $65.00 | $130.00 | $83.20–$130.00 | 1% above | 50% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 | $65.00 | $130.00 | $84.50–$130.00 | — | 50% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA, 125 | $74.50 | $149.00 | $95.36–$149.00 | 13% below | 50% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA, 125 | $74.50 | $149.00 | $96.85–$149.00 | — | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC COVID CEPHEID | $55.50 | $111.00 | $71.04–$111.00 | 37% below | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID AMPLIFIED PROBE | $67.50 | $135.00 | $86.40–$135.00 | 23% below | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID CEPHEID | $67.50 | $135.00 | $86.40–$135.00 | 23% below | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC COVID CEPHEID | $55.50 | $111.00 | $72.15–$111.00 | — | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID AMPLIFIED PROBE | $67.50 | $135.00 | $87.75–$135.00 | — | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID CEPHEID | $67.50 | $135.00 | $87.75–$135.00 | — | 50% |
| Calcium blood test, total CPT 82310 CALCIUM LEVEL TOTAL-Q | $31.50 | $63.00 | $40.32–$63.00 | 12% above | 50% |
| Calcium blood test, total CPT 82310 CALCIUM | $33.00 | $66.00 | $42.24–$66.00 | 17% above | 50% |
| Calcium blood test, total CPT 82310 CALCIUM/LAB | $33.00 | $66.00 | $42.24–$66.00 | 17% above | 50% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM LEVEL TOTAL-Q | $31.50 | $63.00 | $40.95–$63.00 | — | 50% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM/LAB | $33.00 | $66.00 | $42.90–$66.00 | — | 50% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM | $33.00 | $66.00 | $42.90–$66.00 | — | 50% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CEA/LAB | $94.50 | $189.00 | $120.96–$189.00 | 7% above | 50% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA/LAB | $94.50 | $189.00 | $122.85–$189.00 | — | 50% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA-ZOSTER VIRUS ABY, IG | $57.00 | $114.00 | $72.96–$114.00 | 17% above | 50% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER IGM/LAB | $57.00 | $114.00 | $72.96–$114.00 | 17% above | 50% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER, IMMUNE STATU | $57.00 | $114.00 | $72.96–$114.00 | 17% above | 50% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA-ZOSTER VIRUS ABY, IG | $57.00 | $114.00 | $74.10–$114.00 | — | 50% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER IGM/LAB | $57.00 | $114.00 | $74.10–$114.00 | — | 50% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER, IMMUNE STATU | $57.00 | $114.00 | $74.10–$114.00 | — | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMIDIA DIRECT | $59.50 | $119.00 | $76.16–$119.00 | 18% below | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMIDIA DIRECT | $59.50 | $119.00 | $77.35–$119.00 | — | 50% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HDL PROFILE | $67.50 | $135.00 | $86.40–$135.00 | 9% below | 50% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HDL PROFILE | $67.50 | $135.00 | $87.75–$135.00 | — | 50% |
| Complete blood count (CBC) with differential CPT 85025 CBC WITH DIFF-Q | $58.00 | $116.00 | $74.24–$116.00 | 24% above | 50% |
| Complete blood count (CBC) with differential CPT 85025 CBC/AUTO DIFF | $61.00 | $122.00 | $78.08–$122.00 | 30% above | 50% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH DIFF-Q | $58.00 | $116.00 | $75.40–$116.00 | — | 50% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC/AUTO DIFF | $61.00 | $122.00 | $79.30–$122.00 | — | 50% |
| Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFFERENTIAL-Q | $33.50 | $67.00 | $42.88–$67.00 | 8% above | 50% |
| Complete blood count (CBC), no differential CPT 85027 HEMOGRAM | $35.00 | $70.00 | $44.80–$70.00 | 13% above | 50% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC WITHOUT DIFFERENTIAL-Q | $33.50 | $67.00 | $43.55–$67.00 | — | 50% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM | $35.00 | $70.00 | $45.50–$70.00 | — | 50% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANL-Q | $135.00 | $270.00 | $172.80–$270.00 | 28% above | 50% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PAN | $142.00 | $284.00 | $181.76–$284.00 | 35% above | 50% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANL-Q | $135.00 | $270.00 | $175.50–$270.00 | — | 50% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PAN | $142.00 | $284.00 | $184.60–$284.00 | — | 50% |
| Cortisol blood test, total CPT 82533 CORTISOL SALIVA/LAB | $71.50 | $143.00 | $91.52–$143.00 | 2% above | 50% |
| Cortisol blood test, total CPT 82533 CORTISOL PEDS COSYNTROPIN TEST | $71.50 | $143.00 | $91.52–$143.00 | 2% above | 50% |
| Cortisol blood test, total CPT 82533 CORTISOL, PLASMA | $71.50 | $143.00 | $91.52–$143.00 | 2% above | 50% |
| Cortisol blood test, total CPT 82533 ACTH STIMULATION | $71.50 | $143.00 | $91.52–$143.00 | 2% above | 50% |
| Cortisol blood test, total inpatient CPT 82533 ACTH STIMULATION | $71.50 | $143.00 | $92.95–$143.00 | — | 50% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL, PLASMA | $71.50 | $143.00 | $92.95–$143.00 | — | 50% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL SALIVA/LAB | $71.50 | $143.00 | $92.95–$143.00 | — | 50% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL PEDS COSYNTROPIN TEST | $71.50 | $143.00 | $92.95–$143.00 | — | 50% |
| Creatine kinase (CK) blood test, total CPT 82550 TOTAL CK (ARUP) | $53.00 | $106.00 | $67.84–$106.00 | 17% above | 50% |
| Creatine kinase (CK) blood test, total CPT 82550 CPK/LAB | $53.00 | $106.00 | $67.84–$106.00 | 17% above | 50% |
| Creatine kinase (CK) blood test, total CPT 82550 CREATINE KINASE TOTAL-Q | $53.00 | $106.00 | $67.84–$106.00 | 17% above | 50% |
| Creatine kinase (CK) blood test, total CPT 82550 CK, TOTAL | $53.00 | $106.00 | $67.84–$106.00 | 17% above | 50% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CK, TOTAL | $53.00 | $106.00 | $68.90–$106.00 | — | 50% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CREATINE KINASE TOTAL-Q | $53.00 | $106.00 | $68.90–$106.00 | — | 50% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK/LAB | $53.00 | $106.00 | $68.90–$106.00 | — | 50% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 TOTAL CK (ARUP) | $53.00 | $106.00 | $68.90–$106.00 | — | 50% |
| Creatinine blood test CPT 82565 CREATININE SERUM-Q | $31.50 | $63.00 | $40.32–$63.00 | 10% above | 50% |
| Creatinine blood test CPT 82565 CREATININE, SERUM | $33.00 | $66.00 | $42.24–$66.00 | 15% above | 50% |
| Creatinine blood test inpatient CPT 82565 CREATININE SERUM-Q | $31.50 | $63.00 | $40.95–$63.00 | — | 50% |
| Creatinine blood test inpatient CPT 82565 CREATININE, SERUM | $33.00 | $66.00 | $42.90–$66.00 | — | 50% |
| Cytomegalovirus (CMV) antibody test CPT 86644 CMV ANTIBODY, IGG LAB | $51.50 | $103.00 | $65.92–$103.00 | 18% below | 50% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV ANTIBODY, IGG LAB | $51.50 | $103.00 | $66.95–$103.00 | — | 50% |
| D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QUANT | $66.50 | $133.00 | $85.12–$133.00 | 8% below | 50% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER QUANT | $66.50 | $133.00 | $86.45–$133.00 | — | 50% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE | $123.50 | $247.00 | $158.08–$247.00 | 36% above | 50% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE | $123.50 | $247.00 | $160.55–$247.00 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 ETHANOL LEVEL URINE-Q | $122.00 | $244.00 | $156.16–$244.00 | 26% above | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 COTININE SCREEN, URINE | $128.50 | $257.00 | $164.48–$257.00 | 32% above | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN RAPID | $128.50 | $257.00 | $164.48–$257.00 | 32% above | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN 9 PANEL W/REFLEX | $128.50 | $257.00 | $164.48–$257.00 | 32% above | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 ETHYL GLUCURONIDE URINE | $128.50 | $257.00 | $164.48–$257.00 | 32% above | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ETHANOL LEVEL URINE-Q | $122.00 | $244.00 | $158.60–$244.00 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN 9 PANEL W/REFLEX | $128.50 | $257.00 | $167.05–$257.00 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ETHYL GLUCURONIDE URINE | $128.50 | $257.00 | $167.05–$257.00 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 COTININE SCREEN, URINE | $128.50 | $257.00 | $167.05–$257.00 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN RAPID | $128.50 | $257.00 | $167.05–$257.00 | — | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYES-Q | $47.00 | $94.00 | $60.16–$94.00 | 6% below | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL | $49.50 | $99.00 | $63.36–$99.00 | 1% below | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYES-Q | $47.00 | $94.00 | $61.10–$94.00 | — | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL | $49.50 | $99.00 | $64.35–$99.00 | — | 50% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EBV AB V.CAPSID AG | $61.00 | $122.00 | $78.08–$122.00 | at median | 50% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV AB V.CAPSID AG | $61.00 | $122.00 | $79.30–$122.00 | — | 50% |
| Estradiol blood test CPT 82670 ESTRADIOL/LAB | $139.50 | $279.00 | $178.56–$279.00 | 37% above | 50% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL/LAB | $139.50 | $279.00 | $181.35–$279.00 | — | 50% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH/LAB | $84.50 | $169.00 | $108.16–$169.00 | 6% above | 50% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH/LAB | $84.50 | $169.00 | $109.85–$169.00 | — | 50% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CAL PROTECTIN | $139.50 | $279.00 | $178.56–$279.00 | 9% below | 50% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CAL PROTECTIN | $139.50 | $279.00 | $181.35–$279.00 | — | 50% |
| Ferritin blood test (iron stores) CPT 82728 FIBROSURE FERRITIN | $69.00 | $138.00 | $88.32–$138.00 | 8% below | 50% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $69.00 | $138.00 | $88.32–$138.00 | 8% below | 50% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FIBROSURE FERRITIN | $69.00 | $138.00 | $89.70–$138.00 | — | 50% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN | $69.00 | $138.00 | $89.70–$138.00 | — | 50% |
| Fibrinogen blood test CPT 85384 FIBRINOGEN, ACTIVITY | $50.50 | $101.00 | $64.64–$101.00 | 16% below | 50% |
| Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN, ACTIVITY | $50.50 | $101.00 | $65.65–$101.00 | — | 50% |
| Folate (folic acid) blood test CPT 82746 FOLATE,SERUM/LAB | $69.00 | $138.00 | $88.32–$138.00 | 8% below | 50% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLATE,SERUM/LAB | $69.00 | $138.00 | $89.70–$138.00 | — | 50% |
| Free T3 thyroid hormone test CPT 84481 T3 FREE | $90.00 | $180.00 | $115.20–$180.00 | 5% above | 50% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE | $90.00 | $180.00 | $117.00–$180.00 | — | 50% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4/LAB | $78.00 | $156.00 | $99.84–$156.00 | 30% above | 50% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE DIRECT DIALYSIS | $78.00 | $156.00 | $99.84–$156.00 | 30% above | 50% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE DIRECT DIALYSIS | $78.00 | $156.00 | $101.40–$156.00 | — | 50% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4/LAB | $78.00 | $156.00 | $101.40–$156.00 | — | 50% |
| Free testosterone test CPT 84402 TESTOSTERONE, FREE | $92.50 | $185.00 | $118.40–$185.00 | 10% below | 50% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE | $92.50 | $185.00 | $120.25–$185.00 | — | 50% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT/LAB | $48.00 | $96.00 | $61.44–$96.00 | 8% above | 50% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 FIBROMETER GGT | $48.00 | $96.00 | $61.44–$96.00 | 8% above | 50% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 GAMMA GLUTAMYL TRANSFERASE-Q | $48.00 | $96.00 | $61.44–$96.00 | 8% above | 50% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GAMMA GLUTAMYL TRANSFERASE-Q | $48.00 | $96.00 | $62.40–$96.00 | — | 50% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 FIBROMETER GGT | $48.00 | $96.00 | $62.40–$96.00 | — | 50% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT/LAB | $48.00 | $96.00 | $62.40–$96.00 | — | 50% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST DOSE | $40.00 | $80.00 | $51.20–$80.00 | 8% above | 50% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST DOSE | $40.00 | $80.00 | $52.00–$80.00 | — | 50% |
| Glucose tolerance test, 3 samples CPT 82951 LACTOSE TOLERANCE TEST-Q | $69.50 | $139.00 | $88.96–$139.00 | 9% above | 50% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE, GESTATION | $73.00 | $146.00 | $93.44–$146.00 | 14% above | 50% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 LACTOSE TOLERANCE TEST-Q | $69.50 | $139.00 | $90.35–$139.00 | — | 50% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE, GESTATION | $73.00 | $146.00 | $94.90–$146.00 | — | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC DIRECT/LAB | $61.50 | $123.00 | $78.72–$123.00 | 7% below | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC DIRECT/LAB | $61.50 | $123.00 | $79.95–$123.00 | — | 50% |
| H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI AB | $77.50 | $155.00 | $99.20–$155.00 | 1% above | 50% |
| H. pylori antibody blood test CPT 86677 H PYLORI ANTIBODY | $77.50 | $155.00 | $99.20–$155.00 | 1% above | 50% |
| H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI AB | $77.50 | $155.00 | $100.75–$155.00 | — | 50% |
| H. pylori antibody blood test inpatient CPT 86677 H PYLORI ANTIBODY | $77.50 | $155.00 | $100.75–$155.00 | — | 50% |
| H. pylori stool antigen test CPT 87338 H PYLORI AG, FECAL BY EIA | $133.00 | $266.00 | $170.24–$266.00 | 15% above | 50% |
| H. pylori stool antigen test inpatient CPT 87338 H PYLORI AG, FECAL BY EIA | $133.00 | $266.00 | $172.90–$266.00 | — | 50% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA QUANT BY PCR | $229.00 | $458.00 | $293.12–$458.00 | at median | 50% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA QUANT BY PCR | $229.00 | $458.00 | $297.70–$458.00 | — | 50% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV 1 AND HIV 2 ANTIBODY | $45.50 | $91.00 | $58.24–$91.00 | at median | 50% |
| HIV-1 and HIV-2 antibody test CPT 86703 HTLV III (HIV) | $45.50 | $91.00 | $58.24–$91.00 | at median | 50% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1 AND HIV 2 ANTIBODY | $45.50 | $91.00 | $59.15–$91.00 | — | 50% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HTLV III (HIV) | $45.50 | $91.00 | $59.15–$91.00 | — | 50% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV COMBO ANTIGEN/ANTIBODY REF | $33.50 | $67.00 | $42.88–$67.00 | 29% below | 50% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV COMBO ANTIGEN/ANTIBODY REF | $33.50 | $67.00 | $43.55–$67.00 | — | 50% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV DNA ASSAY HIGH RISK | $72.00 | $144.00 | $92.16–$144.00 | 1% above | 50% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV DNA ASSAY HIGH RISK | $72.00 | $144.00 | $93.60–$144.00 | — | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLAT HEMOGLB TST SNGV | $57.00 | $114.00 | $72.96–$114.00 | 9% above | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 POC HEMOGLOBIN A1C | $57.00 | $114.00 | $72.96–$114.00 | 9% above | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSALATED HGB/LAB | $57.00 | $114.00 | $72.96–$114.00 | 9% above | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLATED HEMOGLOB TEST | $76.00 | $152.00 | $97.28–$152.00 | 45% above | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCOSYLAT HEMOGLB TST SNGV | $57.00 | $114.00 | $74.10–$114.00 | — | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 POC HEMOGLOBIN A1C | $57.00 | $114.00 | $74.10–$114.00 | — | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSALATED HGB/LAB | $57.00 | $114.00 | $74.10–$114.00 | — | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCOSYLATED HEMOGLOB TEST | $76.00 | $152.00 | $98.80–$152.00 | — | 50% |
| Hemoglobin blood test CPT 85018 HEMOGLOBIN-Q | $12.00 | $24.00 | $15.36–$24.00 | 21% below | 50% |
| Hemoglobin blood test CPT 85018 HEMOGLOBIN/LAB | $12.50 | $25.00 | $16.00–$25.00 | 18% below | 50% |
| Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN-Q | $12.00 | $24.00 | $15.60–$24.00 | — | 50% |
| Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN/LAB | $12.50 | $25.00 | $16.25–$25.00 | — | 50% |
| Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B ABY, TOT | $58.00 | $116.00 | $74.24–$116.00 | 5% below | 50% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B ABY, TOT | $58.00 | $116.00 | $75.40–$116.00 | — | 50% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ABY | $52.00 | $104.00 | $66.56–$104.00 | 3% above | 50% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE ABY | $52.00 | $104.00 | $67.60–$104.00 | — | 50% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B ANTIGEN | $49.50 | $99.00 | $63.36–$99.00 | 2% above | 50% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B ANTIGEN | $49.50 | $99.00 | $64.35–$99.00 | — | 50% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ABY | $71.00 | $142.00 | $90.88–$142.00 | 3% below | 50% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ABY | $71.00 | $142.00 | $92.30–$142.00 | — | 50% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C RNA, QUANTITATIVE | $181.50 | $363.00 | $232.32–$363.00 | 5% above | 50% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C RNA, QUANTITATIVE | $181.50 | $363.00 | $235.95–$363.00 | — | 50% |
| Herpes blood test, HSV-1 antibody CPT 86695 HSV TP 1 GLYCOPROTIEN IGG | $51.50 | $103.00 | $65.92–$103.00 | 2% below | 50% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV TP 1 GLYCOPROTIEN IGG | $51.50 | $103.00 | $66.95–$103.00 | — | 50% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX VIRUS | $69.00 | $138.00 | $88.32–$138.00 | 3% below | 50% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX VIRUS | $69.00 | $138.00 | $89.70–$138.00 | — | 50% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 CRP-HIGH SENSITIVITY-Q | $55.50 | $111.00 | $71.04–$111.00 | 7% above | 50% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 CRP HIGH SENSITIVITY Q | $55.50 | $111.00 | $71.04–$111.00 | 7% above | 50% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 CRP HIGH SENSITIVITY | $55.50 | $111.00 | $71.04–$111.00 | 7% above | 50% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP HIGH SENSITIVITY | $55.50 | $111.00 | $72.15–$111.00 | — | 50% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP HIGH SENSITIVITY Q | $55.50 | $111.00 | $72.15–$111.00 | — | 50% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP-HIGH SENSITIVITY-Q | $55.50 | $111.00 | $72.15–$111.00 | — | 50% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE | $77.00 | $154.00 | $98.56–$154.00 | 6% above | 50% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE | $77.00 | $154.00 | $100.10–$154.00 | — | 50% |
| Insulin blood test CPT 83525 INSULIN/LAB | $69.50 | $139.00 | $88.96–$139.00 | 7% above | 50% |
| Insulin blood test inpatient CPT 83525 INSULIN/LAB | $69.50 | $139.00 | $90.35–$139.00 | — | 50% |
| Iron blood test (serum iron) CPT 83540 IRON/LAB | $39.00 | $78.00 | $49.92–$78.00 | 4% above | 50% |
| Iron blood test (serum iron) CPT 83540 IRON | $39.00 | $78.00 | $49.92–$78.00 | 4% above | 50% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON | $39.00 | $78.00 | $50.70–$78.00 | — | 50% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON/LAB | $39.00 | $78.00 | $50.70–$78.00 | — | 50% |
| Iron-binding capacity (TIBC) test CPT 83550 IBC/LAB | $45.00 | $90.00 | $57.60–$90.00 | 12% above | 50% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IBC/LAB | $45.00 | $90.00 | $58.50–$90.00 | — | 50% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL-Q | $51.00 | $102.00 | $65.28–$102.00 | 24% below | 50% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $51.00 | $102.00 | $65.28–$102.00 | 24% below | 50% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $51.00 | $102.00 | $66.30–$102.00 | — | 50% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL-Q | $51.00 | $102.00 | $66.30–$102.00 | — | 50% |
| LH (luteinizing hormone) test CPT 83002 LH/LAB | $106.50 | $213.00 | $136.32–$213.00 | 26% above | 50% |
| LH (luteinizing hormone) test inpatient CPT 83002 LH/LAB | $106.50 | $213.00 | $138.45–$213.00 | — | 50% |
| Lactate (lactic acid) blood test CPT 83605 LACTIC ACID | $60.50 | $121.00 | $77.44–$121.00 | 4% above | 50% |
| Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID | $60.50 | $121.00 | $78.65–$121.00 | — | 50% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE DEHYDROGENASE (LDH)-Q | $29.00 | $58.00 | $37.12–$58.00 | 19% below | 50% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH BODY FLUID-Q | $30.50 | $61.00 | $39.04–$61.00 | 15% below | 50% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 TOTAL LD (ARUP) | $30.50 | $61.00 | $39.04–$61.00 | 15% below | 50% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 BODY FLUID LDH | $30.50 | $61.00 | $39.04–$61.00 | 15% below | 50% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH,SERUM/LAB | $30.50 | $61.00 | $39.04–$61.00 | 15% below | 50% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE DEHYDROGENASE (LDH)-Q | $29.00 | $58.00 | $37.70–$58.00 | — | 50% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 BODY FLUID LDH | $30.50 | $61.00 | $39.65–$61.00 | — | 50% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH,SERUM/LAB | $30.50 | $61.00 | $39.65–$61.00 | — | 50% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH BODY FLUID-Q | $30.50 | $61.00 | $39.65–$61.00 | — | 50% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 TOTAL LD (ARUP) | $30.50 | $61.00 | $39.65–$61.00 | — | 50% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE/LAB | $46.50 | $93.00 | $59.52–$93.00 | 1% above | 50% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE LEVEL-Q | $46.50 | $93.00 | $59.52–$93.00 | 1% above | 50% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE LEVEL-Q | $46.50 | $93.00 | $60.45–$93.00 | — | 50% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE/LAB | $46.50 | $93.00 | $60.45–$93.00 | — | 50% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL-Q | $69.50 | $139.00 | $88.96–$139.00 | 16% below | 50% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PAN | $73.00 | $146.00 | $93.44–$146.00 | 12% below | 50% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL-Q | $69.50 | $139.00 | $90.35–$139.00 | — | 50% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PAN | $73.00 | $146.00 | $94.90–$146.00 | — | 50% |
| Lyme disease antibody test CPT 86618 LYME DISEASE TITER/LAB | $81.00 | $162.00 | $103.68–$162.00 | 4% above | 50% |
| Lyme disease antibody test CPT 86618 LYME DISEASE, CSF | $81.00 | $162.00 | $103.68–$162.00 | 4% above | 50% |
| Lyme disease antibody test inpatient CPT 86618 LYME DISEASE TITER/LAB | $81.00 | $162.00 | $105.30–$162.00 | — | 50% |
| Lyme disease antibody test inpatient CPT 86618 LYME DISEASE, CSF | $81.00 | $162.00 | $105.30–$162.00 | — | 50% |
| Magnesium blood test CPT 83735 MAGNESIUM LEVEL-Q | $48.50 | $97.00 | $62.08–$97.00 | 21% above | 50% |
| Magnesium blood test CPT 83735 MAGNESIUM URINE TIMED-Q | $51.00 | $102.00 | $65.28–$102.00 | 27% above | 50% |
| Magnesium blood test CPT 83735 MAGNESIUM URINE RANDOM COLCT-Q | $51.00 | $102.00 | $65.28–$102.00 | 27% above | 50% |
| Magnesium blood test CPT 83735 MAGNESIUM/LAB | $51.00 | $102.00 | $65.28–$102.00 | 27% above | 50% |
| Magnesium blood test CPT 83735 URINE MAGNESIUM LAB | $51.00 | $102.00 | $65.28–$102.00 | 27% above | 50% |
| Magnesium blood test CPT 83735 MAGNESIUM, RBC'S | $51.00 | $102.00 | $65.28–$102.00 | 27% above | 50% |
| Magnesium blood test CPT 83735 STONE ANALYSIS MAGNESIUM | $51.00 | $102.00 | $65.28–$102.00 | 27% above | 50% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM LEVEL-Q | $48.50 | $97.00 | $63.05–$97.00 | — | 50% |
| Magnesium blood test inpatient CPT 83735 STONE ANALYSIS MAGNESIUM | $51.00 | $102.00 | $66.30–$102.00 | — | 50% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM URINE TIMED-Q | $51.00 | $102.00 | $66.30–$102.00 | — | 50% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM, RBC'S | $51.00 | $102.00 | $66.30–$102.00 | — | 50% |
| Magnesium blood test inpatient CPT 83735 URINE MAGNESIUM LAB | $51.00 | $102.00 | $66.30–$102.00 | — | 50% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM/LAB | $51.00 | $102.00 | $66.30–$102.00 | — | 50% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM URINE RANDOM COLCT-Q | $51.00 | $102.00 | $66.30–$102.00 | — | 50% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA IGM ANTIBODY | $43.00 | $86.00 | $55.04–$86.00 | 22% above | 50% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA SCREEN/LAB | $43.00 | $86.00 | $55.04–$86.00 | 22% above | 50% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA IGM ANTIBODY | $43.00 | $86.00 | $55.90–$86.00 | — | 50% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA SCREEN/LAB | $43.00 | $86.00 | $55.90–$86.00 | — | 50% |
| Mono test (heterophile antibody, Monospot) CPT 86308 INFECTIOUS MONO/LAB | $34.00 | $68.00 | $43.52–$68.00 | 6% below | 50% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 INFECTIOUS MONO/LAB | $34.00 | $68.00 | $44.20–$68.00 | — | 50% |
| Mumps immunity blood test CPT 86735 MUMPS IGM/LAB | $54.50 | $109.00 | $69.76–$109.00 | 47% above | 50% |
| Mumps immunity blood test CPT 86735 MUMPS IGG (IMMUNE STATUS) | $54.50 | $109.00 | $69.76–$109.00 | 47% above | 50% |
| Mumps immunity blood test CPT 86735 MUMPS TITER, IGM | $54.50 | $109.00 | $69.76–$109.00 | 47% above | 50% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS TITER, IGM | $54.50 | $109.00 | $70.85–$109.00 | — | 50% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS IGG (IMMUNE STATUS) | $54.50 | $109.00 | $70.85–$109.00 | — | 50% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS IGM/LAB | $54.50 | $109.00 | $70.85–$109.00 | — | 50% |
| Obstetric blood test panel CPT 80055 PRENATAL PROFILE | $243.50 | $487.00 | $311.68–$487.00 | 71% above | 50% |
| Obstetric blood test panel inpatient CPT 80055 PRENATAL PROFILE | $243.50 | $487.00 | $316.55–$487.00 | — | 50% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE | $81.50 | $163.00 | $104.32–$163.00 | 12% below | 50% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, FREE | $81.50 | $163.00 | $105.95–$163.00 | — | 50% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPE-AG/LAB | $73.50 | $147.00 | $94.08–$147.00 | 2% above | 50% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA TOTAL(PART OF PSA FREE) | $73.50 | $147.00 | $94.08–$147.00 | 2% above | 50% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SPE-AG/LAB | $73.50 | $147.00 | $95.55–$147.00 | — | 50% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA TOTAL(PART OF PSA FREE) | $73.50 | $147.00 | $95.55–$147.00 | — | 50% |
| Pap test (liquid-based, automated screening with review) CPT 88175 THIN PREP TEST IMAGIN | $39.50 | $79.00 | $50.56–$79.00 | 38% below | 50% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 THIN PREP TEST IMAGIN | $39.50 | $79.00 | $51.35–$79.00 | — | 50% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 SUREPATH PAP SMR-PREP-NO INTRP | $55.00 | $110.00 | $70.40–$110.00 | 22% below | 50% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATHOLOGY, PAP SMEAR | $55.00 | $110.00 | $70.40–$110.00 | 22% below | 50% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATHOLOGY, PAP SMEAR | $55.00 | $110.00 | $71.50–$110.00 | — | 50% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 SUREPATH PAP SMR-PREP-NO INTRP | $55.00 | $110.00 | $71.50–$110.00 | — | 50% |
| Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT MOLECULE W/CALCIUM | $76.50 | $153.00 | $97.92–$153.00 | 22% below | 50% |
| Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT/LAB | $76.50 | $153.00 | $97.92–$153.00 | 22% below | 50% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT/LAB | $76.50 | $153.00 | $99.45–$153.00 | — | 50% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT MOLECULE W/CALCIUM | $76.50 | $153.00 | $99.45–$153.00 | — | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT/LAB | $42.00 | $84.00 | $53.76–$84.00 | 3% below | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $42.00 | $84.00 | $53.76–$84.00 | 3% below | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL | $42.00 | $84.00 | $54.60–$84.00 | — | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT/LAB | $42.00 | $84.00 | $54.60–$84.00 | — | 50% |
| Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS LEVEL-Q | $19.50 | $39.00 | $24.96–$39.00 | 30% below | 50% |
| Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS/LAB | $20.50 | $41.00 | $26.24–$41.00 | 26% below | 50% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS LEVEL-Q | $19.50 | $39.00 | $25.35–$39.00 | — | 50% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS/LAB | $20.50 | $41.00 | $26.65–$41.00 | — | 50% |
| Potassium blood test CPT 84132 POTASSIUM LEVEL-Q | $19.00 | $38.00 | $24.32–$38.00 | 22% below | 50% |
| Potassium blood test CPT 84132 POTASSIUM,SERUM/LAB | $20.00 | $40.00 | $25.60–$40.00 | 18% below | 50% |
| Potassium blood test inpatient CPT 84132 POTASSIUM LEVEL-Q | $19.00 | $38.00 | $24.70–$38.00 | — | 50% |
| Potassium blood test inpatient CPT 84132 POTASSIUM,SERUM/LAB | $20.00 | $40.00 | $26.00–$40.00 | — | 50% |
| Progesterone blood test CPT 84144 PROGESTERONE/LAB | $92.00 | $184.00 | $117.76–$184.00 | 4% above | 50% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE/LAB | $92.00 | $184.00 | $119.60–$184.00 | — | 50% |
| Prolactin blood test CPT 84146 PROLACTIN DILUTION STUDY | $87.50 | $175.00 | $112.00–$175.00 | 17% above | 50% |
| Prolactin blood test CPT 84146 PROLACTIN/LAB | $87.50 | $175.00 | $112.00–$175.00 | 17% above | 50% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN DILUTION STUDY | $87.50 | $175.00 | $113.75–$175.00 | — | 50% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN/LAB | $87.50 | $175.00 | $113.75–$175.00 | — | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME/LAB | $30.50 | $61.00 | $39.04–$61.00 | 4% above | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROMTHROMBIN TIME/LAB | $30.50 | $61.00 | $39.04–$61.00 | 4% above | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME/LAB | $30.50 | $61.00 | $39.65–$61.00 | — | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROMTHROMBIN TIME/LAB | $30.50 | $61.00 | $39.65–$61.00 | — | 50% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 RAPID GROUP A STREPTOCOCCAL | $39.00 | $78.00 | $49.92–$78.00 | 1% below | 50% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 RAPID STREP | $39.00 | $78.00 | $49.92–$78.00 | 1% below | 50% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RAPID STREP | $39.00 | $78.00 | $50.70–$78.00 | — | 50% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RAPID GROUP A STREPTOCOCCAL | $39.00 | $78.00 | $50.70–$78.00 | — | 50% |
| Renin blood test CPT 84244 RENIN 1 | $79.00 | $158.00 | $101.12–$158.00 | 7% above | 50% |
| Renin blood test inpatient CPT 84244 RENIN 1 | $79.00 | $158.00 | $102.70–$158.00 | — | 50% |
| Rh blood typing CPT 86901 RH TYPE | $44.00 | $88.00 | $56.32–$88.00 | 21% above | 50% |
| Rh blood typing inpatient CPT 86901 RH TYPE | $44.00 | $88.00 | $57.20–$88.00 | — | 50% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT | $36.00 | $72.00 | $46.08–$72.00 | 7% above | 50% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR | $36.00 | $72.00 | $46.08–$72.00 | 7% above | 50% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR | $36.00 | $72.00 | $46.80–$72.00 | — | 50% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT | $36.00 | $72.00 | $46.80–$72.00 | — | 50% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA TITER | $49.00 | $98.00 | $62.72–$98.00 | 2% below | 50% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA TITER | $49.00 | $98.00 | $63.70–$98.00 | — | 50% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE (ESR)-Q | $31.00 | $62.00 | $39.68–$62.00 | 4% above | 50% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE | $31.00 | $62.00 | $39.68–$62.00 | 4% above | 50% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE | $31.00 | $62.00 | $40.30–$62.00 | — | 50% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE (ESR)-Q | $31.00 | $62.00 | $40.30–$62.00 | — | 50% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS/LAB | $34.50 | $69.00 | $44.16–$69.00 | 58% below | 50% |
| Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANALYSIS/LAB | $34.50 | $69.00 | $44.85–$69.00 | — | 50% |
| Sodium blood test CPT 84295 SODIUM LEVEL-Q | $18.00 | $36.00 | $23.04–$36.00 | 24% below | 50% |
| Sodium blood test CPT 84295 SODIUM , SERUM | $19.00 | $38.00 | $24.32–$38.00 | 20% below | 50% |
| Sodium blood test inpatient CPT 84295 SODIUM LEVEL-Q | $18.00 | $36.00 | $23.40–$36.00 | — | 50% |
| Sodium blood test inpatient CPT 84295 SODIUM , SERUM | $19.00 | $38.00 | $24.70–$38.00 | — | 50% |
| Stool ova and parasites exam CPT 87177 OVA&PARASITE COMP-TRAVEL HIST | $31.50 | $63.00 | $40.32–$63.00 | 14% below | 50% |
| Stool ova and parasites exam inpatient CPT 87177 OVA&PARASITE COMP-TRAVEL HIST | $31.50 | $63.00 | $40.95–$63.00 | — | 50% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 HEMOCCULT | $17.00 | $34.00 | $21.76–$34.00 | 18% below | 50% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD ANNUAL SCREEN | $17.00 | $34.00 | $21.76–$34.00 | 18% below | 50% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD ANNUAL SCREEN | $17.00 | $34.00 | $22.10–$34.00 | — | 50% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HEMOCCULT | $17.00 | $34.00 | $22.10–$34.00 | — | 50% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 ASSAY TEST FOR BLOOD FECAL | $37.00 | $74.00 | $47.36–$74.00 | 9% below | 50% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 ASSAY TEST FOR BLOOD FECAL | $37.00 | $74.00 | $48.10–$74.00 | — | 50% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 RPR-FTA-ABS (CONFIRMATION) | $52.00 | $104.00 | $66.56–$104.00 | 3% below | 50% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 RPR-FTA-ABS (CONFIRMATION) | $52.00 | $104.00 | $67.60–$104.00 | — | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR/LAB | $30.50 | $61.00 | $39.04–$61.00 | 2% below | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 CSF TREPONEMA PALLIDUM (VDRL) | $30.50 | $61.00 | $39.04–$61.00 | 2% below | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 CSF TREPONEMA PALLIDUM (VDRL) | $30.50 | $61.00 | $39.65–$61.00 | — | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR/LAB | $30.50 | $61.00 | $39.65–$61.00 | — | 50% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB QUANTIFERON GOLD/LAB | $104.00 | $208.00 | $133.12–$208.00 | 11% below | 50% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB QUANTIFERON GOLD/LAB | $104.00 | $208.00 | $135.20–$208.00 | — | 50% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERON, FREE PANEL | $111.50 | $223.00 | $142.72–$223.00 | 22% above | 50% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE/LAB | $111.50 | $223.00 | $142.72–$223.00 | 22% above | 50% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERON, FREE PANEL | $111.50 | $223.00 | $144.95–$223.00 | — | 50% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE/LAB | $111.50 | $223.00 | $144.95–$223.00 | — | 50% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID AUTOANTIBODY | $86.50 | $173.00 | $110.72–$173.00 | 1% above | 50% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSOME AB/LAB | $86.50 | $173.00 | $110.72–$173.00 | 1% above | 50% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID AUTOANTIBODY | $86.50 | $173.00 | $112.45–$173.00 | — | 50% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY MICROSOME AB/LAB | $86.50 | $173.00 | $112.45–$173.00 | — | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH/LAB | $80.00 | $160.00 | $102.40–$160.00 | 3% above | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH/LAB | $80.00 | $160.00 | $104.00–$160.00 | — | 50% |
| Total IgE blood test CPT 82785 IG E | $86.00 | $172.00 | $110.08–$172.00 | 35% above | 50% |
| Total IgE blood test CPT 82785 IMMUNOGLOBIN E | $86.00 | $172.00 | $110.08–$172.00 | 35% above | 50% |
| Total IgE blood test inpatient CPT 82785 IG E | $86.00 | $172.00 | $111.80–$172.00 | — | 50% |
| Total IgE blood test inpatient CPT 82785 IMMUNOGLOBIN E | $86.00 | $172.00 | $111.80–$172.00 | — | 50% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL TOTAL-Q | $33.00 | $66.00 | $42.24–$66.00 | 35% above | 50% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL/LAB | $34.50 | $69.00 | $44.16–$69.00 | 41% above | 50% |
| Total cholesterol blood test CPT 82465 ASSAY BLD/SERUM CHOLESTEROL | $34.50 | $69.00 | $44.16–$69.00 | 41% above | 50% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL TOTAL-Q | $33.00 | $66.00 | $42.90–$66.00 | — | 50% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL/LAB | $34.50 | $69.00 | $44.85–$69.00 | — | 50% |
| Total cholesterol blood test inpatient CPT 82465 ASSAY BLD/SERUM CHOLESTEROL | $34.50 | $69.00 | $44.85–$69.00 | — | 50% |
| Total thyroxine (T4) blood test CPT 84436 TOTAL T4 | $50.00 | $100.00 | $64.00–$100.00 | 3% above | 50% |
| Total thyroxine (T4) blood test inpatient CPT 84436 TOTAL T4 | $50.00 | $100.00 | $65.00–$100.00 | — | 50% |
| Total triiodothyronine (T3) blood test CPT 84480 TOTAL T3 | $67.50 | $135.00 | $86.40–$135.00 | 20% below | 50% |
| Total triiodothyronine (T3) blood test CPT 84480 T3 TOTAL | $67.50 | $135.00 | $86.40–$135.00 | 20% below | 50% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 TOTAL | $67.50 | $135.00 | $87.75–$135.00 | — | 50% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 TOTAL T3 | $67.50 | $135.00 | $87.75–$135.00 | — | 50% |
| Transferrin blood test CPT 84466 TRANSFERRIN | $36.00 | $72.00 | $46.08–$72.00 | 38% below | 50% |
| Transferrin blood test inpatient CPT 84466 TRANSFERRIN | $36.00 | $72.00 | $46.80–$72.00 | — | 50% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS BY PCR/LAB | $92.50 | $185.00 | $118.40–$185.00 | 3% above | 50% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS BY PCR/LAB | $92.50 | $185.00 | $120.25–$185.00 | — | 50% |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES/LAB | $45.00 | $90.00 | $57.60–$90.00 | 1% above | 50% |
| Triglycerides blood test CPT 84478 TRIGLYCERIDE BODY FLUID | $45.00 | $90.00 | $57.60–$90.00 | 1% above | 50% |
| Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDE BODY FLUID | $45.00 | $90.00 | $58.50–$90.00 | — | 50% |
| Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES/LAB | $45.00 | $90.00 | $58.50–$90.00 | — | 50% |
| Troponin test, quantitative CPT 84484 TROPONIN | $112.50 | $225.00 | $144.00–$225.00 | 41% above | 50% |
| Troponin test, quantitative CPT 84484 TROPONIN T HS (RANDOM)-Q | $112.50 | $225.00 | $144.00–$225.00 | 41% above | 50% |
| Troponin test, quantitative inpatient CPT 84484 TROPONIN | $112.50 | $225.00 | $146.25–$225.00 | — | 50% |
| Troponin test, quantitative inpatient CPT 84484 TROPONIN T HS (RANDOM)-Q | $112.50 | $225.00 | $146.25–$225.00 | — | 50% |
| Uric acid blood test CPT 84550 URIC ACID-Q | $31.00 | $62.00 | $39.68–$62.00 | at median | 50% |
| Uric acid blood test CPT 84550 URIC ACID,SERUM/LAB | $32.50 | $65.00 | $41.60–$65.00 | 5% above | 50% |
| Uric acid blood test inpatient CPT 84550 URIC ACID-Q | $31.00 | $62.00 | $40.30–$62.00 | — | 50% |
| Uric acid blood test inpatient CPT 84550 URIC ACID,SERUM/LAB | $32.50 | $65.00 | $42.25–$65.00 | — | 50% |
| Urinalysis with microscope exam, automated CPT 81001 MICRO SEDIMNT & DIPSTIK (AUTO) | $23.50 | $47.00 | $30.08–$47.00 | 31% below | 50% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS REFLEX TO CULTURE-Q | $23.50 | $47.00 | $30.08–$47.00 | 31% below | 50% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 MICRO SEDIMNT & DIPSTIK (AUTO) | $23.50 | $47.00 | $30.55–$47.00 | — | 50% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS REFLEX TO CULTURE-Q | $23.50 | $47.00 | $30.55–$47.00 | — | 50% |
| Urinalysis with microscope exam, manual CPT 81000 MICRO SEDIMNT & DIPSTICK(MAN) | $13.50 | $27.00 | $17.28–$27.00 | 46% below | 50% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 MICRO SEDIMNT & DIPSTICK(MAN) | $13.50 | $27.00 | $17.55–$27.00 | — | 50% |
| Urinalysis without microscope exam, automated CPT 81003 DIPSTICK-URINE LAB/SCREEN | $18.50 | $37.00 | $23.68–$37.00 | 14% below | 50% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O MICRO | $18.50 | $37.00 | $23.68–$37.00 | 14% below | 50% |
| Urinalysis without microscope exam, automated CPT 81003 URINE SCREEN/LAB | $18.50 | $37.00 | $23.68–$37.00 | 14% below | 50% |
| Urinalysis without microscope exam, automated CPT 81003 DISTICK- URINE LAB/SCREEN | $18.50 | $37.00 | $23.68–$37.00 | 14% below | 50% |
| Urinalysis without microscope exam, automated CPT 81003 PH URINE-Q | $24.00 | $48.00 | $30.72–$48.00 | 11% above | 50% |
| Urinalysis without microscope exam, automated CPT 81003 URINE PH/LAB | $24.00 | $48.00 | $30.72–$48.00 | 11% above | 50% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS W/MICROSCOPIC-Q | $24.00 | $48.00 | $30.72–$48.00 | 11% above | 50% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS MACROSCOPIC-Q | $24.00 | $48.00 | $30.72–$48.00 | 11% above | 50% |
| Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITY URINE-Q | $24.00 | $48.00 | $30.72–$48.00 | 11% above | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O MICRO | $18.50 | $37.00 | $24.05–$37.00 | — | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINE SCREEN/LAB | $18.50 | $37.00 | $24.05–$37.00 | — | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 DISTICK- URINE LAB/SCREEN | $18.50 | $37.00 | $24.05–$37.00 | — | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 DIPSTICK-URINE LAB/SCREEN | $18.50 | $37.00 | $24.05–$37.00 | — | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 PH URINE-Q | $24.00 | $48.00 | $31.20–$48.00 | — | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINE PH/LAB | $24.00 | $48.00 | $31.20–$48.00 | — | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS W/MICROSCOPIC-Q | $24.00 | $48.00 | $31.20–$48.00 | — | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS MACROSCOPIC-Q | $24.00 | $48.00 | $31.20–$48.00 | — | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 SPECIFIC GRAVITY URINE-Q | $24.00 | $48.00 | $31.20–$48.00 | — | 50% |
| Urinalysis without microscope exam, manual CPT 81002 DIPSTICK U/A | $13.50 | $27.00 | $17.28–$27.00 | 14% below | 50% |
| Urinalysis without microscope exam, manual CPT 81002 URINE SUGAR | $13.50 | $27.00 | $17.28–$27.00 | 14% below | 50% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE SUGAR | $13.50 | $27.00 | $17.55–$27.00 | — | 50% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 DIPSTICK U/A | $13.50 | $27.00 | $17.55–$27.00 | — | 50% |
| Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/LAB | $49.00 | $98.00 | $62.72–$98.00 | 24% below | 50% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE/LAB | $49.00 | $98.00 | $63.70–$98.00 | — | 50% |
| Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN URINE RNDM CLCT-Q | $66.00 | $132.00 | $84.48–$132.00 | 29% above | 50% |
| Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN URINE TIMED-Q | $66.00 | $132.00 | $84.48–$132.00 | 29% above | 50% |
| Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN, URINE | $66.00 | $132.00 | $84.48–$132.00 | 29% above | 50% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN, URINE | $66.00 | $132.00 | $85.80–$132.00 | — | 50% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN URINE RNDM CLCT-Q | $66.00 | $132.00 | $85.80–$132.00 | — | 50% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN URINE TIMED-Q | $66.00 | $132.00 | $85.80–$132.00 | — | 50% |
| Urine pregnancy test, read by color change CPT 81025 BETA HCG QUALITATIVE URINE-Q | $29.50 | $59.00 | $37.76–$59.00 | 5% above | 50% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST | $31.00 | $62.00 | $39.68–$62.00 | 11% above | 50% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY | $31.00 | $62.00 | $39.68–$62.00 | 11% above | 50% |
| Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST,URINE | $31.00 | $62.00 | $39.68–$62.00 | 11% above | 50% |
| Urine pregnancy test, read by color change inpatient CPT 81025 BETA HCG QUALITATIVE URINE-Q | $29.50 | $59.00 | $38.35–$59.00 | — | 50% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY | $31.00 | $62.00 | $40.30–$62.00 | — | 50% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST | $31.00 | $62.00 | $40.30–$62.00 | — | 50% |
| Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST,URINE | $31.00 | $62.00 | $40.30–$62.00 | — | 50% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 LEVEL REFLEX | $89.00 | $178.00 | $113.92–$178.00 | 4% above | 50% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12/LAB | $93.50 | $187.00 | $119.68–$187.00 | 9% above | 50% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 LEVEL REFLEX | $89.00 | $178.00 | $115.70–$178.00 | — | 50% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12/LAB | $93.50 | $187.00 | $121.55–$187.00 | — | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25/LAB | $90.00 | $180.00 | $115.20–$180.00 | 21% below | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D2 AND D3 LCMS | $90.00 | $180.00 | $115.20–$180.00 | 21% below | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D2 AND D3 LCMS | $90.00 | $180.00 | $117.00–$180.00 | — | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25/LAB | $90.00 | $180.00 | $117.00–$180.00 | — | 50% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D, 1.25-DIHYDROXY | $133.50 | $267.00 | $170.88–$267.00 | 2% above | 50% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D, 1.25-DIHYDROXY | $133.50 | $267.00 | $173.55–$267.00 | — | 50% |
| Zinc blood test CPT 84630 ZINC | $48.50 | $97.00 | $62.08–$97.00 | 15% above | 50% |
| Zinc blood test CPT 84630 HC ZINC, RED BLOOD CELLS | $57.00 | $114.00 | $72.96–$114.00 | 35% above | 50% |
| Zinc blood test inpatient CPT 84630 ZINC | $48.50 | $97.00 | $63.05–$97.00 | — | 50% |
| Zinc blood test inpatient CPT 84630 HC ZINC, RED BLOOD CELLS | $57.00 | $114.00 | $74.10–$114.00 | — | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG-BET SUBUNIT | $76.50 | $153.00 | $97.92–$153.00 | 6% below | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BHCG CHARGE | $76.50 | $153.00 | $97.92–$153.00 | 6% below | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN | $76.50 | $153.00 | $97.92–$153.00 | 6% below | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG QUANTITATIVE SERUM-Q | $76.50 | $153.00 | $97.92–$153.00 | 6% below | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG QUANTITATIVE SERUM-Q | $76.50 | $153.00 | $99.45–$153.00 | — | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG-BET SUBUNIT | $76.50 | $153.00 | $99.45–$153.00 | — | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BHCG CHARGE | $76.50 | $153.00 | $99.45–$153.00 | — | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN | $76.50 | $153.00 | $99.45–$153.00 | — | 50% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Maine | Off list |
|---|---|---|---|---|---|
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION EXTERNAL FAC | $554.50 | $1,109.00 | $709.76–$1,109.00 | 14% above | 50% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION EXTERNAL FAC | $554.50 | $1,109.00 | $720.85–$1,109.00 | — | 50% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 COLPOSCOPY W/BIOPSY F | $165.00 | $330.00 | $211.20–$330.00 | 21% below | 50% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 COLPOSCOPY W/BIOPSY F | $165.00 | $330.00 | $214.50–$330.00 | — | 50% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOSCOPY/URETHROSCOPY | $271.00 | $542.00 | $346.88–$542.00 | 51% below | 50% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC CYSTOSCOPY/URETHROSCOPY | $271.00 | $542.00 | $352.30–$542.00 | — | 50% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 HC D & C DX&/THER NONOBSTETRIC | $406.00 | $812.00 | $519.68–$812.00 | 74% below | 50% |
| D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC D & C DX&/THER NONOBSTETRIC | $406.00 | $812.00 | $527.80–$812.00 | — | 50% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DSTRC PREMALGNT LES 1ST LES | $79.00 | $158.00 | $101.12–$158.00 | 14% below | 50% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION F | $98.50 | $197.00 | $126.08–$197.00 | 7% above | 50% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DEST CHMO/CRYOSURG 1ST LSION F | $98.50 | $197.00 | $126.08–$197.00 | 7% above | 50% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTN LESION 1ST LESION F | $98.50 | $197.00 | $126.08–$197.00 | 7% above | 50% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DSTRUCT PREML LESION 1ST LES F | $98.50 | $197.00 | $126.08–$197.00 | 7% above | 50% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DSTRC PREMALGNT LES 1ST LES | $79.00 | $158.00 | $102.70–$158.00 | — | 50% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTN LESION 1ST LESION F | $98.50 | $197.00 | $128.05–$197.00 | — | 50% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALG LESION F | $98.50 | $197.00 | $128.05–$197.00 | — | 50% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DSTRUCT PREML LESION 1ST LES F | $98.50 | $197.00 | $128.05–$197.00 | — | 50% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DEST CHMO/CRYOSURG 1ST LSION F | $98.50 | $197.00 | $128.05–$197.00 | — | 50% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI | $50.00 | $100.00 | $64.00–$100.00 | at median | 50% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMACTED CERUMEN UNI MA | $50.00 | $100.00 | $64.00–$100.00 | at median | 50% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 RH REMVE IMPCTD CERUMEN UNI MA | $50.00 | $100.00 | $64.00–$100.00 | at median | 50% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI | $50.00 | $100.00 | $65.00–$100.00 | — | 50% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMACTED CERUMEN UNI MA | $50.00 | $100.00 | $65.00–$100.00 | — | 50% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE IMPATD CERUMEN F | $55.00 | $110.00 | $70.40–$110.00 | 5% below | 50% |
| Earwax removal with instruments, one ear CPT 69210 REMOVAL IMPACTED CERUMEN F | $55.00 | $110.00 | $70.40–$110.00 | 5% below | 50% |
| Earwax removal with instruments, one ear CPT 69210 ER IMPACT. CERUMEN REVL | $55.00 | $110.00 | $70.40–$110.00 | 5% below | 50% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPATD CERUMEN F | $55.00 | $110.00 | $71.50–$110.00 | — | 50% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REMOVAL IMPACTED CERUMEN F | $55.00 | $110.00 | $71.50–$110.00 | — | 50% |
| Earwax removal with instruments, one ear inpatient CPT 69210 ER IMPACT. CERUMEN REVL | $55.00 | $110.00 | $71.50–$110.00 | — | 50% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BIOPSY F | $132.00 | $264.00 | $168.96–$264.00 | 34% below | 50% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BIOPSY F | $132.00 | $264.00 | $171.60–$264.00 | — | 50% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE | $68.50 | $137.00 | $87.68–$137.00 | 59% below | 50% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT INTRAUTERINE DEVICE | $68.50 | $137.00 | $89.05–$137.00 | — | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D ABSC SMPL/SNGL | $125.00 | $250.00 | $160.00–$250.00 | 22% below | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I & D SKIN ABSCESS F | $156.50 | $313.00 | $200.32–$313.00 | 2% below | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE F | $156.50 | $313.00 | $200.32–$313.00 | 2% below | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I & D PARONYCHIA F | $156.50 | $313.00 | $200.32–$313.00 | 2% below | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC DRAINAGE OF SKIN ABSCESS | $156.50 | $313.00 | $200.32–$313.00 | 2% below | 50% |
| Incision and drainage of a simple or single skin abscess CPT 10060 ER PARONYCHIA I&D | $156.50 | $313.00 | $200.32–$313.00 | 2% below | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D ABSC SMPL/SNGL | $125.00 | $250.00 | $162.50–$250.00 | — | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D PARONYCHIA F | $156.50 | $313.00 | $203.45–$313.00 | — | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ER PARONYCHIA I&D | $156.50 | $313.00 | $203.45–$313.00 | — | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE F | $156.50 | $313.00 | $203.45–$313.00 | — | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D SKIN ABSCESS F | $156.50 | $313.00 | $203.45–$313.00 | — | 50% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC DRAINAGE OF SKIN ABSCESS | $156.50 | $313.00 | $203.45–$313.00 | — | 50% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 TENDON LIGAMENT BURSA INJ F | $91.00 | $182.00 | $116.48–$182.00 | 52% below | 50% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT F | $91.00 | $182.00 | $116.48–$182.00 | 52% below | 50% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ 1 TENDN SHEATH/LIGAMENT F | $91.00 | $182.00 | $116.48–$182.00 | 52% below | 50% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ 1 TENDN SHEATH/LIGAMENT F | $91.00 | $182.00 | $118.30–$182.00 | — | 50% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 TENDON LIGAMENT BURSA INJ F | $91.00 | $182.00 | $118.30–$182.00 | — | 50% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT F | $91.00 | $182.00 | $118.30–$182.00 | — | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJECTION MAJ JOINT F | $90.00 | $180.00 | $115.20–$180.00 | 66% below | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT JOINT BURSA F | $90.00 | $180.00 | $115.20–$180.00 | 66% below | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC DRAIN/INJ MJR JNT/BURSA RT | $90.00 | $180.00 | $115.20–$180.00 | 66% below | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC DRAIN/INJ MJR JNT/BURSA LT | $90.00 | $180.00 | $115.20–$180.00 | 66% below | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJECTION MAJ JOINT F | $90.00 | $180.00 | $117.00–$180.00 | — | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJECT JOINT BURSA F | $90.00 | $180.00 | $117.00–$180.00 | — | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC DRAIN/INJ MJR JNT/BURSA RT | $90.00 | $180.00 | $117.00–$180.00 | — | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC DRAIN/INJ MJR JNT/BURSA LT | $90.00 | $180.00 | $117.00–$180.00 | — | 50% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERT DRUG IMPLANT DEVICE | $155.50 | $311.00 | $199.04–$311.00 | 35% above | 50% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC INSERT DRUG IMPLANT DEVICE | $155.50 | $311.00 | $202.15–$311.00 | — | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS/ASPIR JOINT F | $72.50 | $145.00 | $92.80–$145.00 | 60% below | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS MED JOINT F | $72.50 | $145.00 | $92.80–$145.00 | 60% below | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 INJECTION MED JOINT F | $72.50 | $145.00 | $92.80–$145.00 | 60% below | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ER ARTHROCENT/INJECT IM JT | $72.50 | $145.00 | $92.80–$145.00 | 60% below | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 INJECTION MED JOINT F | $72.50 | $145.00 | $94.25–$145.00 | — | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS MED JOINT F | $72.50 | $145.00 | $94.25–$145.00 | — | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS/ASPIR JOINT F | $72.50 | $145.00 | $94.25–$145.00 | — | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ER ARTHROCENT/INJECT IM JT | $72.50 | $145.00 | $94.25–$145.00 | — | 50% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ER ARTHROCENT/INJECT SM JT | $65.50 | $131.00 | $83.84–$131.00 | 67% below | 50% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS SMLL JOINT F | $65.50 | $131.00 | $83.84–$131.00 | 67% below | 50% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS SMALL JOINT F | $65.50 | $131.00 | $83.84–$131.00 | 67% below | 50% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ER ARTHROCENT/INJECT SM JT | $65.50 | $131.00 | $85.15–$131.00 | — | 50% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS SMALL JOINT F | $65.50 | $131.00 | $85.15–$131.00 | — | 50% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS SMLL JOINT F | $65.50 | $131.00 | $85.15–$131.00 | — | 50% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ER LAC (STE) <2.6I | $309.00 | $618.00 | $395.52–$618.00 | 7% above | 50% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 ER LAC (STE) <2.6I | $309.00 | $618.00 | $401.70–$618.00 | — | 50% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCS. BENIGN LESION <0.5CM F | $83.50 | $167.00 | $106.88–$167.00 | 51% below | 50% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCS. BENIGN LESION <0.5CM F | $83.50 | $167.00 | $108.55–$167.00 | — | 50% |
| Nail removal (partial or complete), one nail CPT 11730 ER NAIL AVULSION | $84.00 | $168.00 | $107.52–$168.00 | 36% below | 50% |
| Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION TEMP ONE F | $84.00 | $168.00 | $107.52–$168.00 | 36% below | 50% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 ER NAIL AVULSION | $84.00 | $168.00 | $109.20–$168.00 | — | 50% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION TEMP ONE F | $84.00 | $168.00 | $109.20–$168.00 | — | 50% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL MATRIX F | $286.50 | $573.00 | $366.72–$573.00 | 13% below | 50% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL MATRIX F | $286.50 | $573.00 | $372.45–$573.00 | — | 50% |
| Prostate biopsy CPT 55700 HC PROSTATE NEEDLE BIOPSY | $276.00 | $552.00 | $353.28–$552.00 | 37% below | 50% |
| Removal of a foreign object under the skin, simple CPT 10120 ER FB SKIN/TISS-SIMPL | $142.00 | $284.00 | $181.76–$284.00 | 38% below | 50% |
| Removal of a foreign object under the skin, simple CPT 10120 I&R FOREIGN BODY SIMPLE F | $142.00 | $284.00 | $181.76–$284.00 | 38% below | 50% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 I&R FOREIGN BODY SIMPLE F | $142.00 | $284.00 | $184.60–$284.00 | — | 50% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 ER FB SKIN/TISS-SIMPL | $142.00 | $284.00 | $184.60–$284.00 | — | 50% |
| Short arm cast (elbow to hand) CPT 29075 HC OT SHORT ARM CAST UNITS | $94.00 | $188.00 | $120.32–$188.00 | 46% below | 50% |
| Short arm cast (elbow to hand) inpatient CPT 29075 HC OT SHORT ARM CAST UNITS | $94.00 | $188.00 | $122.20–$188.00 | — | 50% |
| Short arm splint (forearm and hand) CPT 29125 PTA APPL SPL SHORT STATIC FH | $126.50 | $253.00 | $161.92–$253.00 | 10% above | 50% |
| Short arm splint (forearm and hand) CPT 29125 ER SPLINT SHORT ARM | $126.50 | $253.00 | $161.92–$253.00 | 10% above | 50% |
| Short arm splint (forearm and hand) CPT 29125 APPL SPL SHORT STATIC FH | $126.50 | $253.00 | $161.92–$253.00 | 10% above | 50% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APPL SPL SHORT STATIC FH | $126.50 | $253.00 | $164.45–$253.00 | — | 50% |
| Short arm splint (forearm and hand) inpatient CPT 29125 ER SPLINT SHORT ARM | $126.50 | $253.00 | $164.45–$253.00 | — | 50% |
| Short arm splint (forearm and hand) inpatient CPT 29125 PTA APPL SPL SHORT STATIC FH | $126.50 | $253.00 | $164.45–$253.00 | — | 50% |
| Short leg cast (below the knee) CPT 29405 HC PTA SHRT LEG CAST APP UNITS | $103.00 | $206.00 | $131.84–$206.00 | 36% below | 50% |
| Short leg cast (below the knee) inpatient CPT 29405 HC PTA SHRT LEG CAST APP UNITS | $103.00 | $206.00 | $133.90–$206.00 | — | 50% |
| Short leg splint (calf to foot) CPT 29515 APPL SPL SHORT LEG | $126.50 | $253.00 | $161.92–$253.00 | at median | 50% |
| Short leg splint (calf to foot) CPT 29515 PTA APPL SPL SHORT LEG | $126.50 | $253.00 | $161.92–$253.00 | at median | 50% |
| Short leg splint (calf to foot) CPT 29515 ER SPLINT SHORT LEG | $126.50 | $253.00 | $161.92–$253.00 | at median | 50% |
| Short leg splint (calf to foot) inpatient CPT 29515 APPL SPL SHORT LEG | $126.50 | $253.00 | $164.45–$253.00 | — | 50% |
| Short leg splint (calf to foot) inpatient CPT 29515 ER SPLINT SHORT LEG | $126.50 | $253.00 | $164.45–$253.00 | — | 50% |
| Short leg splint (calf to foot) inpatient CPT 29515 PTA APPL SPL SHORT LEG | $126.50 | $253.00 | $164.45–$253.00 | — | 50% |
| 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/< | $185.50 | $371.00 | $237.44–$371.00 | 25% above | 50% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ER LAC (ESNT) <2.6S | $185.50 | $371.00 | $237.44–$371.00 | 25% above | 50% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR- 2.5CM OR LESS F | $185.50 | $371.00 | $237.44–$371.00 | 25% above | 50% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REPAIR- 2.5CM OR LESS F | $185.50 | $371.00 | $241.15–$371.00 | — | 50% |
| 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/< | $185.50 | $371.00 | $241.15–$371.00 | — | 50% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 ER LAC (ESNT) <2.6S | $185.50 | $371.00 | $241.15–$371.00 | — | 50% |
| Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BX SKIN SNGL LESION | $82.50 | $165.00 | $105.60–$165.00 | 68% below | 50% |
| Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BX SKIN SINGLE LESION | $103.00 | $206.00 | $131.84–$206.00 | 60% below | 50% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION F | $103.00 | $206.00 | $131.84–$206.00 | 60% below | 50% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BX SKIN SNGL LESION | $82.50 | $165.00 | $107.25–$165.00 | — | 50% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION F | $103.00 | $206.00 | $133.90–$206.00 | — | 50% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BX SKIN SINGLE LESION | $103.00 | $206.00 | $133.90–$206.00 | — | 50% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC. MALIGNANT LESION <0.5CM F | $190.50 | $381.00 | $243.84–$381.00 | 42% below | 50% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC. MALIGNANT LESION <0.5CM F | $190.50 | $381.00 | $247.65–$381.00 | — | 50% |
| Skin tag removal, up to 15 tags CPT 11200 HC RMVL SKIN TAGS UP-15 LES | $78.00 | $156.00 | $99.84–$156.00 | 41% below | 50% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS F | $97.50 | $195.00 | $124.80–$195.00 | 26% below | 50% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKIN TAGS UP TO 15 F | $97.50 | $195.00 | $124.80–$195.00 | 26% below | 50% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 HC RMVL SKIN TAGS UP-15 LES | $78.00 | $156.00 | $101.40–$156.00 | — | 50% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS F | $97.50 | $195.00 | $126.75–$195.00 | — | 50% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKIN TAGS UP TO 15 F | $97.50 | $195.00 | $126.75–$195.00 | — | 50% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 ER SPINAL PUNCTURE | $104.00 | $208.00 | $133.12–$208.00 | 79% below | 50% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ER SPINAL PUNCTURE | $104.00 | $208.00 | $135.20–$208.00 | — | 50% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ER LAC (ESNT) 2.6-7.5S | $219.50 | $439.00 | $280.96–$439.00 | 18% above | 50% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE REPAIR 2.6-7 CM F | $219.50 | $439.00 | $280.96–$439.00 | 18% above | 50% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 ER LAC (ESNT) 2.6-7.5S | $219.50 | $439.00 | $285.35–$439.00 | — | 50% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPLE REPAIR 2.6-7 CM F | $219.50 | $439.00 | $285.35–$439.00 | — | 50% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ER LAC (FENELM) <2.6S | $225.00 | $450.00 | $288.00–$450.00 | 36% above | 50% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 ER LAC (FENELM) <2.6S | $225.00 | $450.00 | $292.50–$450.00 | — | 50% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BX SKIN SNGL LES | $63.00 | $126.00 | $80.64–$126.00 | 68% below | 50% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY SINGLE F | $79.00 | $158.00 | $101.12–$158.00 | 60% below | 50% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BX SKIN SNGL LES | $63.00 | $126.00 | $81.90–$126.00 | — | 50% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENTIAL BIOPSY SINGLE F | $79.00 | $158.00 | $102.70–$158.00 | — | 50% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ TRIGGER POINT 1-2 MUSCL | $68.50 | $137.00 | $87.68–$137.00 | 64% below | 50% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJECT TRGGER POINT 1-2 MSCL F | $68.50 | $137.00 | $87.68–$137.00 | 64% below | 50% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PT 1-2 MUSCLES F | $68.50 | $137.00 | $87.68–$137.00 | 64% below | 50% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC ER INJ TRIGGR PNT 1-2 MUSCL | $68.50 | $137.00 | $87.68–$137.00 | 64% below | 50% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC ER INJ TRIGGR PNT 1-2 MUSCL | $68.50 | $137.00 | $89.05–$137.00 | — | 50% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PT 1-2 MUSCLES F | $68.50 | $137.00 | $89.05–$137.00 | — | 50% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ TRIGGER POINT 1-2 MUSCL | $68.50 | $137.00 | $89.05–$137.00 | — | 50% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECT TRGGER POINT 1-2 MSCL F | $68.50 | $137.00 | $89.05–$137.00 | — | 50% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 HC VASECTOMY IN OFFICE | $286.00 | $572.00 | $366.08–$572.00 | 44% below | 50% |
| Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 HC VASECTOMY IN OFFICE | $286.00 | $572.00 | $371.80–$572.00 | — | 50% |
| Wart removal, up to 14 warts CPT 17110 HC DEST BEN LES NO SKN TAG1-14 | $109.50 | $219.00 | $140.16–$219.00 | 35% below | 50% |
| Wart removal, up to 14 warts CPT 17110 HC DESTRUCT B9 LESION 1-14 | $137.00 | $274.00 | $175.36–$274.00 | 19% below | 50% |
| Wart removal, up to 14 warts CPT 17110 DEST CHMO/CRYOSURG LSION1-14 F | $137.00 | $274.00 | $175.36–$274.00 | 19% below | 50% |
| Wart removal, up to 14 warts CPT 17110 DEST CHMO/CRYOSRG LSION 1-14 | $137.00 | $274.00 | $175.36–$274.00 | 19% below | 50% |
| Wart removal, up to 14 warts CPT 17110 DEST CHMO/CRYOSRG LESION1-14 F | $137.00 | $274.00 | $175.36–$274.00 | 19% below | 50% |
| Wart removal, up to 14 warts inpatient CPT 17110 HC DEST BEN LES NO SKN TAG1-14 | $109.50 | $219.00 | $142.35–$219.00 | — | 50% |
| Wart removal, up to 14 warts inpatient CPT 17110 DEST CHMO/CRYOSRG LSION 1-14 | $137.00 | $274.00 | $178.10–$274.00 | — | 50% |
| Wart removal, up to 14 warts inpatient CPT 17110 DEST CHMO/CRYOSRG LESION1-14 F | $137.00 | $274.00 | $178.10–$274.00 | — | 50% |
| Wart removal, up to 14 warts inpatient CPT 17110 DEST CHMO/CRYOSURG LSION1-14 F | $137.00 | $274.00 | $178.10–$274.00 | — | 50% |
| Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCT B9 LESION 1-14 | $137.00 | $274.00 | $178.10–$274.00 | — | 50% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN & SUBC TISSUE F | $71.50 | $143.00 | $91.52–$143.00 | 62% below | 50% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 ER DEBRIDE SKIN/SUBCU | $71.50 | $143.00 | $91.52–$143.00 | 62% below | 50% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN & SUBCU TISSUE F | $71.50 | $143.00 | $91.52–$143.00 | 62% below | 50% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SKIN & SUBCU TISSUE F | $71.50 | $143.00 | $92.95–$143.00 | — | 50% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SKIN & SUBC TISSUE F | $71.50 | $143.00 | $92.95–$143.00 | — | 50% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 ER DEBRIDE SKIN/SUBCU | $71.50 | $143.00 | $92.95–$143.00 | — | 50% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Maine | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 ER TRANSFUSE BLOOD | $516.50 | $1,033.00 | $661.12–$1,033.00 | 5% above | 50% |
| Blood transfusion (giving blood or blood components) CPT 36430 HC TRANSFUSION BLD/BLD CPNT(S) | $516.50 | $1,033.00 | $661.12–$1,033.00 | 5% above | 50% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC TRANSFUSION BLD/BLD CPNT(S) | $516.50 | $1,033.00 | $671.45–$1,033.00 | — | 50% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 ER TRANSFUSE BLOOD | $516.50 | $1,033.00 | $671.45–$1,033.00 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ER RESPIRATORY TX SUBS | $335.00 | $670.00 | $428.80–$670.00 | 83% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER TRTMT ADMINSTRATION | $335.00 | $670.00 | $428.80–$670.00 | 83% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ER RESPIRATORY TX INI | $335.00 | $670.00 | $428.80–$670.00 | 83% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ER RESPIRATORY TX INI | $335.00 | $670.00 | $435.50–$670.00 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER TRTMT ADMINSTRATION | $335.00 | $670.00 | $435.50–$670.00 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ER RESPIRATORY TX SUBS | $335.00 | $670.00 | $435.50–$670.00 | — | 50% |
| Critical care, first 30 to 74 minutes CPT 99291 EMERG ROOM LEVEL VI <74MIN | $936.00 | $1,872.00 | $1,198.08–$1,872.00 | 9% below | 50% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 EMERG ROOM LEVEL VI <74MIN | $936.00 | $1,872.00 | $1,216.80–$1,872.00 | — | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG | $137.00 | $274.00 | $175.36–$274.00 | 22% above | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG F | $137.00 | $274.00 | $175.36–$274.00 | 22% above | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ELECTROCARDIOGRAM TRACING | $137.00 | $274.00 | $175.36–$274.00 | 22% above | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC ELECTROCARDIOGRAM TRACING | $137.00 | $274.00 | $178.10–$274.00 | — | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG F | $137.00 | $274.00 | $178.10–$274.00 | — | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG | $137.00 | $274.00 | $178.10–$274.00 | — | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERG ROOM LEVEL I | $108.00 | $216.00 | $138.24–$216.00 | 5% above | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERG ROOM LEVEL I | $108.00 | $216.00 | $140.40–$216.00 | — | 50% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERG ROOM LEVEL II | $209.00 | $418.00 | $267.52–$418.00 | at median | 50% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERG ROOM LEVEL II | $209.00 | $418.00 | $271.70–$418.00 | — | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERG ROOM LEVEL III | $374.50 | $749.00 | $479.36–$749.00 | 12% above | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERG ROOM LEVEL III | $374.50 | $749.00 | $486.85–$749.00 | — | 50% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERG ROOM LEVEL IV | $611.00 | $1,222.00 | $782.08–$1,222.00 | at median | 50% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERG ROOM LEVEL IV | $611.00 | $1,222.00 | $794.30–$1,222.00 | — | 50% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERG ROOM LEVEL V | $1,014.50 | $2,029.00 | $1,298.56–$2,029.00 | 3% above | 50% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERG ROOM LEVEL V | $1,014.50 | $2,029.00 | $1,318.85–$2,029.00 | — | 50% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CV STRESS TEST | $570.00 | $1,140.00 | $729.60–$1,140.00 | 2% below | 50% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CV STRESS TEST | $570.00 | $1,140.00 | $741.00–$1,140.00 | — | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OP HYDRA INF 1ST HR.FLD ONLY | $172.50 | $345.00 | $220.80–$345.00 | 18% below | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ER HYDRA INF, 1ST HR.,FLD ONLY | $172.50 | $345.00 | $220.80–$345.00 | 18% below | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ER HYDRA INF, 1ST HR.,FLD ONLY | $172.50 | $345.00 | $224.25–$345.00 | — | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 OP HYDRA INF 1ST HR.FLD ONLY | $172.50 | $345.00 | $224.25–$345.00 | — | 50% |
| IV infusion of a medicine, first hour CPT 96365 ER INFUSION THERAPY 1 HR | $479.00 | $958.00 | $613.12–$958.00 | 47% above | 50% |
| IV infusion of a medicine, first hour CPT 96365 OP INFUSION THERAPY 1 HR | $479.00 | $958.00 | $613.12–$958.00 | 47% above | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 OP INFUSION THERAPY 1 HR | $479.00 | $958.00 | $622.70–$958.00 | — | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 ER INFUSION THERAPY 1 HR | $479.00 | $958.00 | $622.70–$958.00 | — | 50% |
| IV push of a medicine, first drug CPT 96374 OP IV THERAPY (IV START/PUSH) | $479.00 | $958.00 | $613.12–$958.00 | 143% above | 50% |
| IV push of a medicine, first drug CPT 96374 ER IV THERAPY (IV START/PUSH) | $479.00 | $958.00 | $613.12–$958.00 | 143% above | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 ER IV THERAPY (IV START/PUSH) | $479.00 | $958.00 | $622.70–$958.00 | — | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 OP IV THERAPY (IV START/PUSH) | $479.00 | $958.00 | $622.70–$958.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC THER/PROPHYLCT DX INJ SC/IM | $67.00 | $134.00 | $85.76–$134.00 | 3% below | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION F | $157.50 | $315.00 | $201.60–$315.00 | 128% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER THERAPEUTIC INJECTION | $157.50 | $315.00 | $201.60–$315.00 | 128% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION GIVEN BY MA | $157.50 | $315.00 | $201.60–$315.00 | 128% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 OP IV INJ (PUSH SQ OR IM INJ) | $157.50 | $315.00 | $201.60–$315.00 | 128% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC THERAPEUTIC INJECTION | $157.50 | $315.00 | $201.60–$315.00 | 128% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION BY PROVIDER F | $157.50 | $315.00 | $201.60–$315.00 | 128% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION | $157.50 | $315.00 | $201.60–$315.00 | 128% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION BY MA | $157.50 | $315.00 | $201.60–$315.00 | 128% above | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC THER/PROPHYLCT DX INJ SC/IM | $67.00 | $134.00 | $87.10–$134.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION F | $157.50 | $315.00 | $204.75–$315.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC THERAPEUTIC INJECTION | $157.50 | $315.00 | $204.75–$315.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION BY PROVIDER F | $157.50 | $315.00 | $204.75–$315.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION BY MA | $157.50 | $315.00 | $204.75–$315.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION | $157.50 | $315.00 | $204.75–$315.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 OP IV INJ (PUSH SQ OR IM INJ) | $157.50 | $315.00 | $204.75–$315.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ER THERAPEUTIC INJECTION | $157.50 | $315.00 | $204.75–$315.00 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION GIVEN BY MA | $157.50 | $315.00 | $204.75–$315.00 | — | 50% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC SP NEUROMUSCLR RE-ED 15MINS | $77.00 | $154.00 | $98.56–$154.00 | 22% below | 50% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REED 15 MIN | $77.00 | $154.00 | $98.56–$154.00 | 22% below | 50% |
| Neuromuscular re-education, 15 minutes CPT 97112 PTA NEUROMUSCULAR REED 15 MIN | $77.00 | $154.00 | $98.56–$154.00 | 22% below | 50% |
| Neuromuscular re-education, 15 minutes CPT 97112 OTA NEUROMUSCULAR REED | $77.00 | $154.00 | $98.56–$154.00 | 22% below | 50% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REED | $77.00 | $154.00 | $98.56–$154.00 | 22% below | 50% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC SP NEUROMUSCLR RE-ED 15MINS | $77.00 | $154.00 | $100.10–$154.00 | — | 50% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 OTA NEUROMUSCULAR REED | $77.00 | $154.00 | $100.10–$154.00 | — | 50% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR REED | $77.00 | $154.00 | $100.10–$154.00 | — | 50% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 PTA NEUROMUSCULAR REED 15 MIN | $77.00 | $154.00 | $100.10–$154.00 | — | 50% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR REED 15 MIN | $77.00 | $154.00 | $100.10–$154.00 | — | 50% |
| New patient office visit, about 30 minutes CPT 99203 HC OUTPT CLINIC VST NEW LVL 3 | $81.50 | $163.00 | $104.32–$163.00 | 43% below | 50% |
| New patient office visit, about 30 minutes CPT 99203 HC OFFICE O/P NEW PT 30-44 MIN | $93.50 | $187.00 | $119.68–$187.00 | 35% below | 50% |
| New patient office visit, about 30 minutes CPT 99203 NEW PT E/M LEVEL 3 | $93.50 | $187.00 | $119.68–$187.00 | 35% below | 50% |
| New patient office visit, about 30 minutes CPT 99203 NEW PATIENT E/M LEVEL 3 F | $93.50 | $187.00 | $119.68–$187.00 | 35% below | 50% |
| New patient office visit, about 30 minutes CPT 99203 SUB NEW PT VISIT LVL 3 F | $93.50 | $187.00 | $119.68–$187.00 | 35% below | 50% |
| New patient office visit, about 30 minutes CPT 99203 PAIN MGMT-NEW PT LVL 3 | $93.50 | $187.00 | $119.68–$187.00 | 35% below | 50% |
| New patient office visit, about 30 minutes CPT 99203 HC NEW PATIENT E/M LEVEL 3 | $93.50 | $187.00 | $119.68–$187.00 | 35% below | 50% |
| New patient office visit, about 30 minutes CPT 99203 HC OP CLINIC VST NEW LV 3 SNGV | $93.50 | $187.00 | $119.68–$187.00 | 35% below | 50% |
| New patient office visit, about 30 minutes CPT 99203 NEW PT E/M LEVEL 3 F | $93.50 | $187.00 | $119.68–$187.00 | 35% below | 50% |
| New patient office visit, about 45 minutes CPT 99204 HC OUTPT CLINIC VST NEW LVL 4 | $111.00 | $222.00 | $142.08–$222.00 | 47% below | 50% |
| New patient office visit, about 45 minutes CPT 99204 NEW PT E/M LEVEL 4 | $127.50 | $255.00 | $163.20–$255.00 | 39% below | 50% |
| New patient office visit, about 45 minutes CPT 99204 HC OFFICE O/P NEW PT 45-59 MIN | $127.50 | $255.00 | $163.20–$255.00 | 39% below | 50% |
| New patient office visit, about 45 minutes CPT 99204 SUB NEW PT VISIT LVL 4 F | $127.50 | $255.00 | $163.20–$255.00 | 39% below | 50% |
| New patient office visit, about 45 minutes CPT 99204 HC NEW PATIENT E/M LEVEL 4 | $127.50 | $255.00 | $163.20–$255.00 | 39% below | 50% |
| New patient office visit, about 45 minutes CPT 99204 NEW PATIENT E/M LEVEL 4 F | $127.50 | $255.00 | $163.20–$255.00 | 39% below | 50% |
| New patient office visit, about 45 minutes CPT 99204 PAIN MGMT-NEW PT LVL 4 | $127.50 | $255.00 | $163.20–$255.00 | 39% below | 50% |
| New patient office visit, about 45 minutes CPT 99204 NEW PT E/M LEVEL 4 F | $127.50 | $255.00 | $163.20–$255.00 | 39% below | 50% |
| New patient office visit, about 45 minutes CPT 99204 HC OP CLINIC VST NEW LV 4 SNGV | $127.50 | $255.00 | $163.20–$255.00 | 39% below | 50% |
| New patient office visit, about 60 minutes CPT 99205 HC NEW PATIENT E/M LEVEL 5 | $224.50 | $449.00 | $287.36–$449.00 | 32% below | 50% |
| New patient office visit, about 60 minutes CPT 99205 SUB NEW PT VISIT LVL 5 F | $224.50 | $449.00 | $287.36–$449.00 | 32% below | 50% |
| New patient office visit, about 60 minutes CPT 99205 HC OP CLINIC VST NEW LV 5 SNGV | $224.50 | $449.00 | $287.36–$449.00 | 32% below | 50% |
| New patient office visit, about 60 minutes CPT 99205 NEW PT E/M LEVEL 5 F | $224.50 | $449.00 | $287.36–$449.00 | 32% below | 50% |
| New patient office visit, about 60 minutes CPT 99205 PAIN MGMT-NEW PT LVL 5 | $224.50 | $449.00 | $287.36–$449.00 | 32% below | 50% |
| New patient office visit, about 60 minutes CPT 99205 NEW PATIENT E/M LEVEL 5 F | $224.50 | $449.00 | $287.36–$449.00 | 32% below | 50% |
| New patient office visit, about 60 minutes CPT 99205 HC OFFICE O/P NEW PT 60-74 MIN | $224.50 | $449.00 | $287.36–$449.00 | 32% below | 50% |
| New patient office visit, about 60 minutes CPT 99205 NEW PT E/M LEVEL 5 | $224.50 | $449.00 | $287.36–$449.00 | 32% below | 50% |
| New patient office visit, about 60 minutes CPT 99205 HC OUTPT CLINIC VST NEW LVL 5 | $226.50 | $453.00 | $289.92–$453.00 | 32% below | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OUTPT CLINIC VST NEW LVL 2 | $69.00 | $138.00 | $88.32–$138.00 | 22% below | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT E/M LEVEL 2 F | $79.50 | $159.00 | $101.76–$159.00 | 10% below | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 PAIN MGMT-NEW PT LVL 2 | $79.50 | $159.00 | $101.76–$159.00 | 10% below | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC NEW PATIENT E/M LEVEL 2 | $79.50 | $159.00 | $101.76–$159.00 | 10% below | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PT E/M LEVEL 2 | $79.50 | $159.00 | $101.76–$159.00 | 10% below | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OP CLINIC VST NEW LV 2 SNGV | $79.50 | $159.00 | $101.76–$159.00 | 10% below | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PT E/M LEVEL 2 F | $79.50 | $159.00 | $101.76–$159.00 | 10% below | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 SUB NEW PT VISIT LVL 2 F | $79.50 | $159.00 | $101.76–$159.00 | 10% below | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OFFICE O/P NEW PT 15-29 MIN | $79.50 | $159.00 | $101.76–$159.00 | 10% below | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC NUT THER INIT ASMNT 15MN SV | $45.50 | $91.00 | $58.24–$91.00 | 1% below | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 NUTRITION RX-INIT EA 15 MIN | $45.50 | $91.00 | $58.24–$91.00 | 1% below | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC NUTR THER INIT ASSMNT 15MIN | $61.00 | $122.00 | $78.08–$122.00 | 33% above | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 NUTRITION RX-INIT EA 15 MIN | $45.50 | $91.00 | $59.15–$91.00 | — | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC NUT THER INIT ASMNT 15MN SV | $45.50 | $91.00 | $59.15–$91.00 | — | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC NUTR THER INIT ASSMNT 15MIN | $61.00 | $122.00 | $79.30–$122.00 | — | 50% |
| Occupational therapy evaluation, low complexity CPT 97165 O.T. EVAL LOW COMPLEXITY | $223.00 | $446.00 | $285.44–$446.00 | at median | 50% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 O.T. EVAL LOW COMPLEXITY | $223.00 | $446.00 | $289.90–$446.00 | — | 50% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 P.T. EVAL HIGH COMPLEXITY | $245.50 | $491.00 | $314.24–$491.00 | 12% below | 50% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 P.T. EVAL HIGH COMPLEXITY | $245.50 | $491.00 | $319.15–$491.00 | — | 50% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 P.T. EVAL LOW COMPLEXITY | $223.00 | $446.00 | $285.44–$446.00 | at median | 50% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 P.T. EVAL LOW COMPLEXITY | $223.00 | $446.00 | $289.90–$446.00 | — | 50% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 P.T. EVAL MODERATE COMPLEXITY | $234.00 | $468.00 | $299.52–$468.00 | 14% below | 50% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 P.T. EVAL MODERATE COMPLEXITY | $234.00 | $468.00 | $304.20–$468.00 | — | 50% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY TECHNIQUES 15 M | $71.50 | $143.00 | $91.52–$143.00 | 27% below | 50% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OTA MANUAL THERAPY TECH 15 MIN | $71.50 | $143.00 | $91.52–$143.00 | 27% below | 50% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY TECH 15 MIN | $71.50 | $143.00 | $91.52–$143.00 | 27% below | 50% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PTA MANUAL THERPY TECHNIQ 15 M | $71.50 | $143.00 | $91.52–$143.00 | 27% below | 50% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PTA MANUAL THERPY TECHNIQ 15 M | $71.50 | $143.00 | $92.95–$143.00 | — | 50% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OTA MANUAL THERAPY TECH 15 MIN | $71.50 | $143.00 | $92.95–$143.00 | — | 50% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY TECH 15 MIN | $71.50 | $143.00 | $92.95–$143.00 | — | 50% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY TECHNIQUES 15 M | $71.50 | $143.00 | $92.95–$143.00 | — | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OTA THERAPEUTIC PROCED | $66.00 | $132.00 | $84.48–$132.00 | 3% below | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC PROCED | $66.00 | $132.00 | $84.48–$132.00 | 3% below | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC SP THERAPEUTIC EXER 15 MINS | $66.00 | $132.00 | $84.48–$132.00 | 3% below | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PTA THERAPEUTC EXERCISE 15 MIN | $66.00 | $132.00 | $84.48–$132.00 | 3% below | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE 15 MIN | $66.00 | $132.00 | $84.48–$132.00 | 3% below | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC PROCED | $66.00 | $132.00 | $85.80–$132.00 | — | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE 15 MIN | $66.00 | $132.00 | $85.80–$132.00 | — | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PTA THERAPEUTC EXERCISE 15 MIN | $66.00 | $132.00 | $85.80–$132.00 | — | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OTA THERAPEUTIC PROCED | $66.00 | $132.00 | $85.80–$132.00 | — | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC SP THERAPEUTIC EXER 15 MINS | $66.00 | $132.00 | $85.80–$132.00 | — | 50% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PREVENTIVE NEW PT 18-39 YRS F | $43.00 | $86.00 | $55.04–$86.00 | 70% below | 50% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PREVENTIVE NEW PT 40-64 F | $52.50 | $105.00 | $67.20–$105.00 | 70% below | 50% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PREVENTIVE NEW PT 40-64 YRS F | $52.50 | $105.00 | $67.20–$105.00 | 70% below | 50% |
| Preventive checkup, new patient aged 65 or older CPT 99387 PREVENTIVE NEW PT 65+ YRS F | $56.00 | $112.00 | $71.68–$112.00 | 53% below | 50% |
| Preventive checkup, new patient aged 65 or older CPT 99387 PREVENTIVE NEW PT > 65 YRS F | $56.00 | $112.00 | $71.68–$112.00 | 53% below | 50% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 PREVENTIVE EST PT 18-39 YRS F | $39.50 | $79.00 | $50.56–$79.00 | 66% below | 50% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 PREVNT EXM 18-39 WPAP/PELVC F | $39.50 | $79.00 | $50.56–$79.00 | 66% below | 50% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 PREVNT EXM 18-39 WPAP/PELVIC F | $39.50 | $79.00 | $50.56–$79.00 | 66% below | 50% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 PREVENT EXM 40-64 WPAP/PELVC F | $43.00 | $86.00 | $55.04–$86.00 | 62% below | 50% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 PREVENTIVE EST PT 40-64 YRS F | $43.00 | $86.00 | $55.04–$86.00 | 62% below | 50% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 PREVENT EXAM 65+ WPAP/PELVIC F | $44.50 | $89.00 | $56.96–$89.00 | 71% below | 50% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 PREVENTITIVE EST PT>65 YRS F | $44.50 | $89.00 | $56.96–$89.00 | 71% below | 50% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 PREVENT EXAM 65 AND OVER F | $44.50 | $89.00 | $56.96–$89.00 | 71% below | 50% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 PREVENTIVE EST PT > 65 YRS F | $44.50 | $89.00 | $56.96–$89.00 | 71% below | 50% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 TOBACCO ABUSE COUN 3-10 MIN F | $7.50 | $15.00 | $9.60–$15.00 | 70% below | 50% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 TOBACCO ABUSE COUN 3-10 MIN F | $7.50 | $15.00 | $9.75–$15.00 | — | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OUTPT CLINIC VST EST LVL 5 | $149.00 | $298.00 | $190.72–$298.00 | 3% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OUTPT VST EST LVL 5 SNGV | $171.50 | $343.00 | $219.52–$343.00 | 18% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PT E/M LEVEL 5 F | $171.50 | $343.00 | $219.52–$343.00 | 18% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 PAIN MGMT-EST PT LVL5 | $171.50 | $343.00 | $219.52–$343.00 | 18% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST. PATIENT E/M LEVEL 5 F | $171.50 | $343.00 | $219.52–$343.00 | 18% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTABLISHED PT. E/M LVL 5 F | $171.50 | $343.00 | $219.52–$343.00 | 18% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT LVL 5 | $171.50 | $343.00 | $219.52–$343.00 | 18% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC ESTABLISHED PT E/M LEVEL 5 | $171.50 | $343.00 | $219.52–$343.00 | 18% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT LEVEL 5 F | $171.50 | $343.00 | $219.52–$343.00 | 18% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 SUB ESTAB PT LVL 5 F | $171.50 | $343.00 | $219.52–$343.00 | 18% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PATIENT LEVEL 5 | $171.50 | $343.00 | $219.52–$343.00 | 18% above | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OFFICE VISIT LEVEL 5 EST | $171.50 | $343.00 | $219.52–$343.00 | 18% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OUTPT CLINIC VST EST LVL 3 | $75.00 | $150.00 | $96.00–$150.00 | 2% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC ESTABLISHED PT E/M LEVEL 3 | $86.00 | $172.00 | $110.08–$172.00 | 17% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OUTPT VST EST LVL 3 SNGV | $86.00 | $172.00 | $110.08–$172.00 | 17% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT E/M LEVEL 3 F | $86.00 | $172.00 | $110.08–$172.00 | 17% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 PAIN MGMT-EST PT LVL 3 | $86.00 | $172.00 | $110.08–$172.00 | 17% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTABLISHED PT. E/M LVL 3 F | $86.00 | $172.00 | $110.08–$172.00 | 17% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT LEVEL 3 | $86.00 | $172.00 | $110.08–$172.00 | 17% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT LEVEL 3 F | $86.00 | $172.00 | $110.08–$172.00 | 17% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP DRESSING CHANGE, LARGE | $86.00 | $172.00 | $110.08–$172.00 | 17% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 SUB ESTAB PT LVL 3 F | $86.00 | $172.00 | $110.08–$172.00 | 17% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PATIENT LEVEL 3 | $86.00 | $172.00 | $110.08–$172.00 | 17% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST. PATIENT E/M LEVEL 3 F | $86.00 | $172.00 | $110.08–$172.00 | 17% above | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OFFICE VISIT LEVEL 3 EST | $86.00 | $172.00 | $110.08–$172.00 | 17% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OUTPT CLINIC VST EST LVL 4 | $98.00 | $196.00 | $125.44–$196.00 | 7% below | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CDL PHYSICAL | $113.00 | $226.00 | $144.64–$226.00 | 7% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST. PATIENT E/M LEVEL 4 F | $113.00 | $226.00 | $144.64–$226.00 | 7% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTABLISHED PT. E/M LVL 4 F | $113.00 | $226.00 | $144.64–$226.00 | 7% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT LEVEL 4 | $113.00 | $226.00 | $144.64–$226.00 | 7% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC ESTABLISHED PT E/M LEVEL 4 | $113.00 | $226.00 | $144.64–$226.00 | 7% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT LEVEL 4 F | $113.00 | $226.00 | $144.64–$226.00 | 7% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 SUB ESTAB PT LVL 4 F | $113.00 | $226.00 | $144.64–$226.00 | 7% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PATIENT LEVEL 4 | $113.00 | $226.00 | $144.64–$226.00 | 7% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OUTPT VST EST LVL 4 SNGV | $113.00 | $226.00 | $144.64–$226.00 | 7% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PT E/M LEVEL 4 F | $113.00 | $226.00 | $144.64–$226.00 | 7% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PAIN MGMT-EST PT LVL 4 | $113.00 | $226.00 | $144.64–$226.00 | 7% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OFFICE VISIT LEVEL 4 EST | $113.00 | $226.00 | $144.64–$226.00 | 7% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OUTPT CLINIC VST EST LVL 2 | $58.00 | $116.00 | $74.24–$116.00 | 3% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PAIN MGMT-EST PT LVL 2 | $66.50 | $133.00 | $85.12–$133.00 | 18% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST. PATIENT E/M LEVEL 2 F | $66.50 | $133.00 | $85.12–$133.00 | 18% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PATIENT LEVEL 2 | $66.50 | $133.00 | $85.12–$133.00 | 18% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OFFICE VISIT LEVEL 2 EST | $66.50 | $133.00 | $85.12–$133.00 | 18% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 SUB ESTAB PT LVL 2 F | $66.50 | $133.00 | $85.12–$133.00 | 18% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP DRESSING CHANGE, MEDIUM | $66.50 | $133.00 | $85.12–$133.00 | 18% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT LEVEL 2 F | $66.50 | $133.00 | $85.12–$133.00 | 18% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OUTPT VST EST LVL 2 SNGV | $66.50 | $133.00 | $85.12–$133.00 | 18% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT E/M LEVEL 2 F | $66.50 | $133.00 | $85.12–$133.00 | 18% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC ESTABLISHED PT E/M LEVEL 2 | $66.50 | $133.00 | $85.12–$133.00 | 18% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTABLISHED PT. E/M LVL 2 F | $66.50 | $133.00 | $85.12–$133.00 | 18% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT LEVEL 2 | $66.50 | $133.00 | $85.12–$133.00 | 18% above | 50% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC OV CONSULT NEW/EST PT 40MIN | $47.50 | $95.00 | $60.80–$95.00 | 5% above | 50% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICE CONSULT LEVEL 3 F | $54.50 | $109.00 | $69.76–$109.00 | 21% above | 50% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC OFFICE CONSULT LEVEL 3 | $54.50 | $109.00 | $69.76–$109.00 | 21% above | 50% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULTATION LEVEL 3 F | $54.50 | $109.00 | $69.76–$109.00 | 21% above | 50% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC OV CNSLT NEW/EST PT 40MN SV | $54.50 | $109.00 | $69.76–$109.00 | 21% above | 50% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC OV CONSULT NEW/EST PT 60MIN | $69.50 | $139.00 | $88.96–$139.00 | 8% above | 50% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE CONSULT LEVEL 4 F | $80.00 | $160.00 | $102.40–$160.00 | 25% above | 50% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC OV CNSLT NEW/EST PT 60MN SV | $80.00 | $160.00 | $102.40–$160.00 | 25% above | 50% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULTATION LEVEL 4 F | $80.00 | $160.00 | $102.40–$160.00 | 25% above | 50% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC OFFICE CONSULT LEVEL 4 | $80.00 | $160.00 | $102.40–$160.00 | 25% above | 50% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PAIN MGMT-CONSULT EST 30MIN | $80.00 | $160.00 | $102.40–$160.00 | 25% above | 50% |
| Speech and language evaluation CPT 92523 HC SP SOUND PROD LANG CMP EVAL | $299.50 | $599.00 | $383.36–$599.00 | 7% below | 50% |
| Speech and language evaluation CPT 92523 SLP SOUND PROD, LANG COMP EVAL | $299.50 | $599.00 | $383.36–$599.00 | 7% below | 50% |
| Speech and language evaluation inpatient CPT 92523 SLP SOUND PROD, LANG COMP EVAL | $299.50 | $599.00 | $389.35–$599.00 | — | 50% |
| Speech and language evaluation inpatient CPT 92523 HC SP SOUND PROD LANG CMP EVAL | $299.50 | $599.00 | $389.35–$599.00 | — | 50% |
| Speech therapy session, individual CPT 92507 SLP AUDITORY PROCESS TX UNITS | $163.50 | $327.00 | $209.28–$327.00 | at median | 50% |
| Speech therapy session, individual CPT 92507 HC SP AUDITORY PROCESS TX UNIT | $163.50 | $327.00 | $209.28–$327.00 | at median | 50% |
| Speech therapy session, individual inpatient CPT 92507 HC SP AUDITORY PROCESS TX UNIT | $163.50 | $327.00 | $212.55–$327.00 | — | 50% |
| Speech therapy session, individual inpatient CPT 92507 SLP AUDITORY PROCESS TX UNITS | $163.50 | $327.00 | $212.55–$327.00 | — | 50% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY | $176.50 | $353.00 | $225.92–$353.00 | 25% above | 50% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY F | $176.50 | $353.00 | $225.92–$353.00 | 25% above | 50% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY | $176.50 | $353.00 | $229.45–$353.00 | — | 50% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY F | $176.50 | $353.00 | $229.45–$353.00 | — | 50% |
| Spirometry before and after a bronchodilator CPT 94060 PRE & POST SPIROMETRY | $390.50 | $781.00 | $499.84–$781.00 | 21% above | 50% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 PRE & POST SPIROMETRY | $390.50 | $781.00 | $507.65–$781.00 | — | 50% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 OTA THERAPEUTIC ACT | $88.00 | $176.00 | $112.64–$176.00 | 23% below | 50% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC SP THERAPEUTIC ACT 15MIN CA | $88.00 | $176.00 | $112.64–$176.00 | 23% below | 50% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPY ACTIVITIES 15 MIN | $88.00 | $176.00 | $112.64–$176.00 | 23% below | 50% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 PTA THERAPY ACTIVITIES 15 MIN | $88.00 | $176.00 | $112.64–$176.00 | 23% below | 50% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACT | $88.00 | $176.00 | $112.64–$176.00 | 23% below | 50% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PTA THERAPY ACTIVITIES 15 MIN | $88.00 | $176.00 | $114.40–$176.00 | — | 50% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OTA THERAPEUTIC ACT | $88.00 | $176.00 | $114.40–$176.00 | — | 50% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC SP THERAPEUTIC ACT 15MIN CA | $88.00 | $176.00 | $114.40–$176.00 | — | 50% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPY ACTIVITIES 15 MIN | $88.00 | $176.00 | $114.40–$176.00 | — | 50% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACT | $88.00 | $176.00 | $114.40–$176.00 | — | 50% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY | $153.00 | $306.00 | $195.84–$306.00 | 1% below | 50% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY | $153.00 | $306.00 | $198.90–$306.00 | — | 50% |
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 | $134.00 | $268.00 | $171.52–$268.00 | 16% below | 50% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SPIKEVAX PF (CVX 312) 0.5 ML | $134.00 | $268.00 | $174.20–$268.00 | — | 50% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VAC PF 0.5ML TIV PF | $18.64 | $37.29 | $23.87–$37.29 | 15% below | 50% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VAC PF TIV 0.5 ML | $18.64 | $37.29 | $23.87–$37.29 | 15% below | 50% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VAC PF 0.5ML TIV PF | $18.64 | $37.29 | $24.24–$37.29 | — | 50% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VAC PF TIV 0.5 ML | $18.64 | $37.29 | $24.24–$37.29 | — | 50% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE ADULT | $77.60 | $155.20 | $99.33–$155.20 | 21% below | 50% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VAC ADULT SNGV | $77.60 | $155.20 | $99.33–$155.20 | 21% below | 50% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE ADULT | $77.60 | $155.20 | $100.88–$155.20 | — | 50% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VAC ADULT SNGV | $77.60 | $155.20 | $100.88–$155.20 | — | 50% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 RH HEPATITIS A PEDIATRIC VACC | $34.18 | $68.37 | $43.76–$68.37 | 7% below | 50% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HAVRIX HEPATITIS-A VAC(PEDS) | $34.18 | $68.37 | $43.76–$68.37 | 7% below | 50% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A INJ 1ML SDV (VAQTA | $34.18 | $68.37 | $43.76–$68.37 | 7% below | 50% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A INJ 1ML SDV (VAQTA | $34.18 | $68.37 | $44.44–$68.37 | — | 50% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HAVRIX HEPATITIS-A VAC(PEDS) | $34.18 | $68.37 | $44.44–$68.37 | — | 50% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 RH HEPATITIS A PEDIATRIC VACC | $34.18 | $68.37 | $44.44–$68.37 | — | 50% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VACCINE-ADULT | $62.46 | $124.92 | $79.95–$124.92 | 2% below | 50% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 ENGERIX-B 20MCG INJ | $62.46 | $124.92 | $79.95–$124.92 | 2% below | 50% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE ADULT | $62.46 | $124.92 | $79.95–$124.92 | 2% below | 50% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B ADULT | $62.46 | $124.92 | $79.95–$124.92 | 2% below | 50% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE ADULT | $62.46 | $124.92 | $81.20–$124.92 | — | 50% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 ENGERIX-B 20MCG INJ | $62.46 | $124.92 | $81.20–$124.92 | — | 50% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B ADULT | $62.46 | $124.92 | $81.20–$124.92 | — | 50% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VACCINE-ADULT | $62.46 | $124.92 | $81.20–$124.92 | — | 50% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 ENGERIX-B INJ (PED/ADOLESCENT) | $25.15 | $50.30 | $32.19–$50.30 | 29% below | 50% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 ENGERIX-B INJ (PED/ADOLESCENT) | $25.15 | $50.30 | $32.70–$50.30 | — | 50% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE VACCINE HIGHDOSE | $57.98 | $115.95 | $74.21–$115.95 | 19% below | 50% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VACCINE IIV SPLIT PF | $57.98 | $115.95 | $74.21–$115.95 | 19% below | 50% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VACCINE IIV SPLIT PF | $57.98 | $115.95 | $75.37–$115.95 | — | 50% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE VACCINE HIGHDOSE | $57.98 | $115.95 | $75.37–$115.95 | — | 50% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE - ADULT | $84.56 | $169.13 | $108.24–$169.13 | 35% below | 50% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE ADULT | $84.56 | $169.13 | $108.24–$169.13 | 35% below | 50% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR VACCINE ADULT | $84.56 | $169.13 | $109.93–$169.13 | — | 50% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR VACCINE - ADULT | $84.56 | $169.13 | $109.93–$169.13 | — | 50% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENVEO(GROUPS A,C,Y AND W-135) | $139.62 | $279.23 | $178.71–$279.23 | 35% above | 50% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACTRA VACCINE 0.5 ML | $139.62 | $279.23 | $178.71–$279.23 | 35% above | 50% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENVEO(GROUPS A,C,Y AND W-135) | $139.62 | $279.23 | $181.50–$279.23 | — | 50% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENACTRA VACCINE 0.5 ML | $139.62 | $279.23 | $181.50–$279.23 | — | 50% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20 0.5ML INJ | $247.10 | $494.19 | $316.28–$494.19 | 36% below | 50% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20 0.5ML INJ GRNV | $247.10 | $494.19 | $316.28–$494.19 | 36% below | 50% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20 0.5ML INJ SNGV | $247.10 | $494.19 | $316.28–$494.19 | 36% below | 50% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20 0.5ML INJ SNGV | $247.10 | $494.19 | $321.22–$494.19 | — | 50% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20 0.5ML INJ | $247.10 | $494.19 | $321.22–$494.19 | — | 50% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20 0.5ML INJ GRNV | $247.10 | $494.19 | $321.22–$494.19 | — | 50% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 PNEUMOCOCCAL 21-(CVX 327) | $271.21 | $542.43 | $347.16–$542.43 | 35% above | 50% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 PNEUMOCOCCAL 21-(CVX 327) | $271.21 | $542.43 | $352.58–$542.43 | — | 50% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOVAX INJ | $110.64 | $221.29 | $141.63–$221.29 | 15% above | 50% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOVAX INJ | $110.64 | $221.29 | $143.84–$221.29 | — | 50% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 HC RSV VACCINE, PREF A-PREF B | $241.60 | $483.21 | $309.25–$483.21 | 30% above | 50% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 HC RSV VACCINE, PREF A-PREF B | $241.60 | $483.21 | $314.09–$483.21 | — | 50% |
| Rabies vaccine, one dose CPT 90675 RABIES VACC(IMOVAX) | $358.20 | $716.39 | $458.49–$716.39 | 52% below | 50% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACC(IMOVAX) | $358.20 | $716.39 | $465.65–$716.39 | — | 50% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 DIPTH/TET 0.5ML INJ(ADULT VAC) | $26.44 | $52.89 | $33.85–$52.89 | 36% below | 50% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TET/DIPTH 0.5ML INJ >7 YRS | $26.44 | $52.89 | $33.85–$52.89 | 36% below | 50% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 DIPTH/TET 0.5ML INJ. (>7 YRS) | $26.50 | $53.00 | $33.92–$53.00 | 35% below | 50% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TET/DIPTH 0.5ML INJ >7 YRS | $26.44 | $52.89 | $34.38–$52.89 | — | 50% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 DIPTH/TET 0.5ML INJ(ADULT VAC) | $26.44 | $52.89 | $34.38–$52.89 | — | 50% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 DIPTH/TET 0.5ML INJ. (>7 YRS) | $26.50 | $53.00 | $34.45–$53.00 | — | 50% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX (TDAP) 0.5ML INJ | $41.42 | $82.83 | $53.01–$82.83 | 7% below | 50% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX(TDAP)0.5ML INJ | $41.42 | $82.83 | $53.01–$82.83 | 7% below | 50% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 BOOSTRIX (TDAP) 0.5ML INJ | $41.42 | $82.83 | $53.84–$82.83 | — | 50% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 BOOSTRIX(TDAP)0.5ML INJ | $41.42 | $82.83 | $53.84–$82.83 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 STATE IMM ADMIN SINGLE VAC | $10.79 | $21.58 | $13.81–$21.58 | 39% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN VACCPERC/IM/SC/INTRAD | $31.00 | $62.00 | $39.68–$62.00 | 76% above | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION | $35.00 | $70.00 | $44.80–$70.00 | 98% above | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN MA | $35.00 | $70.00 | $44.80–$70.00 | 98% above | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ER ADM OF IMMUNIZATION (SQIM) | $35.00 | $70.00 | $44.80–$70.00 | 98% above | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN | $35.00 | $70.00 | $44.80–$70.00 | 98% above | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VAC_C FLU VAC ADMINISTRATION | $35.00 | $70.00 | $44.80–$70.00 | 98% above | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 OP ADM OF IMMUNIZATION (SQIM) | $35.00 | $70.00 | $44.80–$70.00 | 98% above | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 STATE IMM ADMIN SINGLE VAC | $10.79 | $21.58 | $14.03–$21.58 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN VACCPERC/IM/SC/INTRAD | $31.00 | $62.00 | $40.30–$62.00 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION | $35.00 | $70.00 | $45.50–$70.00 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN | $35.00 | $70.00 | $45.50–$70.00 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VAC_C FLU VAC ADMINISTRATION | $35.00 | $70.00 | $45.50–$70.00 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 OP ADM OF IMMUNIZATION (SQIM) | $35.00 | $70.00 | $45.50–$70.00 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN MA | $35.00 | $70.00 | $45.50–$70.00 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ER ADM OF IMMUNIZATION (SQIM) | $35.00 | $70.00 | $45.50–$70.00 | — | 50% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 STATE IMM ADMIN EACH ADD | $10.79 | $21.58 | $13.81–$21.58 | 39% below | 50% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 OP IMMUN ADMIN EACH ADDL | $20.00 | $40.00 | $25.60–$40.00 | 13% above | 50% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUN ADMIN, EA ADDL MA ONLY | $20.00 | $40.00 | $25.60–$40.00 | 13% above | 50% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZ ADMIN EACH ADD'L | $20.00 | $40.00 | $25.60–$40.00 | 13% above | 50% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 OP ADM OF IMMUN EA ADD (SQIM) | $20.00 | $40.00 | $25.60–$40.00 | 13% above | 50% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 STATE IMM ADMIN EACH ADD | $10.79 | $21.58 | $14.03–$21.58 | — | 50% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN ADMIN, EA ADDL MA ONLY | $20.00 | $40.00 | $26.00–$40.00 | — | 50% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 OP ADM OF IMMUN EA ADD (SQIM) | $20.00 | $40.00 | $26.00–$40.00 | — | 50% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 OP IMMUN ADMIN EACH ADDL | $20.00 | $40.00 | $26.00–$40.00 | — | 50% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZ ADMIN EACH ADD'L | $20.00 | $40.00 | $26.00–$40.00 | — | 50% |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.
Source file: https://northernlighthealth.org/NLH/media/Price-Transparency/043341666_CA-Dean-hospital_standardcharges.csv