Hospital

Lonesome Pine Hospital

Lonesome Pine Hospital in Big Stone Gap, VA publishes cash prices for 405 common procedures listed here, from its own machine-readable price file updated Mar 23, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Virginia median for 394 of 398 procedures and above it for 1. By typical cash price it ranks #5 of 66 Virginia hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

1990 HOLTON AVE., BIG STONE GAP, VA 24219 Collected Sep 23, 2026 Source price file Check a bill from this hospital (276) 523-3111

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 490114 · CMS hospital register

Financial assistance

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

Lonesome Pine Hospital is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN WOW CON	$617.10	$4,114.00	$167.05–$4,114.00	67% below	85%
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN WOW CON	$617.10	$4,114.00	$167.05–$4,114.00	67% below	85%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN WOW CON	$617.10	$4,114.00	$167.05–$4,114.00	—	85%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN WOW CON	$617.10	$4,114.00	$167.05–$4,114.00	—	85%
Abdominal X-ray, 2 views CPT 74019 HC DX ABDOMEN 2 VIEWS	$69.30	$462.00	$48.61–$462.00	79% below	85%
Abdominal X-ray, 2 views CPT 74019 HC DX ABDOMEN 2 VIEWS	$69.30	$462.00	$48.61–$462.00	79% below	85%
Abdominal X-ray, 2 views inpatient CPT 74019 HC DX ABDOMEN 2 VIEWS	$69.30	$462.00	$48.61–$462.00	—	85%
Abdominal X-ray, 2 views inpatient CPT 74019 HC DX ABDOMEN 2 VIEWS	$69.30	$462.00	$48.61–$462.00	—	85%
Ankle X-ray, complete, 3 or more views CPT 73610 HC DX ANKLE 3 VIEW+ *	$72.75	$485.00	$22.40–$485.00	78% below	85%
Ankle X-ray, complete, 3 or more views CPT 73610 HC DX ANKLE 3 VIEW+ *	$72.75	$485.00	$22.40–$485.00	78% below	85%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC DX ANKLE 3 VIEW+ *	$72.75	$485.00	$22.40–$485.00	—	85%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC DX ANKLE 3 VIEW+ *	$72.75	$485.00	$22.40–$485.00	—	85%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC NONINVAS UE LE ART 1 LEV BILAT	$229.50	$1,530.00	$32.70–$1,530.00	—	85%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC NONINVAS UE LE ART 1 LEV BILAT	$229.50	$1,530.00	$32.70–$1,530.00	—	85%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC NONINVAS UE LE ART 1 LEV BILAT	$229.50	$1,530.00	$32.70–$1,530.00	—	85%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC NONINVAS UE LE ART 1 LEV BILAT	$229.50	$1,530.00	$32.70–$1,530.00	—	85%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREM WO CON	$531.75	$3,545.00	$95.95–$3,545.00	54% below	85%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREM WO CON	$531.75	$3,545.00	$95.95–$3,545.00	54% below	85%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREM WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREM WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY	$69.30	$462.00	$42.92–$462.00	86% below	85%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY	$69.30	$462.00	$42.92–$462.00	86% below	85%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY	$69.30	$462.00	$42.92–$462.00	—	85%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY	$69.30	$462.00	$42.92–$462.00	—	85%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE SCAN WHOLE BODY	$452.25	$3,015.00	$123.47–$3,015.00	68% below	85%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE SCAN WHOLE BODY	$452.25	$3,015.00	$123.47–$3,015.00	68% below	85%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE SCAN WHOLE BODY	$452.25	$3,015.00	$123.47–$3,015.00	—	85%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE SCAN WHOLE BODY	$452.25	$3,015.00	$123.47–$3,015.00	—	85%
Breast ultrasound, complete, one breast CPT 76641 HC US BREAST UNIL COMPLETE	$96.75	$645.00	$45.83–$645.00	83% below	85%
Breast ultrasound, complete, one breast CPT 76641 HC US BREAST UNIL COMPLETE	$96.75	$645.00	$45.83–$645.00	83% below	85%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST UNIL COMPLETE	$96.75	$645.00	$45.83–$645.00	—	85%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST UNIL COMPLETE	$96.75	$645.00	$45.83–$645.00	—	85%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST UNIL LIMITED	$91.80	$612.00	$45.83–$612.00	81% below	85%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST UNIL LIMITED	$91.80	$612.00	$45.83–$612.00	81% below	85%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST UNIL LIMITED	$91.80	$612.00	$45.83–$612.00	—	85%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST UNIL LIMITED	$91.80	$612.00	$45.83–$612.00	—	85%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CT ANGIO ABD & PELV W/O & W/DYE	$559.65	$3,731.00	$290.27–$3,731.00	81% below	85%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CT ANGIO ABD & PELV W/O & W/DYE	$559.65	$3,731.00	$290.27–$3,731.00	81% below	85%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CT ANGIO ABD & PELV W/O & W/DYE	$559.65	$3,731.00	$290.27–$3,731.00	—	85%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CT ANGIO ABD & PELV W/O & W/DYE	$559.65	$3,731.00	$290.27–$3,731.00	—	85%
CT angiography (CTA) of the head CPT 70496 HC CTA HEAD W CONTRAST	$559.65	$3,731.00	$169.24–$3,731.00	69% below	85%
CT angiography (CTA) of the head CPT 70496 HC CTA HEAD W CONTRAST	$559.65	$3,731.00	$169.24–$3,731.00	69% below	85%
CT angiography (CTA) of the head inpatient CPT 70496 HC CTA HEAD W CONTRAST	$559.65	$3,731.00	$169.24–$3,731.00	—	85%
CT angiography (CTA) of the head inpatient CPT 70496 HC CTA HEAD W CONTRAST	$559.65	$3,731.00	$169.24–$3,731.00	—	85%
CT angiography (CTA) of the neck CPT 70498 HC CTA NECK W CONTRAST	$559.65	$3,731.00	$169.24–$3,731.00	71% below	85%
CT angiography (CTA) of the neck CPT 70498 HC CTA NECK W CONTRAST	$559.65	$3,731.00	$169.24–$3,731.00	71% below	85%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CTA NECK W CONTRAST	$559.65	$3,731.00	$169.24–$3,731.00	—	85%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CTA NECK W CONTRAST	$559.65	$3,731.00	$169.24–$3,731.00	—	85%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CTA CHEST WOW CON	$587.70	$3,918.00	$169.24–$3,918.00	67% below	85%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CTA CHEST WOW CON	$587.70	$3,918.00	$169.24–$3,918.00	67% below	85%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CTA CHEST WOW CON	$587.70	$3,918.00	$169.24–$3,918.00	—	85%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CTA CHEST WOW CON	$587.70	$3,918.00	$169.24–$3,918.00	—	85%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CTA HEART W CON CORONARY ART	$559.65	$3,731.00	$130.85–$3,731.00	38% below	85%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CTA HEART W CON CORONARY ART	$559.65	$3,731.00	$130.85–$3,731.00	38% below	85%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CTA HEART W CON CORONARY ART	$559.65	$3,731.00	$130.85–$3,731.00	—	85%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CTA HEART W CON CORONARY ART	$559.65	$3,731.00	$130.85–$3,731.00	—	85%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABDOMEN/PELVIS WO CON	$531.75	$3,545.00	$124.45–$3,545.00	76% below	85%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABDOMEN/PELVIS WO CON	$531.75	$3,545.00	$124.45–$3,545.00	76% below	85%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABDOMEN/PELVIS WO CON	$531.75	$3,545.00	$124.45–$3,545.00	—	85%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABDOMEN/PELVIS WO CON	$531.75	$3,545.00	$124.45–$3,545.00	—	85%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN/PELVIS W CON	$559.65	$3,731.00	$237.47–$3,731.00	82% below	85%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN/PELVIS W CON	$559.65	$3,731.00	$237.47–$3,731.00	82% below	85%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN/PELVIS W CON	$559.65	$3,731.00	$237.47–$3,731.00	—	85%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN/PELVIS W CON	$559.65	$3,731.00	$237.47–$3,731.00	—	85%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD/PEL WOW CON	$587.70	$3,918.00	$290.27–$3,918.00	83% below	85%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD/PEL WOW CON	$587.70	$3,918.00	$290.27–$3,918.00	83% below	85%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABD/PEL WOW CON	$587.70	$3,918.00	$290.27–$3,918.00	—	85%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABD/PEL WOW CON	$587.70	$3,918.00	$290.27–$3,918.00	—	85%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CON	$587.70	$3,918.00	$150.25–$3,918.00	64% below	85%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CON	$587.70	$3,918.00	$150.25–$3,918.00	64% below	85%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W CON	$587.70	$3,918.00	$150.25–$3,918.00	—	85%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W CON	$587.70	$3,918.00	$150.25–$3,918.00	—	85%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CON	$559.65	$3,731.00	$95.95–$3,731.00	61% below	85%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CON	$559.65	$3,731.00	$95.95–$3,731.00	61% below	85%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN WO CON	$559.65	$3,731.00	$95.95–$3,731.00	—	85%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN WO CON	$559.65	$3,731.00	$95.95–$3,731.00	—	85%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CON	$531.75	$3,545.00	$95.95–$3,545.00	59% below	85%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CON	$531.75	$3,545.00	$95.95–$3,545.00	59% below	85%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN WO CONTRAST	$531.75	$3,545.00	$95.95–$3,545.00	60% below	85%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN WO CONTRAST	$531.75	$3,545.00	$95.95–$3,545.00	60% below	85%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN WO CONTRAST	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN WO CONTRAST	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
CT scan of the head with contrast CPT 70460 HC CT HEAD W CON	$559.65	$3,731.00	$150.25–$3,731.00	63% below	85%
CT scan of the head with contrast CPT 70460 HC CT HEAD W CON	$559.65	$3,731.00	$150.25–$3,731.00	63% below	85%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD W CON	$559.65	$3,731.00	$150.25–$3,731.00	—	85%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD W CON	$559.65	$3,731.00	$150.25–$3,731.00	—	85%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD WOW CON	$587.70	$3,918.00	$167.05–$3,918.00	67% below	85%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD WOW CON	$587.70	$3,918.00	$167.05–$3,918.00	67% below	85%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD WOW CON	$587.70	$3,918.00	$167.05–$3,918.00	—	85%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD WOW CON	$587.70	$3,918.00	$167.05–$3,918.00	—	85%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT SPINE LUMBAR WO CON	$531.75	$3,545.00	$95.95–$3,545.00	67% below	85%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT SPINE LUMBAR WO CON	$531.75	$3,545.00	$95.95–$3,545.00	67% below	85%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT SPINE LUMBAR WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT SPINE LUMBAR WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT SPINE CERVICAL WO CON	$531.75	$3,545.00	$95.95–$3,545.00	67% below	85%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT SPINE CERVICAL WO CON	$531.75	$3,545.00	$95.95–$3,545.00	67% below	85%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT SPINE CERVICAL WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT SPINE CERVICAL WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CON	$617.10	$4,114.00	$150.25–$4,114.00	64% below	85%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CON	$617.10	$4,114.00	$150.25–$4,114.00	64% below	85%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CON	$617.10	$4,114.00	$150.25–$4,114.00	—	85%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CON	$617.10	$4,114.00	$150.25–$4,114.00	—	85%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DPLX SCN CARTOID ART BILAT	$229.50	$1,530.00	$76.07–$1,530.00	—	85%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DPLX SCN CARTOID ART BILAT	$229.50	$1,530.00	$76.07–$1,530.00	—	85%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DPLX SCN CARTOID ART BILAT	$229.50	$1,530.00	$76.07–$1,530.00	—	85%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DPLX SCN CARTOID ART BILAT	$229.50	$1,530.00	$76.07–$1,530.00	—	85%
Chest CT scan without and with contrast CPT 71270 HC CT CHEST WOW CON	$587.70	$3,918.00	$167.05–$3,918.00	70% below	85%
Chest CT scan without and with contrast CPT 71270 HC CT CHEST WOW CON	$587.70	$3,918.00	$167.05–$3,918.00	70% below	85%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT CHEST WOW CON	$587.70	$3,918.00	$167.05–$3,918.00	—	85%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT CHEST WOW CON	$587.70	$3,918.00	$167.05–$3,918.00	—	85%
Chest X-ray, 2 views CPT 71046 HC DX CHEST 2 VIEWS	$69.30	$462.00	$31.06–$462.00	75% below	85%
Chest X-ray, 2 views CPT 71046 HC DX CHEST 2 VIEWS	$69.30	$462.00	$31.06–$462.00	75% below	85%
Chest X-ray, 2 views inpatient CPT 71046 HC DX CHEST 2 VIEWS	$69.30	$462.00	$31.06–$462.00	—	85%
Chest X-ray, 2 views inpatient CPT 71046 HC DX CHEST 2 VIEWS	$69.30	$462.00	$31.06–$462.00	—	85%
Chest X-ray, single view CPT 71045 HC DX CHEST 1 VIEW	$65.85	$439.00	$31.06–$439.00	72% below	85%
Chest X-ray, single view CPT 71045 HC DX CHEST 1 VIEW	$65.85	$439.00	$31.06–$439.00	72% below	85%
Chest X-ray, single view inpatient CPT 71045 HC DX CHEST 1 VIEW	$65.85	$439.00	$31.06–$439.00	—	85%
Chest X-ray, single view inpatient CPT 71045 HC DX CHEST 1 VIEW	$65.85	$439.00	$31.06–$439.00	—	85%
Collarbone (clavicle) X-ray, complete CPT 73000 HC DX CLAVICLE COMPLETE	$65.85	$439.00	$22.40–$439.00	78% below	85%
Collarbone (clavicle) X-ray, complete CPT 73000 HC DX CLAVICLE COMPLETE	$65.85	$439.00	$22.40–$439.00	78% below	85%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC DX CLAVICLE COMPLETE	$65.85	$439.00	$22.40–$439.00	—	85%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC DX CLAVICLE COMPLETE	$65.85	$439.00	$22.40–$439.00	—	85%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE	$101.55	$677.00	$48.16–$677.00	84% below	85%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE	$101.55	$677.00	$48.16–$677.00	84% below	85%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE	$101.55	$677.00	$48.16–$677.00	—	85%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE	$101.55	$677.00	$48.16–$677.00	—	85%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC BONE DENSITY DEXA AXIAL	$78.75	$525.00	$35.74–$525.00	87% below	85%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC BONE DENSITY DEXA AXIAL	$78.75	$525.00	$35.74–$525.00	87% below	85%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC BONE DENSITY DEXA AXIAL	$78.75	$525.00	$35.74–$525.00	—	85%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC BONE DENSITY DEXA AXIAL	$78.75	$525.00	$35.74–$525.00	—	85%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC BONE DENSITY DXA APPENDICULAR	$69.30	$462.00	$16.06–$462.00	72% below	85%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC BONE DENSITY DXA APPENDICULAR	$69.30	$462.00	$16.06–$462.00	72% below	85%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC BONE DENSITY DXA APPENDICULAR	$69.30	$462.00	$16.06–$462.00	—	85%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC BONE DENSITY DXA APPENDICULAR	$69.30	$462.00	$16.06–$462.00	—	85%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US PREG COMP SCAN FET ANAT (L2)	$101.55	$677.00	$76.07–$677.00	85% below	85%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US PREG COMP SCAN FET ANAT (L2)	$101.55	$677.00	$76.07–$677.00	85% below	85%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US PREG COMP SCAN FET ANAT (L2)	$101.55	$677.00	$76.07–$677.00	—	85%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US PREG COMP SCAN FET ANAT (L2)	$101.55	$677.00	$76.07–$677.00	—	85%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT CHEST WO CON	$531.75	$3,545.00	$95.95–$3,545.00	61% below	85%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT CHEST WO CON	$531.75	$3,545.00	$95.95–$3,545.00	61% below	85%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT CHEST WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT CHEST WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT CHEST W CON	$559.65	$3,731.00	$150.25–$3,731.00	68% below	85%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT CHEST W CON	$559.65	$3,731.00	$150.25–$3,731.00	68% below	85%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT CHEST W CON	$559.65	$3,731.00	$150.25–$3,731.00	—	85%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT CHEST W CON	$559.65	$3,731.00	$150.25–$3,731.00	—	85%
Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BILAT	$85.50	$570.00	$61.38–$570.00	—	85%
Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BILAT	$85.50	$570.00	$61.38–$570.00	—	85%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DX MAMMO INCL CAD BILAT	$85.50	$570.00	$61.38–$570.00	—	85%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DX MAMMO INCL CAD BILAT	$85.50	$570.00	$61.38–$570.00	—	85%
Diagnostic mammogram, one breast one side CPT 77065 HC DX MAMMO INCL CAD UNILAT	$74.10	$494.00	$48.06–$494.00	78% below	85%
Diagnostic mammogram, one breast one side CPT 77065 HC DX MAMMO INCL CAD UNILAT	$74.10	$494.00	$48.06–$494.00	78% below	85%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC DX MAMMO INCL CAD UNILAT	$74.10	$494.00	$48.06–$494.00	—	85%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC DX MAMMO INCL CAD UNILAT	$74.10	$494.00	$48.06–$494.00	—	85%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUPLEX ART LOWER EXT BILAT	$344.25	$2,295.00	$76.07–$2,295.00	—	85%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUPLEX ART LOWER EXT BILAT	$344.25	$2,295.00	$76.07–$2,295.00	—	85%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUPLEX ART LOWER EXT BILAT	$344.25	$2,295.00	$76.07–$2,295.00	—	85%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUPLEX ART LOWER EXT BILAT	$344.25	$2,295.00	$76.07–$2,295.00	—	85%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUPLEX VEINS EXTREM CMPL BILAT	$344.25	$2,295.00	$76.07–$2,295.00	—	85%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUPLEX VEINS EXTREM CMPL BILAT	$344.25	$2,295.00	$76.07–$2,295.00	—	85%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUPLEX VEINS EXTREM CMPL BILAT	$344.25	$2,295.00	$76.07–$2,295.00	—	85%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUPLEX VEINS EXTREM CMPL BILAT	$344.25	$2,295.00	$76.07–$2,295.00	—	85%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO ADULT TRANSTHORACIC COMP	$448.35	$2,989.00	$170.76–$2,989.00	74% below	85%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO ADULT TRANSTHORACIC COMP	$448.35	$2,989.00	$170.76–$2,989.00	74% below	85%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO ADULT TRANSTHORACIC COMP	$448.35	$2,989.00	$170.76–$2,989.00	—	85%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO ADULT TRANSTHORACIC COMP	$448.35	$2,989.00	$170.76–$2,989.00	—	85%
Elbow X-ray, 2 views CPT 73070 HC DX ELBOW 2 VIEWS	$65.85	$439.00	$22.40–$439.00	75% below	85%
Elbow X-ray, 2 views CPT 73070 HC DX ELBOW 2 VIEWS	$65.85	$439.00	$22.40–$439.00	75% below	85%
Elbow X-ray, 2 views inpatient CPT 73070 HC DX ELBOW 2 VIEWS	$65.85	$439.00	$22.40–$439.00	—	85%
Elbow X-ray, 2 views inpatient CPT 73070 HC DX ELBOW 2 VIEWS	$65.85	$439.00	$22.40–$439.00	—	85%
Elbow X-ray, complete, 3 or more views CPT 73080 HC DX ELBOW 3 VIEW+	$72.75	$485.00	$22.40–$485.00	83% below	85%
Elbow X-ray, complete, 3 or more views CPT 73080 HC DX ELBOW 3 VIEW+	$72.75	$485.00	$22.40–$485.00	83% below	85%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC DX ELBOW 3 VIEW+	$72.75	$485.00	$22.40–$485.00	—	85%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC DX ELBOW 3 VIEW+	$72.75	$485.00	$22.40–$485.00	—	85%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT SELLA INNER EAR WO CON	$559.65	$3,731.00	$95.95–$3,731.00	59% below	85%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT SELLA INNER EAR WO CON	$559.65	$3,731.00	$95.95–$3,731.00	59% below	85%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT SELLA INNER EAR WO CON	$559.65	$3,731.00	$95.95–$3,731.00	—	85%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT SELLA INNER EAR WO CON	$559.65	$3,731.00	$95.95–$3,731.00	—	85%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC DX FACIAL BONE COMPLT MIN 3 VIEWS	$69.30	$462.00	$22.40–$462.00	87% below	85%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC DX FACIAL BONE COMPLT MIN 3 VIEWS	$69.30	$462.00	$22.40–$462.00	87% below	85%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC DX FACIAL BONE COMPLT MIN 3 VIEWS	$69.30	$462.00	$22.40–$462.00	—	85%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC DX FACIAL BONE COMPLT MIN 3 VIEWS	$69.30	$462.00	$22.40–$462.00	—	85%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC DX FOREARM 2 VIEWS	$69.30	$462.00	$22.40–$462.00	79% below	85%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC DX FOREARM 2 VIEWS	$69.30	$462.00	$22.40–$462.00	79% below	85%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC DX FOREARM 2 VIEWS	$69.30	$462.00	$22.40–$462.00	—	85%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC DX FOREARM 2 VIEWS	$69.30	$462.00	$22.40–$462.00	—	85%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBIL HIDA	$452.25	$3,015.00	$146.68–$3,015.00	60% below	85%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBIL HIDA	$452.25	$3,015.00	$146.68–$3,015.00	60% below	85%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM HEPATOBIL HIDA	$452.25	$3,015.00	$146.68–$3,015.00	—	85%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM HEPATOBIL HIDA	$452.25	$3,015.00	$146.68–$3,015.00	—	85%
Hand X-ray, 2 views CPT 73120 HC DX HAND 2 VIEW	$69.30	$462.00	$22.40–$462.00	72% below	85%
Hand X-ray, 2 views CPT 73120 HC DX HAND 2 VIEW	$69.30	$462.00	$22.40–$462.00	72% below	85%
Hand X-ray, 2 views inpatient CPT 73120 HC DX HAND 2 VIEW	$69.30	$462.00	$22.40–$462.00	—	85%
Hand X-ray, 2 views inpatient CPT 73120 HC DX HAND 2 VIEW	$69.30	$462.00	$22.40–$462.00	—	85%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC DX CALCANEUS 2 VIEW+	$69.30	$462.00	$22.40–$462.00	75% below	85%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC DX CALCANEUS 2 VIEW+	$69.30	$462.00	$22.40–$462.00	75% below	85%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC DX CALCANEUS 2 VIEW+	$69.30	$462.00	$22.40–$462.00	—	85%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC DX CALCANEUS 2 VIEW+	$69.30	$462.00	$22.40–$462.00	—	85%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STUDY UNATTENDED	$260.70	$1,738.00	$85.04–$1,738.00	43% below	85%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STUDY UNATTENDED	$260.70	$1,738.00	$85.04–$1,738.00	43% below	85%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STUDY UNATTENDED	$260.70	$1,738.00	$85.04–$1,738.00	—	85%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STUDY UNATTENDED	$260.70	$1,738.00	$85.04–$1,738.00	—	85%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMNOGRAPHY4+ W BIPAP CPAP	$555.60	$3,704.00	$397.29–$3,704.00	75% below	85%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMNOGRAPHY4+ W BIPAP CPAP	$555.60	$3,704.00	$397.29–$3,704.00	75% below	85%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMNOGRAPHY4+ W BIPAP CPAP	$555.60	$3,704.00	$397.29–$3,704.00	—	85%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMNOGRAPHY4+ W BIPAP CPAP	$555.60	$3,704.00	$397.29–$3,704.00	—	85%
Knee X-ray, 3 views CPT 73562 HC DX KNEE 3 VIEW*	$69.30	$462.00	$22.40–$462.00	79% below	85%
Knee X-ray, 3 views CPT 73562 HC DX KNEE 3 VIEW*	$69.30	$462.00	$22.40–$462.00	79% below	85%
Knee X-ray, 3 views inpatient CPT 73562 HC DX KNEE 3 VIEW*	$69.30	$462.00	$22.40–$462.00	—	85%
Knee X-ray, 3 views inpatient CPT 73562 HC DX KNEE 3 VIEW*	$69.30	$462.00	$22.40–$462.00	—	85%
Knee X-ray, complete, 4 or more views CPT 73564 HC DX KNEE 4 VIEW+ COMPLETE	$80.10	$534.00	$22.40–$534.00	82% below	85%
Knee X-ray, complete, 4 or more views CPT 73564 HC DX KNEE 4 VIEW+ COMPLETE	$80.10	$534.00	$22.40–$534.00	82% below	85%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC DX KNEE 4 VIEW+ COMPLETE	$80.10	$534.00	$22.40–$534.00	—	85%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC DX KNEE 4 VIEW+ COMPLETE	$80.10	$534.00	$22.40–$534.00	—	85%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOW EXTREM WO CON	$531.75	$3,545.00	$95.95–$3,545.00	56% below	85%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOW EXTREM WO CON	$531.75	$3,545.00	$95.95–$3,545.00	56% below	85%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOW EXTREM WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOW EXTREM WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LTD	$96.45	$643.00	$48.16–$643.00	85% below	85%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LTD	$96.45	$643.00	$48.16–$643.00	85% below	85%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMEN LTD	$96.45	$643.00	$48.16–$643.00	—	85%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMEN LTD	$96.45	$643.00	$48.16–$643.00	—	85%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S)	$96.45	$643.00	$9.51–$643.00	69% below	85%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S)	$96.45	$643.00	$9.51–$643.00	69% below	85%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S)	$96.45	$643.00	$9.51–$643.00	—	85%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S)	$96.45	$643.00	$9.51–$643.00	—	85%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT CHEST SCREENING LOW DOSE WOUT CONT	$91.05	$607.00	$40.45–$607.00	68% below	85%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT CHEST SCREENING LOW DOSE WOUT CONT	$91.05	$607.00	$40.45–$607.00	68% below	85%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT CHEST SCREENING LOW DOSE WOUT CONT	$91.05	$607.00	$40.45–$607.00	—	85%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT CHEST SCREENING LOW DOSE WOUT CONT	$91.05	$607.00	$40.45–$607.00	—	85%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC DX TIBIA & FIBULA 2 VIEWS	$69.30	$462.00	$22.40–$462.00	78% below	85%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC DX TIBIA & FIBULA 2 VIEWS	$69.30	$462.00	$22.40–$462.00	78% below	85%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC DX TIBIA & FIBULA 2 VIEWS	$69.30	$462.00	$22.40–$462.00	—	85%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC DX TIBIA & FIBULA 2 VIEWS	$69.30	$462.00	$22.40–$462.00	—	85%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD WO CON	$604.95	$4,033.00	$169.21–$4,033.00	74% below	85%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD WO CON	$604.95	$4,033.00	$169.21–$4,033.00	74% below	85%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA HEAD WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA HEAD WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST WOW CON INCL CAD BILAT	$737.10	$4,914.00	$229.55–$4,914.00	—	85%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST WOW CON INCL CAD BILAT	$737.10	$4,914.00	$229.55–$4,914.00	—	85%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 HC MRI BREAST WOW CON INCL CAD BILAT	$737.10	$4,914.00	$229.55–$4,914.00	—	85%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 HC MRI BREAST WOW CON INCL CAD BILAT	$737.10	$4,914.00	$229.55–$4,914.00	—	85%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MR JOINT LOW EXT WO CON	$604.95	$4,033.00	$169.21–$4,033.00	69% below	85%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MR JOINT LOW EXT WO CON	$604.95	$4,033.00	$169.21–$4,033.00	69% below	85%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MR JOINT LOW EXT WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MR JOINT LOW EXT WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MR JOINT LOW EXT WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	81% below	85%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MR JOINT LOW EXT WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	81% below	85%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MR JOINT LOW EXT WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	—	85%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MR JOINT LOW EXT WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	—	85%
MRI of the abdomen without contrast CPT 74181 HC MR ABDOMEN WO CON	$604.95	$4,033.00	$169.21–$4,033.00	63% below	85%
MRI of the abdomen without contrast CPT 74181 HC MR ABDOMEN WO CON	$604.95	$4,033.00	$169.21–$4,033.00	63% below	85%
MRI of the abdomen without contrast inpatient CPT 74181 HC MR ABDOMEN WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the abdomen without contrast inpatient CPT 74181 HC MR ABDOMEN WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MR ABDOMEN WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	77% below	85%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MR ABDOMEN WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	77% below	85%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MR ABDOMEN WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	—	85%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MR ABDOMEN WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	—	85%
MRI of the brain, no contrast dye CPT 70551 HC MR BRAIN WO CON	$604.95	$4,033.00	$169.21–$4,033.00	69% below	85%
MRI of the brain, no contrast dye CPT 70551 HC MR BRAIN WO CON	$604.95	$4,033.00	$169.21–$4,033.00	69% below	85%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MR BRAIN WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MR BRAIN WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the brain, with and without contrast dye CPT 70553 HC MR BRAIN WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	75% below	85%
MRI of the brain, with and without contrast dye CPT 70553 HC MR BRAIN WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	75% below	85%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MR BRAIN WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	—	85%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MR BRAIN WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	—	85%
MRI of the lower back, no contrast dye CPT 72148 HC MR SPINE LUMBAR WO CON	$604.95	$4,033.00	$169.21–$4,033.00	70% below	85%
MRI of the lower back, no contrast dye CPT 72148 HC MR SPINE LUMBAR WO CON	$604.95	$4,033.00	$169.21–$4,033.00	70% below	85%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MR SPINE LUMBAR WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MR SPINE LUMBAR WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MR SPINE LUMBAR WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	80% below	85%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MR SPINE LUMBAR WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	80% below	85%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MR SPINE LUMBAR WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	—	85%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MR SPINE LUMBAR WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	—	85%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MR SPINE THORACIC WO CON	$604.95	$4,033.00	$169.21–$4,033.00	70% below	85%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MR SPINE THORACIC WO CON	$604.95	$4,033.00	$169.21–$4,033.00	70% below	85%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MR SPINE THORACIC WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MR SPINE THORACIC WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MR SPINE CERVICAL WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	80% below	85%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MR SPINE CERVICAL WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	80% below	85%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MR SPINE CERVICAL WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	—	85%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MR SPINE CERVICAL WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	—	85%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MR SPINE CERVICAL WO CON	$604.95	$4,033.00	$169.21–$4,033.00	70% below	85%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MR SPINE CERVICAL WO CON	$604.95	$4,033.00	$169.21–$4,033.00	70% below	85%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MR SPINE CERVICAL WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MR SPINE CERVICAL WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the pelvis without and with contrast CPT 72197 HC MR PELVIS WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	79% below	85%
MRI of the pelvis without and with contrast CPT 72197 HC MR PELVIS WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	79% below	85%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MR PELVIS WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	—	85%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MR PELVIS WOW CON	$668.55	$4,457.00	$267.02–$4,457.00	—	85%
MRI of the pelvis, no contrast dye CPT 72195 HC MR PELVIS WO CON	$604.95	$4,033.00	$169.21–$4,033.00	68% below	85%
MRI of the pelvis, no contrast dye CPT 72195 HC MR PELVIS WO CON	$604.95	$4,033.00	$169.21–$4,033.00	68% below	85%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MR PELVIS WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MR PELVIS WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MR JOINT UPR EXTREM WO CON	$604.95	$4,033.00	$169.21–$4,033.00	69% below	85%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MR JOINT UPR EXTREM WO CON	$604.95	$4,033.00	$169.21–$4,033.00	69% below	85%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MR JOINT UPR EXTREM WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MR JOINT UPR EXTREM WO CON	$604.95	$4,033.00	$169.21–$4,033.00	—	85%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC DX SPINE CERVICAL 4 OR 5 VIEWS*	$72.75	$485.00	$37.74–$485.00	85% below	85%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC DX SPINE CERVICAL 4 OR 5 VIEWS*	$72.75	$485.00	$37.74–$485.00	85% below	85%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC DX SPINE CERVICAL 4 OR 5 VIEWS*	$72.75	$485.00	$37.74–$485.00	—	85%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC DX SPINE CERVICAL 4 OR 5 VIEWS*	$72.75	$485.00	$37.74–$485.00	—	85%
Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W CON	$559.65	$3,731.00	$150.25–$3,731.00	67% below	85%
Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W CON	$559.65	$3,731.00	$150.25–$3,731.00	67% below	85%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT SOFT TISSUE NECK W CON	$559.65	$3,731.00	$150.25–$3,731.00	—	85%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT SOFT TISSUE NECK W CON	$559.65	$3,731.00	$150.25–$3,731.00	—	85%
Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK WO CON	$531.75	$3,545.00	$95.95–$3,545.00	38% below	85%
Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK WO CON	$531.75	$3,545.00	$95.95–$3,545.00	38% below	85%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SOFT TISSUE NECK WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SOFT TISSUE NECK WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
Neck soft tissue X-ray CPT 70360 HC DX NECK SOFT TISSUE	$69.30	$462.00	$22.40–$462.00	80% below	85%
Neck soft tissue X-ray CPT 70360 HC DX NECK SOFT TISSUE	$69.30	$462.00	$22.40–$462.00	80% below	85%
Neck soft tissue X-ray inpatient CPT 70360 HC DX NECK SOFT TISSUE	$69.30	$462.00	$22.40–$462.00	—	85%
Neck soft tissue X-ray inpatient CPT 70360 HC DX NECK SOFT TISSUE	$69.30	$462.00	$22.40–$462.00	—	85%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM MYOCARD PERF SPECT MULTI	$452.25	$3,015.00	$336.24–$3,015.00	86% below	85%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM MYOCARD PERF SPECT MULTI	$452.25	$3,015.00	$336.24–$3,015.00	86% below	85%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM MYOCARD PERF SPECT MULTI	$452.25	$3,015.00	$336.24–$3,015.00	—	85%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM MYOCARD PERF SPECT MULTI	$452.25	$3,015.00	$336.24–$3,015.00	—	85%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC NM PET CT SKULL BASE TO MID THIGH	$1,537.20	$10,248.00	$518.48–$10,248.00	65% below	85%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC NM PET CT SKULL BASE TO MID THIGH	$1,537.20	$10,248.00	$518.48–$10,248.00	65% below	85%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC NM PET CT SKULL BASE TO MID THIGH	$1,537.20	$10,248.00	$518.48–$10,248.00	—	85%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC NM PET CT SKULL BASE TO MID THIGH	$1,537.20	$10,248.00	$518.48–$10,248.00	—	85%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CON	$587.70	$3,918.00	$95.95–$3,918.00	60% below	85%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CON	$587.70	$3,918.00	$95.95–$3,918.00	60% below	85%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS WO CON	$587.70	$3,918.00	$95.95–$3,918.00	—	85%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS WO CON	$587.70	$3,918.00	$95.95–$3,918.00	—	85%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIS LTD FU	$101.55	$677.00	$31.46–$677.00	76% below	85%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIS LTD FU	$101.55	$677.00	$31.46–$677.00	76% below	85%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIS LTD FU	$101.55	$677.00	$31.46–$677.00	—	85%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIS LTD FU	$101.55	$677.00	$31.46–$677.00	—	85%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIS NON OB	$101.55	$677.00	$48.16–$677.00	86% below	85%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIS NON OB	$101.55	$677.00	$48.16–$677.00	86% below	85%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIS NON OB	$101.55	$677.00	$48.16–$677.00	—	85%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIS NON OB	$101.55	$677.00	$48.16–$677.00	—	85%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US PREG COMP >14 WKS SNGL GEST	$101.55	$677.00	$48.16–$677.00	83% below	85%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US PREG COMP >14 WKS SNGL GEST	$101.55	$677.00	$48.16–$677.00	83% below	85%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US PREG COMP >14 WKS SNGL GEST	$101.55	$677.00	$48.16–$677.00	—	85%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US PREG COMP >14 WKS SNGL GEST	$101.55	$677.00	$48.16–$677.00	—	85%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US OB <14 WKS SINGLE FETUS	$101.55	$677.00	$39.76–$677.00	79% below	85%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US OB <14 WKS SINGLE FETUS	$101.55	$677.00	$39.76–$677.00	79% below	85%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US OB <14 WKS SINGLE FETUS	$101.55	$677.00	$39.76–$677.00	—	85%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US OB <14 WKS SINGLE FETUS	$101.55	$677.00	$39.76–$677.00	—	85%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US PREGNANCY LTD 1 OR MORE FETUS	$101.55	$677.00	$31.46–$677.00	79% below	85%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US PREGNANCY LTD 1 OR MORE FETUS	$101.55	$677.00	$31.46–$677.00	79% below	85%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US PREGNANCY LTD 1 OR MORE FETUS	$101.55	$677.00	$31.46–$677.00	—	85%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US PREGNANCY LTD 1 OR MORE FETUS	$101.55	$677.00	$31.46–$677.00	—	85%
Rib X-ray, one side, 2 views one side CPT 71100 HC DX RIBS 2 VIEW UNILAT	$65.85	$439.00	$22.40–$439.00	80% below	85%
Rib X-ray, one side, 2 views one side CPT 71100 HC DX RIBS 2 VIEW UNILAT	$65.85	$439.00	$22.40–$439.00	80% below	85%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC DX RIBS 2 VIEW UNILAT	$65.85	$439.00	$22.40–$439.00	—	85%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC DX RIBS 2 VIEW UNILAT	$65.85	$439.00	$22.40–$439.00	—	85%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC DX RIBS UNI MIN 3 VIEW W PA CHEST	$69.30	$462.00	$22.40–$462.00	83% below	85%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC DX RIBS UNI MIN 3 VIEW W PA CHEST	$69.30	$462.00	$22.40–$462.00	83% below	85%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC DX RIBS UNI MIN 3 VIEW W PA CHEST	$69.30	$462.00	$22.40–$462.00	—	85%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC DX RIBS UNI MIN 3 VIEW W PA CHEST	$69.30	$462.00	$22.40–$462.00	—	85%
Screening mammogram, both breasts CPT 77067 HC SCREEN MAMMO INCL CAD	$74.10	$494.00	$50.76–$494.00	82% below	85%
Screening mammogram, both breasts CPT 77067 HC SCREEN MAMMO INCL CAD	$74.10	$494.00	$50.76–$494.00	82% below	85%
Screening mammogram, both breasts inpatient CPT 77067 HC SCREEN MAMMO INCL CAD	$74.10	$494.00	$50.76–$494.00	—	85%
Screening mammogram, both breasts inpatient CPT 77067 HC SCREEN MAMMO INCL CAD	$74.10	$494.00	$50.76–$494.00	—	85%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC DX SHOULDER 2 VIEW+	$76.35	$509.00	$22.40–$509.00	76% below	85%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC DX SHOULDER 2 VIEW+	$76.35	$509.00	$22.40–$509.00	76% below	85%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC DX SHOULDER 2 VIEW+	$76.35	$509.00	$22.40–$509.00	—	85%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC DX SHOULDER 2 VIEW+	$76.35	$509.00	$22.40–$509.00	—	85%
Sinus X-ray, complete, 3 or more views CPT 70220 HC DX SINUSES COMP 3 VIEW	$69.30	$462.00	$22.40–$462.00	86% below	85%
Sinus X-ray, complete, 3 or more views CPT 70220 HC DX SINUSES COMP 3 VIEW	$69.30	$462.00	$22.40–$462.00	86% below	85%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC DX SINUSES COMP 3 VIEW	$69.30	$462.00	$22.40–$462.00	—	85%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC DX SINUSES COMP 3 VIEW	$69.30	$462.00	$22.40–$462.00	—	85%
Skull X-ray, fewer than 4 views CPT 70250 HC DX SKULL LTD <4 VIEW	$65.85	$439.00	$22.40–$439.00	81% below	85%
Skull X-ray, fewer than 4 views CPT 70250 HC DX SKULL LTD <4 VIEW	$65.85	$439.00	$22.40–$439.00	81% below	85%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC DX SKULL LTD <4 VIEW	$65.85	$439.00	$22.40–$439.00	—	85%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC DX SKULL LTD <4 VIEW	$65.85	$439.00	$22.40–$439.00	—	85%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAPHY 4 PARA ATTENDED	$548.85	$3,659.00	$397.29–$3,659.00	75% below	85%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAPHY 4 PARA ATTENDED	$548.85	$3,659.00	$397.29–$3,659.00	75% below	85%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAPHY 4 PARA ATTENDED	$548.85	$3,659.00	$397.29–$3,659.00	—	85%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAPHY 4 PARA ATTENDED	$548.85	$3,659.00	$397.29–$3,659.00	—	85%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC CONTINOUS MONITORING WITH DRS	$448.35	$2,989.00	$149.95–$2,989.00	74% below	85%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC CONTINOUS MONITORING WITH DRS	$448.35	$2,989.00	$149.95–$2,989.00	74% below	85%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC CONTINOUS MONITORING WITH DRS	$448.35	$2,989.00	$149.95–$2,989.00	—	85%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC CONTINOUS MONITORING WITH DRS	$448.35	$2,989.00	$149.95–$2,989.00	—	85%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY	$69.30	$462.00	$42.92–$462.00	86% below	85%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY	$69.30	$462.00	$42.92–$462.00	86% below	85%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY	$69.30	$462.00	$42.92–$462.00	—	85%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY	$69.30	$462.00	$42.92–$462.00	—	85%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC FEMUR MIN 2 VIEWS	$69.30	$462.00	$30.40–$462.00	77% below	85%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC FEMUR MIN 2 VIEWS	$69.30	$462.00	$30.40–$462.00	77% below	85%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC FEMUR MIN 2 VIEWS	$69.30	$462.00	$30.40–$462.00	—	85%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC FEMUR MIN 2 VIEWS	$69.30	$462.00	$30.40–$462.00	—	85%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT SPINE THORACIC WO CON	$531.75	$3,545.00	$95.95–$3,545.00	67% below	85%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT SPINE THORACIC WO CON	$531.75	$3,545.00	$95.95–$3,545.00	67% below	85%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT SPINE THORACIC WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT SPINE THORACIC WO CON	$531.75	$3,545.00	$95.95–$3,545.00	—	85%
Toe X-ray, 2 or more views CPT 73660 HC DX TOES 2 VIEW+	$69.30	$462.00	$22.40–$462.00	72% below	85%
Toe X-ray, 2 or more views CPT 73660 HC DX TOES 2 VIEW+	$69.30	$462.00	$22.40–$462.00	72% below	85%
Toe X-ray, 2 or more views inpatient CPT 73660 HC DX TOES 2 VIEW+	$69.30	$462.00	$22.40–$462.00	—	85%
Toe X-ray, 2 or more views inpatient CPT 73660 HC DX TOES 2 VIEW+	$69.30	$462.00	$22.40–$462.00	—	85%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON OB	$101.55	$677.00	$48.16–$677.00	83% below	85%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON OB	$101.55	$677.00	$48.16–$677.00	83% below	85%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON OB	$101.55	$677.00	$48.16–$677.00	—	85%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON OB	$101.55	$677.00	$48.16–$677.00	—	85%
Transvaginal ultrasound during pregnancy CPT 76817 HC US PREGNANCY TRANSVAGINAL	$101.55	$677.00	$31.46–$677.00	79% below	85%
Transvaginal ultrasound during pregnancy CPT 76817 HC US PREGNANCY TRANSVAGINAL	$101.55	$677.00	$31.46–$677.00	79% below	85%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US PREGNANCY TRANSVAGINAL	$101.55	$677.00	$31.46–$677.00	—	85%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US PREGNANCY TRANSVAGINAL	$101.55	$677.00	$31.46–$677.00	—	85%
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMEN COMPLETE	$101.55	$677.00	$48.16–$677.00	88% below	85%
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMEN COMPLETE	$101.55	$677.00	$48.16–$677.00	88% below	85%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMEN COMPLETE	$101.55	$677.00	$48.16–$677.00	—	85%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMEN COMPLETE	$101.55	$677.00	$48.16–$677.00	—	85%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM	$101.55	$677.00	$48.16–$677.00	86% below	85%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM	$101.55	$677.00	$48.16–$677.00	86% below	85%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM	$101.55	$677.00	$48.16–$677.00	—	85%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM	$101.55	$677.00	$48.16–$677.00	—	85%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US SOFT TISS HEAD OR NECK	$101.55	$677.00	$48.16–$677.00	84% below	85%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US SOFT TISS HEAD OR NECK	$101.55	$677.00	$48.16–$677.00	84% below	85%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US SOFT TISS HEAD OR NECK	$101.55	$677.00	$48.16–$677.00	—	85%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US SOFT TISS HEAD OR NECK	$101.55	$677.00	$48.16–$677.00	—	85%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY	$69.30	$462.00	$42.92–$462.00	92% below	85%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY	$69.30	$462.00	$42.92–$462.00	92% below	85%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY	$69.30	$462.00	$42.92–$462.00	—	85%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY	$69.30	$462.00	$42.92–$462.00	—	85%
Upper arm X-ray (humerus), 2 views CPT 73060 HC DX HUMERUS 2 VIEW+	$69.30	$462.00	$22.40–$462.00	79% below	85%
Upper arm X-ray (humerus), 2 views CPT 73060 HC DX HUMERUS 2 VIEW+	$69.30	$462.00	$22.40–$462.00	79% below	85%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC DX HUMERUS 2 VIEW+	$69.30	$462.00	$22.40–$462.00	—	85%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC DX HUMERUS 2 VIEW+	$69.30	$462.00	$22.40–$462.00	—	85%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC DUPLEX VEINS EXTREM LTD UNIL	$229.50	$1,530.00	$48.16–$1,530.00	69% below	85%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC DUPLEX VEINS EXTREM LTD UNIL	$229.50	$1,530.00	$48.16–$1,530.00	69% below	85%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC DUPLEX VEINS EXTREM LTD UNIL	$229.50	$1,530.00	$48.16–$1,530.00	—	85%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC DUPLEX VEINS EXTREM LTD UNIL	$229.50	$1,530.00	$48.16–$1,530.00	—	85%
Wrist X-ray, 2 views CPT 73100 HC DX WRIST 2 VIEWS	$65.85	$439.00	$22.40–$439.00	74% below	85%
Wrist X-ray, 2 views CPT 73100 HC DX WRIST 2 VIEWS	$65.85	$439.00	$22.40–$439.00	74% below	85%
Wrist X-ray, 2 views inpatient CPT 73100 HC DX WRIST 2 VIEWS	$65.85	$439.00	$22.40–$439.00	—	85%
Wrist X-ray, 2 views inpatient CPT 73100 HC DX WRIST 2 VIEWS	$65.85	$439.00	$22.40–$439.00	—	85%
Wrist X-ray, complete, 3 or more views CPT 73110 HC DX WRIST 3 VIEW+*	$76.35	$509.00	$22.40–$509.00	75% below	85%
Wrist X-ray, complete, 3 or more views CPT 73110 HC DX WRIST 3 VIEW+*	$76.35	$509.00	$22.40–$509.00	75% below	85%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC DX WRIST 3 VIEW+*	$76.35	$509.00	$22.40–$509.00	—	85%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC DX WRIST 3 VIEW+*	$76.35	$509.00	$22.40–$509.00	—	85%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS	$69.30	$462.00	$30.40–$462.00	72% below	85%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS	$69.30	$462.00	$30.40–$462.00	72% below	85%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS	$69.30	$462.00	$30.40–$462.00	—	85%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS	$69.30	$462.00	$30.40–$462.00	—	85%
X-ray of the abdomen, 1 view CPT 74018 HC DX ABDOMEN 1 VIEW	$65.85	$439.00	$31.06–$439.00	76% below	85%
X-ray of the abdomen, 1 view CPT 74018 HC DX ABDOMEN 1 VIEW	$65.85	$439.00	$31.06–$439.00	76% below	85%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC DX ABDOMEN 1 VIEW	$65.85	$439.00	$31.06–$439.00	—	85%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC DX ABDOMEN 1 VIEW	$65.85	$439.00	$31.06–$439.00	—	85%
X-ray of the ankle, 2 views CPT 73600 HC DX ANKLE 2 VIEWS	$65.85	$439.00	$22.40–$439.00	76% below	85%
X-ray of the ankle, 2 views CPT 73600 HC DX ANKLE 2 VIEWS	$65.85	$439.00	$22.40–$439.00	76% below	85%
X-ray of the ankle, 2 views inpatient CPT 73600 HC DX ANKLE 2 VIEWS	$65.85	$439.00	$22.40–$439.00	—	85%
X-ray of the ankle, 2 views inpatient CPT 73600 HC DX ANKLE 2 VIEWS	$65.85	$439.00	$22.40–$439.00	—	85%
X-ray of the finger(s), 2 or more views CPT 73140 HC DX FINGER 2 VIEW+	$69.30	$462.00	$22.40–$462.00	71% below	85%
X-ray of the finger(s), 2 or more views CPT 73140 HC DX FINGER 2 VIEW+	$69.30	$462.00	$22.40–$462.00	71% below	85%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC DX FINGER 2 VIEW+	$69.30	$462.00	$22.40–$462.00	—	85%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC DX FINGER 2 VIEW+	$69.30	$462.00	$22.40–$462.00	—	85%
X-ray of the foot, 2 views one side CPT 73620 HC DX FOOT 2 VIEWS UNILATERAL	$65.85	$439.00	$22.40–$439.00	78% below	85%
X-ray of the foot, 2 views one side CPT 73620 HC DX FOOT 2 VIEWS UNILATERAL	$65.85	$439.00	$22.40–$439.00	78% below	85%
X-ray of the foot, 2 views inpatient one side CPT 73620 HC DX FOOT 2 VIEWS UNILATERAL	$65.85	$439.00	$22.40–$439.00	—	85%
X-ray of the foot, 2 views inpatient one side CPT 73620 HC DX FOOT 2 VIEWS UNILATERAL	$65.85	$439.00	$22.40–$439.00	—	85%
X-ray of the foot, complete, 3 or more views CPT 73630 HC DX FOOT 3 VIEW+*	$72.75	$485.00	$22.40–$485.00	77% below	85%
X-ray of the foot, complete, 3 or more views CPT 73630 HC DX FOOT 3 VIEW+*	$72.75	$485.00	$22.40–$485.00	77% below	85%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC DX FOOT 3 VIEW+*	$72.75	$485.00	$22.40–$485.00	—	85%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC DX FOOT 3 VIEW+*	$72.75	$485.00	$22.40–$485.00	—	85%
X-ray of the hand, 3 or more views CPT 73130 HC DX HAND 3 VIEW+*	$76.35	$509.00	$22.40–$509.00	74% below	85%
X-ray of the hand, 3 or more views CPT 73130 HC DX HAND 3 VIEW+*	$76.35	$509.00	$22.40–$509.00	74% below	85%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC DX HAND 3 VIEW+*	$76.35	$509.00	$22.40–$509.00	—	85%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC DX HAND 3 VIEW+*	$76.35	$509.00	$22.40–$509.00	—	85%
X-ray of the knee, 1 or 2 views CPT 73560 HC DX KNEE 1 OR 2 VIEW	$62.55	$417.00	$22.40–$417.00	76% below	85%
X-ray of the knee, 1 or 2 views CPT 73560 HC DX KNEE 1 OR 2 VIEW	$62.55	$417.00	$22.40–$417.00	76% below	85%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC DX KNEE 1 OR 2 VIEW	$62.55	$417.00	$22.40–$417.00	—	85%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC DX KNEE 1 OR 2 VIEW	$62.55	$417.00	$22.40–$417.00	—	85%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC DX SPINE LUMBAR 2 OR 3 VIEWS	$65.85	$439.00	$22.40–$439.00	82% below	85%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC DX SPINE LUMBAR 2 OR 3 VIEWS	$65.85	$439.00	$22.40–$439.00	82% below	85%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC DX SPINE LUMBAR 2 OR 3 VIEWS	$65.85	$439.00	$22.40–$439.00	—	85%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC DX SPINE LUMBAR 2 OR 3 VIEWS	$65.85	$439.00	$22.40–$439.00	—	85%
X-ray of the lower back, 4 or more views CPT 72110 HC DX SPINE LUMBAR MIN 4 VIEWS	$69.30	$462.00	$37.74–$462.00	87% below	85%
X-ray of the lower back, 4 or more views CPT 72110 HC DX SPINE LUMBAR MIN 4 VIEWS	$69.30	$462.00	$37.74–$462.00	87% below	85%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC DX SPINE LUMBAR MIN 4 VIEWS	$69.30	$462.00	$37.74–$462.00	—	85%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC DX SPINE LUMBAR MIN 4 VIEWS	$69.30	$462.00	$37.74–$462.00	—	85%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC DX SPINE THORACIC 2 VIEWS	$65.85	$439.00	$22.40–$439.00	80% below	85%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC DX SPINE THORACIC 2 VIEWS	$65.85	$439.00	$22.40–$439.00	80% below	85%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC DX SPINE THORACIC 2 VIEWS	$65.85	$439.00	$22.40–$439.00	—	85%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC DX SPINE THORACIC 2 VIEWS	$65.85	$439.00	$22.40–$439.00	—	85%
X-ray of the nasal bones, 3 or more views CPT 70160 HC DX NASAL BONE 3 VIEWS	$69.30	$462.00	$22.40–$462.00	76% below	85%
X-ray of the nasal bones, 3 or more views CPT 70160 HC DX NASAL BONE 3 VIEWS	$69.30	$462.00	$22.40–$462.00	76% below	85%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC DX NASAL BONE 3 VIEWS	$69.30	$462.00	$22.40–$462.00	—	85%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC DX NASAL BONE 3 VIEWS	$69.30	$462.00	$22.40–$462.00	—	85%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC DX SPINE CERVICAL 2 OR 3 VIEWS	$69.30	$462.00	$22.40–$462.00	81% below	85%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC DX SPINE CERVICAL 2 OR 3 VIEWS	$69.30	$462.00	$22.40–$462.00	81% below	85%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC DX SPINE CERVICAL 2 OR 3 VIEWS	$69.30	$462.00	$22.40–$462.00	—	85%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC DX SPINE CERVICAL 2 OR 3 VIEWS	$69.30	$462.00	$22.40–$462.00	—	85%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC DX PELVIS 1 OR 2 VIEWS*	$65.85	$439.00	$22.40–$439.00	80% below	85%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC DX PELVIS 1 OR 2 VIEWS*	$65.85	$439.00	$22.40–$439.00	80% below	85%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC DX PELVIS 1 OR 2 VIEWS*	$65.85	$439.00	$22.40–$439.00	—	85%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC DX PELVIS 1 OR 2 VIEWS*	$65.85	$439.00	$22.40–$439.00	—	85%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC DX SACRUM COCCYX 2 VIEW	$69.30	$462.00	$22.40–$462.00	83% below	85%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC DX SACRUM COCCYX 2 VIEW	$69.30	$462.00	$22.40–$462.00	83% below	85%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC DX SACRUM COCCYX 2 VIEW	$69.30	$462.00	$22.40–$462.00	—	85%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC DX SACRUM COCCYX 2 VIEW	$69.30	$462.00	$22.40–$462.00	—	85%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
ACTH blood test CPT 82024 HC ADRENOCORTICOTROPIC HORMONE ACTH	$67.50	$450.00	$19.31–$450.00	71% below	85%
ACTH blood test CPT 82024 HC ADRENOCORTICOTROPIC HORMONE ACTH	$67.50	$450.00	$19.31–$450.00	71% below	85%
ACTH blood test inpatient CPT 82024 HC ADRENOCORTICOTROPIC HORMONE ACTH	$67.50	$450.00	$19.31–$450.00	—	85%
ACTH blood test inpatient CPT 82024 HC ADRENOCORTICOTROPIC HORMONE ACTH	$67.50	$450.00	$19.31–$450.00	—	85%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC SGPT ALT	$9.30	$62.00	$2.65–$62.00	81% below	85%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC SGPT ALT	$9.30	$62.00	$2.65–$62.00	81% below	85%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC SGPT ALT	$9.30	$62.00	$2.65–$62.00	—	85%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC SGPT ALT	$9.30	$62.00	$2.65–$62.00	—	85%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC SGOT AST	$9.15	$61.00	$2.59–$61.00	82% below	85%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC SGOT AST	$9.15	$61.00	$2.59–$61.00	82% below	85%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC SGOT AST	$9.15	$61.00	$2.59–$61.00	—	85%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC SGOT AST	$9.15	$61.00	$2.59–$61.00	—	85%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS PANEL ACUTE	$80.70	$538.00	$9.79–$538.00	72% below	85%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS PANEL ACUTE	$80.70	$538.00	$9.79–$538.00	72% below	85%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS PANEL ACUTE	$80.70	$538.00	$9.79–$538.00	—	85%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS PANEL ACUTE	$80.70	$538.00	$9.79–$538.00	—	85%
Albumin blood test CPT 82040 HC ALBUMIN SERUM PLASMA OR WHOLE BLD	$8.70	$58.00	$2.48–$58.00	78% below	85%
Albumin blood test CPT 82040 HC ALBUMIN SERUM PLASMA OR WHOLE BLD	$8.70	$58.00	$2.48–$58.00	78% below	85%
Albumin blood test inpatient CPT 82040 HC ALBUMIN SERUM PLASMA OR WHOLE BLD	$8.70	$58.00	$2.48–$58.00	—	85%
Albumin blood test inpatient CPT 82040 HC ALBUMIN SERUM PLASMA OR WHOLE BLD	$8.70	$58.00	$2.48–$58.00	—	85%
Aldosterone blood test CPT 82088 HC ALDOSTERONE	$68.70	$458.00	$20.38–$458.00	61% below	85%
Aldosterone blood test CPT 82088 HC ALDOSTERONE	$68.70	$458.00	$20.38–$458.00	61% below	85%
Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE	$68.70	$458.00	$20.38–$458.00	—	85%
Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE	$68.70	$458.00	$20.38–$458.00	—	85%
Alkaline phosphatase (ALP) blood test CPT 84075 HC PHOSPHATASE ALKALINE	$9.15	$61.00	$2.59–$61.00	75% below	85%
Alkaline phosphatase (ALP) blood test CPT 84075 HC PHOSPHATASE ALKALINE	$9.15	$61.00	$2.59–$61.00	75% below	85%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC PHOSPHATASE ALKALINE	$9.15	$61.00	$2.59–$61.00	—	85%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC PHOSPHATASE ALKALINE	$9.15	$61.00	$2.59–$61.00	—	85%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE	$9.15	$61.00	$2.61–$61.00	63% below	85%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE	$9.15	$61.00	$2.61–$61.00	63% below	85%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE	$9.15	$61.00	$2.61–$61.00	—	85%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE	$9.15	$61.00	$2.61–$61.00	—	85%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA FETOPROTEIN SERUM	$29.40	$196.00	$8.39–$196.00	74% below	85%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA FETOPROTEIN SERUM	$29.40	$196.00	$8.39–$196.00	74% below	85%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA FETOPROTEIN SERUM	$29.40	$196.00	$8.39–$196.00	—	85%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA FETOPROTEIN SERUM	$29.40	$196.00	$8.39–$196.00	—	85%
Ammonia blood test CPT 82140 HC AMMONIA NH3	$25.50	$170.00	$7.29–$170.00	72% below	85%
Ammonia blood test CPT 82140 HC AMMONIA NH3	$25.50	$170.00	$7.29–$170.00	72% below	85%
Ammonia blood test inpatient CPT 82140 HC AMMONIA NH3	$25.50	$170.00	$7.29–$170.00	—	85%
Ammonia blood test inpatient CPT 82140 HC AMMONIA NH3	$25.50	$170.00	$7.29–$170.00	—	85%
Amylase blood test CPT 82150 HC AMYLASE	$11.40	$76.00	$3.24–$76.00	80% below	85%
Amylase blood test CPT 82150 HC AMYLASE	$11.40	$76.00	$3.24–$76.00	80% below	85%
Amylase blood test inpatient CPT 82150 HC AMYLASE	$11.40	$76.00	$3.24–$76.00	—	85%
Amylase blood test inpatient CPT 82150 HC AMYLASE	$11.40	$76.00	$3.24–$76.00	—	85%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CCP ANITBODY	$12.15	$81.00	$6.48–$81.00	83% below	85%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CCP ANITBODY	$12.15	$81.00	$6.48–$81.00	83% below	85%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CCP ANITBODY	$12.15	$81.00	$6.48–$81.00	—	85%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CCP ANITBODY	$12.15	$81.00	$6.48–$81.00	—	85%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA SCREEN	$21.15	$141.00	$6.05–$141.00	85% below	85%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA SCREEN	$21.15	$141.00	$6.05–$141.00	85% below	85%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA SCREEN	$21.15	$141.00	$6.05–$141.00	—	85%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA SCREEN	$21.15	$141.00	$6.05–$141.00	—	85%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE	$59.40	$396.00	$19.63–$396.00	69% below	85%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE	$59.40	$396.00	$19.63–$396.00	69% below	85%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE	$59.40	$396.00	$19.63–$396.00	—	85%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE	$59.40	$396.00	$19.63–$396.00	—	85%
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	$15.15	$101.00	$4.31–$101.00	78% below	85%
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	$15.15	$101.00	$4.31–$101.00	78% below	85%
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	$15.15	$101.00	$4.31–$101.00	—	85%
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	$15.15	$101.00	$4.31–$101.00	—	85%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL (CA TOTAL)	$14.40	$96.00	$4.23–$96.00	81% below	85%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL (CA TOTAL)	$14.40	$96.00	$4.23–$96.00	81% below	85%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL (CA TOTAL)	$14.40	$96.00	$4.23–$96.00	—	85%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL (CA TOTAL)	$14.40	$96.00	$4.23–$96.00	—	85%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL	$8.85	$59.00	$2.51–$59.00	80% below	85%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL	$8.85	$59.00	$2.51–$59.00	80% below	85%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL	$8.85	$59.00	$2.51–$59.00	—	85%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL	$8.85	$59.00	$2.51–$59.00	—	85%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC SURGICAL PATH LEVEL IV	$75.45	$503.00	$18.41–$503.00	65% below	85%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC SURGICAL PATH LEVEL IV	$75.45	$503.00	$18.41–$503.00	65% below	85%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC SURGICAL PATH LEVEL IV	$75.45	$503.00	$18.41–$503.00	—	85%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC SURGICAL PATH LEVEL IV	$75.45	$503.00	$18.41–$503.00	—	85%
Blood culture for bacteria CPT 87040 HC BLOOD CULTURE	$18.00	$120.00	$5.16–$120.00	83% below	85%
Blood culture for bacteria CPT 87040 HC BLOOD CULTURE	$18.00	$120.00	$5.16–$120.00	83% below	85%
Blood culture for bacteria inpatient CPT 87040 HC BLOOD CULTURE	$18.00	$120.00	$5.16–$120.00	—	85%
Blood culture for bacteria inpatient CPT 87040 HC BLOOD CULTURE	$18.00	$120.00	$5.16–$120.00	—	85%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE	$6.90	$46.00	$1.50–$46.00	61% below	85%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE	$6.90	$46.00	$1.50–$46.00	61% below	85%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE	$6.90	$46.00	$1.50–$46.00	—	85%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE	$6.90	$46.00	$1.50–$46.00	—	85%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANT BLOOD	$6.90	$46.00	$1.97–$46.00	85% below	85%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANT BLOOD	$6.90	$46.00	$1.97–$46.00	85% below	85%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE QUANT BLOOD	$6.90	$46.00	$1.97–$46.00	—	85%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE QUANT BLOOD	$6.90	$46.00	$1.97–$46.00	—	85%
Blood lead test CPT 83655 HC LEAD	$21.15	$141.00	$6.06–$141.00	66% below	85%
Blood lead test CPT 83655 HC LEAD	$21.15	$141.00	$6.06–$141.00	66% below	85%
Blood lead test inpatient CPT 83655 HC LEAD	$21.15	$141.00	$6.06–$141.00	—	85%
Blood lead test inpatient CPT 83655 HC LEAD	$21.15	$141.00	$6.06–$141.00	—	85%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC QUAL	$13.20	$88.00	$3.76–$88.00	87% below	85%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC QUAL	$13.20	$88.00	$3.76–$88.00	87% below	85%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC GONADOTROPIN CHORIONIC QUAL	$13.20	$88.00	$3.76–$88.00	—	85%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC GONADOTROPIN CHORIONIC QUAL	$13.20	$88.00	$3.76–$88.00	—	85%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO	$18.45	$123.00	$2.99–$282.99	80% below	85%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO	$18.45	$123.00	$2.99–$282.99	80% below	85%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO	$18.45	$123.00	$2.99–$282.99	—	85%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO	$18.45	$123.00	$2.99–$282.99	—	85%
Blood urea nitrogen (BUN) test CPT 84520 HC BUN BLOOD UREA NITROGEN	$6.90	$46.00	$1.98–$46.00	87% below	85%
Blood urea nitrogen (BUN) test CPT 84520 HC BUN BLOOD UREA NITROGEN	$6.90	$46.00	$1.98–$46.00	87% below	85%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC BUN BLOOD UREA NITROGEN	$6.90	$46.00	$1.98–$46.00	—	85%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC BUN BLOOD UREA NITROGEN	$6.90	$46.00	$1.98–$46.00	—	85%
C-peptide blood test CPT 84681 HC C PEPTIDE	$36.45	$243.00	$10.41–$243.00	67% below	85%
C-peptide blood test CPT 84681 HC C PEPTIDE	$36.45	$243.00	$10.41–$243.00	67% below	85%
C-peptide blood test inpatient CPT 84681 HC C PEPTIDE	$36.45	$243.00	$10.41–$243.00	—	85%
C-peptide blood test inpatient CPT 84681 HC C PEPTIDE	$36.45	$243.00	$10.41–$243.00	—	85%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C REACTIVE PROTEIN	$9.15	$61.00	$2.59–$61.00	89% below	85%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C REACTIVE PROTEIN	$9.15	$61.00	$2.59–$61.00	89% below	85%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C REACTIVE PROTEIN	$9.15	$61.00	$2.59–$61.00	—	85%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C REACTIVE PROTEIN	$9.15	$61.00	$2.59–$61.00	—	85%
C. difficile toxin gene test (stool PCR) CPT 87493 HC C DIFF AMPLIFIED PROBE	$61.50	$410.00	$18.64–$410.00	51% below	85%
C. difficile toxin gene test (stool PCR) CPT 87493 HC C DIFF AMPLIFIED PROBE	$61.50	$410.00	$18.64–$410.00	51% below	85%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC C DIFF AMPLIFIED PROBE	$61.50	$410.00	$18.64–$410.00	—	85%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC C DIFF AMPLIFIED PROBE	$61.50	$410.00	$18.64–$410.00	—	85%
CA 19-9 blood test (tumor marker) CPT 86301 HC TUMOR ANTIGEN CA 19-9	$36.45	$243.00	$10.41–$243.00	64% below	85%
CA 19-9 blood test (tumor marker) CPT 86301 HC TUMOR ANTIGEN CA 19-9	$36.45	$243.00	$10.41–$243.00	64% below	85%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC TUMOR ANTIGEN CA 19-9	$36.45	$243.00	$10.41–$243.00	—	85%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC TUMOR ANTIGEN CA 19-9	$36.45	$243.00	$10.41–$243.00	—	85%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC TUMOR ANTIGEN CA 125	$36.45	$243.00	$10.41–$243.00	70% below	85%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC TUMOR ANTIGEN CA 125	$36.45	$243.00	$10.41–$243.00	70% below	85%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC TUMOR ANTIGEN CA 125	$36.45	$243.00	$10.41–$243.00	—	85%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC TUMOR ANTIGEN CA 125	$36.45	$243.00	$10.41–$243.00	—	85%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ	$15.00	$100.00	$25.32–$111.86	81% below	85%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ	$15.00	$100.00	$25.32–$111.86	81% below	85%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ	$15.00	$100.00	$25.32–$111.86	—	85%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ	$15.00	$100.00	$25.32–$111.86	—	85%
Calcium blood test, total CPT 82310 HC CALCIUM TOTAL	$9.15	$61.00	$2.31–$61.00	78% below	85%
Calcium blood test, total CPT 82310 HC CALCIUM TOTAL	$9.15	$61.00	$2.31–$61.00	78% below	85%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM TOTAL	$9.15	$61.00	$2.31–$61.00	—	85%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM TOTAL	$9.15	$61.00	$2.31–$61.00	—	85%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CARCINOEMBRYONIC ANTIGEN CEA	$33.30	$222.00	$9.48–$222.00	71% below	85%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CARCINOEMBRYONIC ANTIGEN CEA	$33.30	$222.00	$9.48–$222.00	71% below	85%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CARCINOEMBRYONIC ANTIGEN CEA	$33.30	$222.00	$9.48–$222.00	—	85%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CARCINOEMBRYONIC ANTIGEN CEA	$33.30	$222.00	$9.48–$222.00	—	85%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER ANTIBODY	$22.50	$150.00	$6.44–$150.00	79% below	85%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER ANTIBODY	$22.50	$150.00	$6.44–$150.00	79% below	85%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER ANTIBODY	$22.50	$150.00	$6.44–$150.00	—	85%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER ANTIBODY	$22.50	$150.00	$6.44–$150.00	—	85%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS AMP PROBE	$61.50	$410.00	$17.55–$410.00	54% below	85%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS AMP PROBE	$61.50	$410.00	$17.55–$410.00	54% below	85%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACHOMATIS AMP PROBE	$61.50	$410.00	$17.55–$410.00	—	85%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACHOMATIS AMP PROBE	$61.50	$410.00	$17.55–$410.00	—	85%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$23.40	$156.00	$6.70–$156.00	72% below	85%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$23.40	$156.00	$6.70–$156.00	72% below	85%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL	$23.40	$156.00	$6.70–$156.00	—	85%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL	$23.40	$156.00	$6.70–$156.00	—	85%
Complete blood count (CBC) with differential CPT 85025 HC CBC WITH AUTO DIFF	$13.50	$90.00	$3.89–$90.00	53% below	85%
Complete blood count (CBC) with differential CPT 85025 HC CBC WITH AUTO DIFF	$13.50	$90.00	$3.89–$90.00	53% below	85%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC WITH AUTO DIFF	$13.50	$90.00	$3.89–$90.00	—	85%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC WITH AUTO DIFF	$13.50	$90.00	$3.89–$90.00	—	85%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD CT COMPLETE AUTOMATED	$11.40	$76.00	$3.24–$76.00	86% below	85%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD CT COMPLETE AUTOMATED	$11.40	$76.00	$3.24–$76.00	86% below	85%
Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD CT COMPLETE AUTOMATED	$11.40	$76.00	$3.24–$76.00	—	85%
Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD CT COMPLETE AUTOMATED	$11.40	$76.00	$3.24–$76.00	—	85%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METABOLIC PANEL	$17.70	$118.00	$5.28–$118.00	90% below	85%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METABOLIC PANEL	$17.70	$118.00	$5.28–$118.00	90% below	85%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHENSIVE METABOLIC PANEL	$17.70	$118.00	$5.28–$118.00	—	85%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHENSIVE METABOLIC PANEL	$17.70	$118.00	$5.28–$118.00	—	85%
Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL	$28.65	$191.00	$8.15–$191.00	67% below	85%
Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL	$28.65	$191.00	$8.15–$191.00	67% below	85%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL TOTAL	$28.65	$191.00	$8.15–$191.00	—	85%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL TOTAL	$28.65	$191.00	$8.15–$191.00	—	85%
Creatine kinase (CK) blood test, total CPT 82550 HC CPK CREATINE KINASE	$11.40	$76.00	$3.26–$76.00	82% below	85%
Creatine kinase (CK) blood test, total CPT 82550 HC CPK CREATINE KINASE	$11.40	$76.00	$3.26–$76.00	82% below	85%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CPK CREATINE KINASE	$11.40	$76.00	$3.26–$76.00	—	85%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CPK CREATINE KINASE	$11.40	$76.00	$3.26–$76.00	—	85%
Creatinine blood test CPT 82565 HC CREATININE BLOOD	$9.00	$60.00	$2.31–$60.00	86% below	85%
Creatinine blood test CPT 82565 HC CREATININE BLOOD	$9.00	$60.00	$2.31–$60.00	86% below	85%
Creatinine blood test inpatient CPT 82565 HC CREATININE BLOOD	$9.00	$60.00	$2.31–$60.00	—	85%
Creatinine blood test inpatient CPT 82565 HC CREATININE BLOOD	$9.00	$60.00	$2.31–$60.00	—	85%
Cytomegalovirus (CMV) antibody test CPT 86644 HC ANTIBODY CYTOMEGALOVIRUS	$25.20	$168.00	$7.20–$168.00	63% below	85%
Cytomegalovirus (CMV) antibody test CPT 86644 HC ANTIBODY CYTOMEGALOVIRUS	$25.20	$168.00	$7.20–$168.00	63% below	85%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC ANTIBODY CYTOMEGALOVIRUS	$25.20	$168.00	$7.20–$168.00	—	85%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC ANTIBODY CYTOMEGALOVIRUS	$25.20	$168.00	$7.20–$168.00	—	85%
D-dimer blood test (blood clot marker) CPT 85379 HC D DIMER QUANTITATIVE	$17.85	$119.00	$4.78–$119.00	89% below	85%
D-dimer blood test (blood clot marker) CPT 85379 HC D DIMER QUANTITATIVE	$17.85	$119.00	$4.78–$119.00	89% below	85%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC D DIMER QUANTITATIVE	$17.85	$119.00	$4.78–$119.00	—	85%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC D DIMER QUANTITATIVE	$17.85	$119.00	$4.78–$119.00	—	85%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE SULFATE	$38.85	$259.00	$11.12–$259.00	68% below	85%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE SULFATE	$38.85	$259.00	$11.12–$259.00	68% below	85%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DEHYDROEPIANDROSTERONE SULFATE	$38.85	$259.00	$11.12–$259.00	—	85%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DEHYDROEPIANDROSTERONE SULFATE	$38.85	$259.00	$11.12–$259.00	—	85%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR	$102.45	$683.00	$31.07–$683.00	33% below	85%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR	$102.45	$683.00	$31.07–$683.00	33% below	85%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR	$102.45	$683.00	$31.07–$683.00	—	85%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR	$102.45	$683.00	$31.07–$683.00	—	85%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTES	$12.00	$80.00	$3.51–$80.00	87% below	85%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTES	$12.00	$80.00	$3.51–$80.00	87% below	85%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTES	$12.00	$80.00	$3.51–$80.00	—	85%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTES	$12.00	$80.00	$3.51–$80.00	—	85%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EBV VIRAL CAPSID	$30.60	$204.00	$9.07–$204.00	67% below	85%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EBV VIRAL CAPSID	$30.60	$204.00	$9.07–$204.00	67% below	85%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EBV VIRAL CAPSID	$30.60	$204.00	$9.07–$204.00	—	85%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EBV VIRAL CAPSID	$30.60	$204.00	$9.07–$204.00	—	85%
Estradiol blood test CPT 82670 HC ESTRADIOL TOTAL	$49.05	$327.00	$13.97–$327.00	60% below	85%
Estradiol blood test CPT 82670 HC ESTRADIOL TOTAL	$49.05	$327.00	$13.97–$327.00	60% below	85%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL TOTAL	$49.05	$327.00	$13.97–$327.00	—	85%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL TOTAL	$49.05	$327.00	$13.97–$327.00	—	85%
FSH (follicle-stimulating hormone) test CPT 83001 HC FOLLICLE STIMULATING HORMONE	$32.55	$217.00	$9.29–$217.00	69% below	85%
FSH (follicle-stimulating hormone) test CPT 83001 HC FOLLICLE STIMULATING HORMONE	$32.55	$217.00	$9.29–$217.00	69% below	85%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC FOLLICLE STIMULATING HORMONE	$32.55	$217.00	$9.29–$217.00	—	85%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC FOLLICLE STIMULATING HORMONE	$32.55	$217.00	$9.29–$217.00	—	85%
Fecal calprotectin (stool inflammation test) CPT 83993 HC CALPROTECTIN FECAL	$34.35	$229.00	$9.82–$229.00	72% below	85%
Fecal calprotectin (stool inflammation test) CPT 83993 HC CALPROTECTIN FECAL	$34.35	$229.00	$9.82–$229.00	72% below	85%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC CALPROTECTIN FECAL	$34.35	$229.00	$9.82–$229.00	—	85%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC CALPROTECTIN FECAL	$34.35	$229.00	$9.82–$229.00	—	85%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN	$23.85	$159.00	$6.82–$159.00	82% below	85%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN	$23.85	$159.00	$6.82–$159.00	82% below	85%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN	$23.85	$159.00	$6.82–$159.00	—	85%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN	$23.85	$159.00	$6.82–$159.00	—	85%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN ACTIVITY	$15.00	$100.00	$4.78–$100.00	82% below	85%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN ACTIVITY	$15.00	$100.00	$4.78–$100.00	82% below	85%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN ACTIVITY	$15.00	$100.00	$4.78–$100.00	—	85%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN ACTIVITY	$15.00	$100.00	$4.78–$100.00	—	85%
Folate (folic acid) blood test CPT 82746 HC FOLATE FOLIC ACID SERUM	$25.80	$172.00	$7.35–$172.00	76% below	85%
Folate (folic acid) blood test CPT 82746 HC FOLATE FOLIC ACID SERUM	$25.80	$172.00	$7.35–$172.00	76% below	85%
Folate (folic acid) blood test inpatient CPT 82746 HC FOLATE FOLIC ACID SERUM	$25.80	$172.00	$7.35–$172.00	—	85%
Folate (folic acid) blood test inpatient CPT 82746 HC FOLATE FOLIC ACID SERUM	$25.80	$172.00	$7.35–$172.00	—	85%
Free T3 thyroid hormone test CPT 84481 HC FREE T3 TRIIODOTHYRONINE	$29.55	$197.00	$8.47–$197.00	71% below	85%
Free T3 thyroid hormone test CPT 84481 HC FREE T3 TRIIODOTHYRONINE	$29.55	$197.00	$8.47–$197.00	71% below	85%
Free T3 thyroid hormone test inpatient CPT 84481 HC FREE T3 TRIIODOTHYRONINE	$29.55	$197.00	$8.47–$197.00	—	85%
Free T3 thyroid hormone test inpatient CPT 84481 HC FREE T3 TRIIODOTHYRONINE	$29.55	$197.00	$8.47–$197.00	—	85%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC FREE T4 THYROXINE	$15.75	$105.00	$4.51–$105.00	80% below	85%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC FREE T4 THYROXINE	$15.75	$105.00	$4.51–$105.00	80% below	85%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC FREE T4 THYROXINE	$15.75	$105.00	$4.51–$105.00	—	85%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC FREE T4 THYROXINE	$15.75	$105.00	$4.51–$105.00	—	85%
Free testosterone test CPT 84402 HC TESTOSTERONE FREE	$43.05	$287.00	$12.74–$287.00	76% below	85%
Free testosterone test CPT 84402 HC TESTOSTERONE FREE	$43.05	$287.00	$12.74–$287.00	76% below	85%
Free testosterone test inpatient CPT 84402 HC TESTOSTERONE FREE	$43.05	$287.00	$12.74–$287.00	—	85%
Free testosterone test inpatient CPT 84402 HC TESTOSTERONE FREE	$43.05	$287.00	$12.74–$287.00	—	85%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GGT GAMMA GT	$12.60	$84.00	$2.31–$84.00	70% below	85%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GGT GAMMA GT	$12.60	$84.00	$2.31–$84.00	70% below	85%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GGT GAMMA GT	$12.60	$84.00	$2.31–$84.00	—	85%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GGT GAMMA GT	$12.60	$84.00	$2.31–$84.00	—	85%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PANEL	$49.20	$328.00	$9.79–$328.00	51% below	85%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PANEL	$49.20	$328.00	$9.79–$328.00	51% below	85%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC GENERAL HEALTH PANEL	$49.20	$328.00	$9.79–$328.00	—	85%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC GENERAL HEALTH PANEL	$49.20	$328.00	$9.79–$328.00	—	85%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE POST GLUCOSE DOSE	$8.40	$56.00	$2.38–$56.00	79% below	85%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE POST GLUCOSE DOSE	$8.40	$56.00	$2.38–$56.00	79% below	85%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE POST GLUCOSE DOSE	$8.40	$56.00	$2.38–$56.00	—	85%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE POST GLUCOSE DOSE	$8.40	$56.00	$2.38–$56.00	—	85%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE 3 SPEC	$17.70	$118.00	$6.44–$118.00	78% below	85%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE 3 SPEC	$17.70	$118.00	$6.44–$118.00	78% below	85%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE 3 SPEC	$17.70	$118.00	$6.44–$118.00	—	85%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE 3 SPEC	$17.70	$118.00	$6.44–$118.00	—	85%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N GONORRHOEAE DNA AMP PROBE	$61.50	$410.00	$17.55–$410.00	44% below	85%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N GONORRHOEAE DNA AMP PROBE	$61.50	$410.00	$17.55–$410.00	44% below	85%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N GONORRHOEAE DNA AMP PROBE	$61.50	$410.00	$17.55–$410.00	—	85%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N GONORRHOEAE DNA AMP PROBE	$61.50	$410.00	$17.55–$410.00	—	85%
H. pylori antibody blood test CPT 86677 HC ANTIBODY HELICOBACTER PYLORI	$25.50	$170.00	$8.43–$170.00	66% below	85%
H. pylori antibody blood test CPT 86677 HC ANTIBODY HELICOBACTER PYLORI	$25.50	$170.00	$8.43–$170.00	66% below	85%
H. pylori antibody blood test inpatient CPT 86677 HC ANTIBODY HELICOBACTER PYLORI	$25.50	$170.00	$8.43–$170.00	—	85%
H. pylori antibody blood test inpatient CPT 86677 HC ANTIBODY HELICOBACTER PYLORI	$25.50	$170.00	$8.43–$170.00	—	85%
H. pylori stool antigen test CPT 87338 HC HELICOBACTER PYLORI AG STOOL EIA ELISA IMCA	$25.20	$168.00	$7.19–$168.00	77% below	85%
H. pylori stool antigen test CPT 87338 HC HELICOBACTER PYLORI AG STOOL EIA ELISA IMCA	$25.20	$168.00	$7.19–$168.00	77% below	85%
H. pylori stool antigen test inpatient CPT 87338 HC HELICOBACTER PYLORI AG STOOL EIA ELISA IMCA	$25.20	$168.00	$7.19–$168.00	—	85%
H. pylori stool antigen test inpatient CPT 87338 HC HELICOBACTER PYLORI AG STOOL EIA ELISA IMCA	$25.20	$168.00	$7.19–$168.00	—	85%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV 1 DNA QUANT OR REV TRANS	$148.95	$993.00	$42.55–$993.00	50% below	85%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV 1 DNA QUANT OR REV TRANS	$148.95	$993.00	$42.55–$993.00	50% below	85%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV 1 DNA QUANT OR REV TRANS	$148.95	$993.00	$42.55–$993.00	—	85%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV 1 DNA QUANT OR REV TRANS	$148.95	$993.00	$42.55–$993.00	—	85%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV1 HIV2 ANTIBODY SINGLE ASSAY	$24.00	$160.00	$6.86–$160.00	80% below	85%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV1 HIV2 ANTIBODY SINGLE ASSAY	$24.00	$160.00	$6.86–$160.00	80% below	85%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV1 HIV2 ANTIBODY SINGLE ASSAY	$24.00	$160.00	$6.86–$160.00	—	85%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV1 HIV2 ANTIBODY SINGLE ASSAY	$24.00	$160.00	$6.86–$160.00	—	85%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB EIA ELISA IMCA	$42.15	$281.00	$10.67–$281.00	62% below	85%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB EIA ELISA IMCA	$42.15	$281.00	$10.67–$281.00	62% below	85%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB EIA ELISA IMCA	$42.15	$281.00	$10.67–$281.00	—	85%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB EIA ELISA IMCA	$42.15	$281.00	$10.67–$281.00	—	85%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC HPV HIGH RISK TYPES	$30.75	$205.00	$17.55–$205.00	73% below	85%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC HPV HIGH RISK TYPES	$30.75	$205.00	$17.55–$205.00	73% below	85%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC HPV HIGH RISK TYPES	$30.75	$205.00	$17.55–$205.00	—	85%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC HPV HIGH RISK TYPES	$30.75	$205.00	$17.55–$205.00	—	85%
Hemoglobin blood test CPT 85018 HC HGB HEMOGLOBIN	$4.05	$27.00	$1.19–$27.00	78% below	85%
Hemoglobin blood test CPT 85018 HC HGB HEMOGLOBIN	$4.05	$27.00	$1.19–$27.00	78% below	85%
Hemoglobin blood test inpatient CPT 85018 HC HGB HEMOGLOBIN	$4.05	$27.00	$1.19–$27.00	—	85%
Hemoglobin blood test inpatient CPT 85018 HC HGB HEMOGLOBIN	$4.05	$27.00	$1.19–$27.00	—	85%
Hepatitis B core antibody test (total) CPT 86704 HC HEPATITIS B CORE AB TOTAL	$21.15	$141.00	$6.03–$141.00	68% below	85%
Hepatitis B core antibody test (total) CPT 86704 HC HEPATITIS B CORE AB TOTAL	$21.15	$141.00	$6.03–$141.00	68% below	85%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEPATITIS B CORE AB TOTAL	$21.15	$141.00	$6.03–$141.00	—	85%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEPATITIS B CORE AB TOTAL	$21.15	$141.00	$6.03–$141.00	—	85%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE AB	$18.90	$126.00	$5.37–$126.00	77% below	85%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE AB	$18.90	$126.00	$5.37–$126.00	77% below	85%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURFACE AB	$18.90	$126.00	$5.37–$126.00	—	85%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURFACE AB	$18.90	$126.00	$5.37–$126.00	—	85%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC HEPATITIS B SURFACE AG EIA ELISA IMCA	$17.40	$116.00	$5.17–$116.00	72% below	85%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC HEPATITIS B SURFACE AG EIA ELISA IMCA	$17.40	$116.00	$5.17–$116.00	72% below	85%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC HEPATITIS B SURFACE AG EIA ELISA IMCA	$17.40	$116.00	$5.17–$116.00	—	85%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC HEPATITIS B SURFACE AG EIA ELISA IMCA	$17.40	$116.00	$5.17–$116.00	—	85%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C AB	$25.05	$167.00	$7.14–$167.00	68% below	85%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C AB	$25.05	$167.00	$7.14–$167.00	68% below	85%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C AB	$25.05	$167.00	$7.14–$167.00	—	85%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C AB	$25.05	$167.00	$7.14–$167.00	—	85%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEP C RNA PCR QUANTITAT/REV TRANS	$75.15	$501.00	$21.42–$501.00	70% below	85%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEP C RNA PCR QUANTITAT/REV TRANS	$75.15	$501.00	$21.42–$501.00	70% below	85%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEP C RNA PCR QUANTITAT/REV TRANS	$75.15	$501.00	$21.42–$501.00	—	85%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEP C RNA PCR QUANTITAT/REV TRANS	$75.15	$501.00	$21.42–$501.00	—	85%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX AB TYPE 1	$23.10	$154.00	$6.60–$154.00	72% below	85%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX AB TYPE 1	$23.10	$154.00	$6.60–$154.00	72% below	85%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES SIMPLEX AB TYPE 1	$23.10	$154.00	$6.60–$154.00	—	85%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES SIMPLEX AB TYPE 1	$23.10	$154.00	$6.60–$154.00	—	85%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX AB TYPE 2	$17.55	$117.00	$9.68–$117.00	81% below	85%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX AB TYPE 2	$17.55	$117.00	$9.68–$117.00	81% below	85%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX AB TYPE 2	$17.55	$117.00	$9.68–$117.00	—	85%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX AB TYPE 2	$17.55	$117.00	$9.68–$117.00	—	85%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVI	$22.65	$151.00	$6.48–$151.00	58% below	85%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVI	$22.65	$151.00	$6.48–$151.00	58% below	85%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVI	$22.65	$151.00	$6.48–$151.00	—	85%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVI	$22.65	$151.00	$6.48–$151.00	—	85%
Homocysteine blood test CPT 83090 HC HOMOCYSTEINE	$29.55	$197.00	$8.96–$197.00	73% below	85%
Homocysteine blood test CPT 83090 HC HOMOCYSTEINE	$29.55	$197.00	$8.96–$197.00	73% below	85%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTEINE	$29.55	$197.00	$8.96–$197.00	—	85%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTEINE	$29.55	$197.00	$8.96–$197.00	—	85%
Insulin blood test CPT 83525 HC INSULIN	$19.95	$133.00	$5.72–$133.00	71% below	85%
Insulin blood test CPT 83525 HC INSULIN	$19.95	$133.00	$5.72–$133.00	71% below	85%
Insulin blood test inpatient CPT 83525 HC INSULIN	$19.95	$133.00	$5.72–$133.00	—	85%
Insulin blood test inpatient CPT 83525 HC INSULIN	$19.95	$133.00	$5.72–$133.00	—	85%
Iron blood test (serum iron) CPT 83540 HC IRON	$11.40	$76.00	$2.31–$76.00	86% below	85%
Iron blood test (serum iron) CPT 83540 HC IRON	$11.40	$76.00	$2.31–$76.00	86% below	85%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON	$11.40	$76.00	$2.31–$76.00	—	85%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON	$11.40	$76.00	$2.31–$76.00	—	85%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY	$15.45	$103.00	$2.31–$103.00	77% below	85%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY	$15.45	$103.00	$2.31–$103.00	77% below	85%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY	$15.45	$103.00	$2.31–$103.00	—	85%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY	$15.45	$103.00	$2.31–$103.00	—	85%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL	$14.70	$98.00	$4.34–$98.00	86% below	85%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL	$14.70	$98.00	$4.34–$98.00	86% below	85%
Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL	$14.70	$98.00	$4.34–$98.00	—	85%
Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL	$14.70	$98.00	$4.34–$98.00	—	85%
LH (luteinizing hormone) test CPT 83002 HC LH LEUTINIZING HORMONE	$32.40	$216.00	$9.26–$216.00	76% below	85%
LH (luteinizing hormone) test CPT 83002 HC LH LEUTINIZING HORMONE	$32.40	$216.00	$9.26–$216.00	76% below	85%
LH (luteinizing hormone) test inpatient CPT 83002 HC LH LEUTINIZING HORMONE	$32.40	$216.00	$9.26–$216.00	—	85%
LH (luteinizing hormone) test inpatient CPT 83002 HC LH LEUTINIZING HORMONE	$32.40	$216.00	$9.26–$216.00	—	85%
Lactate (lactic acid) blood test CPT 83605 HC LACTATE LACTIC ACID	$18.75	$125.00	$5.79–$125.00	79% below	85%
Lactate (lactic acid) blood test CPT 83605 HC LACTATE LACTIC ACID	$18.75	$125.00	$5.79–$125.00	79% below	85%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTATE LACTIC ACID	$18.75	$125.00	$5.79–$125.00	—	85%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTATE LACTIC ACID	$18.75	$125.00	$5.79–$125.00	—	85%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH LACTATE DEHYDROGENASE	$10.50	$70.00	$3.02–$70.00	81% below	85%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH LACTATE DEHYDROGENASE	$10.50	$70.00	$3.02–$70.00	81% below	85%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH LACTATE DEHYDROGENASE	$10.50	$70.00	$3.02–$70.00	—	85%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH LACTATE DEHYDROGENASE	$10.50	$70.00	$3.02–$70.00	—	85%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE	$12.15	$81.00	$3.45–$81.00	89% below	85%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE	$12.15	$81.00	$3.45–$81.00	89% below	85%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE	$12.15	$81.00	$3.45–$81.00	—	85%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE	$12.15	$81.00	$3.45–$81.00	—	85%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL	$13.65	$91.00	$4.09–$91.00	84% below	85%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL	$13.65	$91.00	$4.09–$91.00	84% below	85%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL	$13.65	$91.00	$4.09–$91.00	—	85%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL	$13.65	$91.00	$4.09–$91.00	—	85%
Lyme disease antibody test CPT 86618 HC LYME DISEASE AB	$28.65	$191.00	$8.52–$191.00	67% below	85%
Lyme disease antibody test CPT 86618 HC LYME DISEASE AB	$28.65	$191.00	$8.52–$191.00	67% below	85%
Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE AB	$28.65	$191.00	$8.52–$191.00	—	85%
Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE AB	$28.65	$191.00	$8.52–$191.00	—	85%
Magnesium blood test CPT 83735 HC MG MAGNESIUM	$11.85	$79.00	$2.31–$79.00	78% below	85%
Magnesium blood test CPT 83735 HC MG MAGNESIUM	$11.85	$79.00	$2.31–$79.00	78% below	85%
Magnesium blood test inpatient CPT 83735 HC MG MAGNESIUM	$11.85	$79.00	$2.31–$79.00	—	85%
Magnesium blood test inpatient CPT 83735 HC MG MAGNESIUM	$11.85	$79.00	$2.31–$79.00	—	85%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA ANTIBODY	$22.50	$150.00	$6.44–$150.00	70% below	85%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA ANTIBODY	$22.50	$150.00	$6.44–$150.00	70% below	85%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA ANTIBODY	$22.50	$150.00	$6.44–$150.00	—	85%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA ANTIBODY	$22.50	$150.00	$6.44–$150.00	—	85%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTI SCREENING	$9.15	$61.00	$2.59–$61.00	90% below	85%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTI SCREENING	$9.15	$61.00	$2.59–$61.00	90% below	85%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE ANTI SCREENING	$9.15	$61.00	$2.59–$61.00	—	85%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE ANTI SCREENING	$9.15	$61.00	$2.59–$61.00	—	85%
Mumps immunity blood test CPT 86735 HC MUMPS AB	$22.80	$152.00	$6.53–$152.00	67% below	85%
Mumps immunity blood test CPT 86735 HC MUMPS AB	$22.80	$152.00	$6.53–$152.00	67% below	85%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS AB	$22.80	$152.00	$6.53–$152.00	—	85%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS AB	$22.80	$152.00	$6.53–$152.00	—	85%
Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL	$71.85	$479.00	$9.79–$479.00	62% below	85%
Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL	$71.85	$479.00	$9.79–$479.00	62% below	85%
Obstetric blood test panel inpatient CPT 80055 HC OBSTETRIC PANEL	$71.85	$479.00	$9.79–$479.00	—	85%
Obstetric blood test panel inpatient CPT 80055 HC OBSTETRIC PANEL	$71.85	$479.00	$9.79–$479.00	—	85%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$32.25	$215.00	$9.20–$215.00	70% below	85%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$32.25	$215.00	$9.20–$215.00	70% below	85%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$32.25	$215.00	$9.20–$215.00	—	85%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$32.25	$215.00	$9.20–$215.00	—	85%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPEC ANTIGEN TOTAL REF	$32.25	$215.00	$9.20–$215.00	67% below	85%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPEC ANTIGEN TOTAL REF	$32.25	$215.00	$9.20–$215.00	67% below	85%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATE SPEC ANTIGEN TOTAL REF	$32.25	$215.00	$9.20–$215.00	—	85%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATE SPEC ANTIGEN TOTAL REF	$32.25	$215.00	$9.20–$215.00	—	85%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTOPATHOLOGY CV THINPREP IMAG	$23.40	$156.00	$13.31–$156.00	76% below	85%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTOPATHOLOGY CV THINPREP IMAG	$23.40	$156.00	$13.31–$156.00	76% below	85%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC CYTOPATHOLOGY CV THINPREP IMAG	$23.40	$156.00	$13.31–$156.00	—	85%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC CYTOPATHOLOGY CV THINPREP IMAG	$23.40	$156.00	$13.31–$156.00	—	85%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV	$35.40	$236.00	$10.13–$236.00	48% below	85%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV	$35.40	$236.00	$10.13–$236.00	48% below	85%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV	$35.40	$236.00	$10.13–$236.00	—	85%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV	$35.40	$236.00	$10.13–$236.00	—	85%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHORMONE PARATHYROID HORM	$72.30	$482.00	$20.64–$482.00	69% below	85%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHORMONE PARATHYROID HORM	$72.30	$482.00	$20.64–$482.00	69% below	85%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHORMONE PARATHYROID HORM	$72.30	$482.00	$20.64–$482.00	—	85%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHORMONE PARATHYROID HORM	$72.30	$482.00	$20.64–$482.00	—	85%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT THROMBOPLASTIN TIME PARTIAL	$10.50	$70.00	$3.01–$70.00	82% below	85%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT THROMBOPLASTIN TIME PARTIAL	$10.50	$70.00	$3.01–$70.00	82% below	85%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT THROMBOPLASTIN TIME PARTIAL	$10.50	$70.00	$3.01–$70.00	—	85%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT THROMBOPLASTIN TIME PARTIAL	$10.50	$70.00	$3.01–$70.00	—	85%
Phosphorus (phosphate) blood test CPT 84100 HC PHOSPHORUS SERUM	$7.95	$53.00	$2.37–$53.00	83% below	85%
Phosphorus (phosphate) blood test CPT 84100 HC PHOSPHORUS SERUM	$7.95	$53.00	$2.37–$53.00	83% below	85%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC PHOSPHORUS SERUM	$7.95	$53.00	$2.37–$53.00	—	85%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC PHOSPHORUS SERUM	$7.95	$53.00	$2.37–$53.00	—	85%
Potassium blood test CPT 84132 HC K POTAS SERUM PLASMA WHOLE BLD	$8.10	$54.00	$2.31–$54.00	79% below	85%
Potassium blood test CPT 84132 HC K POTAS SERUM PLASMA WHOLE BLD	$8.10	$54.00	$2.31–$54.00	79% below	85%
Potassium blood test inpatient CPT 84132 HC K POTAS SERUM PLASMA WHOLE BLD	$8.10	$54.00	$2.31–$54.00	—	85%
Potassium blood test inpatient CPT 84132 HC K POTAS SERUM PLASMA WHOLE BLD	$8.10	$54.00	$2.31–$54.00	—	85%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC FETAL CHRMOML ANEUPLOIDY	$1,029.60	$6,864.00	$379.53–$6,864.00	at median	85%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC FETAL CHRMOML ANEUPLOIDY	$1,029.60	$6,864.00	$379.53–$6,864.00	at median	85%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC FETAL CHRMOML ANEUPLOIDY	$1,029.60	$6,864.00	$379.53–$6,864.00	—	85%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC FETAL CHRMOML ANEUPLOIDY	$1,029.60	$6,864.00	$379.53–$6,864.00	—	85%
Progesterone blood test CPT 84144 HC PROGESTERONE	$36.60	$244.00	$10.43–$244.00	80% below	85%
Progesterone blood test CPT 84144 HC PROGESTERONE	$36.60	$244.00	$10.43–$244.00	80% below	85%
Progesterone blood test inpatient CPT 84144 HC PROGESTERONE	$36.60	$244.00	$10.43–$244.00	—	85%
Progesterone blood test inpatient CPT 84144 HC PROGESTERONE	$36.60	$244.00	$10.43–$244.00	—	85%
Prolactin blood test CPT 84146 HC PROLACTIN	$33.90	$226.00	$9.69–$226.00	71% below	85%
Prolactin blood test CPT 84146 HC PROLACTIN	$33.90	$226.00	$9.69–$226.00	71% below	85%
Prolactin blood test inpatient CPT 84146 HC PROLACTIN	$33.90	$226.00	$9.69–$226.00	—	85%
Prolactin blood test inpatient CPT 84146 HC PROLACTIN	$33.90	$226.00	$9.69–$226.00	—	85%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PT PROTHROMBIN TIME	$6.90	$46.00	$2.15–$46.00	73% below	85%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PT PROTHROMBIN TIME	$6.90	$46.00	$2.15–$46.00	73% below	85%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PT PROTHROMBIN TIME	$6.90	$46.00	$2.15–$46.00	—	85%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PT PROTHROMBIN TIME	$6.90	$46.00	$2.15–$46.00	—	85%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG TEST PRSMV DIR OPT OBS	$19.20	$128.00	$6.30–$128.00	55% below	85%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG TEST PRSMV DIR OPT OBS	$19.20	$128.00	$6.30–$128.00	55% below	85%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC DRUG TEST PRSMV DIR OPT OBS	$19.20	$128.00	$6.30–$128.00	—	85%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC DRUG TEST PRSMV DIR OPT OBS	$19.20	$128.00	$6.30–$128.00	—	85%
Rapid flu test (influenza antigen) CPT 87804 HC ZZ INFLU A AG	$20.10	$134.00	$8.28–$134.00	76% below	85%
Rapid flu test (influenza antigen) CPT 87804 HC ZZ INFLU A AG	$20.10	$134.00	$8.28–$134.00	76% below	85%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC ZZ INFLU A AG	$20.10	$134.00	$8.28–$134.00	—	85%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC ZZ INFLU A AG	$20.10	$134.00	$8.28–$134.00	—	85%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREPTOCOCCAL GROUP A AG SCRN	$20.10	$134.00	$8.27–$134.00	78% below	85%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREPTOCOCCAL GROUP A AG SCRN	$20.10	$134.00	$8.27–$134.00	78% below	85%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREPTOCOCCAL GROUP A AG SCRN	$20.10	$134.00	$8.27–$134.00	—	85%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREPTOCOCCAL GROUP A AG SCRN	$20.10	$134.00	$8.27–$134.00	—	85%
Renin blood test CPT 84244 HC RENIN	$38.55	$257.00	$11.00–$257.00	71% below	85%
Renin blood test CPT 84244 HC RENIN	$38.55	$257.00	$11.00–$257.00	71% below	85%
Renin blood test inpatient CPT 84244 HC RENIN	$38.55	$257.00	$11.00–$257.00	—	85%
Renin blood test inpatient CPT 84244 HC RENIN	$38.55	$257.00	$11.00–$257.00	—	85%
Rh blood typing CPT 86901 HC BLOOD TYPING SEROLOGIC RH	$22.80	$152.00	$2.99–$152.00	63% below	85%
Rh blood typing CPT 86901 HC BLOOD TYPING SEROLOGIC RH	$22.80	$152.00	$2.99–$152.00	63% below	85%
Rh blood typing inpatient CPT 86901 HC BLOOD TYPING SEROLOGIC RH	$22.80	$152.00	$2.99–$152.00	—	85%
Rh blood typing inpatient CPT 86901 HC BLOOD TYPING SEROLOGIC RH	$22.80	$152.00	$2.99–$152.00	—	85%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR	$9.90	$66.00	$2.84–$66.00	72% below	85%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR	$9.90	$66.00	$2.84–$66.00	72% below	85%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR	$9.90	$66.00	$2.84–$66.00	—	85%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR	$9.90	$66.00	$2.84–$66.00	—	85%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY	$25.20	$168.00	$7.20–$168.00	74% below	85%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY	$25.20	$168.00	$7.20–$168.00	74% below	85%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA ANTIBODY	$25.20	$168.00	$7.20–$168.00	—	85%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA ANTIBODY	$25.20	$168.00	$7.20–$168.00	—	85%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SEDIMENTATION RATE AUTOMATED	$4.80	$32.00	$1.35–$32.00	92% below	85%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SEDIMENTATION RATE AUTOMATED	$4.80	$32.00	$1.35–$32.00	92% below	85%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SEDIMENTATION RATE AUTOMATED	$4.80	$32.00	$1.35–$32.00	—	85%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SEDIMENTATION RATE AUTOMATED	$4.80	$32.00	$1.35–$32.00	—	85%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS VOL CNT MOTIL DIFF	$21.15	$141.00	$5.33–$141.00	86% below	85%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS VOL CNT MOTIL DIFF	$21.15	$141.00	$5.33–$141.00	86% below	85%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC SEMEN ANALYSIS VOL CNT MOTIL DIFF	$21.15	$141.00	$5.33–$141.00	—	85%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC SEMEN ANALYSIS VOL CNT MOTIL DIFF	$21.15	$141.00	$5.33–$141.00	—	85%
Sodium blood test CPT 84295 HC NA SODIUM SERUM PLASMA/WHL BLD	$8.55	$57.00	$2.41–$57.00	83% below	85%
Sodium blood test CPT 84295 HC NA SODIUM SERUM PLASMA/WHL BLD	$8.55	$57.00	$2.41–$57.00	83% below	85%
Sodium blood test inpatient CPT 84295 HC NA SODIUM SERUM PLASMA/WHL BLD	$8.55	$57.00	$2.41–$57.00	—	85%
Sodium blood test inpatient CPT 84295 HC NA SODIUM SERUM PLASMA/WHL BLD	$8.55	$57.00	$2.41–$57.00	—	85%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES	$15.60	$104.00	$4.45–$104.00	71% below	85%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES	$15.60	$104.00	$4.45–$104.00	71% below	85%
Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITES	$15.60	$104.00	$4.45–$104.00	—	85%
Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITES	$15.60	$104.00	$4.45–$104.00	—	85%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECES SCREENING	$8.55	$57.00	$2.19–$57.00	63% below	85%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECES SCREENING	$8.55	$57.00	$2.19–$57.00	63% below	85%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD FECES SCREENING	$8.55	$57.00	$2.19–$57.00	—	85%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD FECES SCREENING	$8.55	$57.00	$2.19–$57.00	—	85%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC ASSAY TEST FOR BLOOD FECAL	$27.75	$185.00	$7.96–$185.00	64% below	85%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC ASSAY TEST FOR BLOOD FECAL	$27.75	$185.00	$7.96–$185.00	64% below	85%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC ASSAY TEST FOR BLOOD FECAL	$27.75	$185.00	$7.96–$185.00	—	85%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC ASSAY TEST FOR BLOOD FECAL	$27.75	$185.00	$7.96–$185.00	—	85%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC AB TREPONEMA PALLIDUM CONFIRM	$23.10	$154.00	$6.62–$154.00	67% below	85%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC AB TREPONEMA PALLIDUM CONFIRM	$23.10	$154.00	$6.62–$154.00	67% below	85%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC AB TREPONEMA PALLIDUM CONFIRM	$23.10	$154.00	$6.62–$154.00	—	85%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC AB TREPONEMA PALLIDUM CONFIRM	$23.10	$154.00	$6.62–$154.00	—	85%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST QUAL	$7.20	$48.00	$2.14–$48.00	71% below	85%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST QUAL	$7.20	$48.00	$2.14–$48.00	71% below	85%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST QUAL	$7.20	$48.00	$2.14–$48.00	—	85%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST QUAL	$7.20	$48.00	$2.14–$48.00	—	85%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB TEST CELL IMMUN MEASURE	$108.45	$723.00	$30.99–$723.00	51% below	85%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB TEST CELL IMMUN MEASURE	$108.45	$723.00	$30.99–$723.00	51% below	85%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB TEST CELL IMMUN MEASURE	$108.45	$723.00	$30.99–$723.00	—	85%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB TEST CELL IMMUN MEASURE	$108.45	$723.00	$30.99–$723.00	—	85%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$45.15	$301.00	$12.91–$301.00	70% below	85%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$45.15	$301.00	$12.91–$301.00	70% below	85%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL	$45.15	$301.00	$12.91–$301.00	—	85%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL	$45.15	$301.00	$12.91–$301.00	—	85%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EA REF	$25.50	$170.00	$7.28–$170.00	66% below	85%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EA REF	$25.50	$170.00	$7.28–$170.00	66% below	85%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES EA REF	$25.50	$170.00	$7.28–$170.00	—	85%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES EA REF	$25.50	$170.00	$7.28–$170.00	—	85%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE TSH	$29.40	$196.00	$8.40–$196.00	70% below	85%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE TSH	$29.40	$196.00	$8.40–$196.00	70% below	85%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE TSH	$29.40	$196.00	$8.40–$196.00	—	85%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE TSH	$29.40	$196.00	$8.40–$196.00	—	85%
Total IgE blood test CPT 82785 HC IGE IMMUNOGLOBULIN E	$28.80	$192.00	$8.23–$192.00	68% below	85%
Total IgE blood test CPT 82785 HC IGE IMMUNOGLOBULIN E	$28.80	$192.00	$8.23–$192.00	68% below	85%
Total IgE blood test inpatient CPT 82785 HC IGE IMMUNOGLOBULIN E	$28.80	$192.00	$8.23–$192.00	—	85%
Total IgE blood test inpatient CPT 82785 HC IGE IMMUNOGLOBULIN E	$28.80	$192.00	$8.23–$192.00	—	85%
Total cholesterol blood test CPT 82465 HC CHOLESTEROL	$7.50	$50.00	$2.18–$50.00	86% below	85%
Total cholesterol blood test CPT 82465 HC CHOLESTEROL	$7.50	$50.00	$2.18–$50.00	86% below	85%
Total cholesterol blood test inpatient CPT 82465 HC CHOLESTEROL	$7.50	$50.00	$2.18–$50.00	—	85%
Total cholesterol blood test inpatient CPT 82465 HC CHOLESTEROL	$7.50	$50.00	$2.18–$50.00	—	85%
Total thyroxine (T4) blood test CPT 84436 HC T4 THYROXINE TOTAL	$12.15	$81.00	$3.44–$81.00	75% below	85%
Total thyroxine (T4) blood test CPT 84436 HC T4 THYROXINE TOTAL	$12.15	$81.00	$3.44–$81.00	75% below	85%
Total thyroxine (T4) blood test inpatient CPT 84436 HC T4 THYROXINE TOTAL	$12.15	$81.00	$3.44–$81.00	—	85%
Total thyroxine (T4) blood test inpatient CPT 84436 HC T4 THYROXINE TOTAL	$12.15	$81.00	$3.44–$81.00	—	85%
Total triiodothyronine (T3) blood test CPT 84480 HC T3 TOTAL TRIIODOTHYRONINE	$24.90	$166.00	$7.09–$166.00	75% below	85%
Total triiodothyronine (T3) blood test CPT 84480 HC T3 TOTAL TRIIODOTHYRONINE	$24.90	$166.00	$7.09–$166.00	75% below	85%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC T3 TOTAL TRIIODOTHYRONINE	$24.90	$166.00	$7.09–$166.00	—	85%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC T3 TOTAL TRIIODOTHYRONINE	$24.90	$166.00	$7.09–$166.00	—	85%
Transferrin blood test CPT 84466 HC TRANSFERRIN	$22.05	$147.00	$6.38–$147.00	71% below	85%
Transferrin blood test CPT 84466 HC TRANSFERRIN	$22.05	$147.00	$6.38–$147.00	71% below	85%
Transferrin blood test inpatient CPT 84466 HC TRANSFERRIN	$22.05	$147.00	$6.38–$147.00	—	85%
Transferrin blood test inpatient CPT 84466 HC TRANSFERRIN	$22.05	$147.00	$6.38–$147.00	—	85%
Trichomonas test (NAAT) CPT 87661 HC TRICHOMONAS VAGINALIS AMPLIF	$30.90	$206.00	$17.55–$206.00	72% below	85%
Trichomonas test (NAAT) CPT 87661 HC TRICHOMONAS VAGINALIS AMPLIF	$30.90	$206.00	$17.55–$206.00	72% below	85%
Trichomonas test (NAAT) inpatient CPT 87661 HC TRICHOMONAS VAGINALIS AMPLIF	$30.90	$206.00	$17.55–$206.00	—	85%
Trichomonas test (NAAT) inpatient CPT 87661 HC TRICHOMONAS VAGINALIS AMPLIF	$30.90	$206.00	$17.55–$206.00	—	85%
Triglycerides blood test CPT 84478 HC TRIGLYCERIDES	$10.05	$67.00	$2.31–$67.00	81% below	85%
Triglycerides blood test CPT 84478 HC TRIGLYCERIDES	$10.05	$67.00	$2.31–$67.00	81% below	85%
Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDES	$10.05	$67.00	$2.31–$67.00	—	85%
Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDES	$10.05	$67.00	$2.31–$67.00	—	85%
Troponin test, quantitative CPT 84484 HC TROPONIN I	$17.10	$114.00	$6.24–$114.00	83% below	85%
Troponin test, quantitative CPT 84484 HC TROPONIN I	$17.10	$114.00	$6.24–$114.00	83% below	85%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN I	$17.10	$114.00	$6.24–$114.00	—	85%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN I	$17.10	$114.00	$6.24–$114.00	—	85%
Uric acid blood test CPT 84550 HC URIC ACID BLOOD	$7.95	$53.00	$2.26–$53.00	89% below	85%
Uric acid blood test CPT 84550 HC URIC ACID BLOOD	$7.95	$53.00	$2.26–$53.00	89% below	85%
Uric acid blood test inpatient CPT 84550 HC URIC ACID BLOOD	$7.95	$53.00	$2.26–$53.00	—	85%
Uric acid blood test inpatient CPT 84550 HC URIC ACID BLOOD	$7.95	$53.00	$2.26–$53.00	—	85%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTO W MICROSCOPY	$5.70	$38.00	$1.59–$38.00	87% below	85%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTO W MICROSCOPY	$5.70	$38.00	$1.59–$38.00	87% below	85%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS AUTO W MICROSCOPY	$5.70	$38.00	$1.59–$38.00	—	85%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS AUTO W MICROSCOPY	$5.70	$38.00	$1.59–$38.00	—	85%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO WO MICROSCOPY	$3.90	$26.00	$1.13–$26.00	88% below	85%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO WO MICROSCOPY	$3.90	$26.00	$1.13–$26.00	88% below	85%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO WO MICROSCOPY	$3.90	$26.00	$1.13–$26.00	—	85%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO WO MICROSCOPY	$3.90	$26.00	$1.13–$26.00	—	85%
Urinalysis without microscope exam, manual CPT 81002 HC URINE DIP WO MICROSCOPY	$4.35	$29.00	$1.74–$29.00	79% below	85%
Urinalysis without microscope exam, manual CPT 81002 HC URINE DIP WO MICROSCOPY	$4.35	$29.00	$1.74–$29.00	79% below	85%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINE DIP WO MICROSCOPY	$4.35	$29.00	$1.74–$29.00	—	85%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINE DIP WO MICROSCOPY	$4.35	$29.00	$1.74–$29.00	—	85%
Urine culture for bacteria, with colony count CPT 87086 HC URINE CULTURE	$13.95	$93.00	$4.04–$93.00	82% below	85%
Urine culture for bacteria, with colony count CPT 87086 HC URINE CULTURE	$13.95	$93.00	$4.04–$93.00	82% below	85%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC URINE CULTURE	$13.95	$93.00	$4.04–$93.00	—	85%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC URINE CULTURE	$13.95	$93.00	$4.04–$93.00	—	85%
Urine microalbumin (albumin) test CPT 82043 HC ALBUMIN URINE QUANT	$9.75	$65.00	$2.89–$65.00	84% below	85%
Urine microalbumin (albumin) test CPT 82043 HC ALBUMIN URINE QUANT	$9.75	$65.00	$2.89–$65.00	84% below	85%
Urine microalbumin (albumin) test inpatient CPT 82043 HC ALBUMIN URINE QUANT	$9.75	$65.00	$2.89–$65.00	—	85%
Urine microalbumin (albumin) test inpatient CPT 82043 HC ALBUMIN URINE QUANT	$9.75	$65.00	$2.89–$65.00	—	85%
Urine pregnancy test, read by color change CPT 81025 HC VISUAL URINE PREGNANCY	$11.10	$74.00	$3.18–$74.00	88% below	85%
Urine pregnancy test, read by color change CPT 81025 HC VISUAL URINE PREGNANCY	$11.10	$74.00	$3.18–$74.00	88% below	85%
Urine pregnancy test, read by color change inpatient CPT 81025 HC VISUAL URINE PREGNANCY	$11.10	$74.00	$3.18–$74.00	—	85%
Urine pregnancy test, read by color change inpatient CPT 81025 HC VISUAL URINE PREGNANCY	$11.10	$74.00	$3.18–$74.00	—	85%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B12	$26.40	$176.00	$7.54–$176.00	69% below	85%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B12	$26.40	$176.00	$7.54–$176.00	69% below	85%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B12	$26.40	$176.00	$7.54–$176.00	—	85%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B12	$26.40	$176.00	$7.54–$176.00	—	85%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D 25-OH	$52.05	$347.00	$14.80–$347.00	63% below	85%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D 25-OH	$52.05	$347.00	$14.80–$347.00	63% below	85%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D 25-OH	$52.05	$347.00	$14.80–$347.00	—	85%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D 25-OH	$52.05	$347.00	$14.80–$347.00	—	85%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC VITAMIN D 1 25 DIHYDROXY	$67.35	$449.00	$19.25–$449.00	69% below	85%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC VITAMIN D 1 25 DIHYDROXY	$67.35	$449.00	$19.25–$449.00	69% below	85%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC VITAMIN D 1 25 DIHYDROXY	$67.35	$449.00	$19.25–$449.00	—	85%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC VITAMIN D 1 25 DIHYDROXY	$67.35	$449.00	$19.25–$449.00	—	85%
Zinc blood test CPT 84630 HC ZINC	$19.95	$133.00	$5.70–$133.00	69% below	85%
Zinc blood test CPT 84630 HC ZINC	$19.95	$133.00	$5.70–$133.00	69% below	85%
Zinc blood test inpatient CPT 84630 HC ZINC	$19.95	$133.00	$5.70–$133.00	—	85%
Zinc blood test inpatient CPT 84630 HC ZINC	$19.95	$133.00	$5.70–$133.00	—	85%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANT	$26.25	$175.00	$7.53–$175.00	81% below	85%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANT	$26.25	$175.00	$7.53–$175.00	81% below	85%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC QUANT	$26.25	$175.00	$7.53–$175.00	—	85%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC QUANT	$26.25	$175.00	$7.53–$175.00	—	85%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
Botox injections for chronic migraine CPT 64615 HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$56.85	$379.00	$95.96–$652.88	88% below	85%
Botox injections for chronic migraine CPT 64615 HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$56.85	$379.00	$95.96–$652.88	88% below	85%
Botox injections for chronic migraine inpatient CPT 64615 HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$56.85	$379.00	$95.96–$652.88	—	85%
Botox injections for chronic migraine inpatient CPT 64615 HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$56.85	$379.00	$95.96–$652.88	—	85%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC CB STEREO LOC BRST BX 1ST LESION	$432.60	$2,884.00	$697.00–$3,512.94	84% below	85%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC CB STEREO LOC BRST BX 1ST LESION	$432.60	$2,884.00	$697.00–$3,512.94	84% below	85%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC CB STEREO LOC BRST BX 1ST LESION	$432.60	$2,884.00	$697.00–$3,512.94	—	85%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC CB STEREO LOC BRST BX 1ST LESION	$432.60	$2,884.00	$697.00–$3,512.94	—	85%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC CLSD TX DISTAL FIB FX WO MAN	$241.50	$1,610.00	$106.00–$1,610.00	at median	85%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC CLSD TX DISTAL FIB FX WO MAN	$241.50	$1,610.00	$106.00–$1,610.00	at median	85%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC CLSD TX DISTAL FIB FX WO MAN	$241.50	$1,610.00	$106.00–$1,610.00	—	85%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC CLSD TX DISTAL FIB FX WO MAN	$241.50	$1,610.00	$106.00–$1,610.00	—	85%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC TX METATARSAL FX WO MANIP	$66.60	$444.00	$106.00–$649.88	77% below	85%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC TX METATARSAL FX WO MANIP	$66.60	$444.00	$106.00–$649.88	77% below	85%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC TX METATARSAL FX WO MANIP	$66.60	$444.00	$106.00–$649.88	—	85%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC TX METATARSAL FX WO MANIP	$66.60	$444.00	$106.00–$649.88	—	85%
Cardiac catheterization with coronary angiogram one side CPT 93458 HC LEFT HEART CATH W/LV WITHOUT CORS	$2,405.40	$16,036.00	$2,062.00–$16,036.00	75% below	85%
Cardiac catheterization with coronary angiogram one side CPT 93458 HC LEFT HEART CATH W/LV WITHOUT CORS	$2,405.40	$16,036.00	$2,062.00–$16,036.00	75% below	85%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 HC LEFT HEART CATH W/LV WITHOUT CORS	$2,405.40	$16,036.00	$2,062.00–$16,036.00	—	85%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 HC LEFT HEART CATH W/LV WITHOUT CORS	$2,405.40	$16,036.00	$2,062.00–$16,036.00	—	85%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTIVE	$513.90	$3,426.00	$186.22–$3,426.00	57% below	85%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTIVE	$513.90	$3,426.00	$186.22–$3,426.00	57% below	85%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTIVE	$513.90	$3,426.00	$186.22–$3,426.00	—	85%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTIVE	$513.90	$3,426.00	$186.22–$3,426.00	—	85%
Carpal tunnel release, open surgery CPT 64721 HC REVISE MEDIAN N/CARPAL TUNNEL SURG	$905.25	$6,035.00	$375.46–$6,035.00	88% below	85%
Carpal tunnel release, open surgery CPT 64721 HC REVISE MEDIAN N/CARPAL TUNNEL SURG	$905.25	$6,035.00	$375.46–$6,035.00	88% below	85%
Carpal tunnel release, open surgery inpatient CPT 64721 HC REVISE MEDIAN N/CARPAL TUNNEL SURG	$905.25	$6,035.00	$375.46–$6,035.00	—	85%
Carpal tunnel release, open surgery inpatient CPT 64721 HC REVISE MEDIAN N/CARPAL TUNNEL SURG	$905.25	$6,035.00	$375.46–$6,035.00	—	85%
Catheter ablation for atrial fibrillation CPT 93656 HC EPS/AFIB ABLATION	$4,032.60	$26,884.00	$1,571.00–$55,595.04	81% below	85%
Catheter ablation for atrial fibrillation CPT 93656 HC EPS/AFIB ABLATION	$4,032.60	$26,884.00	$1,571.00–$55,595.04	81% below	85%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC EPS/AFIB ABLATION	$4,032.60	$26,884.00	$1,571.00–$55,595.04	—	85%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC EPS/AFIB ABLATION	$4,032.60	$26,884.00	$1,571.00–$55,595.04	—	85%
Cervical biopsy CPT 57500 HC BX CRVX SNGL/MULTI LOC EXC WOW FULG	$138.30	$922.00	$87.39–$1,959.07	92% below	85%
Cervical biopsy CPT 57500 HC BX CRVX SNGL/MULTI LOC EXC WOW FULG	$138.30	$922.00	$87.39–$1,959.07	92% below	85%
Cervical biopsy inpatient CPT 57500 HC BX CRVX SNGL/MULTI LOC EXC WOW FULG	$138.30	$922.00	$87.39–$1,959.07	—	85%
Cervical biopsy inpatient CPT 57500 HC BX CRVX SNGL/MULTI LOC EXC WOW FULG	$138.30	$922.00	$87.39–$1,959.07	—	85%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION W CLAMP/OTH DEV W BLOCK	$426.60	$2,844.00	$88.31–$4,446.23	72% below	85%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION W CLAMP/OTH DEV W BLOCK	$426.60	$2,844.00	$88.31–$4,446.23	72% below	85%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC CIRCUMCISION W CLAMP/OTH DEV W BLOCK	$426.60	$2,844.00	$88.31–$4,446.23	—	85%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC CIRCUMCISION W CLAMP/OTH DEV W BLOCK	$426.60	$2,844.00	$88.31–$4,446.23	—	85%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC CLOS TX DIST RADIAL FX WO MAN	$236.55	$1,577.00	$106.00–$1,577.00	30% below	85%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC CLOS TX DIST RADIAL FX WO MAN	$236.55	$1,577.00	$106.00–$1,577.00	30% below	85%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC CLOS TX DIST RADIAL FX WO MAN	$236.55	$1,577.00	$106.00–$1,577.00	—	85%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC CLOS TX DIST RADIAL FX WO MAN	$236.55	$1,577.00	$106.00–$1,577.00	—	85%
Colonoscopy with tissue sample CPT 45380 HC COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$484.05	$3,227.00	$697.00–$3,227.00	72% below	85%
Colonoscopy with tissue sample CPT 45380 HC COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$484.05	$3,227.00	$697.00–$3,227.00	72% below	85%
Colonoscopy with tissue sample inpatient CPT 45380 HC COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$484.05	$3,227.00	$697.00–$3,227.00	—	85%
Colonoscopy with tissue sample inpatient CPT 45380 HC COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$484.05	$3,227.00	$697.00–$3,227.00	—	85%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC COLPOSCOPY CRVX INCL UPPER/ADJ VAG W LOOP ELTRD BX CRVX	$1,140.00	$7,600.00	$266.56–$7,600.00	78% below	85%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC COLPOSCOPY CRVX INCL UPPER/ADJ VAG W LOOP ELTRD BX CRVX	$1,140.00	$7,600.00	$266.56–$7,600.00	78% below	85%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HC COLPOSCOPY CRVX INCL UPPER/ADJ VAG W LOOP ELTRD BX CRVX	$1,140.00	$7,600.00	$266.56–$7,600.00	—	85%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HC COLPOSCOPY CRVX INCL UPPER/ADJ VAG W LOOP ELTRD BX CRVX	$1,140.00	$7,600.00	$266.56–$7,600.00	—	85%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC COLPOSCOPY CRVX INCL UPPER/AND VAG W BX/ENDOCRV CURR	$61.65	$411.00	$104.07–$698.58	89% below	85%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC COLPOSCOPY CRVX INCL UPPER/AND VAG W BX/ENDOCRV CURR	$61.65	$411.00	$104.07–$698.58	89% below	85%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC COLPOSCOPY CRVX INCL UPPER/AND VAG W BX/ENDOCRV CURR	$61.65	$411.00	$104.07–$698.58	—	85%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC COLPOSCOPY CRVX INCL UPPER/AND VAG W BX/ENDOCRV CURR	$61.65	$411.00	$104.07–$698.58	—	85%
Coronary stent placement, one artery CPT 92928 HC STENT PLCMNT INTRA W ANGIO	$3,339.75	$22,265.00	$2,786.00–$24,554.41	68% below	85%
Coronary stent placement, one artery CPT 92928 HC STENT PLCMNT INTRA W ANGIO	$3,339.75	$22,265.00	$2,786.00–$24,554.41	68% below	85%
Coronary stent placement, one artery inpatient CPT 92928 HC STENT PLCMNT INTRA W ANGIO	$3,339.75	$22,265.00	$2,786.00–$24,554.41	—	85%
Coronary stent placement, one artery inpatient CPT 92928 HC STENT PLCMNT INTRA W ANGIO	$3,339.75	$22,265.00	$2,786.00–$24,554.41	—	85%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOSCOPY W/DILATION BLADDER	$271.35	$1,809.00	$103.91–$2,099.87	69% below	85%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOSCOPY W/DILATION BLADDER	$271.35	$1,809.00	$103.91–$2,099.87	69% below	85%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC CYSTOSCOPY W/DILATION BLADDER	$271.35	$1,809.00	$103.91–$2,099.87	—	85%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC CYSTOSCOPY W/DILATION BLADDER	$271.35	$1,809.00	$103.91–$2,099.87	—	85%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC	$1,271.85	$8,479.00	$106.00–$8,479.00	46% below	85%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC	$1,271.85	$8,479.00	$106.00–$8,479.00	46% below	85%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC	$1,271.85	$8,479.00	$106.00–$8,479.00	—	85%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC	$1,271.85	$8,479.00	$106.00–$8,479.00	—	85%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DESTRUCTION PREMALIGNANT LESION FIRST LESION	$99.60	$664.00	$44.48–$664.00	17% below	85%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DESTRUCTION PREMALIGNANT LESION FIRST LESION	$99.60	$664.00	$44.48–$664.00	17% below	85%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DESTRUCTION PREMALIGNANT LESION FIRST LESION	$99.60	$664.00	$44.48–$664.00	—	85%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DESTRUCTION PREMALIGNANT LESION FIRST LESION	$99.60	$664.00	$44.48–$664.00	—	85%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC REMOVE IMPACTED CERUMEN IRRIGATION UNIL	$27.45	$183.00	$46.34–$183.00	72% below	85%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC REMOVE IMPACTED CERUMEN IRRIGATION UNIL	$27.45	$183.00	$46.34–$183.00	72% below	85%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC REMOVE IMPACTED CERUMEN IRRIGATION UNIL	$27.45	$183.00	$46.34–$183.00	—	85%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC REMOVE IMPACTED CERUMEN IRRIGATION UNIL	$27.45	$183.00	$46.34–$183.00	—	85%
Earwax removal with instruments, one ear CPT 69210 HC REMOVE IMPACTED CERUMEN INSTRUMENT UNIL	$31.05	$207.00	$39.52–$207.00	82% below	85%
Earwax removal with instruments, one ear CPT 69210 HC REMOVE IMPACTED CERUMEN INSTRUMENT UNIL	$31.05	$207.00	$39.52–$207.00	82% below	85%
Earwax removal with instruments, one ear inpatient CPT 69210 HC REMOVE IMPACTED CERUMEN INSTRUMENT UNIL	$31.05	$207.00	$39.52–$207.00	—	85%
Earwax removal with instruments, one ear inpatient CPT 69210 HC REMOVE IMPACTED CERUMEN INSTRUMENT UNIL	$31.05	$207.00	$39.52–$207.00	—	85%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH	$37.20	$248.00	$62.79–$698.58	88% below	85%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH	$37.20	$248.00	$62.79–$698.58	88% below	85%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH	$37.20	$248.00	$62.79–$698.58	—	85%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH	$37.20	$248.00	$62.79–$698.58	—	85%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC INJ CERVICAL/THORACIC W IMG GUID	$152.25	$1,015.00	$253.60–$1,501.40	89% below	85%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC INJ CERVICAL/THORACIC W IMG GUID	$152.25	$1,015.00	$253.60–$1,501.40	89% below	85%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC INJ CERVICAL/THORACIC W IMG GUID	$152.25	$1,015.00	$253.60–$1,501.40	—	85%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC INJ CERVICAL/THORACIC W IMG GUID	$152.25	$1,015.00	$253.60–$1,501.40	—	85%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 HC INJ DX/THER AGT PVRT FACET JT LMBR/SAC UNILAT 1 LEVEL	$552.30	$3,682.00	$390.00–$3,682.00	61% below	85%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 HC INJ DX/THER AGT PVRT FACET JT LMBR/SAC UNILAT 1 LEVEL	$552.30	$3,682.00	$390.00–$3,682.00	61% below	85%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 HC INJ DX/THER AGT PVRT FACET JT LMBR/SAC UNILAT 1 LEVEL	$552.30	$3,682.00	$390.00–$3,682.00	—	85%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 HC INJ DX/THER AGT PVRT FACET JT LMBR/SAC UNILAT 1 LEVEL	$552.30	$3,682.00	$390.00–$3,682.00	—	85%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA IF PFRMD	$393.75	$2,625.00	$390.00–$2,625.00	65% below	85%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA IF PFRMD	$393.75	$2,625.00	$390.00–$2,625.00	65% below	85%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA IF PFRMD	$393.75	$2,625.00	$390.00–$2,625.00	—	85%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA IF PFRMD	$393.75	$2,625.00	$390.00–$2,625.00	—	85%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC INJ CATH HYSTEROSALPINGOGRAM.	$74.55	$497.00	$125.84–$497.00	86% below	85%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC INJ CATH HYSTEROSALPINGOGRAM.	$74.55	$497.00	$125.84–$497.00	86% below	85%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC INJ CATH HYSTEROSALPINGOGRAM.	$74.55	$497.00	$125.84–$497.00	—	85%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC INJ CATH HYSTEROSALPINGOGRAM.	$74.55	$497.00	$125.84–$497.00	—	85%
IUD insertion (the device itself billed separately) CPT 58300 HC INSERT IUD	$223.65	$1,491.00	$26.10–$1,491.00	3% below	85%
IUD insertion (the device itself billed separately) CPT 58300 HC INSERT IUD	$223.65	$1,491.00	$26.10–$1,491.00	3% below	85%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC INSERT IUD	$223.65	$1,491.00	$26.10–$1,491.00	—	85%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC INSERT IUD	$223.65	$1,491.00	$26.10–$1,491.00	—	85%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D ABSCESS SIMPLE OR SINGLE	$86.25	$575.00	$50.22–$575.00	78% below	85%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D ABSCESS SIMPLE OR SINGLE	$86.25	$575.00	$50.22–$575.00	78% below	85%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D ABSCESS SIMPLE OR SINGLE	$86.25	$575.00	$50.22–$575.00	—	85%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D ABSCESS SIMPLE OR SINGLE	$86.25	$575.00	$50.22–$575.00	—	85%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$235.35	$1,569.00	$47.63–$1,569.00	36% below	85%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$235.35	$1,569.00	$47.63–$1,569.00	36% below	85%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$235.35	$1,569.00	$47.63–$1,569.00	—	85%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$235.35	$1,569.00	$47.63–$1,569.00	—	85%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT	$295.05	$1,967.00	$223.00–$1,967.00	24% below	85%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT	$295.05	$1,967.00	$223.00–$1,967.00	24% below	85%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT	$295.05	$1,967.00	$223.00–$1,967.00	—	85%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT	$295.05	$1,967.00	$223.00–$1,967.00	—	85%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERTION DRUG DELIVERY IMPLANT	$55.35	$369.00	$65.88–$369.00	90% below	85%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERTION DRUG DELIVERY IMPLANT	$55.35	$369.00	$65.88–$369.00	90% below	85%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC INSERTION DRUG DELIVERY IMPLANT	$55.35	$369.00	$65.88–$369.00	—	85%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC INSERTION DRUG DELIVERY IMPLANT	$55.35	$369.00	$65.88–$369.00	—	85%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID	$267.00	$1,780.00	$223.00–$1,780.00	37% below	85%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID	$267.00	$1,780.00	$223.00–$1,780.00	37% below	85%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID	$267.00	$1,780.00	$223.00–$1,780.00	—	85%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID	$267.00	$1,780.00	$223.00–$1,780.00	—	85%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ASPIRATE INJECT SMALL JOINT W/O US GUID	$89.55	$597.00	$43.66–$652.88	76% below	85%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ASPIRATE INJECT SMALL JOINT W/O US GUID	$89.55	$597.00	$43.66–$652.88	76% below	85%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ASPIRATE INJECT SMALL JOINT W/O US GUID	$89.55	$597.00	$43.66–$652.88	—	85%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ASPIRATE INJECT SMALL JOINT W/O US GUID	$89.55	$597.00	$43.66–$652.88	—	85%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 HC LAPROSCOPIC APPENDECTOMY	$2,401.65	$16,011.00	$1,523.00–$16,011.00	86% below	85%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 HC LAPROSCOPIC APPENDECTOMY	$2,401.65	$16,011.00	$1,523.00–$16,011.00	86% below	85%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 HC LAPROSCOPIC APPENDECTOMY	$2,401.65	$16,011.00	$1,523.00–$16,011.00	—	85%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 HC LAPROSCOPIC APPENDECTOMY	$2,401.65	$16,011.00	$1,523.00–$16,011.00	—	85%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 HC POST-CATARACT LASER SURGERY	$251.55	$1,677.00	$390.00–$1,677.00	77% below	85%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 HC POST-CATARACT LASER SURGERY	$251.55	$1,677.00	$390.00–$1,677.00	77% below	85%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 HC POST-CATARACT LASER SURGERY	$251.55	$1,677.00	$390.00–$1,677.00	—	85%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 HC POST-CATARACT LASER SURGERY	$251.55	$1,677.00	$390.00–$1,677.00	—	85%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC LAYER CLOS SCLP TRUNK LESS 2.5	$100.05	$667.00	$106.00–$864.65	81% below	85%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC LAYER CLOS SCLP TRUNK LESS 2.5	$100.05	$667.00	$106.00–$864.65	81% below	85%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC LAYER CLOS SCLP TRUNK LESS 2.5	$100.05	$667.00	$106.00–$864.65	—	85%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC LAYER CLOS SCLP TRUNK LESS 2.5	$100.05	$667.00	$106.00–$864.65	—	85%
Left heart catheterization, diagnostic one side CPT 93452 HC LEFT HEART CATH W/LV	$2,405.40	$16,036.00	$2,062.00–$16,036.00	63% below	85%
Left heart catheterization, diagnostic one side CPT 93452 HC LEFT HEART CATH W/LV	$2,405.40	$16,036.00	$2,062.00–$16,036.00	63% below	85%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC LEFT HEART CATH W/LV	$2,405.40	$16,036.00	$2,062.00–$16,036.00	—	85%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC LEFT HEART CATH W/LV	$2,405.40	$16,036.00	$2,062.00–$16,036.00	—	85%
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ LUMBAR/SACRAL W IMG GUID	$447.90	$2,986.00	$390.00–$2,986.00	73% below	85%
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ LUMBAR/SACRAL W IMG GUID	$447.90	$2,986.00	$390.00–$2,986.00	73% below	85%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ LUMBAR/SACRAL W IMG GUID	$447.90	$2,986.00	$390.00–$2,986.00	—	85%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ LUMBAR/SACRAL W IMG GUID	$447.90	$2,986.00	$390.00–$2,986.00	—	85%
Lower-back epidural injection, without imaging guidance CPT 62322 HC INJ LUMBAR/SACRAL W/O IMG GUID	$323.40	$2,156.00	$253.60–$2,156.00	78% below	85%
Lower-back epidural injection, without imaging guidance CPT 62322 HC INJ LUMBAR/SACRAL W/O IMG GUID	$323.40	$2,156.00	$253.60–$2,156.00	78% below	85%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC INJ LUMBAR/SACRAL W/O IMG GUID	$323.40	$2,156.00	$253.60–$2,156.00	—	85%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC INJ LUMBAR/SACRAL W/O IMG GUID	$323.40	$2,156.00	$253.60–$2,156.00	—	85%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC INJ ANES &/ STEROID TRFML EPIDURAL LMBR/SAC UNILAT 1 LEVEL	$179.40	$1,196.00	$211.82–$1,881.27	88% below	85%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC INJ ANES &/ STEROID TRFML EPIDURAL LMBR/SAC UNILAT 1 LEVEL	$179.40	$1,196.00	$211.82–$1,881.27	88% below	85%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 HC INJ ANES &/ STEROID TRFML EPIDURAL LMBR/SAC UNILAT 1 LEVEL	$179.40	$1,196.00	$211.82–$1,881.27	—	85%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 HC INJ ANES &/ STEROID TRFML EPIDURAL LMBR/SAC UNILAT 1 LEVEL	$179.40	$1,196.00	$211.82–$1,881.27	—	85%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<	$176.40	$1,176.00	$71.20–$1,506.19	69% below	85%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<	$176.40	$1,176.00	$71.20–$1,506.19	69% below	85%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<	$176.40	$1,176.00	$71.20–$1,506.19	—	85%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<	$176.40	$1,176.00	$71.20–$1,506.19	—	85%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS	$135.60	$904.00	$90.08–$1,506.19	89% below	85%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS	$135.60	$904.00	$90.08–$1,506.19	89% below	85%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS	$135.60	$904.00	$90.08–$1,506.19	—	85%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS	$135.60	$904.00	$90.08–$1,506.19	—	85%
Nail removal (partial or complete), one nail CPT 11730 HC AVUL NAIL PLAT PART CMPL SINGL	$92.55	$617.00	$53.92–$617.00	57% below	85%
Nail removal (partial or complete), one nail CPT 11730 HC AVUL NAIL PLAT PART CMPL SINGL	$92.55	$617.00	$53.92–$617.00	57% below	85%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC AVUL NAIL PLAT PART CMPL SINGL	$92.55	$617.00	$53.92–$617.00	—	85%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC AVUL NAIL PLAT PART CMPL SINGL	$92.55	$617.00	$53.92–$617.00	—	85%
Occipital nerve block (injection for headaches) one side CPT 64405 HC INJECT ANES/STEROID NERV BLCK GREAT OCCIPTL UNILAT	$56.85	$379.00	$88.96–$652.88	90% below	85%
Occipital nerve block (injection for headaches) one side CPT 64405 HC INJECT ANES/STEROID NERV BLCK GREAT OCCIPTL UNILAT	$56.85	$379.00	$88.96–$652.88	90% below	85%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 HC INJECT ANES/STEROID NERV BLCK GREAT OCCIPTL UNILAT	$56.85	$379.00	$88.96–$652.88	—	85%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 HC INJECT ANES/STEROID NERV BLCK GREAT OCCIPTL UNILAT	$56.85	$379.00	$88.96–$652.88	—	85%
Pacemaker implant (dual chamber) CPT 33208 HC INSERT / REPLC PACEMAKER DUAL	$4,345.65	$28,971.00	$619.98–$28,971.00	63% below	85%
Pacemaker implant (dual chamber) CPT 33208 HC INSERT / REPLC PACEMAKER DUAL	$4,345.65	$28,971.00	$619.98–$28,971.00	63% below	85%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC INSERT / REPLC PACEMAKER DUAL	$4,345.65	$28,971.00	$619.98–$28,971.00	—	85%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC INSERT / REPLC PACEMAKER DUAL	$4,345.65	$28,971.00	$619.98–$28,971.00	—	85%
Paracentesis with imaging guidance CPT 49083 HC ABD PARACENTESIS W IMG GUID	$324.60	$2,164.00	$547.92–$2,164.00	72% below	85%
Paracentesis with imaging guidance CPT 49083 HC ABD PARACENTESIS W IMG GUID	$324.60	$2,164.00	$547.92–$2,164.00	72% below	85%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABD PARACENTESIS W IMG GUID	$324.60	$2,164.00	$547.92–$2,164.00	—	85%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABD PARACENTESIS W IMG GUID	$324.60	$2,164.00	$547.92–$2,164.00	—	85%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC EXC NAIL&MATRIX PART CMPL PERM	$214.20	$1,428.00	$106.00–$1,428.00	64% below	85%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC EXC NAIL&MATRIX PART CMPL PERM	$214.20	$1,428.00	$106.00–$1,428.00	64% below	85%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC EXC NAIL&MATRIX PART CMPL PERM	$214.20	$1,428.00	$106.00–$1,428.00	—	85%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC EXC NAIL&MATRIX PART CMPL PERM	$214.20	$1,428.00	$106.00–$1,428.00	—	85%
Prostate biopsy CPT 55700 HC BX PROSTATE NDL/PUNCH SNG/MULTI ANY APPR	$390.30	$2,602.00	$96.26–$2,602.00	85% below	85%
Prostate biopsy CPT 55700 HC BX PROSTATE NDL/PUNCH SNG/MULTI ANY APPR	$390.30	$2,602.00	$96.26–$2,602.00	85% below	85%
Prostate biopsy inpatient CPT 55700 HC BX PROSTATE NDL/PUNCH SNG/MULTI ANY APPR	$390.30	$2,602.00	$96.26–$2,602.00	—	85%
Prostate biopsy inpatient CPT 55700 HC BX PROSTATE NDL/PUNCH SNG/MULTI ANY APPR	$390.30	$2,602.00	$96.26–$2,602.00	—	85%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	$382.95	$2,553.00	$646.42–$4,153.43	86% below	85%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	$382.95	$2,553.00	$646.42–$4,153.43	86% below	85%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	$382.95	$2,553.00	$646.42–$4,153.43	—	85%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	$382.95	$2,553.00	$646.42–$4,153.43	—	85%
Removal of a foreign object under the skin, simple CPT 10120 HC INCISE & REMOVAL FB SUBQ SIMP	$120.30	$802.00	$61.81–$864.65	79% below	85%
Removal of a foreign object under the skin, simple CPT 10120 HC INCISE & REMOVAL FB SUBQ SIMP	$120.30	$802.00	$61.81–$864.65	79% below	85%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INCISE & REMOVAL FB SUBQ SIMP	$120.30	$802.00	$61.81–$864.65	—	85%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INCISE & REMOVAL FB SUBQ SIMP	$120.30	$802.00	$61.81–$864.65	—	85%
Short arm cast (elbow to hand) CPT 29075 HC APPLY SHORT ARM CAST	$130.20	$868.00	$64.86–$868.00	52% below	85%
Short arm cast (elbow to hand) CPT 29075 HC APPLY SHORT ARM CAST	$130.20	$868.00	$64.86–$868.00	52% below	85%
Short arm cast (elbow to hand) inpatient CPT 29075 HC APPLY SHORT ARM CAST	$130.20	$868.00	$64.86–$868.00	—	85%
Short arm cast (elbow to hand) inpatient CPT 29075 HC APPLY SHORT ARM CAST	$130.20	$868.00	$64.86–$868.00	—	85%
Short arm splint (forearm and hand) CPT 29125 HC APPLY SHORT ARM SPLINT STATIC	$77.25	$515.00	$43.32–$515.00	68% below	85%
Short arm splint (forearm and hand) CPT 29125 HC APPLY SHORT ARM SPLINT STATIC	$77.25	$515.00	$43.32–$515.00	68% below	85%
Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLY SHORT ARM SPLINT STATIC	$77.25	$515.00	$43.32–$515.00	—	85%
Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLY SHORT ARM SPLINT STATIC	$77.25	$515.00	$43.32–$515.00	—	85%
Short leg cast (below the knee) CPT 29405 HC APPLY SHORT LEG CAST	$99.60	$664.00	$88.82–$664.00	69% below	85%
Short leg cast (below the knee) CPT 29405 HC APPLY SHORT LEG CAST	$99.60	$664.00	$88.82–$664.00	69% below	85%
Short leg cast (below the knee) inpatient CPT 29405 HC APPLY SHORT LEG CAST	$99.60	$664.00	$88.82–$664.00	—	85%
Short leg cast (below the knee) inpatient CPT 29405 HC APPLY SHORT LEG CAST	$99.60	$664.00	$88.82–$664.00	—	85%
Short leg splint (calf to foot) CPT 29515 HC APPLY SHORT LEG SPLINT	$64.65	$431.00	$55.86–$431.00	72% below	85%
Short leg splint (calf to foot) CPT 29515 HC APPLY SHORT LEG SPLINT	$64.65	$431.00	$55.86–$431.00	72% below	85%
Short leg splint (calf to foot) inpatient CPT 29515 HC APPLY SHORT LEG SPLINT	$64.65	$431.00	$55.86–$431.00	—	85%
Short leg splint (calf to foot) inpatient CPT 29515 HC APPLY SHORT LEG SPLINT	$64.65	$431.00	$55.86–$431.00	—	85%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC SMPL REPR SCLP TRUNK LESS 2.5	$84.00	$560.00	$85.04–$560.00	77% below	85%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC SMPL REPR SCLP TRUNK LESS 2.5	$84.00	$560.00	$85.04–$560.00	77% below	85%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC SMPL REPR SCLP TRUNK LESS 2.5	$84.00	$560.00	$85.04–$560.00	—	85%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC SMPL REPR SCLP TRUNK LESS 2.5	$84.00	$560.00	$85.04–$560.00	—	85%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BX SKIN SNGL LESION	$75.45	$503.00	$88.23–$864.65	76% below	85%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BX SKIN SNGL LESION	$75.45	$503.00	$88.23–$864.65	76% below	85%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BX SKIN SNGL LESION	$75.45	$503.00	$88.23–$864.65	—	85%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BX SKIN SNGL LESION	$75.45	$503.00	$88.23–$864.65	—	85%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG	$294.75	$1,965.00	$105.55–$1,965.00	74% below	85%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG	$294.75	$1,965.00	$105.55–$1,965.00	74% below	85%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG	$294.75	$1,965.00	$105.55–$1,965.00	—	85%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG	$294.75	$1,965.00	$105.55–$1,965.00	—	85%
Skin tag removal, up to 15 tags CPT 11200 HC REMV SKIN TAGS TO 15 LESIONS	$38.25	$255.00	$52.47–$426.75	85% below	85%
Skin tag removal, up to 15 tags CPT 11200 HC REMV SKIN TAGS TO 15 LESIONS	$38.25	$255.00	$52.47–$426.75	85% below	85%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC REMV SKIN TAGS TO 15 LESIONS	$38.25	$255.00	$52.47–$426.75	—	85%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC REMV SKIN TAGS TO 15 LESIONS	$38.25	$255.00	$52.47–$426.75	—	85%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINE PUNCT LUMBAR DX	$282.90	$1,886.00	$390.00–$1,886.00	67% below	85%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINE PUNCT LUMBAR DX	$282.90	$1,886.00	$390.00–$1,886.00	67% below	85%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINE PUNCT LUMBAR DX	$282.90	$1,886.00	$390.00–$1,886.00	—	85%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINE PUNCT LUMBAR DX	$282.90	$1,886.00	$390.00–$1,886.00	—	85%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC SIMP RPR SCLP TRUNK 2.6-7.5	$85.50	$570.00	$106.00–$570.00	80% below	85%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC SIMP RPR SCLP TRUNK 2.6-7.5	$85.50	$570.00	$106.00–$570.00	80% below	85%
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 SIMP RPR SCLP TRUNK 2.6-7.5	$85.50	$570.00	$106.00–$570.00	—	85%
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 SIMP RPR SCLP TRUNK 2.6-7.5	$85.50	$570.00	$106.00–$570.00	—	85%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC SIMP REP FACE MUCOUS LESS 2.5	$89.40	$596.00	$106.00–$596.00	76% below	85%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC SIMP REP FACE MUCOUS LESS 2.5	$89.40	$596.00	$106.00–$596.00	76% below	85%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC SIMP REP FACE MUCOUS LESS 2.5	$89.40	$596.00	$106.00–$596.00	—	85%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC SIMP REP FACE MUCOUS LESS 2.5	$89.40	$596.00	$106.00–$596.00	—	85%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BX SKIN SNGL LESION	$39.15	$261.00	$66.09–$864.65	84% below	85%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BX SKIN SNGL LESION	$39.15	$261.00	$66.09–$864.65	84% below	85%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BX SKIN SNGL LESION	$39.15	$261.00	$66.09–$864.65	—	85%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BX SKIN SNGL LESION	$39.15	$261.00	$66.09–$864.65	—	85%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS ASPIR W IMAG GUID	$383.85	$2,559.00	$390.00–$2,559.00	71% below	85%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS ASPIR W IMAG GUID	$383.85	$2,559.00	$390.00–$2,559.00	71% below	85%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS ASPIR W IMAG GUID	$383.85	$2,559.00	$390.00–$2,559.00	—	85%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS ASPIR W IMAG GUID	$383.85	$2,559.00	$390.00–$2,559.00	—	85%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ ONE MX TRIG POINT 1/2 MUSC	$245.85	$1,639.00	$56.91–$1,639.00	33% below	85%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ ONE MX TRIG POINT 1/2 MUSC	$245.85	$1,639.00	$56.91–$1,639.00	33% below	85%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ ONE MX TRIG POINT 1/2 MUSC	$245.85	$1,639.00	$56.91–$1,639.00	—	85%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ ONE MX TRIG POINT 1/2 MUSC	$245.85	$1,639.00	$56.91–$1,639.00	—	85%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC US GUIDE FOR BX 1ST LESION	$432.60	$2,884.00	$697.00–$3,512.94	78% below	85%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC US GUIDE FOR BX 1ST LESION	$432.60	$2,884.00	$697.00–$3,512.94	78% below	85%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC US GUIDE FOR BX 1ST LESION	$432.60	$2,884.00	$697.00–$3,512.94	—	85%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC US GUIDE FOR BX 1ST LESION	$432.60	$2,884.00	$697.00–$3,512.94	—	85%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC EGD W BALLOON DILATION ESOP < 30 MM	$581.40	$3,876.00	$106.00–$4,081.50	75% below	85%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC EGD W BALLOON DILATION ESOP < 30 MM	$581.40	$3,876.00	$106.00–$4,081.50	75% below	85%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC EGD W BALLOON DILATION ESOP < 30 MM	$581.40	$3,876.00	$106.00–$4,081.50	—	85%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC EGD W BALLOON DILATION ESOP < 30 MM	$581.40	$3,876.00	$106.00–$4,081.50	—	85%
Upper endoscopy (EGD) with biopsy CPT 43239 HC EGD W BIOPSY SINGLE OR MULTIPLE	$384.60	$2,564.00	$106.00–$2,564.00	74% below	85%
Upper endoscopy (EGD) with biopsy CPT 43239 HC EGD W BIOPSY SINGLE OR MULTIPLE	$384.60	$2,564.00	$106.00–$2,564.00	74% below	85%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC EGD W BIOPSY SINGLE OR MULTIPLE	$384.60	$2,564.00	$106.00–$2,564.00	—	85%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC EGD W BIOPSY SINGLE OR MULTIPLE	$384.60	$2,564.00	$106.00–$2,564.00	—	85%
Upper endoscopy (EGD), diagnostic CPT 43235 HC EGD TRANSORAL DX INCL BRUSH/WASH	$426.60	$2,844.00	$106.00–$2,844.00	71% below	85%
Upper endoscopy (EGD), diagnostic CPT 43235 HC EGD TRANSORAL DX INCL BRUSH/WASH	$426.60	$2,844.00	$106.00–$2,844.00	71% below	85%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC EGD TRANSORAL DX INCL BRUSH/WASH	$426.60	$2,844.00	$106.00–$2,844.00	—	85%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC EGD TRANSORAL DX INCL BRUSH/WASH	$426.60	$2,844.00	$106.00–$2,844.00	—	85%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 HC REMOVAL OF SPERM DUCT(S)	$898.95	$5,993.00	$312.90–$5,993.00	at median	85%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 HC REMOVAL OF SPERM DUCT(S)	$898.95	$5,993.00	$312.90–$5,993.00	at median	85%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 HC REMOVAL OF SPERM DUCT(S)	$898.95	$5,993.00	$312.90–$5,993.00	—	85%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 HC REMOVAL OF SPERM DUCT(S)	$898.95	$5,993.00	$312.90–$5,993.00	—	85%
Vein ablation, radiofrequency, first vein CPT 36475 HC ENDOVEN ABLT INCMPTNT VEIN XTR RF 1ST VEIN	$1,290.30	$8,602.00	$1,082.00–$8,602.00	68% below	85%
Vein ablation, radiofrequency, first vein CPT 36475 HC ENDOVEN ABLT INCMPTNT VEIN XTR RF 1ST VEIN	$1,290.30	$8,602.00	$1,082.00–$8,602.00	68% below	85%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC ENDOVEN ABLT INCMPTNT VEIN XTR RF 1ST VEIN	$1,290.30	$8,602.00	$1,082.00–$8,602.00	—	85%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC ENDOVEN ABLT INCMPTNT VEIN XTR RF 1ST VEIN	$1,290.30	$8,602.00	$1,082.00–$8,602.00	—	85%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCTION BENIGN LESIONS UP TO 14	$39.15	$261.00	$46.85–$426.75	71% below	85%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCTION BENIGN LESIONS UP TO 14	$39.15	$261.00	$46.85–$426.75	71% below	85%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCTION BENIGN LESIONS UP TO 14	$39.15	$261.00	$46.85–$426.75	—	85%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCTION BENIGN LESIONS UP TO 14	$39.15	$261.00	$46.85–$426.75	—	85%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<	$304.65	$2,031.00	$70.65–$2,031.00	49% below	85%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<	$304.65	$2,031.00	$70.65–$2,031.00	49% below	85%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<	$304.65	$2,031.00	$70.65–$2,031.00	—	85%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<	$304.65	$2,031.00	$70.65–$2,031.00	—	85%

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 TRANSFUSION BLD BLD COMPONENT	$119.40	$796.00	$45.17–$938.37	86% below	85%
Blood transfusion (giving blood or blood components) CPT 36430 HC TRANSFUSION BLD BLD COMPONENT	$119.40	$796.00	$45.17–$938.37	86% below	85%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC TRANSFUSION BLD BLD COMPONENT	$119.40	$796.00	$45.17–$938.37	—	85%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC TRANSFUSION BLD BLD COMPONENT	$119.40	$796.00	$45.17–$938.37	—	85%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AEROSOL OR VAPOR INHALAT TX INIT	$98.55	$657.00	$14.86–$657.00	38% below	85%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AEROSOL OR VAPOR INHALAT TX INIT	$98.55	$657.00	$14.86–$657.00	38% below	85%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AEROSOL OR VAPOR INHALAT TX INIT	$98.55	$657.00	$14.86–$657.00	—	85%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AEROSOL OR VAPOR INHALAT TX INIT	$98.55	$657.00	$14.86–$657.00	—	85%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO ADM IV INF INITIAL TO 1HR	$260.40	$1,736.00	$103.89–$1,736.00	66% below	85%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO ADM IV INF INITIAL TO 1HR	$260.40	$1,736.00	$103.89–$1,736.00	66% below	85%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO ADM IV INF INITIAL TO 1HR	$260.40	$1,736.00	$103.89–$1,736.00	—	85%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO ADM IV INF INITIAL TO 1HR	$260.40	$1,736.00	$103.89–$1,736.00	—	85%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 HC OPHTH MEDICAL EXAM/EVAL COMPRE NEW PT 1 OR MORE VST	$58.35	$389.00	$47.56–$389.00	—	85%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 HC OPHTH MEDICAL EXAM/EVAL COMPRE NEW PT 1 OR MORE VST	$58.35	$389.00	$47.56–$389.00	—	85%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 HC OPHTH MEDICAL EXAM/EVAL COMPRE NEW PT 1 OR MORE VST	$58.35	$389.00	$47.56–$389.00	—	85%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 HC OPHTH MEDICAL EXAM/EVAL COMPRE NEW PT 1 OR MORE VST	$58.35	$389.00	$47.56–$389.00	—	85%
Comprehensive eye exam, returning patient CPT 92014 HC OPHTH MEDICAL EXAM/EVAL CCOMPRE EST PT 1 OR MORE VST	$58.35	$389.00	$36.06–$389.00	66% below	85%
Comprehensive eye exam, returning patient CPT 92014 HC OPHTH MEDICAL EXAM/EVAL CCOMPRE EST PT 1 OR MORE VST	$58.35	$389.00	$36.06–$389.00	66% below	85%
Comprehensive eye exam, returning patient inpatient CPT 92014 HC OPHTH MEDICAL EXAM/EVAL CCOMPRE EST PT 1 OR MORE VST	$58.35	$389.00	$36.06–$389.00	—	85%
Comprehensive eye exam, returning patient inpatient CPT 92014 HC OPHTH MEDICAL EXAM/EVAL CCOMPRE EST PT 1 OR MORE VST	$58.35	$389.00	$36.06–$389.00	—	85%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC COMPREHENSIVE HEARING TEST	$44.25	$295.00	$42.58–$295.00	84% below	85%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC COMPREHENSIVE HEARING TEST	$44.25	$295.00	$42.58–$295.00	84% below	85%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC COMPREHENSIVE HEARING TEST	$44.25	$295.00	$42.58–$295.00	—	85%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC COMPREHENSIVE HEARING TEST	$44.25	$295.00	$42.58–$295.00	—	85%
Critical care, first 30 to 74 minutes CPT 99291 HC FAC CRITICAL CARE 30 TO 74MIN	$699.60	$4,664.00	$50.00–$4,664.00	72% below	85%
Critical care, first 30 to 74 minutes CPT 99291 HC FAC CRITICAL CARE 30 TO 74MIN	$699.60	$4,664.00	$50.00–$4,664.00	72% below	85%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC FAC CRITICAL CARE 30 TO 74MIN	$699.60	$4,664.00	$50.00–$4,664.00	—	85%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC FAC CRITICAL CARE 30 TO 74MIN	$699.60	$4,664.00	$50.00–$4,664.00	—	85%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE & DROWSY	$205.50	$1,370.00	$71.39–$1,370.00	64% below	85%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE & DROWSY	$205.50	$1,370.00	$71.39–$1,370.00	64% below	85%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG AWAKE & DROWSY	$205.50	$1,370.00	$71.39–$1,370.00	—	85%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG AWAKE & DROWSY	$205.50	$1,370.00	$71.39–$1,370.00	—	85%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ELECTROCARDIOGRAM	$70.95	$473.00	$13.38–$473.00	66% below	85%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ELECTROCARDIOGRAM	$70.95	$473.00	$13.38–$473.00	66% below	85%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC ELECTROCARDIOGRAM	$70.95	$473.00	$13.38–$473.00	—	85%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC ELECTROCARDIOGRAM	$70.95	$473.00	$13.38–$473.00	—	85%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED FAC VISIT LEVEL 1	$68.40	$456.00	$50.00–$456.00	64% below	85%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED FAC VISIT LEVEL 1	$68.40	$456.00	$50.00–$456.00	64% below	85%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED FAC VISIT LEVEL 1	$68.40	$456.00	$50.00–$456.00	—	85%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED FAC VISIT LEVEL 1	$68.40	$456.00	$50.00–$456.00	—	85%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED FAC VISIT LEVEL 2	$94.35	$629.00	$50.00–$629.00	72% below	85%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED FAC VISIT LEVEL 2	$94.35	$629.00	$50.00–$629.00	72% below	85%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED FAC VISIT LEVEL 2	$94.35	$629.00	$50.00–$629.00	—	85%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED FAC VISIT LEVEL 2	$94.35	$629.00	$50.00–$629.00	—	85%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED FAC VISIT LEVEL 3	$204.75	$1,365.00	$50.00–$1,365.00	59% below	85%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED FAC VISIT LEVEL 3	$204.75	$1,365.00	$50.00–$1,365.00	59% below	85%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED FAC VISIT LEVEL 3	$204.75	$1,365.00	$50.00–$1,365.00	—	85%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED FAC VISIT LEVEL 3	$204.75	$1,365.00	$50.00–$1,365.00	—	85%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED FAC VISIT LEVEL 4	$300.30	$2,002.00	$50.00–$2,002.00	67% below	85%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED FAC VISIT LEVEL 4	$300.30	$2,002.00	$50.00–$2,002.00	67% below	85%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED FAC VISIT LEVEL 4	$300.30	$2,002.00	$50.00–$2,002.00	—	85%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED FAC VISIT LEVEL 4	$300.30	$2,002.00	$50.00–$2,002.00	—	85%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED FAC VISIT LEVEL 5	$456.15	$3,041.00	$50.00–$3,041.00	68% below	85%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED FAC VISIT LEVEL 5	$456.15	$3,041.00	$50.00–$3,041.00	68% below	85%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED FAC VISIT LEVEL 5	$456.15	$3,041.00	$50.00–$3,041.00	—	85%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED FAC VISIT LEVEL 5	$456.15	$3,041.00	$50.00–$3,041.00	—	85%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC STRESS TESTING TRACING ONLY	$223.95	$1,493.00	$71.73–$1,493.00	70% below	85%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC STRESS TESTING TRACING ONLY	$223.95	$1,493.00	$71.73–$1,493.00	70% below	85%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC STRESS TESTING TRACING ONLY	$223.95	$1,493.00	$71.73–$1,493.00	—	85%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC STRESS TESTING TRACING ONLY	$223.95	$1,493.00	$71.73–$1,493.00	—	85%
Eye exam, returning patient, intermediate CPT 92012 HC OPHTH MEDICAL EXAM/EVAL INTERMED EST PT	$58.35	$389.00	$36.06–$389.00	62% below	85%
Eye exam, returning patient, intermediate CPT 92012 HC OPHTH MEDICAL EXAM/EVAL INTERMED EST PT	$58.35	$389.00	$36.06–$389.00	62% below	85%
Eye exam, returning patient, intermediate inpatient CPT 92012 HC OPHTH MEDICAL EXAM/EVAL INTERMED EST PT	$58.35	$389.00	$36.06–$389.00	—	85%
Eye exam, returning patient, intermediate inpatient CPT 92012 HC OPHTH MEDICAL EXAM/EVAL INTERMED EST PT	$58.35	$389.00	$36.06–$389.00	—	85%
Family therapy with the patient, 50 minutes CPT 90847 HC FAMILY THERAPY W PT PRESENT 50 MIN	$81.45	$543.00	$63.62–$543.00	65% below	85%
Family therapy with the patient, 50 minutes CPT 90847 HC FAMILY THERAPY W PT PRESENT 50 MIN	$81.45	$543.00	$63.62–$543.00	65% below	85%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC FAMILY THERAPY W PT PRESENT 50 MIN	$81.45	$543.00	$63.62–$543.00	—	85%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC FAMILY THERAPY W PT PRESENT 50 MIN	$81.45	$543.00	$63.62–$543.00	—	85%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY THERAPY W/O PT PRESENT 50 MIN	$76.80	$512.00	$63.62–$512.00	68% below	85%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY THERAPY W/O PT PRESENT 50 MIN	$76.80	$512.00	$63.62–$512.00	68% below	85%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY THERAPY W/O PT PRESENT 50 MIN	$76.80	$512.00	$63.62–$512.00	—	85%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY THERAPY W/O PT PRESENT 50 MIN	$76.80	$512.00	$63.62–$512.00	—	85%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY	$49.65	$331.00	$26.52–$336.50	65% below	85%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY	$49.65	$331.00	$26.52–$336.50	65% below	85%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY	$49.65	$331.00	$26.52–$336.50	—	85%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY	$49.65	$331.00	$26.52–$336.50	—	85%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INF HYDRATION 31 MIN - 1 HR	$79.95	$533.00	$36.35–$533.00	76% below	85%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INF HYDRATION 31 MIN - 1 HR	$79.95	$533.00	$36.35–$533.00	76% below	85%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV INF HYDRATION 31 MIN - 1 HR	$79.95	$533.00	$36.35–$533.00	—	85%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV INF HYDRATION 31 MIN - 1 HR	$79.95	$533.00	$36.35–$533.00	—	85%
IV infusion of a medicine, first hour CPT 96365 HC IV INF TX/PROPH/DX UP TO 1HR	$92.55	$617.00	$61.37–$617.00	75% below	85%
IV infusion of a medicine, first hour CPT 96365 HC IV INF TX/PROPH/DX UP TO 1HR	$92.55	$617.00	$61.37–$617.00	75% below	85%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INF TX/PROPH/DX UP TO 1HR	$92.55	$617.00	$61.37–$617.00	—	85%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INF TX/PROPH/DX UP TO 1HR	$92.55	$617.00	$61.37–$617.00	—	85%
IV push of a medicine, first drug CPT 96374 HC IV PUSH TX/PROPH/DX INITIAL	$59.70	$398.00	$17.41–$452.42	78% below	85%
IV push of a medicine, first drug CPT 96374 HC IV PUSH TX/PROPH/DX INITIAL	$59.70	$398.00	$17.41–$452.42	78% below	85%
IV push of a medicine, first drug inpatient CPT 96374 HC IV PUSH TX/PROPH/DX INITIAL	$59.70	$398.00	$17.41–$452.42	—	85%
IV push of a medicine, first drug inpatient CPT 96374 HC IV PUSH TX/PROPH/DX INITIAL	$59.70	$398.00	$17.41–$452.42	—	85%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECT TX/PROPH/DX IM OR SUBQ	$31.95	$213.00	$17.41–$213.00	71% below	85%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECT TX/PROPH/DX IM OR SUBQ	$31.95	$213.00	$17.41–$213.00	71% below	85%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJECT TX/PROPH/DX IM OR SUBQ	$31.95	$213.00	$17.41–$213.00	—	85%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJECT TX/PROPH/DX IM OR SUBQ	$31.95	$213.00	$17.41–$213.00	—	85%
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSCULAR RE ED 15MIN	$32.25	$215.00	$30.10–$215.00	70% below	85%
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSCULAR RE ED 15MIN	$32.25	$215.00	$30.10–$215.00	70% below	85%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSCULAR RE ED 15MIN	$32.25	$215.00	$30.10–$215.00	—	85%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSCULAR RE ED 15MIN	$32.25	$215.00	$30.10–$215.00	—	85%
New patient office visit, about 30 minutes CPT 99203 HC NEW VISIT LEVEL 3	$39.15	$261.00	$47.56–$261.00	79% below	85%
New patient office visit, about 30 minutes CPT 99203 HC NEW VISIT LEVEL 3	$39.15	$261.00	$47.56–$261.00	79% below	85%
New patient office visit, about 30 minutes inpatient CPT 99203 HC NEW VISIT LEVEL 3	$39.15	$261.00	$47.56–$261.00	—	85%
New patient office visit, about 30 minutes inpatient CPT 99203 HC NEW VISIT LEVEL 3	$39.15	$261.00	$47.56–$261.00	—	85%
New patient office visit, about 45 minutes CPT 99204 HC NEW VISIT LEVEL 4	$51.00	$340.00	$65.21–$340.00	69% below	85%
New patient office visit, about 45 minutes CPT 99204 HC NEW VISIT LEVEL 4	$51.00	$340.00	$65.21–$340.00	69% below	85%
New patient office visit, about 45 minutes inpatient CPT 99204 HC NEW VISIT LEVEL 4	$51.00	$340.00	$65.21–$340.00	—	85%
New patient office visit, about 45 minutes inpatient CPT 99204 HC NEW VISIT LEVEL 4	$51.00	$340.00	$65.21–$340.00	—	85%
New patient office visit, about 60 minutes CPT 99205 HC NEW VISIT LEVEL 5	$65.55	$437.00	$88.26–$437.00	72% below	85%
New patient office visit, about 60 minutes CPT 99205 HC NEW VISIT LEVEL 5	$65.55	$437.00	$88.26–$437.00	72% below	85%
New patient office visit, about 60 minutes inpatient CPT 99205 HC NEW VISIT LEVEL 5	$65.55	$437.00	$88.26–$437.00	—	85%
New patient office visit, about 60 minutes inpatient CPT 99205 HC NEW VISIT LEVEL 5	$65.55	$437.00	$88.26–$437.00	—	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC NEW VISIT LEVEL 2	$27.75	$185.00	$36.06–$185.00	74% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC NEW VISIT LEVEL 2	$27.75	$185.00	$36.06–$185.00	74% below	85%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC NEW VISIT LEVEL 2	$27.75	$185.00	$36.06–$185.00	—	85%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC NEW VISIT LEVEL 2	$27.75	$185.00	$36.06–$185.00	—	85%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MED NUT THR INT IND 15 MIN	$15.75	$105.00	$15.83–$275.64	39% below	85%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MED NUT THR INT IND 15 MIN	$15.75	$105.00	$15.83–$275.64	39% below	85%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MED NUT THR INT IND 15 MIN	$15.75	$105.00	$15.83–$275.64	—	85%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MED NUT THR INT IND 15 MIN	$15.75	$105.00	$15.83–$275.64	—	85%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEX 30 MIN	$71.70	$478.00	$46.00–$478.00	66% below	85%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEX 30 MIN	$71.70	$478.00	$46.00–$478.00	66% below	85%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEX 30 MIN	$71.70	$478.00	$46.00–$478.00	—	85%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEX 30 MIN	$71.70	$478.00	$46.00–$478.00	—	85%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEX 45 MIN	$81.75	$545.00	$46.00–$545.00	67% below	85%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEX 45 MIN	$81.75	$545.00	$46.00–$545.00	67% below	85%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEX 45 MIN	$81.75	$545.00	$46.00–$545.00	—	85%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEX 45 MIN	$81.75	$545.00	$46.00–$545.00	—	85%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEX 20 MIN	$73.80	$492.00	$46.00–$492.00	66% below	85%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEX 20 MIN	$73.80	$492.00	$46.00–$492.00	66% below	85%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEX 20 MIN	$73.80	$492.00	$46.00–$492.00	—	85%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEX 20 MIN	$73.80	$492.00	$46.00–$492.00	—	85%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEX 30 MIN	$77.85	$519.00	$46.00–$519.00	66% below	85%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEX 30 MIN	$77.85	$519.00	$46.00–$519.00	66% below	85%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEX 30 MIN	$77.85	$519.00	$46.00–$519.00	—	85%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEX 30 MIN	$77.85	$519.00	$46.00–$519.00	—	85%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY 15MIN	$28.95	$193.00	$25.48–$193.00	67% below	85%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY 15MIN	$28.95	$193.00	$25.48–$193.00	67% below	85%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY 15MIN	$28.95	$193.00	$25.48–$193.00	—	85%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY 15MIN	$28.95	$193.00	$25.48–$193.00	—	85%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC PROC EA 15MIN	$30.90	$206.00	$26.72–$206.00	67% below	85%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC PROC EA 15MIN	$30.90	$206.00	$26.72–$206.00	67% below	85%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC PROC EA 15MIN	$30.90	$206.00	$26.72–$206.00	—	85%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC PROC EA 15MIN	$30.90	$206.00	$26.72–$206.00	—	85%
Preventive checkup, new patient aged 18–39 CPT 99385 HC WELLNESS - 18-39YRS	$70.35	$469.00	$47.66–$469.00	45% below	85%
Preventive checkup, new patient aged 18–39 CPT 99385 HC WELLNESS - 18-39YRS	$70.35	$469.00	$47.66–$469.00	45% below	85%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC WELLNESS - 18-39YRS	$70.35	$469.00	$47.66–$469.00	—	85%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC WELLNESS - 18-39YRS	$70.35	$469.00	$47.66–$469.00	—	85%
Preventive checkup, new patient aged 40–64 CPT 99386 HC WELLNESS - 40-64YRS	$73.20	$488.00	$57.70–$488.00	50% below	85%
Preventive checkup, new patient aged 40–64 CPT 99386 HC WELLNESS - 40-64YRS	$73.20	$488.00	$57.70–$488.00	50% below	85%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC WELLNESS - 40-64YRS	$73.20	$488.00	$57.70–$488.00	—	85%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC WELLNESS - 40-64YRS	$73.20	$488.00	$57.70–$488.00	—	85%
Preventive checkup, new patient aged 65 or older CPT 99387 HC WELLNESS - 65+YRS	$76.50	$510.00	$62.29–$510.00	58% below	85%
Preventive checkup, new patient aged 65 or older CPT 99387 HC WELLNESS - 65+YRS	$76.50	$510.00	$62.29–$510.00	58% below	85%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC WELLNESS - 65+YRS	$76.50	$510.00	$62.29–$510.00	—	85%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC WELLNESS - 65+YRS	$76.50	$510.00	$62.29–$510.00	—	85%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC WELLNESS EST 18-39 YRS	$61.80	$412.00	$43.06–$412.00	55% below	85%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC WELLNESS EST 18-39 YRS	$61.80	$412.00	$43.06–$412.00	55% below	85%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC WELLNESS EST 18-39 YRS	$61.80	$412.00	$43.06–$412.00	—	85%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC WELLNESS EST 18-39 YRS	$61.80	$412.00	$43.06–$412.00	—	85%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC WELLNESS EST 40-64 YRS	$64.95	$433.00	$46.97–$433.00	70% below	85%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC WELLNESS EST 40-64 YRS	$64.95	$433.00	$46.97–$433.00	70% below	85%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC WELLNESS EST 40-64 YRS	$64.95	$433.00	$46.97–$433.00	—	85%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC WELLNESS EST 40-64 YRS	$64.95	$433.00	$46.97–$433.00	—	85%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC WELLNESS EST 65+ YRS	$66.60	$444.00	$49.87–$444.00	38% below	85%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC WELLNESS EST 65+ YRS	$66.60	$444.00	$49.87–$444.00	38% below	85%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC WELLNESS EST 65+ YRS	$66.60	$444.00	$49.87–$444.00	—	85%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC WELLNESS EST 65+ YRS	$66.60	$444.00	$49.87–$444.00	—	85%
Psychotherapy session, 30 minutes CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN	$44.10	$294.00	$41.43–$377.53	71% below	85%
Psychotherapy session, 30 minutes CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN	$44.10	$294.00	$41.43–$377.53	71% below	85%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN	$44.10	$294.00	$41.43–$377.53	—	85%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN	$44.10	$294.00	$41.43–$377.53	—	85%
Psychotherapy session, 45 minutes CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN	$44.85	$299.00	$55.08–$377.53	78% below	85%
Psychotherapy session, 45 minutes CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN	$44.85	$299.00	$55.08–$377.53	78% below	85%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN	$44.85	$299.00	$55.08–$377.53	—	85%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN	$44.85	$299.00	$55.08–$377.53	—	85%
Psychotherapy session, 60 minutes CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN	$49.65	$331.00	$55.08–$377.53	80% below	85%
Psychotherapy session, 60 minutes CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN	$49.65	$331.00	$55.08–$377.53	80% below	85%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN	$49.65	$331.00	$55.08–$377.53	—	85%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN	$49.65	$331.00	$55.08–$377.53	—	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC VISIT LEVEL 5 EST	$46.20	$308.00	$65.21–$308.00	81% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC VISIT LEVEL 5 EST	$46.20	$308.00	$65.21–$308.00	81% below	85%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC VISIT LEVEL 5 EST	$46.20	$308.00	$65.21–$308.00	—	85%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC VISIT LEVEL 5 EST	$46.20	$308.00	$65.21–$308.00	—	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC VISIT LEVEL 3 EST	$36.30	$242.00	$36.06–$242.00	76% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC VISIT LEVEL 3 EST	$36.30	$242.00	$36.06–$242.00	76% below	85%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC VISIT LEVEL 3 EST	$36.30	$242.00	$36.06–$242.00	—	85%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC VISIT LEVEL 3 EST	$36.30	$242.00	$36.06–$242.00	—	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC VISIT LEVEL 4 EST	$41.70	$278.00	$47.56–$278.00	70% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC VISIT LEVEL 4 EST	$41.70	$278.00	$47.56–$278.00	70% below	85%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC VISIT LEVEL 4 EST	$41.70	$278.00	$47.56–$278.00	—	85%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC VISIT LEVEL 4 EST	$41.70	$278.00	$47.56–$278.00	—	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC VISIT LEVEL 2 EST	$22.35	$149.00	$30.65–$149.00	82% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC VISIT LEVEL 2 EST	$22.35	$149.00	$30.65–$149.00	82% below	85%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC VISIT LEVEL 2 EST	$22.35	$149.00	$30.65–$149.00	—	85%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC VISIT LEVEL 2 EST	$22.35	$149.00	$30.65–$149.00	—	85%
Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND PROD W/LANG COM	$185.85	$1,239.00	$46.00–$1,239.00	43% below	85%
Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND PROD W/LANG COM	$185.85	$1,239.00	$46.00–$1,239.00	43% below	85%
Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND PROD W/LANG COM	$185.85	$1,239.00	$46.00–$1,239.00	—	85%
Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND PROD W/LANG COM	$185.85	$1,239.00	$46.00–$1,239.00	—	85%
Speech therapy session, individual CPT 92507 HC SPEECH/LANGUAGE/COMM THERAPY	$77.40	$516.00	$46.00–$516.00	56% below	85%
Speech therapy session, individual CPT 92507 HC SPEECH/LANGUAGE/COMM THERAPY	$77.40	$516.00	$46.00–$516.00	56% below	85%
Speech therapy session, individual inpatient CPT 92507 HC SPEECH/LANGUAGE/COMM THERAPY	$77.40	$516.00	$46.00–$516.00	—	85%
Speech therapy session, individual inpatient CPT 92507 HC SPEECH/LANGUAGE/COMM THERAPY	$77.40	$516.00	$46.00–$516.00	—	85%
Spirometry (breathing test) CPT 94010 HC SPIROMETRY W GRAPHIC RECORD	$86.40	$576.00	$19.51–$576.00	67% below	85%
Spirometry (breathing test) CPT 94010 HC SPIROMETRY W GRAPHIC RECORD	$86.40	$576.00	$19.51–$576.00	67% below	85%
Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY W GRAPHIC RECORD	$86.40	$576.00	$19.51–$576.00	—	85%
Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY W GRAPHIC RECORD	$86.40	$576.00	$19.51–$576.00	—	85%
Spirometry before and after a bronchodilator CPT 94060 HC SPIROMETRY BRONCHOSPASM EVAL	$194.55	$1,297.00	$36.63–$1,297.00	53% below	85%
Spirometry before and after a bronchodilator CPT 94060 HC SPIROMETRY BRONCHOSPASM EVAL	$194.55	$1,297.00	$36.63–$1,297.00	53% below	85%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC SPIROMETRY BRONCHOSPASM EVAL	$194.55	$1,297.00	$36.63–$1,297.00	—	85%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC SPIROMETRY BRONCHOSPASM EVAL	$194.55	$1,297.00	$36.63–$1,297.00	—	85%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUTIC ACT 15MIN	$33.60	$224.00	$32.21–$224.00	67% below	85%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUTIC ACT 15MIN	$33.60	$224.00	$32.21–$224.00	67% below	85%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUTIC ACT 15MIN	$33.60	$224.00	$32.21–$224.00	—	85%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUTIC ACT 15MIN	$33.60	$224.00	$32.21–$224.00	—	85%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY THERAPEUTIC	$65.10	$434.00	$21.33–$434.00	74% below	85%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY THERAPEUTIC	$65.10	$434.00	$21.33–$434.00	74% below	85%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY THERAPEUTIC	$65.10	$434.00	$21.33–$434.00	—	85%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY THERAPEUTIC	$65.10	$434.00	$21.33–$434.00	—	85%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE INJ SUSP 1440 EL UNIT/ML	$136.12	$907.48	$33.36–$907.48	44% below	85%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE INJ SUSP 1440 EL UNIT/ML	$136.12	$907.48	$33.36–$907.48	44% below	85%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE INJ SUSP 1440 EL UNIT/ML	$136.12	$907.48	$33.36–$907.48	—	85%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE INJ SUSP 1440 EL UNIT/ML	$136.12	$907.48	$33.36–$907.48	—	85%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML	$57.08	$380.55	$29.86–$380.55	72% below	85%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML	$57.08	$380.55	$29.86–$380.55	72% below	85%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML	$57.08	$380.55	$29.86–$380.55	—	85%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML	$57.08	$380.55	$29.86–$380.55	—	85%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML	$55.58	$370.51	$12.11–$370.51	41% below	85%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML	$55.58	$370.51	$12.11–$370.51	41% below	85%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VACCINE (RECOMBINANT) SUSP 5 MCG/0.5MLHEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 5 MCG/0.5ML	$55.60	$370.69	$12.11–$370.69	41% below	85%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VACCINE (RECOMBINANT) SUSP 5 MCG/0.5MLHEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 5 MCG/0.5ML	$55.60	$370.69	$12.11–$370.69	41% below	85%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML	$55.58	$370.51	$12.11–$370.51	—	85%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML	$55.58	$370.51	$12.11–$370.51	—	85%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VACCINE (RECOMBINANT) SUSP 5 MCG/0.5MLHEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 5 MCG/0.5ML	$55.60	$370.69	$12.11–$370.69	—	85%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VACCINE (RECOMBINANT) SUSP 5 MCG/0.5MLHEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 5 MCG/0.5ML	$55.60	$370.69	$12.11–$370.69	—	85%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN	$159.55	$1,063.65	$33.36–$1,063.65	53% below	85%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN	$159.55	$1,063.65	$33.36–$1,063.65	53% below	85%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN	$159.55	$1,063.65	$33.36–$1,063.65	—	85%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN	$159.55	$1,063.65	$33.36–$1,063.65	—	85%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE INJ	$326.57	$2,177.13	$64.64–$2,177.13	at median	85%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE INJ	$326.57	$2,177.13	$64.64–$2,177.13	at median	85%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE INJ	$326.57	$2,177.13	$64.64–$2,177.13	—	85%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE INJ	$326.57	$2,177.13	$64.64–$2,177.13	—	85%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML	$359.12	$2,394.13	$132.37–$2,394.13	9% above	85%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML	$359.12	$2,394.13	$132.37–$2,394.13	9% above	85%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML	$359.12	$2,394.13	$132.37–$2,394.13	—	85%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML	$359.12	$2,394.13	$132.37–$2,394.13	—	85%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 PCV21 VACCINE IM	$415.01	$2,766.72	$161.07–$2,766.72	29% below	85%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 PCV21 VACCINE IM	$415.01	$2,766.72	$161.07–$2,766.72	29% below	85%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 PCV21 VACCINE IM	$415.01	$2,766.72	$161.07–$2,766.72	—	85%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 PCV21 VACCINE IM	$415.01	$2,766.72	$161.07–$2,766.72	—	85%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE PCEC FOR INJ	$546.67	$3,644.47	$53.19–$3,644.47	42% below	85%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE PCEC FOR INJ	$546.67	$3,644.47	$53.19–$3,644.47	42% below	85%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM	$584.36	$3,895.71	$53.19–$3,895.71	38% below	85%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM	$584.36	$3,895.71	$53.19–$3,895.71	38% below	85%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE PCEC FOR INJ	$546.67	$3,644.47	$53.19–$3,644.47	—	85%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE PCEC FOR INJ	$546.67	$3,644.47	$53.19–$3,644.47	—	85%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM	$584.36	$3,895.71	$53.19–$3,895.71	—	85%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM	$584.36	$3,895.71	$53.19–$3,895.71	—	85%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 2-2 LF/0.5ML	$57.34	$382.25	$21.50–$382.25	56% below	85%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 2-2 LF/0.5ML	$57.34	$382.25	$21.50–$382.25	56% below	85%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACC NO PRESV 7 YRS+ IM	$67.32	$448.79	$21.50–$448.79	48% below	85%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACC NO PRESV 7 YRS+ IM	$67.32	$448.79	$21.50–$448.79	48% below	85%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 2-2 LF/0.5ML	$57.34	$382.25	$21.50–$382.25	—	85%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 2-2 LF/0.5ML	$57.34	$382.25	$21.50–$382.25	—	85%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACC NO PRESV 7 YRS+ IM	$67.32	$448.79	$21.50–$448.79	—	85%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACC NO PRESV 7 YRS+ IM	$67.32	$448.79	$21.50–$448.79	—	85%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2.5-18.5 LF-LF-MCG/0.5MLTET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML	$79.54	$530.25	$33.36–$530.25	27% below	85%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2.5-18.5 LF-LF-MCG/0.5MLTET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML	$79.54	$530.25	$33.36–$530.25	27% below	85%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2.5-18.5 LF-LF-MCG/0.5MLTET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML	$79.54	$530.25	$33.36–$530.25	—	85%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2.5-18.5 LF-LF-MCG/0.5MLTET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML	$79.54	$530.25	$33.36–$530.25	—	85%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMIN 1 VACCINE	$25.50	$170.00	$17.41–$170.00	55% below	85%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMIN 1 VACCINE	$25.50	$170.00	$17.41–$170.00	55% below	85%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMIN 1 VACCINE	$25.50	$170.00	$17.41–$170.00	—	85%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMIN 1 VACCINE	$25.50	$170.00	$17.41–$170.00	—	85%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMIN EACH ADDL	$14.70	$98.00	$12.41–$98.00	64% below	85%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMIN EACH ADDL	$14.70	$98.00	$12.41–$98.00	64% below	85%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADMIN EACH ADDL	$14.70	$98.00	$12.41–$98.00	—	85%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADMIN EACH ADDL	$14.70	$98.00	$12.41–$98.00	—	85%

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.balladhealth.org/sites/default/files/2026-03/621636465_lonesome-pine-hospital_standardcharges.zip