Hospital Richmond, VA

Bon Secours Southside Medical Center

Listed in its price file as “Bon Secours Mercy Health Petersburg LLC”.

Bon Secours Southside Medical Center in Petersburg, VA publishes cash prices for 423 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Virginia median for 278 of 420 procedures and below it for 138. By typical cash price it ranks #49 of 66 Virginia hospitals and #5 of 11 hospitals in the Richmond, VA area, cheapest first. Select a procedure to compare it with other hospitals nearby.

200 Medical Park Blvd.,Petersburg,VA 23805 Collected Sep 23, 2026 Source price file Check a bill from this hospital (804) 765-5000

Acute care hospital For-profit hospital Emergency department CMS star rating 2 of 5 CCN 490067 · CMS hospital register NPI 1720623853

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT Abd W&W/O Cont	$4,433.10	$14,777.00	—	134% above	70%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abd W&W/O Cont	$4,433.10	$14,777.00	—	—	70%
Abdominal X-ray, 2 views CPT 74019 HC X-Ray Exam Abdomen 2 Views	$641.40	$2,138.00	—	96% above	70%
Abdominal X-ray, 2 views inpatient CPT 74019 HC X-Ray Exam Abdomen 2 Views	$641.40	$2,138.00	—	—	70%
Ankle X-ray, complete, 3 or more views CPT 73610 HC X-Ray Ankle Rout 3 Views	$484.20	$1,614.00	—	43% above	70%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC X-Ray Ankle Rout 3 Views	$484.20	$1,614.00	—	—	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC Tcp02/Abi 1-2 Levels	$861.60	$2,872.00	—	122% above	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC Tcp02/Abi 1-2 Levels	$861.60	$2,872.00	—	—	70%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT Upper Extremity W/O Contrast	$2,120.40	$7,068.00	—	85% above	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT Upper Extremity W/O Contrast	$2,120.40	$7,068.00	—	—	70%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC Fluro Esophagram	$970.20	$3,234.00	—	100% above	70%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC Fluro Esophagram	$970.20	$3,234.00	—	—	70%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM Bone Scan Whole Body	$1,561.50	$5,205.00	—	12% above	70%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM Bone Scan Whole Body	$1,561.50	$5,205.00	—	—	70%
Breast ultrasound, complete, one breast CPT 76641 HC US Breast Comp	$1,089.60	$3,632.00	—	94% above	70%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US Breast Comp	$1,089.60	$3,632.00	—	—	70%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US Breast Ltd	$1,089.60	$3,632.00	—	120% above	70%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US Breast Ltd	$1,089.60	$3,632.00	—	—	70%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC Cta Abd & Pelvis W & W/O Cont	$2,740.20	$9,134.00	—	9% below	70%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC Cta Abd & Pelvis W & W/O Cont	$2,740.20	$9,134.00	—	—	70%
CT angiography (CTA) of the head CPT 70496 HC Cta Head W & W/O Cont	$1,479.60	$4,932.00	—	18% below	70%
CT angiography (CTA) of the head inpatient CPT 70496 HC Cta Head W & W/O Cont	$1,479.60	$4,932.00	—	—	70%
CT angiography (CTA) of the neck CPT 70498 HC Cta Neck/Carotid W & W/O Cont	$1,479.60	$4,932.00	—	23% below	70%
CT angiography (CTA) of the neck inpatient CPT 70498 HC Cta Neck/Carotid W & W/O Cont	$1,479.60	$4,932.00	—	—	70%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT Angio Chest W & W/O Cont	$2,783.40	$9,278.00	—	56% above	70%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT Angio Chest W & W/O Cont	$2,783.40	$9,278.00	—	—	70%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT Heart No Contrast Quant Eval Coronry Calcium	$1,301.00	$1,301.00	—	554% above	—
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT Heart No Contrast Quant Eval Coronry Calcium	$1,301.00	$1,301.00	—	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT Abd/Pelvis W/O Contrast	$2,698.50	$8,995.00	—	23% above	70%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT Abd/Pelvis W/O Contrast	$2,698.50	$8,995.00	—	—	70%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abd/Pel W Cont	$3,614.10	$12,047.00	—	17% above	70%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abd/Pel W Cont	$3,614.10	$12,047.00	—	—	70%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Abd/Pelvis W W/O Contrast	$4,098.90	$13,663.00	—	19% above	70%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Abd/Pelvis W W/O Contrast	$4,098.90	$13,663.00	—	—	70%
CT scan of the abdomen with contrast CPT 74160 HC CT Abdomen W/ Cont	$4,084.20	$13,614.00	—	149% above	70%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT Abdomen W/ Cont	$4,084.20	$13,614.00	—	—	70%
CT scan of the abdomen without contrast CPT 74150 HC CT Abdomen W/O Cont	$3,010.50	$10,035.00	—	111% above	70%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT Abdomen W/O Cont	$3,010.50	$10,035.00	—	—	70%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT Facial Bones W/O Contrast	$2,276.40	$7,588.00	—	75% above	70%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT Facial Bones W/O Contrast	$2,276.40	$7,588.00	—	—	70%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT Brain W/O Contrast	$2,471.10	$8,237.00	—	86% above	70%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Brain W/O Contrast	$2,471.10	$8,237.00	—	—	70%
CT scan of the head with contrast CPT 70460 HC CT Brain W/ Contrast	$3,471.60	$11,572.00	—	127% above	70%
CT scan of the head with contrast inpatient CPT 70460 HC CT Brain W/ Contrast	$3,471.60	$11,572.00	—	—	70%
CT scan of the head without and with contrast CPT 70470 HC CT Brain W/WO Contrast	$4,264.80	$14,216.00	—	143% above	70%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT Brain W/WO Contrast	$4,264.80	$14,216.00	—	—	70%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT L-Spine W/O Contrast	$3,150.60	$10,502.00	—	98% above	70%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT L-Spine W/O Contrast	$3,150.60	$10,502.00	—	—	70%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT C-Spine W/O Contrast	$2,617.80	$8,726.00	—	64% above	70%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT C-Spine W/O Contrast	$2,617.80	$8,726.00	—	—	70%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/ Contrast	$3,523.80	$11,746.00	—	108% above	70%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/ Contrast	$3,523.80	$11,746.00	—	—	70%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC Extracranial Bilat Study	$2,185.50	$7,285.00	—	—	70%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC Extracranial Bilat Study	$2,185.50	$7,285.00	—	—	70%
Chest CT scan without and with contrast CPT 71270 HC CT Chest W/WO Contrast	$3,960.60	$13,202.00	—	103% above	70%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT Chest W/WO Contrast	$3,960.60	$13,202.00	—	—	70%
Chest X-ray, 2 views CPT 71046 HC X-Ray Exam Chest 2 Views	$806.40	$2,688.00	—	186% above	70%
Chest X-ray, 2 views inpatient CPT 71046 HC X-Ray Exam Chest 2 Views	$806.40	$2,688.00	—	—	70%
Chest X-ray, single view CPT 71045 HC X-Ray Exam Chest 1 View	$351.60	$1,172.00	—	50% above	70%
Chest X-ray, single view inpatient CPT 71045 HC X-Ray Exam Chest 1 View	$351.60	$1,172.00	—	—	70%
Collarbone (clavicle) X-ray, complete CPT 73000 HC X-Ray Clavicle	$453.90	$1,513.00	—	53% above	70%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC X-Ray Clavicle	$453.90	$1,513.00	—	—	70%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US Retroperitoneal Complete	$1,150.50	$3,835.00	—	80% above	70%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US Retroperitoneal Complete	$1,150.50	$3,835.00	—	—	70%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC Dexa Axial Skeleton	$177.60	$592.00	—	70% below	70%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC Dexa Axial Skeleton	$177.60	$592.00	—	—	70%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Chest W/O Contrast	$2,265.00	$7,550.00	—	65% above	70%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT Chest W/O Contrast	$2,265.00	$7,550.00	—	—	70%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT Chest W/ Contrast	$4,011.30	$13,371.00	—	132% above	70%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT Chest W/ Contrast	$4,011.30	$13,371.00	—	—	70%
Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammo Dgx Bilateral Incl Cad if Perf	$637.50	$2,125.00	—	—	70%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammo Dgx Bilateral Incl Cad if Perf	$637.50	$2,125.00	—	—	70%
Diagnostic mammogram, one breast one side CPT 77065 HC Mammo Dgx Unilateral Incl Cad if Perf	$543.60	$1,812.00	—	60% above	70%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammo Dgx Unilateral Incl Cad if Perf	$543.60	$1,812.00	—	—	70%
Duplex ultrasound of the leg arteries, both legs CPT 93925 HC Bil Niv Arterial Low Ext Duplex	$1,168.20	$3,894.00	—	18% below	70%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 HC Bil Niv Arterial Low Ext Duplex	$1,168.20	$3,894.00	—	—	70%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC Niv Venous Duplex Bilat Study	$1,764.60	$5,882.00	—	—	70%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC Niv Venous Duplex Bilat Study	$1,764.60	$5,882.00	—	—	70%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC 2d Echo Without Contrast - With Dop/Color Flow	$3,250.50	$10,835.00	—	88% above	70%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC 2d Echo Without Contrast - With Dop/Color Flow	$3,250.50	$10,835.00	—	—	70%
Elbow X-ray, 2 views CPT 73070 HC Elbow 2 Views	$408.30	$1,361.00	—	52% above	70%
Elbow X-ray, 2 views inpatient CPT 73070 HC Elbow 2 Views	$408.30	$1,361.00	—	—	70%
Elbow X-ray, complete, 3 or more views CPT 73080 HC Elbow Min 3 Views	$453.90	$1,513.00	—	7% above	70%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC Elbow Min 3 Views	$453.90	$1,513.00	—	—	70%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT Orbit/Ear/Fossa W/O Contrast	$2,032.80	$6,776.00	—	50% above	70%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT Orbit/Ear/Fossa W/O Contrast	$2,032.80	$6,776.00	—	—	70%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC Facial Bones Min 3 Views	$649.50	$2,165.00	—	25% above	70%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC Facial Bones Min 3 Views	$649.50	$2,165.00	—	—	70%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC Forearm 2 Views	$453.90	$1,513.00	—	38% above	70%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC Forearm 2 Views	$453.90	$1,513.00	—	—	70%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM Hepatobiliary Imaging WO Pharm	$1,734.30	$5,781.00	—	53% above	70%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM Hepatobiliary Imaging WO Pharm	$1,734.30	$5,781.00	—	—	70%
Hand X-ray, 2 views CPT 73120 HC Hand 2 Views	$379.80	$1,266.00	—	51% above	70%
Hand X-ray, 2 views inpatient CPT 73120 HC Hand 2 Views	$379.80	$1,266.00	—	—	70%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC X-Ray Os Calcis Min 2 Views	$387.90	$1,293.00	—	39% above	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC X-Ray Os Calcis Min 2 Views	$387.90	$1,293.00	—	—	70%
Knee X-ray, 3 views CPT 73562 HC X-Ray Knee 3 Views	$707.10	$2,357.00	—	111% above	70%
Knee X-ray, 3 views inpatient CPT 73562 HC X-Ray Knee 3 Views	$707.10	$2,357.00	—	—	70%
Knee X-ray, complete, 4 or more views CPT 73564 HC X-Ray Knee Rout Inc Tun Pat Min 4 View	$788.40	$2,628.00	—	81% above	70%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC X-Ray Knee Rout Inc Tun Pat Min 4 View	$788.40	$2,628.00	—	—	70%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT Lower Ext W/O Cont	$2,373.60	$7,912.00	—	97% above	70%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT Lower Ext W/O Cont	$2,373.60	$7,912.00	—	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US Abdominal Limited	$924.00	$3,080.00	—	40% above	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US Abdominal Limited	$924.00	$3,080.00	—	—	70%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US Extrem Limited Nonvasc	$174.30	$581.00	—	43% below	70%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US Extrem Limited Nonvasc	$174.30	$581.00	—	—	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT Chest Screening Low Dose Wout Cont	$1,899.00	$6,330.00	—	576% above	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT Chest Screening Low Dose Wout Cont	$1,899.00	$6,330.00	—	—	70%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC X-Ray Tibia/Fibula 2 Views	$464.10	$1,547.00	—	49% above	70%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC X-Ray Tibia/Fibula 2 Views	$464.10	$1,547.00	—	—	70%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRI-Angio Head WO Contrast	$2,452.50	$8,175.00	—	7% above	70%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRI-Angio Head WO Contrast	$2,452.50	$8,175.00	—	—	70%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Lower Ext Jnt W/O Cont	$5,133.60	$17,112.00	—	166% above	70%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Lower Ext Jnt W/O Cont	$5,133.60	$17,112.00	—	—	70%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI Lower Ext Jnt W&W/O Cont	$6,580.80	$21,936.00	—	92% above	70%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI Lower Ext Jnt W&W/O Cont	$6,580.80	$21,936.00	—	—	70%
MRI of the abdomen without contrast CPT 74181 HC MRI-Abdomen WO Contrast	$2,326.80	$7,756.00	—	43% above	70%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI-Abdomen WO Contrast	$2,326.80	$7,756.00	—	—	70%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI-Abdomen W & WO Contrast	$1,689.60	$5,632.00	—	41% below	70%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI-Abdomen W & WO Contrast	$1,689.60	$5,632.00	—	—	70%
MRI of the brain, no contrast dye CPT 70551 HC MRI Brain WO Ctrst	$4,790.10	$15,967.00	—	148% above	70%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain WO Ctrst	$4,790.10	$15,967.00	—	—	70%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI-Brain WO & W Contrast	$8,307.00	$27,690.00	—	205% above	70%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI-Brain WO & W Contrast	$8,307.00	$27,690.00	—	—	70%
MRI of the lower back, no contrast dye CPT 72148 HC MRI-Spine Lumbar WO Contrast	$5,799.60	$19,332.00	—	190% above	70%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI-Spine Lumbar WO Contrast	$5,799.60	$19,332.00	—	—	70%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI-Spine Lumbar WO & W Cont	$8,307.00	$27,690.00	—	151% above	70%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI-Spine Lumbar WO & W Cont	$8,307.00	$27,690.00	—	—	70%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI-Spine Thoracic WO Contrast	$4,998.00	$16,660.00	—	150% above	70%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI-Spine Thoracic WO Contrast	$4,998.00	$16,660.00	—	—	70%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI-Spine Cervical W & WO Cont	$7,422.60	$24,742.00	—	127% above	70%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI-Spine Cervical W & WO Cont	$7,422.60	$24,742.00	—	—	70%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI-Spine Cervical WO Contrast	$6,642.90	$22,143.00	—	232% above	70%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI-Spine Cervical WO Contrast	$6,642.90	$22,143.00	—	—	70%
MRI of the pelvis without and with contrast CPT 72197 HC MRI-Pelvis WO & W Contrast	$6,279.30	$20,931.00	—	98% above	70%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI-Pelvis WO & W Contrast	$6,279.30	$20,931.00	—	—	70%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI-Pelvis WO Contrast	$3,948.30	$13,161.00	—	112% above	70%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI-Pelvis WO Contrast	$3,948.30	$13,161.00	—	—	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI-Upper Ext Jnt WO Cont	$5,133.60	$17,112.00	—	166% above	70%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI-Upper Ext Jnt WO Cont	$5,133.60	$17,112.00	—	—	70%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC C-Spine Min 4 Views	$795.60	$2,652.00	—	64% above	70%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC C-Spine Min 4 Views	$795.60	$2,652.00	—	—	70%
Neck soft tissue CT scan with contrast CPT 70491 HC CT Soft Tissue Neck W/ Contrast	$3,889.20	$12,964.00	—	132% above	70%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT Soft Tissue Neck W/ Contrast	$3,889.20	$12,964.00	—	—	70%
Neck soft tissue CT scan without contrast CPT 70490 HC CT Soft Tissue Neck W/O Contrast	$3,889.20	$12,964.00	—	355% above	70%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT Soft Tissue Neck W/O Contrast	$3,889.20	$12,964.00	—	—	70%
Neck soft tissue X-ray CPT 70360 HC Soft Tissue Lat Neck	$429.90	$1,433.00	—	25% above	70%
Neck soft tissue X-ray inpatient CPT 70360 HC Soft Tissue Lat Neck	$429.90	$1,433.00	—	—	70%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM Sest. Rest Stress Mult	$5,667.00	$18,890.00	—	79% above	70%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM Sest. Rest Stress Mult	$5,667.00	$18,890.00	—	—	70%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC Pet/CT Skull Base to Mid Thigh	$4,293.90	$14,313.00	—	3% below	70%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC Pet/CT Skull Base to Mid Thigh	$4,293.90	$14,313.00	—	—	70%
Pelvic CT scan without contrast CPT 72192 HC CT Pelvis W/O Contrast	$2,671.20	$8,904.00	—	81% above	70%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT Pelvis W/O Contrast	$2,671.20	$8,904.00	—	—	70%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US Pelvis Limited	$649.50	$2,165.00	—	51% above	70%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US Pelvis Limited	$649.50	$2,165.00	—	—	70%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US Pelvis Complete	$1,297.50	$4,325.00	—	76% above	70%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US Pelvis Complete	$1,297.50	$4,325.00	—	—	70%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC Fetal Eval 2-3 Trim Sgl Gest	$1,216.50	$4,055.00	—	101% above	70%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC Fetal Eval 2-3 Trim Sgl Gest	$1,216.50	$4,055.00	—	—	70%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC Fetal Eval 1st Tri Sgl Gest	$460.80	$1,536.00	—	4% below	70%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC Fetal Eval 1st Tri Sgl Gest	$460.80	$1,536.00	—	—	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US Fetal Evaluation-Limited	$963.00	$3,210.00	—	103% above	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US Fetal Evaluation-Limited	$963.00	$3,210.00	—	—	70%
Rib X-ray, one side, 2 views one side CPT 71100 HC Ribs Unilateral 2 Views	$468.00	$1,560.00	—	42% above	70%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC Ribs Unilateral 2 Views	$468.00	$1,560.00	—	—	70%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC X-Ray, Ribs, Pa Chest, 3	$556.80	$1,856.00	—	35% above	70%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC X-Ray, Ribs, Pa Chest, 3	$556.80	$1,856.00	—	—	70%
Screening mammogram, both breasts CPT 77067 HC Mammo Screening Incl Cad if Perf	$461.40	$1,538.00	—	11% above	70%
Screening mammogram, both breasts inpatient CPT 77067 HC Mammo Screening Incl Cad if Perf	$461.40	$1,538.00	—	—	70%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC Shoulder Complete Min 2 Views	$596.70	$1,989.00	—	87% above	70%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC Shoulder Complete Min 2 Views	$596.70	$1,989.00	—	—	70%
Sinus X-ray, complete, 3 or more views CPT 70220 HC Sinuses Min 3 Views	$669.00	$2,230.00	—	37% above	70%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC Sinuses Min 3 Views	$669.00	$2,230.00	—	—	70%
Skull X-ray, fewer than 4 views CPT 70250 HC Skull Less Than 4 Views	$488.40	$1,628.00	—	42% above	70%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC Skull Less Than 4 Views	$488.40	$1,628.00	—	—	70%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC 2d Echo Stress Tst Rest&Cardio	$3,686.10	$12,287.00	—	115% above	70%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC 2d Echo Stress Tst Rest&Cardio	$3,686.10	$12,287.00	—	—	70%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC Dysphagia/Swallowing Study	$771.30	$2,571.00	—	59% above	70%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC Dysphagia/Swallowing Study	$771.30	$2,571.00	—	—	70%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-Ray Exam of Femur Min 2 Views	$582.90	$1,943.00	—	90% above	70%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC X-Ray Exam of Femur Min 2 Views	$582.90	$1,943.00	—	—	70%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT T-Spine W/O Contrast	$2,671.20	$8,904.00	—	66% above	70%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT T-Spine W/O Contrast	$2,671.20	$8,904.00	—	—	70%
Toe X-ray, 2 or more views CPT 73660 HC X-Ray Toes Min 2 Views	$338.40	$1,128.00	—	35% above	70%
Toe X-ray, 2 or more views inpatient CPT 73660 HC X-Ray Toes Min 2 Views	$338.40	$1,128.00	—	—	70%
Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal, Non OB	$1,297.50	$4,325.00	—	122% above	70%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal, Non OB	$1,297.50	$4,325.00	—	—	70%
Transvaginal ultrasound during pregnancy CPT 76817 HC US Transvaginal Obsetrical	$1,838.10	$6,127.00	—	282% above	70%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US Transvaginal Obsetrical	$1,838.10	$6,127.00	—	—	70%
Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete	$1,893.30	$6,311.00	—	118% above	70%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Abdomen Complete	$1,893.30	$6,311.00	—	—	70%
Ultrasound of the scrotum and testicles CPT 76870 HC US Scrotum & Contents	$920.70	$3,069.00	—	29% above	70%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US Scrotum & Contents	$920.70	$3,069.00	—	—	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC Soft Tissue Neck US	$817.50	$2,725.00	—	33% above	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC Soft Tissue Neck US	$817.50	$2,725.00	—	—	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC Rad Exam Upr GI Tract Single Contrast Study	$1,098.90	$3,663.00	—	32% above	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC Rad Exam Upr GI Tract Single Contrast Study	$1,098.90	$3,663.00	—	—	70%
Upper arm X-ray (humerus), 2 views CPT 73060 HC Humerus Min 2 View	$519.30	$1,731.00	—	54% above	70%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC Humerus Min 2 View	$519.30	$1,731.00	—	—	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC Niv Venous Duplex Uni/Ltd Study	$1,130.10	$3,767.00	—	53% above	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC Niv Venous Duplex Uni/Ltd Study	$1,130.10	$3,767.00	—	—	70%
Wrist X-ray, 2 views CPT 73100 HC Xr Wrist 2 Views	$516.30	$1,721.00	—	103% above	70%
Wrist X-ray, 2 views inpatient CPT 73100 HC Xr Wrist 2 Views	$516.30	$1,721.00	—	—	70%
Wrist X-ray, complete, 3 or more views CPT 73110 HC Wrist Min 3 Views	$562.50	$1,875.00	—	84% above	70%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC Wrist Min 3 Views	$562.50	$1,875.00	—	—	70%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-Ray Exam Hip Uni 2-3 Views	$568.80	$1,896.00	—	127% above	70%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC X-Ray Exam Hip Uni 2-3 Views	$568.80	$1,896.00	—	—	70%
X-ray of the abdomen, 1 view CPT 74018 HC X-Ray Exam Abdomen 1 View	$453.90	$1,513.00	—	64% above	70%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC X-Ray Exam Abdomen 1 View	$453.90	$1,513.00	—	—	70%
X-ray of the ankle, 2 views CPT 73600 HC X-Ray Ankle 2 Views	$429.90	$1,433.00	—	60% above	70%
X-ray of the ankle, 2 views inpatient CPT 73600 HC X-Ray Ankle 2 Views	$429.90	$1,433.00	—	—	70%
X-ray of the finger(s), 2 or more views CPT 73140 HC Fingers Min 2 Views	$425.40	$1,418.00	—	79% above	70%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC Fingers Min 2 Views	$425.40	$1,418.00	—	—	70%
X-ray of the foot, 2 views CPT 73620 HC X-Ray Foot 2 Views	$429.90	$1,433.00	—	45% above	70%
X-ray of the foot, 2 views inpatient CPT 73620 HC X-Ray Foot 2 Views	$429.90	$1,433.00	—	—	70%
X-ray of the foot, complete, 3 or more views CPT 73630 HC X-Ray Foot Min 3 Views Complete	$484.20	$1,614.00	—	53% above	70%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC X-Ray Foot Min 3 Views Complete	$484.20	$1,614.00	—	—	70%
X-ray of the hand, 3 or more views CPT 73130 HC Hand Routine Min 3 Views	$556.80	$1,856.00	—	87% above	70%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC Hand Routine Min 3 Views	$556.80	$1,856.00	—	—	70%
X-ray of the knee, 1 or 2 views CPT 73560 HC X-Ray Knee 1-2 Views	$321.60	$1,072.00	—	23% above	70%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC X-Ray Knee 1-2 Views	$321.60	$1,072.00	—	—	70%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC L-Spine 2-3 Views	$512.10	$1,707.00	—	40% above	70%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC L-Spine 2-3 Views	$512.10	$1,707.00	—	—	70%
X-ray of the lower back, 4 or more views CPT 72110 HC L-Spine Min 4 Views	$864.30	$2,881.00	—	64% above	70%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC L-Spine Min 4 Views	$864.30	$2,881.00	—	—	70%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC T-Spine 2 Views	$481.50	$1,605.00	—	47% above	70%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC T-Spine 2 Views	$481.50	$1,605.00	—	—	70%
X-ray of the nasal bones, 3 or more views CPT 70160 HC Nasal Bones Min 3 Views	$606.90	$2,023.00	—	113% above	70%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC Nasal Bones Min 3 Views	$606.90	$2,023.00	—	—	70%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC C-Spine 2-3 Views	$495.60	$1,652.00	—	33% above	70%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC C-Spine 2-3 Views	$495.60	$1,652.00	—	—	70%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC Pelvis Ap Only	$453.90	$1,513.00	—	38% above	70%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC Pelvis Ap Only	$453.90	$1,513.00	—	—	70%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC Sacrum and Coccyx Min 2 Views	$453.90	$1,513.00	—	8% above	70%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC Sacrum and Coccyx Min 2 Views	$453.90	$1,513.00	—	—	70%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
ACTH blood test CPT 82024 HC So Acth	$993.90	$3,313.00	—	327% above	70%
ACTH blood test inpatient CPT 82024 HC So Acth	$993.90	$3,313.00	—	—	70%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC So Sgpt (Alt)	$10.20	$34.00	—	80% below	70%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC Sgpt (Alt)	$45.90	$153.00	—	8% below	70%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC So Sgpt (Alt)	$10.20	$34.00	—	—	70%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC Sgpt (Alt)	$45.90	$153.00	—	—	70%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC So Sgot (Ast)	$9.60	$32.00	—	81% below	70%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC Transferase Aspartate Amino Ast Sgot	$45.90	$153.00	—	8% below	70%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC So Sgot (Ast)	$9.60	$32.00	—	—	70%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC Transferase Aspartate Amino Ast Sgot	$45.90	$153.00	—	—	70%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC So Hepatitis Panel Acute	$251.40	$838.00	—	13% below	70%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC Acute Hepatitis Panel	$354.30	$1,181.00	—	23% above	70%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC So Hepatitis Panel Acute	$251.40	$838.00	—	—	70%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC Acute Hepatitis Panel	$354.30	$1,181.00	—	—	70%
Albumin blood test CPT 82040 HC Albumin Serum Plasma/Whole Blood	$52.80	$176.00	—	35% above	70%
Albumin blood test inpatient CPT 82040 HC Albumin Serum Plasma/Whole Blood	$52.80	$176.00	—	—	70%
Aldosterone blood test CPT 82088 HC So Aldosterone, Serum	$250.80	$836.00	—	42% above	70%
Aldosterone blood test inpatient CPT 82088 HC So Aldosterone, Serum	$250.80	$836.00	—	—	70%
Alkaline phosphatase (ALP) blood test CPT 84075 HC So Alkaline Phosphatase	$18.30	$61.00	—	50% below	70%
Alkaline phosphatase (ALP) blood test CPT 84075 HC Alkaline Phosphatase	$56.70	$189.00	—	54% above	70%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC So Alkaline Phosphatase	$18.30	$61.00	—	—	70%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC Alkaline Phosphatase	$56.70	$189.00	—	—	70%
Allergy blood test, specific IgE, per allergen CPT 86003 HC So1 Allergen Specific	$13.20	$44.00	—	46% below	70%
Allergy blood test, specific IgE, per allergen CPT 86003 HC So Allergen Specific	$22.50	$75.00	—	9% below	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC So1 Allergen Specific	$13.20	$44.00	—	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC So Allergen Specific	$22.50	$75.00	—	—	70%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC So1 Alpha Fetoprotein	$35.40	$118.00	—	68% below	70%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC So Alpha Fetoprotein	$90.90	$303.00	—	18% below	70%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC So1 Alpha Fetoprotein	$35.40	$118.00	—	—	70%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC So Alpha Fetoprotein	$90.90	$303.00	—	—	70%
Ammonia blood test CPT 82140 HC Ammonia	$120.60	$402.00	—	31% above	70%
Ammonia blood test inpatient CPT 82140 HC Ammonia	$120.60	$402.00	—	—	70%
Amylase blood test CPT 82150 HC Amylase	$145.80	$486.00	—	160% above	70%
Amylase blood test inpatient CPT 82150 HC Amylase	$145.80	$486.00	—	—	70%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC So Cyclic Citrullinated Peptd,Ab	$188.10	$627.00	—	157% above	70%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC So Cyclic Citrullinated Peptd,Ab	$188.10	$627.00	—	—	70%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC So Anti Nuclear Antibody	$249.30	$831.00	—	81% above	70%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC So Anti Nuclear Antibody	$249.30	$831.00	—	—	70%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC Natriuretic Peptide	$151.50	$505.00	—	22% below	70%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC Natriuretic Peptide	$151.50	$505.00	—	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC So Body Fluid Culture	$57.00	$190.00	—	17% below	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Cul Bact Xcpt Urine Blood/Stool Aerobic Isol	$71.40	$238.00	—	4% above	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC So Body Fluid Culture	$57.00	$190.00	—	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Cul Bact Xcpt Urine Blood/Stool Aerobic Isol	$71.40	$238.00	—	—	70%
Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel Calcium Total	$209.40	$698.00	—	179% above	70%
Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel Calcium Total	$209.40	$698.00	—	—	70%
Bilirubin blood test, total CPT 82247 HC Bilirubin Total	$102.60	$342.00	—	130% above	70%
Bilirubin blood test, total inpatient CPT 82247 HC Bilirubin Total	$102.60	$342.00	—	—	70%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC So Tissue Level IV	$90.60	$302.00	—	58% below	70%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC Tissue Level IV	$270.00	$900.00	—	24% above	70%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC So Tissue Level IV	$90.60	$302.00	—	—	70%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC Tissue Level IV	$270.00	$900.00	—	—	70%
Blood culture for bacteria CPT 87040 HC Culture Bacterial Blood Aerobic W/ID Isolates	$318.60	$1,062.00	—	208% above	70%
Blood culture for bacteria inpatient CPT 87040 HC Culture Bacterial Blood Aerobic W/ID Isolates	$318.60	$1,062.00	—	—	70%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Collection Venous Blood Venipuncture	$30.00	$100.00	—	71% above	70%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Collection Venous Blood Venipuncture	$30.00	$100.00	—	—	70%
Blood glucose (sugar) test CPT 82947 HC Glucose, Fasting	$27.90	$93.00	—	38% below	70%
Blood glucose (sugar) test inpatient CPT 82947 HC Glucose, Fasting	$27.90	$93.00	—	—	70%
Blood lead test CPT 83655 HC So Lead	$144.30	$481.00	—	129% above	70%
Blood lead test inpatient CPT 83655 HC So Lead	$144.30	$481.00	—	—	70%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC Gonadotropin, Chorionic (Hcg) Qualitative	$140.40	$468.00	—	33% above	70%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC Gonadotropin, Chorionic (Hcg) Qualitative	$140.40	$468.00	—	—	70%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC So Abo	$42.30	$141.00	—	53% below	70%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC So Abo	$42.30	$141.00	—	—	70%
Blood urea nitrogen (BUN) test CPT 84520 HC Assay of Urea Nitrogen Quantitative	$56.70	$189.00	—	9% above	70%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Assay of Urea Nitrogen Quantitative	$56.70	$189.00	—	—	70%
C-peptide blood test CPT 84681 HC So Peptide,C	$138.60	$462.00	—	27% above	70%
C-peptide blood test inpatient CPT 84681 HC So Peptide,C	$138.60	$462.00	—	—	70%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-Reactive Protein	$129.90	$433.00	—	52% above	70%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-Reactive Protein	$129.90	$433.00	—	—	70%
C. difficile toxin gene test (stool PCR) CPT 87493 HC So Clost Diff,Toxin Gene,Amp Prbe	$109.50	$365.00	—	13% below	70%
C. difficile toxin gene test (stool PCR) CPT 87493 HC Inf Agent Det Nucleic Acid Clostridium Amp Probe	$110.70	$369.00	—	12% below	70%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC So Clost Diff,Toxin Gene,Amp Prbe	$109.50	$365.00	—	—	70%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC Inf Agent Det Nucleic Acid Clostridium Amp Probe	$110.70	$369.00	—	—	70%
CA 19-9 blood test (tumor marker) CPT 86301 HC So Carbohydrate Antigen 19-9	$207.60	$692.00	—	103% above	70%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC So Carbohydrate Antigen 19-9	$207.60	$692.00	—	—	70%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC Immunoassay Tumor Antigen Quantitative Ca 125	$41.40	$138.00	—	66% below	70%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC Immunoassay Tumor Antigen Quantitative Ca 125	$41.40	$138.00	—	—	70%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC So Iadna Sars-Cov-2-19 Amp Probe Tq	$57.60	$192.00	—	25% below	70%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC Iadna Sars-Cov-2-19 Amp Probe Tq	$60.60	$202.00	—	21% below	70%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC So Iadna Sars-Cov-2-19 Amp Probe Tq	$57.60	$192.00	—	—	70%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC Iadna Sars-Cov-2-19 Amp Probe Tq	$60.60	$202.00	—	—	70%
Calcium blood test, total CPT 82310 HC Calcium Total	$53.10	$177.00	—	30% above	70%
Calcium blood test, total inpatient CPT 82310 HC Calcium Total	$53.10	$177.00	—	—	70%
Carcinoembryonic antigen (CEA) test CPT 82378 HC Carcinoembryonic Antigen Cea	$154.80	$516.00	—	34% above	70%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC Carcinoembryonic Antigen Cea	$154.80	$516.00	—	—	70%
Chickenpox (varicella) immunity blood test CPT 86787 HC So Varicella Igg Igm	$201.90	$673.00	—	91% above	70%
Chickenpox (varicella) immunity blood test CPT 86787 HC So1 Varicella Igg Igm	$228.30	$761.00	—	116% above	70%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC So Varicella Igg Igm	$201.90	$673.00	—	—	70%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC So1 Varicella Igg Igm	$228.30	$761.00	—	—	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC Chlamydia Amp Probe Tech, 1	$293.40	$978.00	—	121% above	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC Chlamydia Amp Probe Tech, 1	$293.40	$978.00	—	—	70%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC So Lipid Panel	$26.10	$87.00	—	69% below	70%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel	$189.00	$630.00	—	122% above	70%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC So Lipid Panel	$26.10	$87.00	—	—	70%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel	$189.00	$630.00	—	—	70%
Complete blood count (CBC) with differential CPT 85025 HC So Cbc	$14.40	$48.00	—	50% below	70%
Complete blood count (CBC) with differential CPT 85025 HC Cbc	$207.30	$691.00	—	620% above	70%
Complete blood count (CBC) with differential inpatient CPT 85025 HC So Cbc	$14.40	$48.00	—	—	70%
Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc	$207.30	$691.00	—	—	70%
Complete blood count (CBC), no differential CPT 85027 HC Cbc (Hemogram)	$161.40	$538.00	—	96% above	70%
Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc (Hemogram)	$161.40	$538.00	—	—	70%
Comprehensive metabolic panel (blood test) CPT 80053 HC So Comp Metabolic Panel	$48.90	$163.00	—	71% below	70%
Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel	$228.30	$761.00	—	34% above	70%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC So Comp Metabolic Panel	$48.90	$163.00	—	—	70%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel	$228.30	$761.00	—	—	70%
Cortisol blood test, total CPT 82533 HC So Cortisol,Serum	$30.30	$101.00	—	65% below	70%
Cortisol blood test, total CPT 82533 HC Cortisol Total	$114.60	$382.00	—	32% above	70%
Cortisol blood test, total inpatient CPT 82533 HC So Cortisol,Serum	$30.30	$101.00	—	—	70%
Cortisol blood test, total inpatient CPT 82533 HC Cortisol Total	$114.60	$382.00	—	—	70%
Creatine kinase (CK) blood test, total CPT 82550 HC Creatine Kinase Total	$131.40	$438.00	—	107% above	70%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC Creatine Kinase Total	$131.40	$438.00	—	—	70%
Creatinine blood test CPT 82565 HC Creatinine,Serum	$44.40	$148.00	—	31% below	70%
Creatinine blood test inpatient CPT 82565 HC Creatinine,Serum	$44.40	$148.00	—	—	70%
Cytomegalovirus (CMV) antibody test CPT 86644 HC So Cytomegalovirus, Igg Antibody	$75.30	$251.00	—	10% above	70%
Cytomegalovirus (CMV) antibody test CPT 86644 HC So1 Cytomegalovirus, Igg Antibody	$172.50	$575.00	—	153% above	70%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC So Cytomegalovirus, Igg Antibody	$75.30	$251.00	—	—	70%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC So1 Cytomegalovirus, Igg Antibody	$172.50	$575.00	—	—	70%
D-dimer blood test (blood clot marker) CPT 85379 HC So D-Dimer, Quantitative	$30.00	$100.00	—	81% below	70%
D-dimer blood test (blood clot marker) CPT 85379 HC Fibrin Dgradj Products D-Dimer Quantitative	$346.80	$1,156.00	—	122% above	70%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC So D-Dimer, Quantitative	$30.00	$100.00	—	—	70%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC Fibrin Dgradj Products D-Dimer Quantitative	$346.80	$1,156.00	—	—	70%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC So Dhea Sulfate	$225.00	$750.00	—	87% above	70%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC So Dhea Sulfate	$225.00	$750.00	—	—	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC So Drg Scrn Class List A	$85.80	$286.00	—	44% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC So1 Drg Scrn Class List A	$119.40	$398.00	—	22% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC So2 Drg Scrn Class List A	$186.30	$621.00	—	21% above	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Drug Tst Prsmv Instrmnt Chem Analyzers PR Date	$779.70	$2,599.00	—	408% above	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC So Drg Scrn Class List A	$85.80	$286.00	—	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC So1 Drg Scrn Class List A	$119.40	$398.00	—	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC So2 Drg Scrn Class List A	$186.30	$621.00	—	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Drug Tst Prsmv Instrmnt Chem Analyzers PR Date	$779.70	$2,599.00	—	—	70%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC Electrolyte Panel	$132.00	$440.00	—	38% above	70%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC Electrolyte Panel	$132.00	$440.00	—	—	70%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC So Epstein-Barr Virus Vca	$122.40	$408.00	—	32% above	70%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC So Epstein-Barr Virus Vca	$122.40	$408.00	—	—	70%
Estradiol blood test CPT 82670 HC Assay of Total Estradiol	$53.70	$179.00	—	56% below	70%
Estradiol blood test CPT 82670 HC So Estradiol	$65.10	$217.00	—	47% below	70%
Estradiol blood test inpatient CPT 82670 HC Assay of Total Estradiol	$53.70	$179.00	—	—	70%
Estradiol blood test inpatient CPT 82670 HC So Estradiol	$65.10	$217.00	—	—	70%
FSH (follicle-stimulating hormone) test CPT 83001 HC So Fsh	$29.40	$98.00	—	72% below	70%
FSH (follicle-stimulating hormone) test CPT 83001 HC Gonadotropin Follicle Stimulating Hormone	$126.90	$423.00	—	20% above	70%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC So Fsh	$29.40	$98.00	—	—	70%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC Gonadotropin Follicle Stimulating Hormone	$126.90	$423.00	—	—	70%
Fecal calprotectin (stool inflammation test) CPT 83993 HC So Calprotectin Fecal	$170.40	$568.00	—	40% above	70%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC So Calprotectin Fecal	$170.40	$568.00	—	—	70%
Ferritin blood test (iron stores) CPT 82728 HC Assay of Ferritin	$154.80	$516.00	—	20% above	70%
Ferritin blood test (iron stores) inpatient CPT 82728 HC Assay of Ferritin	$154.80	$516.00	—	—	70%
Fibrinogen blood test CPT 85384 HC So Fibrinogen	$19.20	$64.00	—	77% below	70%
Fibrinogen blood test CPT 85384 HC Fibrinogen Activity	$79.20	$264.00	—	5% below	70%
Fibrinogen blood test inpatient CPT 85384 HC So Fibrinogen	$19.20	$64.00	—	—	70%
Fibrinogen blood test inpatient CPT 85384 HC Fibrinogen Activity	$79.20	$264.00	—	—	70%
Folate (folic acid) blood test CPT 82746 HC So1 Folic Acid Serum	$23.40	$78.00	—	78% below	70%
Folate (folic acid) blood test CPT 82746 HC So Folic Acid, Serum	$25.80	$86.00	—	76% below	70%
Folate (folic acid) blood test CPT 82746 HC Assay of Folic Acid Serum	$114.90	$383.00	—	6% above	70%
Folate (folic acid) blood test inpatient CPT 82746 HC So1 Folic Acid Serum	$23.40	$78.00	—	—	70%
Folate (folic acid) blood test inpatient CPT 82746 HC So Folic Acid, Serum	$25.80	$86.00	—	—	70%
Folate (folic acid) blood test inpatient CPT 82746 HC Assay of Folic Acid Serum	$114.90	$383.00	—	—	70%
Free T3 thyroid hormone test CPT 84481 HC Assay of Triiodothyronine T3 Free	$97.80	$326.00	—	5% below	70%
Free T3 thyroid hormone test CPT 84481 HC So Triiodothyronine T-3, Free	$204.00	$680.00	—	98% above	70%
Free T3 thyroid hormone test inpatient CPT 84481 HC Assay of Triiodothyronine T3 Free	$97.80	$326.00	—	—	70%
Free T3 thyroid hormone test inpatient CPT 84481 HC So Triiodothyronine T-3, Free	$204.00	$680.00	—	—	70%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC So T4 Free	$32.10	$107.00	—	59% below	70%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC Assay of Free Thyroxine	$194.40	$648.00	—	151% above	70%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC So T4 Free	$32.10	$107.00	—	—	70%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC Assay of Free Thyroxine	$194.40	$648.00	—	—	70%
Free testosterone test CPT 84402 HC So Testosterone Free	$195.90	$653.00	—	7% above	70%
Free testosterone test inpatient CPT 84402 HC So Testosterone Free	$195.90	$653.00	—	—	70%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC So Ggtp	$13.20	$44.00	—	69% below	70%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC Assay of Glutamyltrase Gamma	$63.00	$210.00	—	48% above	70%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC So Ggtp	$13.20	$44.00	—	—	70%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC Assay of Glutamyltrase Gamma	$63.00	$210.00	—	—	70%
Glucose tolerance test, 3 samples CPT 82951 HC Glucose Tolerance Test	$208.50	$695.00	—	153% above	70%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC Glucose Tolerance Test	$208.50	$695.00	—	—	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC So N Gonorrhoeae Dna Amp Prob	$94.50	$315.00	—	13% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.Gonorrhea, Dna, Amp Probe	$311.10	$1,037.00	—	186% above	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC So N Gonorrhoeae Dna Amp Prob	$94.50	$315.00	—	—	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N.Gonorrhea, Dna, Amp Probe	$311.10	$1,037.00	—	—	70%
H. pylori antibody blood test CPT 86677 HC So H.Pylori. Serum	$60.90	$203.00	—	18% below	70%
H. pylori antibody blood test CPT 86677 HC So1 H.Pylori. Serum	$102.90	$343.00	—	39% above	70%
H. pylori antibody blood test CPT 86677 HC So2 H.Pylori. Serum	$225.00	$750.00	—	204% above	70%
H. pylori antibody blood test inpatient CPT 86677 HC So H.Pylori. Serum	$60.90	$203.00	—	—	70%
H. pylori antibody blood test inpatient CPT 86677 HC So1 H.Pylori. Serum	$102.90	$343.00	—	—	70%
H. pylori antibody blood test inpatient CPT 86677 HC So2 H.Pylori. Serum	$225.00	$750.00	—	—	70%
H. pylori stool antigen test CPT 87338 HC So H.Pylori Stool Antigen	$48.00	$160.00	—	55% below	70%
H. pylori stool antigen test inpatient CPT 87338 HC So H.Pylori Stool Antigen	$48.00	$160.00	—	—	70%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC So Hiv-1, Quantification	$163.80	$546.00	—	45% below	70%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC So1 Hiv-1 Quantification	$640.50	$2,135.00	—	114% above	70%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC So Hiv-1, Quantification	$163.80	$546.00	—	—	70%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC So1 Hiv-1 Quantification	$640.50	$2,135.00	—	—	70%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$266.40	$888.00	—	138% above	70%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$266.40	$888.00	—	—	70%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC Iadna Human Papillomavirus Hi-Rsk Typ Poold Rslt	$60.90	$203.00	—	47% below	70%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC Iadna Human Papillomavirus Hi-Rsk Typ Poold Rslt	$60.90	$203.00	—	—	70%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC Hemoglobin Glycosylated A1c	$82.20	$274.00	—	25% below	70%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC Hemoglobin Glycosylated A1c	$82.20	$274.00	—	—	70%
Hemoglobin blood test CPT 85018 HC Blood Count Hemoglobin	$66.60	$222.00	—	270% above	70%
Hemoglobin blood test inpatient CPT 85018 HC Blood Count Hemoglobin	$66.60	$222.00	—	—	70%
Hepatitis B core antibody test (total) CPT 86704 HC So Hepatitis B Core Antibody	$25.20	$84.00	—	62% below	70%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC So Hepatitis B Core Antibody	$25.20	$84.00	—	—	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC Hepatitis B Surf Antibody Hbsab	$18.00	$60.00	—	78% below	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC So Anti-Hbs	$66.90	$223.00	—	20% below	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC Hepatitis B Surf Antibody Hbsab	$18.00	$60.00	—	—	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC So Anti-Hbs	$66.90	$223.00	—	—	70%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC Iaad Ia Hepatitis B Surface Antigen	$32.10	$107.00	—	49% below	70%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC Iaad Ia Hepatitis B Surface Antigen	$32.10	$107.00	—	—	70%
Hepatitis C antibody blood test (screening) CPT 86803 HC So Hepatitis C Virus Antibody	$30.60	$102.00	—	61% below	70%
Hepatitis C antibody blood test (screening) CPT 86803 HC Hepatitis C Antibody	$318.60	$1,062.00	—	306% above	70%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC So Hepatitis C Virus Antibody	$30.60	$102.00	—	—	70%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC Hepatitis C Antibody	$318.60	$1,062.00	—	—	70%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC So Hcv Ultraquant	$276.00	$920.00	—	9% above	70%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC So1 Hcv Ultraquant	$515.70	$1,719.00	—	104% above	70%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC So Hcv Ultraquant	$276.00	$920.00	—	—	70%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC So1 Hcv Ultraquant	$515.70	$1,719.00	—	—	70%
Herpes blood test, HSV-1 antibody CPT 86695 HC So Herpes Simplex, Type 1	$59.40	$198.00	—	29% below	70%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC So Herpes Simplex, Type 1	$59.40	$198.00	—	—	70%
Herpes blood test, HSV-2 antibody CPT 86696 HC So Herpes Simplex, Type 2	$38.40	$128.00	—	58% below	70%
Herpes blood test, HSV-2 antibody CPT 86696 HC So1 Herpes Simplex, Type 2	$176.10	$587.00	—	93% above	70%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC So Herpes Simplex, Type 2	$38.40	$128.00	—	—	70%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC So1 Herpes Simplex, Type 2	$176.10	$587.00	—	—	70%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-Reactive Protein High Sensitivity	$133.50	$445.00	—	147% above	70%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-Reactive Protein High Sensitivity	$133.50	$445.00	—	—	70%
Homocysteine blood test CPT 83090 HC Assay of Homocysteine	$39.60	$132.00	—	64% below	70%
Homocysteine blood test inpatient CPT 83090 HC Assay of Homocysteine	$39.60	$132.00	—	—	70%
Insulin blood test CPT 83525 HC So Insulin	$89.70	$299.00	—	29% above	70%
Insulin blood test inpatient CPT 83525 HC So Insulin	$89.70	$299.00	—	—	70%
Iron blood test (serum iron) CPT 83540 HC Assay of Iron	$60.30	$201.00	—	23% below	70%
Iron blood test (serum iron) CPT 83540 HC So Iron	$188.10	$627.00	—	139% above	70%
Iron blood test (serum iron) inpatient CPT 83540 HC Assay of Iron	$60.30	$201.00	—	—	70%
Iron blood test (serum iron) inpatient CPT 83540 HC So Iron	$188.10	$627.00	—	—	70%
Iron-binding capacity (TIBC) test CPT 83550 HC Iron Binding Capacity	$17.10	$57.00	—	74% below	70%
Iron-binding capacity (TIBC) test CPT 83550 HC So Iron Binding Capacity	$54.60	$182.00	—	18% below	70%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC Iron Binding Capacity	$17.10	$57.00	—	—	70%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC So Iron Binding Capacity	$54.60	$182.00	—	—	70%
Kidney function blood test panel CPT 80069 HC Renal Function Panel	$224.70	$749.00	—	108% above	70%
Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel	$224.70	$749.00	—	—	70%
LH (luteinizing hormone) test CPT 83002 HC So L H (Luteinizing Hormon	$29.40	$98.00	—	78% below	70%
LH (luteinizing hormone) test CPT 83002 HC Gonadotropin Luteinizing Hormone	$136.80	$456.00	—	2% above	70%
LH (luteinizing hormone) test inpatient CPT 83002 HC So L H (Luteinizing Hormon	$29.40	$98.00	—	—	70%
LH (luteinizing hormone) test inpatient CPT 83002 HC Gonadotropin Luteinizing Hormone	$136.80	$456.00	—	—	70%
Lactate (lactic acid) blood test CPT 83605 HC Assay of Lactate	$96.00	$320.00	—	7% above	70%
Lactate (lactic acid) blood test inpatient CPT 83605 HC Assay of Lactate	$96.00	$320.00	—	—	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC So Ldh	$43.80	$146.00	—	19% below	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC Lactate Dehydrogenase Ldh	$53.10	$177.00	—	1% below	70%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC So Ldh	$43.80	$146.00	—	—	70%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC Lactate Dehydrogenase Ldh	$53.10	$177.00	—	—	70%
Lipase blood test (pancreas enzyme) CPT 83690 HC Assay of Lipase	$159.30	$531.00	—	48% above	70%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC Assay of Lipase	$159.30	$531.00	—	—	70%
Liver function blood test panel CPT 80076 HC So Hepatic Function Panel	$14.40	$48.00	—	83% below	70%
Liver function blood test panel CPT 80076 HC Hepatic Function Panel	$209.40	$698.00	—	151% above	70%
Liver function blood test panel inpatient CPT 80076 HC So Hepatic Function Panel	$14.40	$48.00	—	—	70%
Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel	$209.40	$698.00	—	—	70%
Lyme disease antibody test CPT 86618 HC So2 Lyme Disease Total Anitbodies	$86.10	$287.00	—	2% below	70%
Lyme disease antibody test CPT 86618 HC So Lyme Disease Total Anitbodies	$86.10	$287.00	—	2% below	70%
Lyme disease antibody test inpatient CPT 86618 HC So2 Lyme Disease Total Anitbodies	$86.10	$287.00	—	—	70%
Lyme disease antibody test inpatient CPT 86618 HC So Lyme Disease Total Anitbodies	$86.10	$287.00	—	—	70%
Magnesium blood test CPT 83735 HC So2 Magnesium	$10.80	$36.00	—	80% below	70%
Magnesium blood test CPT 83735 HC So Magnesium	$12.00	$40.00	—	78% below	70%
Magnesium blood test CPT 83735 HC Assay of Magnesium	$75.00	$250.00	—	37% above	70%
Magnesium blood test inpatient CPT 83735 HC So2 Magnesium	$10.80	$36.00	—	—	70%
Magnesium blood test inpatient CPT 83735 HC So Magnesium	$12.00	$40.00	—	—	70%
Magnesium blood test inpatient CPT 83735 HC Assay of Magnesium	$75.00	$250.00	—	—	70%
Measles (rubeola) antibody test CPT 86765 HC So1 Rubeola Igg / Igm	$78.00	$260.00	—	4% above	70%
Measles (rubeola) antibody test CPT 86765 HC So Rubeola Igg / Igm	$138.60	$462.00	—	85% above	70%
Measles (rubeola) antibody test inpatient CPT 86765 HC So1 Rubeola Igg / Igm	$78.00	$260.00	—	—	70%
Measles (rubeola) antibody test inpatient CPT 86765 HC So Rubeola Igg / Igm	$138.60	$462.00	—	—	70%
Mono test (heterophile antibody, Monospot) CPT 86308 HC Mono Spot Test,Agglutination	$138.00	$460.00	—	54% above	70%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC Mono Spot Test,Agglutination	$138.00	$460.00	—	—	70%
Mumps immunity blood test CPT 86735 HC So Antibody; Mumps	$32.10	$107.00	—	54% below	70%
Mumps immunity blood test CPT 86735 HC So1 Antibody; Mumps	$89.70	$299.00	—	29% above	70%
Mumps immunity blood test inpatient CPT 86735 HC So Antibody; Mumps	$32.10	$107.00	—	—	70%
Mumps immunity blood test inpatient CPT 86735 HC So1 Antibody; Mumps	$89.70	$299.00	—	—	70%
Obstetric blood test panel CPT 80055 HC Obstetric Panel	$94.20	$314.00	—	50% below	70%
Obstetric blood test panel inpatient CPT 80055 HC Obstetric Panel	$94.20	$314.00	—	—	70%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC So Prostate Specific Antigen/Free	$33.60	$112.00	—	69% below	70%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC So Prostate Specific Antigen/Free	$33.60	$112.00	—	—	70%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC So Assay of Psa Total	$33.60	$112.00	—	66% below	70%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC Assay of Prostate Specific Antigen Total	$115.20	$384.00	—	16% above	70%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC So Assay of Psa Total	$33.60	$112.00	—	—	70%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Assay of Prostate Specific Antigen Total	$115.20	$384.00	—	—	70%
Parathyroid hormone (PTH) blood test CPT 83970 HC Assay of Parathormone	$236.40	$788.00	—	3% above	70%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC Assay of Parathormone	$236.40	$788.00	—	—	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC So Ptt	$26.40	$88.00	—	56% below	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ptt	$132.90	$443.00	—	123% above	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC So Ptt	$26.40	$88.00	—	—	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Ptt	$132.90	$443.00	—	—	70%
Phosphorus (phosphate) blood test CPT 84100 HC Assay of Phosphorus Inorganic	$46.50	$155.00	—	3% below	70%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC Assay of Phosphorus Inorganic	$46.50	$155.00	—	—	70%
Potassium blood test CPT 84132 HC Potassium Serum Plasma/Whole Blood	$52.50	$175.00	—	35% above	70%
Potassium blood test inpatient CPT 84132 HC Potassium Serum Plasma/Whole Blood	$52.50	$175.00	—	—	70%
Progesterone blood test CPT 84144 HC So Progesterone	$92.70	$309.00	—	49% below	70%
Progesterone blood test inpatient CPT 84144 HC So Progesterone	$92.70	$309.00	—	—	70%
Prolactin blood test CPT 84146 HC Assay of Prolactin	$75.00	$250.00	—	36% below	70%
Prolactin blood test inpatient CPT 84146 HC Assay of Prolactin	$75.00	$250.00	—	—	70%
Prothrombin time (PT/INR) clotting test CPT 85610 HC So Prothrombin Time	$12.60	$42.00	—	51% below	70%
Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time	$97.20	$324.00	—	275% above	70%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC So Prothrombin Time	$12.60	$42.00	—	—	70%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time	$97.20	$324.00	—	—	70%
Rapid flu test (influenza antigen) CPT 87804 HC Iaadiadoo Influenza	$90.00	$300.00	—	7% above	70%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC Iaadiadoo Influenza	$90.00	$300.00	—	—	70%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC Iaadiadoo Streptococcus Group A	$214.20	$714.00	—	139% above	70%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC Iaadiadoo Streptococcus Group A	$214.20	$714.00	—	—	70%
Renin blood test CPT 84244 HC So Renin	$149.70	$499.00	—	13% above	70%
Renin blood test inpatient CPT 84244 HC So Renin	$149.70	$499.00	—	—	70%
Rh blood typing CPT 86901 HC So Rh	$40.50	$135.00	—	34% below	70%
Rh blood typing inpatient CPT 86901 HC So Rh	$40.50	$135.00	—	—	70%
Rheumatoid factor (RF) test CPT 86431 HC So Ra Titer, Quantitative	$88.50	$295.00	—	146% above	70%
Rheumatoid factor (RF) test CPT 86431 HC Rheumatoid Factor Quantitative	$138.00	$460.00	—	283% above	70%
Rheumatoid factor (RF) test inpatient CPT 86431 HC So Ra Titer, Quantitative	$88.50	$295.00	—	—	70%
Rheumatoid factor (RF) test inpatient CPT 86431 HC Rheumatoid Factor Quantitative	$138.00	$460.00	—	—	70%
Rubella antibody test (immunity check) CPT 86762 HC Antibody Rubella	$67.20	$224.00	—	31% below	70%
Rubella antibody test (immunity check) CPT 86762 HC So Rubella Latex Test	$170.10	$567.00	—	75% above	70%
Rubella antibody test (immunity check) CPT 86762 HC So1 Rubella Latex Test	$279.30	$931.00	—	187% above	70%
Rubella antibody test (immunity check) inpatient CPT 86762 HC Antibody Rubella	$67.20	$224.00	—	—	70%
Rubella antibody test (immunity check) inpatient CPT 86762 HC So Rubella Latex Test	$170.10	$567.00	—	—	70%
Rubella antibody test (immunity check) inpatient CPT 86762 HC So1 Rubella Latex Test	$279.30	$931.00	—	—	70%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC Sed Rate	$119.10	$397.00	—	107% above	70%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC Sed Rate	$119.10	$397.00	—	—	70%
Sodium blood test CPT 84295 HC Sodium Serum Plasma or Whole Blood	$50.40	$168.00	—	at median	70%
Sodium blood test inpatient CPT 84295 HC Sodium Serum Plasma or Whole Blood	$50.40	$168.00	—	—	70%
Stool ova and parasites exam CPT 87177 HC So Ova and Parasites	$30.60	$102.00	—	43% below	70%
Stool ova and parasites exam inpatient CPT 87177 HC So Ova and Parasites	$30.60	$102.00	—	—	70%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC Blood Occult Peroxidase Actv Qual Feces 1 Deter	$37.80	$126.00	—	64% above	70%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC Blood Occult Peroxidase Actv Qual Feces 1 Deter	$37.80	$126.00	—	—	70%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC So Occult Blood Fecal	$67.20	$224.00	—	13% below	70%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC So Occult Blood Fecal	$67.20	$224.00	—	—	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC So Fta-Abs	$30.30	$101.00	—	57% below	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC Antibody Treponema Pallidum	$35.40	$118.00	—	50% below	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC So1 Fta-Abs	$117.00	$390.00	—	65% above	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC So Fta-Abs	$30.30	$101.00	—	—	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC Antibody Treponema Pallidum	$35.40	$118.00	—	—	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC So1 Fta-Abs	$117.00	$390.00	—	—	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC So Vdrl / Rpr	$12.90	$43.00	—	49% below	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC Syphilis Test Non-Treponemal Antibody Qual	$14.10	$47.00	—	44% below	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC So1 Vdrl / Rpr	$44.70	$149.00	—	77% above	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC So Vdrl / Rpr	$12.90	$43.00	—	—	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC Syphilis Test Non-Treponemal Antibody Qual	$14.10	$47.00	—	—	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC So1 Vdrl / Rpr	$44.70	$149.00	—	—	70%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC So TB Test, Cell Immun Measure	$144.90	$483.00	—	34% below	70%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC So TB Test, Cell Immun Measure	$144.90	$483.00	—	—	70%
Testosterone blood test, total (not free testosterone) CPT 84403 HC So Testosterone Total	$172.50	$575.00	—	15% above	70%
Testosterone blood test, total (not free testosterone) CPT 84403 HC So1 Testosterone Free	$172.50	$575.00	—	15% above	70%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC So Testosterone Total	$172.50	$575.00	—	—	70%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC So1 Testosterone Free	$172.50	$575.00	—	—	70%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC So Microsomal Antibody	$114.60	$382.00	—	54% above	70%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC So Microsomal Antibody	$114.60	$382.00	—	—	70%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC So Tsh 3rd Generation	$174.30	$581.00	—	78% above	70%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone	$183.00	$610.00	—	87% above	70%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC So Tsh 3rd Generation	$174.30	$581.00	—	—	70%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone	$183.00	$610.00	—	—	70%
Total IgE blood test CPT 82785 HC So Immunoglobulin,Ige	$121.50	$405.00	—	37% above	70%
Total IgE blood test inpatient CPT 82785 HC So Immunoglobulin,Ige	$121.50	$405.00	—	—	70%
Total cholesterol blood test CPT 82465 HC So Cholesterol	$8.10	$27.00	—	85% below	70%
Total cholesterol blood test CPT 82465 HC Cholesterol Serum/Whole Blood Total	$37.80	$126.00	—	31% below	70%
Total cholesterol blood test inpatient CPT 82465 HC So Cholesterol	$8.10	$27.00	—	—	70%
Total cholesterol blood test inpatient CPT 82465 HC Cholesterol Serum/Whole Blood Total	$37.80	$126.00	—	—	70%
Total thyroxine (T4) blood test CPT 84436 HC So Thyroxine Total	$21.00	$70.00	—	56% below	70%
Total thyroxine (T4) blood test CPT 84436 HC Assay of Thyroxine Total	$52.80	$176.00	—	10% above	70%
Total thyroxine (T4) blood test inpatient CPT 84436 HC So Thyroxine Total	$21.00	$70.00	—	—	70%
Total thyroxine (T4) blood test inpatient CPT 84436 HC Assay of Thyroxine Total	$52.80	$176.00	—	—	70%
Transferrin blood test CPT 84466 HC So Transferrin	$47.40	$158.00	—	38% below	70%
Transferrin blood test inpatient CPT 84466 HC So Transferrin	$47.40	$158.00	—	—	70%
Trichomonas test (NAAT) CPT 87661 HC So1 Trichomonas Vaginalis Amplif	$55.20	$184.00	—	50% below	70%
Trichomonas test (NAAT) CPT 87661 HC Iadna Trichomonas Vaginalis Amplified Probe Tech	$61.20	$204.00	—	45% below	70%
Trichomonas test (NAAT) CPT 87661 HC So Trichomonas Vaginalis Amplif	$91.50	$305.00	—	17% below	70%
Trichomonas test (NAAT) inpatient CPT 87661 HC So1 Trichomonas Vaginalis Amplif	$55.20	$184.00	—	—	70%
Trichomonas test (NAAT) inpatient CPT 87661 HC Iadna Trichomonas Vaginalis Amplified Probe Tech	$61.20	$204.00	—	—	70%
Trichomonas test (NAAT) inpatient CPT 87661 HC So Trichomonas Vaginalis Amplif	$91.50	$305.00	—	—	70%
Triglycerides blood test CPT 84478 HC So Triglycerides	$11.10	$37.00	—	79% below	70%
Triglycerides blood test inpatient CPT 84478 HC So Triglycerides	$11.10	$37.00	—	—	70%
Troponin test, quantitative CPT 84484 HC Assay of Troponin Quantitative	$242.10	$807.00	—	138% above	70%
Troponin test, quantitative inpatient CPT 84484 HC Assay of Troponin Quantitative	$242.10	$807.00	—	—	70%
Uric acid blood test CPT 84550 HC Assay of Blood/Uric Acid	$56.70	$189.00	—	19% below	70%
Uric acid blood test inpatient CPT 84550 HC Assay of Blood/Uric Acid	$56.70	$189.00	—	—	70%
Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis W/ Microscopy	$139.80	$466.00	—	214% above	70%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis W/ Microscopy	$139.80	$466.00	—	—	70%
Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis, Auto, W/O Scope	$25.20	$84.00	—	24% below	70%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis, Auto, W/O Scope	$25.20	$84.00	—	—	70%
Urinalysis without microscope exam, manual CPT 81002 HC Non-Auto,Urine W/O Microscopy	$12.00	$40.00	—	41% below	70%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC Non-Auto,Urine W/O Microscopy	$12.00	$40.00	—	—	70%
Urine culture for bacteria, with colony count CPT 87086 HC Urine Cult./Colony Count	$26.10	$87.00	—	66% below	70%
Urine culture for bacteria, with colony count CPT 87086 HC Culture Bacterial Quanttative Colony Count Urine	$261.60	$872.00	—	238% above	70%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC Urine Cult./Colony Count	$26.10	$87.00	—	—	70%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC Culture Bacterial Quanttative Colony Count Urine	$261.60	$872.00	—	—	70%
Urine microalbumin (albumin) test CPT 82043 HC Urine Albumin Quantitative	$57.00	$190.00	—	4% below	70%
Urine microalbumin (albumin) test inpatient CPT 82043 HC Urine Albumin Quantitative	$57.00	$190.00	—	—	70%
Urine pregnancy test, read by color change CPT 81025 HC Hcg (Urine) Pregnancy Test	$113.70	$379.00	—	24% above	70%
Urine pregnancy test, read by color change inpatient CPT 81025 HC Hcg (Urine) Pregnancy Test	$113.70	$379.00	—	—	70%
Vitamin B12 (cobalamin) blood test CPT 82607 HC Cyanocobalamin Vitamin B-12	$114.90	$383.00	—	37% above	70%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC Cyanocobalamin Vitamin B-12	$114.90	$383.00	—	—	70%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC So Dihydroxyvitamin D, 1 25	$143.70	$479.00	—	34% below	70%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC So Dihydroxyvitamin D, 1 25	$143.70	$479.00	—	—	70%
Zinc blood test CPT 84630 HC So Zinc, Serum	$87.00	$290.00	—	36% above	70%
Zinc blood test inpatient CPT 84630 HC So Zinc, Serum	$87.00	$290.00	—	—	70%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC So Hcg Quantitative	$51.00	$170.00	—	62% below	70%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Hcg Quantitative	$384.90	$1,283.00	—	185% above	70%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC So Hcg Quantitative	$51.00	$170.00	—	—	70%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Hcg Quantitative	$384.90	$1,283.00	—	—	70%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 Adenoidectomy Primary <Age 12	$11,345.60	$18,909.33	$3,234.84–$3,299.54	24% above	40%
Arthroscopic ACL reconstruction or repair of the knee one side CPT 29888 Arthrs Aided Ant Cruciate Ligm Rpr/Agmntj/Rcnstj\|RIGHT SIDE	$32,249.32	$53,748.87	$12,526.51–$12,777.04	at median	40%
Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 Surgical Arthroscopy Shoulder W/Rotator Cuff Rpr\|RIGHT SIDE	$30,770.07	$51,283.45	$7,079.78	11% above	40%
Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 Surgical Arthroscopy Shoulder W/Rotator Cuff Rpr\|LEFT SIDE	$35,204.11	$58,673.52	$7,079.78–$7,221.37	27% above	40%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC Bx Breast 1st Lesion Strtctc	$2,850.30	$9,501.00	—	5% above	70%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC Bx Breast 1st Lesion Strtctc	$2,850.30	$9,501.00	—	—	70%
Bunion correction with a bone cut near the head of the first metatarsal one side CPT 28296 Corrj Hallux Valgus W/Sesmdc W/Dist Metar Osteot\|RIGHT SIDE	$15,316.51	$25,527.52	$3,192.44–$3,256.29	17% below	40%
Bunion correction with a bone cut near the head of the first metatarsal one side CPT 28296 Corrj Hallux Valgus W/Sesmdc W/Dist Metar Osteot\|LEFT SIDE	$15,986.40	$26,644.00	$3,192.44–$3,256.29	13% below	40%
Cardiac catheterization with coronary angiogram CPT 93458 HC L Heart W Lv & Coronary	$17,905.50	$59,685.00	—	85% above	70%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 HC L Heart W Lv & Coronary	$17,905.50	$59,685.00	—	—	70%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC Cardioversion	$2,247.90	$7,493.00	—	87% above	70%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC Cardioversion	$2,247.90	$7,493.00	—	—	70%
Carpal tunnel release, open surgery one side CPT 64721 Neuroplasty &/Transpos Median Nrv Carpal Tunne\|LEFT SIDE	$11,271.74	$18,786.23	$1,905.24–$1,943.35	53% above	40%
Carpal tunnel release, open surgery one side CPT 64721 Neuroplasty &/Transpos Median Nrv Carpal Tunne\|RIGHT SIDE	$12,295.01	$20,491.68	$1,905.24–$1,943.35	67% above	40%
Catheter ablation for atrial fibrillation CPT 93656 HC Ep Tx Atrial Fib Pul Vn Isolat	$15,197.40	$50,658.00	—	29% below	70%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC Ep Tx Atrial Fib Pul Vn Isolat	$15,197.40	$50,658.00	—	—	70%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC Circum 28 Days or Older	$773.10	$2,577.00	—	52% below	70%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC Circumcision Age>28 Days	$12,055.05	$20,091.75	$2,039.56–$2,080.35	653% above	40%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 HC Circum 28 Days or Older	$773.10	$2,577.00	—	—	70%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC Circumcision W/Clamp/Oth Dev W/Block	$1,932.60	$6,442.00	—	28% above	70%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC Circumcision W/Clamp/Oth Dev W/Block	$1,932.60	$6,442.00	—	—	70%
Circumcision, surgical, older than a newborn CPT 54160 HC Circumcision <=28 Days Excision Crmc Use Only	$651.60	$2,172.00	—	57% below	70%
Circumcision, surgical, older than a newborn inpatient CPT 54160 HC Circumcision <=28 Days Excision Crmc Use Only	$651.60	$2,172.00	—	—	70%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC Treat Radius/Ulna Fx	$86.40	$288.00	—	74% below	70%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC Treat Radius/Ulna Fx	$86.40	$288.00	—	—	70%
Colonoscopy with polyp removal CPT 45385 Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$14,124.92	$23,541.53	$1,167.54–$1,190.90	265% above	40%
Colonoscopy with tissue sample CPT 45380 Colonoscopy W/Biopsy Single/Multiple	$13,577.94	$22,629.90	$1,167.54–$1,190.90	677% above	40%
Colonoscopy, diagnostic CPT 45378 Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$12,388.44	$20,647.40	$907.35–$925.49	776% above	40%
Coronary stent placement, one artery CPT 92928 HC Perq Tcat Plmt Ntrac St 1 Les 1+C Segments	$16,707.30	$55,691.00	—	60% above	70%
Coronary stent placement, one artery inpatient CPT 92928 HC Perq Tcat Plmt Ntrac St 1 Les 1+C Segments	$16,707.30	$55,691.00	—	—	70%
Cystoscopy with ureteral stent placement CPT 52332 Cysto W/Insert Ureteral Stent	$9,469.48	$15,782.47	$3,439.27–$3,508.06	121% above	40%
Cystoscopy with ureteral stent placement one side CPT 52332 Cysto W/Insert Ureteral Stent\|LEFT SIDE	$11,657.88	$19,429.80	$3,439.27–$3,508.06	172% above	40%
Cystoscopy with ureteral stent placement one side CPT 52332 Cysto W/Insert Ureteral Stent\|RIGHT SIDE	$16,556.27	$27,593.78	$3,439.27–$3,508.06	286% above	40%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC Cystourethroscopy (Separate Procedure)	$260.70	$869.00	—	70% below	70%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC Cystourethroscopy	$8,212.54	$13,687.57	$680.34–$693.95	845% above	40%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC Cystourethroscopy (Separate Procedure)	$260.70	$869.00	—	—	70%
D&C (dilation and curettage), not related to pregnancy CPT 58120 Dilation & Curettage Dx&/Ther Nonobstetric	$10,512.90	$17,521.50	$3,158.41–$3,221.58	349% above	40%
Ear tube placement (tympanostomy) under general anesthesia, one ear one side CPT 69436 Tympanostomy General Anesthesia\|LEFT SIDE	$18,148.53	$30,247.55	$3,234.84–$3,299.54	318% above	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC Rem Impact Cerumen Irrigat Uni	$74.70	$249.00	—	23% below	70%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC Rem Impact Cerumen Irrigat Uni	$74.70	$249.00	—	—	70%
Earwax removal with instruments, one ear CPT 69210 HC Remove Impacted Cerumen	$97.20	$324.00	—	44% below	70%
Earwax removal with instruments, one ear one side CPT 69210 HC Removal Impacted Cerumen Unilateral	$10,369.50	$17,282.50	$5,775.89–$5,891.41	5919% above	40%
Earwax removal with instruments, one ear inpatient CPT 69210 HC Remove Impacted Cerumen	$97.20	$324.00	—	—	70%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 Nasal/Sinus Endoscopy W/Maxillary Antrostomy	$20,067.67	$33,446.12	$3,637.69–$3,710.44	2% above	40%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus one side CPT 31256 Nasal/Sinus Endoscopy W/Maxillary Antrostomy\|LEFT SIDE	$17,481.85	$29,136.42	$3,637.69–$3,710.44	12% below	40%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus one side CPT 31256 Nasal/Sinus Endoscopy W/Maxillary Antrostomy\|RIGHT SIDE	$22,819.50	$38,032.50	$6,885.86–$7,023.57	15% above	40%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue one side CPT 31267 Nsl/Sinus Ndsc Max Antrost W/Rmvl Tiss Max Sinus\|LEFT SIDE	$19,658.94	$32,764.90	$6,885.86–$7,023.57	20% above	40%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue one side CPT 31267 Nsl/Sinus Ndsc Max Antrost W/Rmvl Tiss Max Sinus\|RIGHT SIDE	$22,424.93	$37,374.88	$6,885.86–$7,023.57	37% above	40%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn	$1,055.70	$3,519.00	—	21% below	70%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn	$1,055.70	$3,519.00	—	—	70%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC N Block Paravert Lumbar 1st	$887.70	$2,959.00	—	37% below	70%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC N Block Paravert Lumbar 1st	$887.70	$2,959.00	—	—	70%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Rpr Aa Hernia 1st 3-10 Cm Reducible	$20,217.22	$33,695.37	$6,316.41–$6,442.74	33% above	40%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Rpr Aa Hernia 1st < 3 Cm Reducible	$13,448.16	$22,413.60	$3,493.34–$3,563.21	at median	40%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy Flx Dx W/Collj Spec Br/Wa if Pfrmd	$12,027.90	$20,046.50	$907.35–$925.49	964% above	40%
Gallbladder removal, laparoscopic CPT 47562 Laparoscopy Surg Cholecystectomy	$18,572.11	$30,953.52	$5,898.53–$6,016.50	9% above	40%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Laps Surg Cholecystectomy W/Cholangiography	$22,798.16	$37,996.93	$5,898.53–$6,016.50	11% above	40%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC Ligation of Hemorrhoids	$14,992.54	$24,987.57	$907.35–$925.49	933% above	40%
Hysterectomy through an abdominal incision (total) CPT 58150 Total Abdominal Hysterect W/WO Rmvl Tube Ovary	$24,992.92	$41,654.87	$3,439.27–$3,508.06	3% above	40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC Cath/Intro Sal Cont Hyst	$3,401.40	$11,338.00	—	549% above	70%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC Cath/Intro Sal Cont Hyst	$3,401.40	$11,338.00	—	—	70%
Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy Endometrial Ablation	$15,816.22	$26,360.37	$4,880.81–$4,978.43	9% above	40%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$12,002.71	$20,004.52	$3,158.41	76% above	40%
IUD insertion (the device itself billed separately) CPT 58300 HC Insert Intrauterine Device	$13,801.07	$23,001.78	$3,158.41–$3,221.58	5887% above	40%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I & D Simple	$177.90	$593.00	—	54% below	70%
Incision and drainage of a simple or single skin abscess CPT 10060 HC Incision & Drainage-Simple	$861.60	$2,872.00	—	123% above	70%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I & D Simple	$6,701.73	$11,169.55	$195.76	1632% above	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I & D Simple	$177.90	$593.00	—	—	70%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC Incision & Drainage-Simple	$861.60	$2,872.00	—	—	70%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible	$16,353.98	$27,256.63	$3,493.34–$3,563.21	22% above	40%
Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible\|LEFT SIDE	$13,815.65	$23,026.08	$3,493.34–$3,563.21	3% above	40%
Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible\|RIGHT SIDE	$16,161.52	$26,935.87	$3,493.34–$3,563.21	20% above	40%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC Inject Tendon Sheath Ligament	$473.70	$1,579.00	—	29% above	70%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC Inject Tendon Sheath Ligament	$473.70	$1,579.00	—	—	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Asp Injection Major Joint	$131.10	$437.00	—	66% below	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Arthrocent/Aspiration Maj Jnt	$1,515.60	$5,052.00	—	291% above	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC Asp Injection Major Joint	$131.10	$437.00	—	—	70%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC Arthrocent/Aspiration Maj Jnt	$1,515.60	$5,052.00	—	—	70%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC Asp Inj Intermediate Joint	$131.10	$437.00	—	69% below	70%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC Asp Inj Intermediate Joint	$131.10	$437.00	—	—	70%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC Drain/Inject Joint/Bursa	$131.10	$437.00	—	64% below	70%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC Drain/Inject Joint/Bursa	$131.10	$437.00	—	—	70%
Knee arthroscopy with meniscus repair (one side of the knee) one side CPT 29882 Arthroscopy Knee W/Meniscus Rpr Medial/Lateral\|LEFT SIDE	$24,176.76	$40,294.60	$3,192.44–$3,256.29	6% below	40%
Knee arthroscopy with meniscus repair (one side of the knee) one side CPT 29882 Arthroscopy Knee W/Meniscus Rpr Medial/Lateral\|RIGHT SIDE	$32,249.32	$53,748.87	$12,526.51–$12,777.04	25% above	40%
Knee arthroscopy with meniscus trim one side CPT 29881 Arthrs Kne Surg W/Meniscectomy Med/Lat W/Shvg\|RIGHT SIDE	$12,228.31	$20,380.52	$3,192.44–$3,256.29	6% above	40%
Knee arthroscopy with meniscus trim one side CPT 29881 Arthrs Kne Surg W/Meniscectomy Med/Lat W/Shvg\|LEFT SIDE	$13,131.31	$21,885.52	$3,192.44–$3,256.29	14% above	40%
Knee arthroscopy with removal of both torn meniscus parts one side CPT 29880 Arthrs Knee W/Meniscectomy Med&Lat W/Shaving\|LEFT SIDE	$15,161.80	$25,269.67	$3,192.44–$3,256.29	10% above	40%
Knee arthroscopy with removal of both torn meniscus parts one side CPT 29880 Arthrs Knee W/Meniscectomy Med&Lat W/Shaving\|RIGHT SIDE	$17,610.51	$29,350.85	$3,192.44–$3,256.29	27% above	40%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Arthrs Knee Debridement/Shaving Artclr Crtlg	$39,734.37	$66,223.95	$3,192.44–$3,256.29	179% above	40%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) one side CPT 29877 Arthrs Knee Debridement/Shaving Artclr Crtlg\|RIGHT SIDE	$50,732.34	$84,553.90	$7,079.78–$7,221.37	256% above	40%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) one side CPT 29877 Arthrs Knee Debridement/Shaving Artclr Crtlg\|LEFT SIDE	$95,083.76	$158,472.93	$3,192.44	567% above	40%
Laparoscopic Roux-en-Y gastric bypass, standard limb length CPT 43644 Laps Gstr Rstcv Px W/Byp Roux-en-Y Limb <150 Cm	$39,177.12	$65,295.20	$10,371.37–$10,578.79	18% below	40%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Laparoscopic Appendectomy	$21,784.68	$36,307.80	$5,898.53–$6,016.50	24% above	40%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 Laps Total Hysterect 250 Gm/< W/Rmvl Tube/Ovary	$23,680.61	$39,467.68	$10,371.37–$10,578.79	7% below	40%
Laparoscopic inguinal (groin) hernia repair, first repair on that side one side CPT 49650 Laparoscopy Surg Rpr Initial Inguinal Hernia\|RIGHT SIDE	$20,753.63	$34,589.38	$5,898.53–$6,016.50	39% above	40%
Laparoscopic inguinal (groin) hernia repair, first repair on that side one side CPT 49650 Laparoscopy Surg Rpr Initial Inguinal Hernia\|LEFT SIDE	$23,457.35	$39,095.58	$5,898.53–$6,016.50	57% above	40%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia one side CPT 49651 Laps Surg Rpr Recurrent Inguinal Hernia\|RIGHT SIDE	$18,853.06	$31,421.77	$5,898.53–$6,016.50	28% above	40%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia one side CPT 49651 Laps Surg Rpr Recurrent Inguinal Hernia\|LEFT SIDE	$30,239.00	$50,398.33	$10,371.37–$10,578.79	106% above	40%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy W/Rmvl Adnexal Structures	$19,526.97	$32,544.95	$5,898.53–$6,016.50	12% above	40%
Laparoscopic removal of fallopian tubes and/or ovaries one side CPT 58661 Laparoscopy W/Rmvl Adnexal Structures\|LEFT SIDE	$17,379.43	$28,965.72	$5,898.53–$6,016.50	at median	40%
Laparoscopic removal of fallopian tubes and/or ovaries one side CPT 58661 Laparoscopy W/Rmvl Adnexal Structures\|RIGHT SIDE	$18,346.89	$30,578.15	$5,898.53–$6,016.50	5% above	40%
Laparoscopic sleeve gastrectomy for weight loss CPT 43775 Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy	$33,766.61	$56,277.68	$349.73–$356.73	21% below	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC Lyr Clos Sc Tk Ext <2.5 Cm	$554.40	$1,848.00	—	7% above	70%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC Lyr Clos Sc Tk Ext <2.5 Cm	$10,892.12	$18,153.53	$1,611.44–$1,643.67	2007% above	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC Lyr Clos Sc Tk Ext <2.5 Cm	$554.40	$1,848.00	—	—	70%
Left heart catheterization, diagnostic CPT 93452 HC L Heart W Lvgram	$14,713.80	$49,046.00	—	124% above	70%
Left heart catheterization, diagnostic inpatient CPT 93452 HC L Heart W Lvgram	$14,713.80	$49,046.00	—	—	70%
Lower-back epidural injection, with imaging guidance CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$1,647.60	$5,492.00	—	2% below	70%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$1,647.60	$5,492.00	—	—	70%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Inj a/S Transforam Lumbar	$680.70	$2,269.00	—	55% below	70%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC Inj a/S Transforam Lumbar	$680.70	$2,269.00	—	—	70%
Lumpectomy (partial mastectomy) one side CPT 19301 Mastectomy Partial\|RIGHT SIDE	$17,954.99	$29,924.98	$3,820.23	63% above	40%
Lumpectomy (partial mastectomy) one side CPT 19301 Mastectomy Partial\|LEFT SIDE	$19,216.95	$32,028.25	$6,478.71–$6,608.28	75% above	40%
Mastectomy (total removal of the breast) CPT 19303 Mastectomy Simple Complete	$24,427.24	$40,712.07	$6,478.71–$6,608.28	18% above	40%
Mastectomy (total removal of the breast) one side CPT 19303 Mastectomy Simple Complete\|LEFT SIDE	$24,427.24	$40,712.07	$6,478.71–$6,608.28	18% above	40%
Miscarriage treatment with D&C, first trimester CPT 59820 HC Tx Missed Abortion First Trimester Surgical	$1,178.40	$3,928.00	—	50% below	70%
Miscarriage treatment with D&C, first trimester CPT 59820 Tx Missed Abortion First Trimester Surgical	$9,959.84	$16,599.73	$3,158.41–$3,221.58	323% above	40%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC Tx Missed Abortion First Trimester Surgical	$1,178.40	$3,928.00	—	—	70%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC Exc Tr-Ext B9+Marg 0.5 Cm<	$270.60	$902.00	—	52% below	70%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC Excis Benign Les to 0.5 Cm; Trunk/Arms/Legs	$13,875.91	$23,126.52	$3,439.27–$3,508.06	2371% above	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC Exc Tr-Ext B9+Marg 0.5 Cm<	$270.60	$902.00	—	—	70%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC Exc Face-Mm B9+Marg 0.5 Cm/<	$270.60	$902.00	—	77% below	70%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC Exc Skin Benig <5mm Face Facial	$10,567.38	$17,612.30	$690.91–$704.73	787% above	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC Exc Face-Mm B9+Marg 0.5 Cm/<	$270.60	$902.00	—	—	70%
Nail removal (partial or complete), one nail CPT 11730 HC Avulsion of Nail Plate	$75.00	$250.00	—	65% below	70%
Nail removal (partial or complete), one nail CPT 11730 HC ED Avulsion Nail Plate Single	$218.10	$727.00	—	2% above	70%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC Avulsion of Nail Plate	$75.00	$250.00	—	—	70%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC ED Avulsion Nail Plate Single	$218.10	$727.00	—	—	70%
Occipital nerve block (injection for headaches) CPT 64405 HC Inj Aa&/Strd Greater Occipital Nerve	$594.00	$1,980.00	—	8% above	70%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC Inj Aa&/Strd Greater Occipital Nerve	$594.00	$1,980.00	—	—	70%
Pacemaker implant (dual chamber) CPT 33208 HC Ins/Repl of Dual Cham Ppm Lead	$12,900.60	$43,002.00	—	10% above	70%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC Ins/Repl of Dual Cham Ppm Lead	$12,900.60	$43,002.00	—	—	70%
Paracentesis with imaging guidance CPT 49083 HC Abdom Paracentesis Dx/Ther W Imaging Guidance	$344.40	$1,148.00	—	70% below	70%
Paracentesis with imaging guidance CPT 49083 HC Abd Paracentesis W Guide	$3,475.50	$11,585.00	—	199% above	70%
Paracentesis with imaging guidance CPT 49083 HC Abd Paracentesis W Guide	$4,085.32	$6,808.87	$884.93–$902.63	251% above	40%
Paracentesis with imaging guidance inpatient CPT 49083 HC Abdom Paracentesis Dx/Ther W Imaging Guidance	$344.40	$1,148.00	—	—	70%
Paracentesis with imaging guidance inpatient CPT 49083 HC Abd Paracentesis W Guide	$3,475.50	$11,585.00	—	—	70%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC Excis Nail Matrix Perm Rmvl	$155.70	$519.00	—	74% below	70%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC Excis Nail Matrix Perm Rmvl	$155.70	$519.00	—	—	70%
Prostate biopsy CPT 55700 HC Biopsy Prostate Needle or Punc	$6,179.21	$10,298.68	$122.17–$124.61	143% above	40%
Prostate removal (prostatectomy), laparoscopic CPT 55866 Laps Surg Prst8ect Rpbic Rad W/Nrv Sparing Robot	$33,883.09	$56,471.82	$10,371.37–$10,578.79	2% above	40%
Removal of a breast lump, open surgery one side CPT 19120 Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion\|RIGHT SIDE	$9,688.62	$16,147.70	$3,820.23	66% above	40%
Removal of a breast lump, open surgery one side CPT 19120 Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion\|LEFT SIDE	$13,718.01	$22,863.35	$3,820.23	135% above	40%
Removal of a foreign object under the skin, simple CPT 10120 HC Removal FB Skin	$624.60	$2,082.00	—	11% above	70%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC Removal FB Skin	$624.60	$2,082.00	—	—	70%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 Total Thyroid Lobectomy Uni W/WO Isthmusectomy	$20,787.20	$34,645.33	$5,898.53–$6,016.50	15% below	40%
Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 Total Thyroid Lobectomy Uni W/WO Isthmusectomy\|LEFT SIDE	$22,190.84	$36,984.73	$5,898.53–$6,016.50	9% below	40%
Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 Total Thyroid Lobectomy Uni W/WO Isthmusectomy\|RIGHT SIDE	$30,316.76	$50,527.93	$5,898.53–$6,016.50	24% above	40%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colon Ca Scrn Not Hi Rsk Ind	$12,121.79	$20,202.98	$907.35–$925.49	285% above	40%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal Scrn; Hi Risk Ind	$12,765.24	$21,275.40	$907.35–$925.49	340% above	40%
Septoplasty to straighten the nasal septum CPT 30520 Septoplasty/Submucous Resecj W/WO Cartilage Grf	$19,363.34	$32,272.23	$5,775.89–$5,891.41	22% above	40%
Shock-wave lithotripsy to break up kidney stones (from outside the body) one side CPT 50590 HC Lithotripsy\|LEFT SIDE	$11,660.59	$19,434.32	$3,439.27–$3,508.06	33% above	40%
Shock-wave lithotripsy to break up kidney stones (from outside the body) one side CPT 50590 HC Lithotripsy\|RIGHT SIDE	$12,305.97	$20,509.95	$3,439.27–$3,508.06	40% above	40%
Short arm cast (elbow to hand) CPT 29075 HC Cast - Short Arm	$99.90	$333.00	—	63% below	70%
Short arm cast (elbow to hand) inpatient CPT 29075 HC Cast - Short Arm	$99.90	$333.00	—	—	70%
Short arm splint (forearm and hand) CPT 29125 HC Splint App Short Arm Stat	$243.60	$812.00	—	at median	70%
Short arm splint (forearm and hand) inpatient CPT 29125 HC Splint App Short Arm Stat	$243.60	$812.00	—	—	70%
Short leg cast (below the knee) CPT 29405 HC Cast Short Leg	$99.90	$333.00	—	69% below	70%
Short leg cast (below the knee) inpatient CPT 29405 HC Cast Short Leg	$99.90	$333.00	—	—	70%
Short leg splint (calf to foot) CPT 29515 HC Splint App/Short Leg	$243.60	$812.00	—	5% above	70%
Short leg splint (calf to foot) one side CPT 29515 HC Splint App/Short Leg\|LEFT SIDE	$243.60	$812.00	—	5% above	70%
Short leg splint (calf to foot) one side CPT 29515 HC Splint App/Short Leg\|RIGHT SIDE	$243.60	$812.00	—	5% above	70%
Short leg splint (calf to foot) inpatient CPT 29515 HC Splint App/Short Leg	$243.60	$812.00	—	—	70%
Short leg splint (calf to foot) inpatient one side CPT 29515 HC Splint App/Short Leg\|RIGHT SIDE	$243.60	$812.00	—	—	70%
Short leg splint (calf to foot) inpatient one side CPT 29515 HC Splint App/Short Leg\|LEFT SIDE	$243.60	$812.00	—	—	70%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) one side CPT 29824 Surgical Arthroscopy Shoulder Dstl Claviculc\|RIGHT SIDE	$30,770.07	$51,283.45	$7,079.78–$7,221.37	38% above	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) one side CPT 29824 Surgical Arthroscopy Shoulder Dstl Claviculc\|LEFT SIDE	$37,678.43	$62,797.38	$7,079.78–$7,221.37	69% above	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls\|RIGHT SIDE	$26,936.01	$44,893.35	$7,079.78–$7,221.37	14% above	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls\|LEFT SIDE	$35,204.11	$58,673.52	$7,079.78–$7,221.37	49% above	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC Rep Lac Smp Not Face <2.5cm	$470.70	$1,569.00	—	30% above	70%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC Rep Lac Smp Not Face <2.5cm	$470.70	$1,569.00	—	—	70%
Skin biopsy, punch, one lesion CPT 11104 HC Punch Biopsy Skin Single Lesion	$226.20	$754.00	—	27% below	70%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC Punch Biopsy Skin Single Lesion	$226.20	$754.00	—	—	70%
Skin tag removal, up to 15 tags CPT 11200 HC Excision Up to 15 Skin Tags	$75.30	$251.00	—	70% below	70%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC Excision Up to 15 Skin Tags	$75.30	$251.00	—	—	70%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Spinal Puncture Lumbar Diagnos	$902.40	$3,008.00	—	5% above	70%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Spinal Puncture, Lumbar, Diagnostic	$936.60	$3,122.00	—	9% above	70%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC Spinal Puncture Lumbar Diagnos	$902.40	$3,008.00	—	—	70%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC Spinal Puncture, Lumbar, Diagnostic	$936.60	$3,122.00	—	—	70%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC Rpr Lac Smp Scalp 2.6-7.5	$470.70	$1,569.00	—	12% above	70%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC Repr Smp Not Face 2.6-7.5cm	$470.70	$1,569.00	—	12% above	70%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC Rpr Lac Smp Scalp 2.6-7.5	$470.70	$1,569.00	—	—	70%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC Repr Smp Not Face 2.6-7.5cm	$470.70	$1,569.00	—	—	70%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC Simple Rep Wnd Face <2.5 Cm	$470.70	$1,569.00	—	25% above	70%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC Simple Rep Wnd Face <2.5 Cm	$470.70	$1,569.00	—	—	70%
TURP (transurethral resection of the prostate) CPT 52601 Trurl Electrosurg Rescj Prostate Bleed Complete	$22,390.74	$37,317.90	$5,231.42–$5,336.05	23% above	40%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC Tangential Biopsy Skin Single Lesion	$75.30	$251.00	—	70% below	70%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC Tangential Biopsy Skin Single Lesion	$75.30	$251.00	—	—	70%
Thoracentesis with imaging guidance CPT 32555 HC Sp Thora for Aspiration	$3,599.70	$11,999.00	—	172% above	70%
Thoracentesis with imaging guidance inpatient CPT 32555 HC Sp Thora for Aspiration	$3,599.70	$11,999.00	—	—	70%
Tonsil and adenoid removal, age 12 or older CPT 42821 Tonsillectomy & Adenoidectomy Age 12/>	$11,981.31	$19,968.85	$3,234.84–$3,299.54	5% above	40%
Tonsil and adenoid removal, child under 12 CPT 42820 Tonsillectomy & Adenoidectomy <Age 12	$11,577.52	$19,295.87	$5,775.89–$5,891.41	5% above	40%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Tonsillectomy Primary/Secondary Age 12/>	$17,974.77	$29,957.95	$3,234.84–$3,299.54	50% above	40%
Total knee replacement one side CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments\|LEFT SIDE	$42,366.58	$70,610.97	$12,526.51	16% above	40%
Total knee replacement one side CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments\|RIGHT SIDE	$48,023.11	$80,038.52	—	31% above	40%
Total shoulder replacement one side CPT 23472 Arthroplasty Glenohumeral Joint Total Shoulder\|LEFT SIDE	$54,666.44	$91,110.73	$17,107.48–$17,449.63	1% below	40%
Total thyroid removal (thyroidectomy) CPT 60240 Thyroidectomy Total/Complete	$34,523.72	$57,539.53	$5,898.53–$6,016.50	12% above	40%
Trigger finger release surgery CPT 26055 HC Incise Finger Tendon Sheath	$597.90	$1,993.00	—	81% below	70%
Trigger finger release surgery inpatient CPT 26055 HC Incise Finger Tendon Sheath	$597.90	$1,993.00	—	—	70%
Trigger point injections, 1 or 2 muscles CPT 20552 HC Inj Trigger Points 1-2 Musc	$113.40	$378.00	—	69% below	70%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC Inj Trigger Points 1-2 Musc	$113.40	$378.00	—	—	70%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC Bx Breast 1st Lesion US Img	$1,868.10	$6,227.00	—	7% below	70%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 HC Bx Breast 1st Lesion US Img\|RIGHT SIDE	$4,795.65	$7,992.75	$1,611.44–$1,643.67	139% above	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 HC Bx Breast 1st Lesion US Img\|LEFT SIDE	$4,933.30	$8,222.17	$1,611.44–$1,643.67	145% above	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC Bx Breast 1st Lesion US Img	$1,868.10	$6,227.00	—	—	70%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Egd Balloon Dilation Esophagus <30 Mm Diam	$12,885.60	$21,476.00	$1,872.25–$1,909.69	448% above	40%
Upper endoscopy (EGD) with biopsy CPT 43239 Egd Transoral Biopsy Single/Multiple	$12,885.00	$21,475.00	$884.93–$902.63	768% above	40%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Egd Removal Tumor Polyp/Other Lesion Snare Tech	$12,330.78	$20,551.30	$1,872.25–$1,909.69	234% above	40%
Upper endoscopy (EGD), diagnostic CPT 43235 HC Egd Diagnostic Brush Wash	$12,776.58	$21,294.30	$884.93–$902.63	761% above	40%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 Egd Transoral Transmural Drainage Pseudocyst	$39,186.60	$65,311.00	$5,923.28–$6,041.75	431% above	40%
Ureteroscopy with laser stone breaking (lithotripsy) one side CPT 52353 Cysto W/Ureteroscopy W/Lithotripsy\|RIGHT SIDE	$14,668.26	$24,447.10	$5,231.42–$5,336.05	at median	40%
Ureteroscopy with laser stone breaking (lithotripsy) one side CPT 52353 Cysto W/Ureteroscopy W/Lithotripsy\|LEFT SIDE	$15,766.66	$26,277.77	$5,231.42–$5,336.05	7% above	40%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt	$25,379.37	$42,298.95	$5,231.42–$5,336.05	51% above	40%
Ureteroscopy with laser stone breaking and stent placement one side CPT 52356 Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt\|LEFT SIDE	$18,537.75	$30,896.25	$5,231.42–$5,336.05	10% above	40%
Ureteroscopy with laser stone breaking and stent placement one side CPT 52356 Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt\|RIGHT SIDE	$20,523.17	$34,205.28	$5,231.42–$5,336.05	22% above	40%
Wart removal, up to 14 warts CPT 17110 HC Destruct B9 Lesion 1-14	$75.30	$251.00	—	45% below	70%
Wart removal, up to 14 warts inpatient CPT 17110 HC Destruct B9 Lesion 1-14	$75.30	$251.00	—	—	70%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Debride Skin and Subcu	$155.70	$519.00	—	74% below	70%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Debride Subq First 20 Sq Cm	$1,905.90	$3,176.50	$396.63–$404.56	219% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Debride Subq First 20 Sq Cm	$1,905.90	$6,353.00	—	219% above	70%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC Debride Skin and Subcu	$155.70	$519.00	—	—	70%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC Debride Subq First 20 Sq Cm	$1,905.90	$6,353.00	—	—	70%
Wrist fracture surgery (plate and screws), distal radius one side CPT 25607 Optx Dstl Radl X-Artic Fx/Epiphysl Sep\|RIGHT SIDE	$23,434.38	$39,057.30	$7,079.78–$7,221.37	10% above	40%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC Blood Administration	$864.30	$2,881.00	—	1% above	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC Blood Administration	$864.30	$2,881.00	—	—	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Aerosol, Hhn, Mdi, Ippb	$133.80	$446.00	—	15% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Sputum Induction	$140.70	$469.00	—	11% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Aerosol, Hhn, Mdi, Ippb	$133.80	$446.00	—	—	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Sputum Induction	$140.70	$469.00	—	—	70%
Chemotherapy IV infusion, first hour CPT 96413 HC Chemo Infusion 1st Hour Chemo	$408.60	$1,362.00	—	46% below	70%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC Chemo Infusion 1st Hour Chemo	$408.60	$1,362.00	—	—	70%
Critical care, first 30 to 74 minutes CPT 99291 HC E/M Crit Care,ER, 1st 30-74min	$6,468.30	$21,561.00	—	155% above	70%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC E/M Crit Care,ER, 1st 30-74min	$6,468.30	$21,561.00	—	—	70%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC Eeg Awake & Drowsy	$1,138.50	$3,795.00	—	102% above	70%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC Eeg Awake & Drowsy	$1,138.50	$3,795.00	—	—	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC >= 12 Lead Ekg	$430.80	$1,436.00	—	106% above	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC >= 12 Lead Ekg	$1,171.80	$1,953.00	$57.56–$58.71	461% above	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC >= 12 Lead Ekg	$430.80	$1,436.00	—	—	70%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ER Level 1	$189.00	$630.00	—	1% above	70%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ER Level 1	$189.00	$630.00	—	—	70%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ER Level 2	$617.40	$2,058.00	—	86% above	70%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC OB ER Level 2	$617.40	$2,058.00	—	86% above	70%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ER Level 2	$617.40	$2,058.00	—	—	70%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC OB ER Level 2	$617.40	$2,058.00	—	—	70%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ER Level 3	$972.90	$3,243.00	—	94% above	70%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC OB ER Level 3	$972.90	$3,243.00	—	94% above	70%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC OB ER Level 3	$972.90	$3,243.00	—	—	70%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ER Level 3	$972.90	$3,243.00	—	—	70%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC OB ER Level 4	$1,482.00	$4,940.00	—	63% above	70%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ER Level 4	$1,482.00	$4,940.00	—	63% above	70%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ER Level 4	$16,121.68	$26,869.47	$2,039.56–$2,080.35	1673% above	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ER Level 4	$1,482.00	$4,940.00	—	—	70%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC OB ER Level 4	$1,482.00	$4,940.00	—	—	70%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC OB ER Level 5	$2,316.60	$7,722.00	—	62% above	70%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ER Level 5	$2,316.60	$7,722.00	—	62% above	70%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ER Level 5	$2,316.60	$7,722.00	—	—	70%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC OB ER Level 5	$2,316.60	$7,722.00	—	—	70%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC Cardiac Stress Test	$1,303.80	$4,346.00	—	74% above	70%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC Cardiac Stress Test	$1,303.80	$4,346.00	—	—	70%
Family therapy with the patient, 50 minutes CPT 90847 HC Php Family Psychotherapy W/Patient Present 50 Mins	$151.80	$506.00	—	34% below	70%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Php Family Psychotherapy W/Patient Present 50 Mins	$151.80	$506.00	—	—	70%
Group psychotherapy session CPT 90853 HC Php Group Psychotherapy	$95.10	$317.00	—	33% below	70%
Group psychotherapy session CPT 90853 HC Iop Group	$95.10	$317.00	—	33% below	70%
Group psychotherapy session inpatient CPT 90853 HC Iop Group	$95.10	$317.00	—	—	70%
Group psychotherapy session inpatient CPT 90853 HC Php Group Psychotherapy	$95.10	$317.00	—	—	70%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC Inf 1st Hour Hyd	$283.20	$944.00	—	16% below	70%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC Inf 1st Hour Hyd	$283.20	$944.00	—	—	70%
IV infusion of a medicine, first hour CPT 96365 HC IV 1st Hour Init Drug	$553.80	$1,846.00	—	52% above	70%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV 1st Hour Init Drug	$553.80	$1,846.00	—	—	70%
IV push of a medicine, first drug CPT 96374 HC IV Push Initial Drug	$190.20	$634.00	—	30% below	70%
IV push of a medicine, first drug inpatient CPT 96374 HC IV Push Initial Drug	$190.20	$634.00	—	—	70%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC Injection Im Sub Q	$151.20	$504.00	—	39% above	70%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC Injection Im Sub Q	$151.20	$504.00	—	—	70%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Psych Evaluation	$153.90	$513.00	—	51% below	70%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Php Psych Evaluation	$153.90	$513.00	—	51% below	70%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Php Psych Evaluation	$153.90	$513.00	—	—	70%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Psych Evaluation	$153.90	$513.00	—	—	70%
Neuromuscular re-education, 15 minutes CPT 97112 HC Neuromuscular Re-Education, Ot	$216.90	$723.00	—	99% above	70%
Neuromuscular re-education, 15 minutes CPT 97112 HC Pt Neuro Facilitation Ea 15 Min	$216.90	$723.00	—	99% above	70%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC Pt Neuro Facilitation Ea 15 Min	$216.90	$723.00	—	—	70%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC Neuromuscular Re-Education, Ot	$216.90	$723.00	—	—	70%
New patient office visit, about 30 minutes CPT 99203 HC New Pt, Outpt Visit Level 3	$257.70	$859.00	—	35% above	70%
New patient office visit, about 30 minutes inpatient CPT 99203 HC New Pt, Outpt Visit Level 3	$257.70	$859.00	—	—	70%
New patient office visit, about 45 minutes CPT 99204 HC New Pt, Outpt Visit Level 4	$288.90	$963.00	—	78% above	70%
New patient office visit, about 45 minutes inpatient CPT 99204 HC New Pt, Outpt Visit Level 4	$288.90	$963.00	—	—	70%
New patient office visit, about 60 minutes CPT 99205 HC New Pt, Outpt Visit Level 5	$363.30	$1,211.00	—	55% above	70%
New patient office visit, about 60 minutes inpatient CPT 99205 HC New Pt, Outpt Visit Level 5	$363.30	$1,211.00	—	—	70%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC New Pt, Outpt Visit Level 2	$211.50	$705.00	—	100% above	70%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC New Pt, Outpt Visit Level 2	$211.50	$705.00	—	—	70%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC Med Nut Therapy Ind Init 15 Min	$60.30	$201.00	—	132% above	70%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC Med Nut Therapy Ind Init 15 Min	$60.30	$201.00	—	—	70%
Occupational therapy evaluation, low complexity CPT 97165 HC Ot Eval Low Complex	$253.80	$846.00	—	19% above	70%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC Ot Eval Low Complex	$253.80	$846.00	—	—	70%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC Pt Eval High Complex	$256.20	$854.00	—	3% above	70%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC Pt Eval High Complex	$256.20	$854.00	—	—	70%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC Pt Eval Low Complex	$256.20	$854.00	—	19% above	70%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC Pt Eval Low Complex	$256.20	$854.00	—	—	70%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC Pt Eval Mod Complex	$256.20	$854.00	—	11% above	70%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC Pt Eval Mod Complex	$256.20	$854.00	—	—	70%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Ot Manual Therapy per 15 Min.	$35.10	$117.00	—	60% below	70%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Pt Manual Therapy Ea 15	$192.90	$643.00	—	119% above	70%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC Ot Manual Therapy per 15 Min.	$35.10	$117.00	—	—	70%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC Pt Manual Therapy Ea 15	$192.90	$643.00	—	—	70%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Exercise,Ea 15 Min	$255.90	$853.00	—	177% above	70%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Ther Ex per 15 Min	$382.50	$1,275.00	—	314% above	70%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Exercise,Ea 15 Min	$255.90	$853.00	—	—	70%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Ther Ex per 15 Min	$382.50	$1,275.00	—	—	70%
Psychiatric evaluation with medical services CPT 90792 HC Php Psy Eval W/Med Srvc	$150.00	$500.00	—	53% below	70%
Psychiatric evaluation with medical services inpatient CPT 90792 HC Php Psy Eval W/Med Srvc	$150.00	$500.00	—	—	70%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC Php Psychotherapy for Crisis Initial 60 Minutes	$180.60	$602.00	—	39% below	70%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC Php Psychotherapy for Crisis Initial 60 Minutes	$180.60	$602.00	—	—	70%
Psychotherapy session, 30 minutes CPT 90832 HC Php Psychotherapy W/Patient 30 Minutes	$180.60	$602.00	—	20% above	70%
Psychotherapy session, 30 minutes CPT 90832 HC Iop Tx 30 Min	$180.60	$602.00	—	20% above	70%
Psychotherapy session, 30 minutes CPT 90832 HC OP Psych Tx 30 Min	$180.60	$602.00	—	20% above	70%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC OP Psych Tx 30 Min	$180.60	$602.00	—	—	70%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC Php Psychotherapy W/Patient 30 Minutes	$180.60	$602.00	—	—	70%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC Iop Tx 30 Min	$180.60	$602.00	—	—	70%
Psychotherapy session, 45 minutes CPT 90834 HC Php Psychotherapy W/Patient 45 Minutes	$361.20	$1,204.00	—	74% above	70%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC Php Psychotherapy W/Patient 45 Minutes	$361.20	$1,204.00	—	—	70%
Psychotherapy session, 60 minutes CPT 90837 HC Php Psychotherapy W/Patient 60 Minutes	$180.60	$602.00	—	28% below	70%
Psychotherapy session, 60 minutes CPT 90837 HC Php Psych Tx 60 Min	$180.60	$602.00	—	28% below	70%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC Php Psychotherapy W/Patient 60 Minutes	$180.60	$602.00	—	—	70%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC Php Psych Tx 60 Min	$180.60	$602.00	—	—	70%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Est Pt, Outpt Visit Level 5	$363.30	$1,211.00	—	48% above	70%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Est Pt, Outpt Visit Level 5	$363.30	$1,211.00	—	—	70%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Est Pt, Outpt Visit Level 3	$257.70	$859.00	—	70% above	70%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Est Pt, Outpt Visit Level 3	$257.70	$859.00	—	—	70%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Est Pt, Outpt Visit Level 4	$288.90	$963.00	—	108% above	70%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Est Pt, Outpt Visit Level 4	$288.90	$963.00	—	—	70%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Est Pt, E/M Level 2	$109.50	$365.00	—	10% below	70%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Est Pt, Outpt Visit Level 2	$211.50	$705.00	—	74% above	70%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Est Pt, E/M Level 2	$109.50	$365.00	—	—	70%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Est Pt, Outpt Visit Level 2	$211.50	$705.00	—	—	70%
Speech and language evaluation CPT 92523 HC Eval Speech Sound Lang Comprhension	$346.50	$1,155.00	—	5% above	70%
Speech and language evaluation inpatient CPT 92523 HC Eval Speech Sound Lang Comprhension	$346.50	$1,155.00	—	—	70%
Speech therapy session, individual CPT 92507 HC Speech/Language Therapy	$445.50	$1,485.00	—	152% above	70%
Speech therapy session, individual inpatient CPT 92507 HC Speech/Language Therapy	$445.50	$1,485.00	—	—	70%
Spirometry (breathing test) CPT 94010 HC Pif (Copd Assessment)	$377.40	$1,258.00	—	45% above	70%
Spirometry (breathing test) CPT 94010 HC Spirometry / Tvc / Mvv	$377.40	$1,258.00	—	45% above	70%
Spirometry (breathing test) inpatient CPT 94010 HC Pif (Copd Assessment)	$377.40	$1,258.00	—	—	70%
Spirometry (breathing test) inpatient CPT 94010 HC Spirometry / Tvc / Mvv	$377.40	$1,258.00	—	—	70%
Spirometry before and after a bronchodilator CPT 94060 HC Before / After Bronchodilator	$970.20	$3,234.00	—	136% above	70%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC Before / After Bronchodilator	$970.20	$3,234.00	—	—	70%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC Pt Therapeutic Activities 15 Min	$249.00	$830.00	—	143% above	70%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC Ot Therapeutic Activities 15 Min	$249.00	$830.00	—	143% above	70%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC Pt Therapeutic Activities 15 Min	$249.00	$830.00	—	—	70%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC Ot Therapeutic Activities 15 Min	$249.00	$830.00	—	—	70%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC Phlebotomy,Tx	$275.40	$918.00	—	11% above	70%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC Phlebotomy,Tx	$275.40	$918.00	—	—	70%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 DIPHTH-ACELL PERTUSSIS-TETANUS 15-23-5 LF-MCG/0.5 IM SUSP	$113.98	$189.96	—	2% above	40%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 DIPHTH-ACELL PERTUSSIS-TETANUS 15-23-5 LF-MCG/0.5 IM SUSP	$113.98	$189.96	—	—	40%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY	$30.28	$50.47	—	12% below	40%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY	$30.28	$50.47	—	—	40%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY	$584.06	$973.44	—	231% above	40%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY	$584.06	$973.44	—	—	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY	$98.76	$164.60	—	5% above	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY	$98.76	$164.60	—	—	40%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR	$50.27	$83.79	—	80% above	40%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR	$50.27	$83.79	—	—	40%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$367.46	$612.44	—	8% above	40%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$367.46	$612.44	—	—	40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY	$439.05	$731.75	—	130% above	40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY	$439.05	$731.75	—	—	40%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR	$1,629.79	$2,716.32	—	74% above	40%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC IM SUSR	$1,629.79	$2,716.32	—	—	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP	$158.42	$264.04	—	22% above	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP	$158.42	$264.04	—	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY	$182.80	$304.67	—	69% above	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY	$182.80	$304.67	—	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Immunization Administration	$137.10	$457.00	—	143% above	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Immunization Administration	$952.00	$1,586.67	$70.25–$71.65	1588% above	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC Immunization Administration	$137.10	$457.00	—	—	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC Subsequent Immun Admin	$179.10	$597.00	—	334% above	70%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC Subsequent Immun Admin	$179.10	$597.00	—	—	70%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://www.bonsecours.com/-/media/bon-secours/patients-and-visitors/corporate/pricing/843050337_bon-secours-mercy-health-petersburg-llc_standardcharges.ashx