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Demo — Price Audit Complete

St. Mary's Regional Medical Center

Jane Doe · 02/14/2026 · 8 items scanned

Overcharge Rate
92%
Total Billed
$14,875
Fair Estimate
$1,200
Potential Savings
$13,675
Issues Found
8
ℹ️

Important: These are potential issues to review, not definitive billing errors. Fair estimates are based on 2x CMS Medicare rates — the midpoint of typical commercial insurance reimbursement (1.5–2.5x Medicare). Flagged items exceed even typical commercial rates and are strong candidates for dispute.

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Fair estimates based on 2x CMS 2026 Medicare rates (Physician Fee Schedule + Clinical Lab Fee Schedule). Commercial insurance typically reimburses 1.5–2.5x Medicare.

2 Duplicates1 Upcoding4 Overcharges1 Unbundling

Potential Issues Found— click any item for details

Upcoding
Emergency Dept Visit - Level 5
CPT 99285
$4,250
Fair est: $465.22 (2x Medicare $232.61)
Save $3,785
Overcharge
MRI Brain w/ & w/o Contrast
CPT 70553
$3,800
Fair est: $633.94 (2x Medicare $316.97)
Save $3,166
Overcharge
Routine Venipuncture (Blood Draw)
CPT 36415
$125
Fair est: $18.68 (2x Medicare $9.34)
Save $106
Overcharge
Complete Blood Count (CBC)
CPT 85025
$350
Fair est: $15.54 (2x Medicare $7.77)
Save $334
Duplicate
Complete Blood Count (CBC) — DUPLICATE
CPT 85025
$350
Fair est: Remove (2x Medicare $7.77)
Save $350
Duplicate
Emergency Dept Visit - Level 5 — DUPLICATE
CPT 99285
$4,250
Fair est: Remove (2x Medicare $232.61)
Save $4,250
Overcharge
IV Infusion - First Hour
CPT 96360
$950
Fair est: $66.80 (2x Medicare $33.40)
Save $883
Unbundled
Normal Saline 1000ml
CPT J7030
$800
Fair est: Remove (bundled)
Save $800
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