Hospital Astoria, OR

Providence Seaside Hospital

Listed in its price file as “Providence Health and Services - Oregon”.

Providence Seaside Hospital in Seaside, OR publishes cash prices for 471 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Oregon median for 299 of 466 procedures and above it for 151. By typical cash price it ranks #14 of 49 Oregon hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

725 S Wahanna Rd, Seaside, OR 97138 Collected Sep 23, 2026 Source price file Check a bill from this hospital (503) 717-7000

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CMS star rating 3 of 5 CCN 381303 · CMS hospital register NPI 1578500492

Financial assistance

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

Providence Seaside 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.

State law

This state limits hospital bills for lower-income patients

Oregon law (ORS 442.614) requires nonprofit hospitals to cut what patients owe for medically necessary care by 100% for household income up to 200% of the federal poverty level, and by at least 75%, 50% or 25% up to 400%. Ask the hospital for its financial assistance application. Other states' laws.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Oregon	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN W & W/O CONTRAST	$2,292.75	$3,057.00	—	31% above	25%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN W & W/O CONTRAST	$2,292.75	$3,057.00	—	—	25%
Abdominal X-ray, 2 views CPT 74019 HC XR ABDOMEN 2 VIEWS	$178.50	$238.00	—	39% below	25%
Abdominal X-ray, 2 views inpatient CPT 74019 HC XR ABDOMEN 2 VIEWS	$178.50	$238.00	—	—	25%
Ankle X-ray, complete, 3 or more views CPT 73610 HC XR ANKLE COMPLETE MIN 3 VIEWS	$250.50	$334.00	—	11% below	25%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC XR ANKLE COMPLETE MIN 3 VIEWS	$250.50	$334.00	—	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC PR 93922 ABI BILAT LTD W DOPP	$235.50	$314.00	—	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC PR 93922 ABI BILAT LTD W DOPP	$235.50	$314.00	—	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$309.00	$412.00	—	41% below	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC PR 93922 ABI BILAT LTD W DOPP	$235.50	$314.00	—	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$309.00	$412.00	—	—	25%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY WO CONTRAST	$1,668.75	$2,225.00	—	49% above	25%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREMITY WO CONTRAST	$1,668.75	$2,225.00	—	—	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC XR ESOPHAGUS W CONTRAST	$525.00	$700.00	—	6% below	25%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC XR ESOPHAGUS W CONTRAST	$525.00	$700.00	—	—	25%
Breast ultrasound, complete, one breast CPT 76641 HC US BREAST UNI COMPLETE	$226.50	$302.00	—	37% below	25%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST UNI COMPLETE	$226.50	$302.00	—	—	25%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST UNI LIMITED	$226.50	$302.00	—	25% below	25%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US ED BREAST UNI LIMITED CDM	$226.50	$302.00	—	25% below	25%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US ED BREAST UNI LIMITED CDM	$226.50	$302.00	—	—	25%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST UNI LIMITED	$226.50	$302.00	—	—	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CTA ABDOMEN PELVIS	$3,261.00	$4,348.00	—	31% above	25%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CTA ABDOMEN PELVIS	$3,261.00	$4,348.00	—	—	25%
CT angiography (CTA) of the head CPT 70496 HC CT ANGIOGRAPHY HEAD W CONTRAST	$1,792.50	$2,390.00	—	8% below	25%
CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIOGRAPHY HEAD W CONTRAST	$1,792.50	$2,390.00	—	—	25%
CT angiography (CTA) of the neck CPT 70498 HC CT ANGIOGRAPHY NECK W CONTRAST	$1,691.25	$2,255.00	—	12% below	25%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIOGRAPHY NECK W CONTRAST	$1,691.25	$2,255.00	—	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIOGRAPHY CHEST	$1,412.25	$1,883.00	—	23% below	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIOGRAPHY CHEST	$1,412.25	$1,883.00	—	—	25%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST	$64.50	$86.00	—	44% below	25%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST	$64.50	$86.00	—	—	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD & PELVIS WO CONTRAST	$1,384.50	$1,846.00	—	34% below	25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD & PELVIS WO CONTRAST	$1,384.50	$1,846.00	—	—	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST	$1,896.75	$2,529.00	—	26% below	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST	$1,896.75	$2,529.00	—	—	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN & PELVIS W & W/O CONTRAST	$2,491.50	$3,322.00	—	18% below	25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABDOMEN & PELVIS W & W/O CONTRAST	$2,491.50	$3,322.00	—	—	25%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST	$1,878.75	$2,505.00	—	27% above	25%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W CONTRAST	$1,878.75	$2,505.00	—	—	25%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CONTRAST	$1,810.50	$2,414.00	—	60% above	25%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN WO CONTRAST	$1,810.50	$2,414.00	—	—	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST	$1,536.75	$2,049.00	—	42% above	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST	$1,536.75	$2,049.00	—	—	25%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN WO CONTRAST	$779.25	$1,039.00	—	23% below	25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN WO CONTRAST	$779.25	$1,039.00	—	—	25%
CT scan of the head with contrast CPT 70460 HC CT HEAD/BRAIN W CONTRAST	$1,622.25	$2,163.00	—	24% above	25%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD/BRAIN W CONTRAST	$1,622.25	$2,163.00	—	—	25%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD/BRAIN W & W/O CONTRAST	$1,878.75	$2,505.00	—	20% above	25%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD/BRAIN W & W/O CONTRAST	$1,878.75	$2,505.00	—	—	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONTRAST	$2,008.50	$2,678.00	—	55% above	25%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE WO CONTRAST	$2,008.50	$2,678.00	—	—	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT NECK SPINE WO CONTRAST	$1,819.50	$2,426.00	—	49% above	25%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT NECK SPINE WO CONTRAST	$1,819.50	$2,426.00	—	—	25%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST	$1,275.75	$1,701.00	—	14% below	25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST	$1,275.75	$1,701.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC PR 93880 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY RHC	$539.25	$719.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC PR 93880 DUPLEX EXTRACRANIAL STUDY BILAT	$539.25	$719.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$846.00	$1,128.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC PR 93880 DUPLEX EXTRACRANIAL STUDY BILAT	$539.25	$719.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$846.00	$1,128.00	—	—	25%
Chest CT scan without and with contrast CPT 71270 HC CT THORAX W & W/O CONTRAST	$2,482.50	$3,310.00	—	33% above	25%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT THORAX W & W/O CONTRAST	$2,482.50	$3,310.00	—	—	25%
Chest X-ray, 2 views CPT 71046 HC XR CHEST 2 VIEWS	$198.75	$265.00	—	26% below	25%
Chest X-ray, 2 views inpatient CPT 71046 HC XR CHEST 2 VIEWS	$198.75	$265.00	—	—	25%
Chest X-ray, single view CPT 71045 HC XR CHEST PORTABLE 1 VIEW	$159.75	$213.00	—	37% below	25%
Chest X-ray, single view CPT 71045 HC XR CHEST 1 VIEW	$159.75	$213.00	—	37% below	25%
Chest X-ray, single view inpatient CPT 71045 HC XR CHEST PORTABLE 1 VIEW	$159.75	$213.00	—	—	25%
Chest X-ray, single view inpatient CPT 71045 HC XR CHEST 1 VIEW	$159.75	$213.00	—	—	25%
Collarbone (clavicle) X-ray, complete CPT 73000 HC XR CLAVICLE COMPLETE	$228.00	$304.00	—	6% above	25%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC XR CLAVICLE COMPLETE	$228.00	$304.00	—	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE	$522.75	$697.00	—	8% below	25%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE	$522.75	$697.00	—	—	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC XR DXA BONE DENSITY STUDY AXIAL	$342.75	$457.00	—	11% below	25%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC XR DXA BONE DENSITY STUDY AXIAL	$342.75	$457.00	—	—	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC BONE DENSITY PERIPHERAL SKELETON	$69.75	$93.00	—	71% below	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC BONE DENSITY PERIPHERAL SKELETON	$69.75	$93.00	—	—	25%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC PR 76811 US OB DETAILED SINGLE FETUS	$510.75	$681.00	—	19% below	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX W/O DYE F/U LUNG SCREENING	$1,921.50	$2,562.00	—	57% above	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX WO CONTRAST	$1,921.50	$2,562.00	—	57% above	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX W/O DYE F/U LUNG SCREENING	$1,921.50	$2,562.00	—	—	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX WO CONTRAST	$1,921.50	$2,562.00	—	—	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W CONTRAST	$1,991.25	$2,655.00	—	30% above	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX W CONTRAST	$1,991.25	$2,655.00	—	—	25%
Diagnostic mammogram, both breasts CPT 77066 HC MAMMO DIAG BIL W CAD	$380.25	$507.00	—	11% below	25%
Diagnostic mammogram, both breasts inpatient CPT 77066 HC MAMMO DIAG BIL W CAD	$380.25	$507.00	—	—	25%
Diagnostic mammogram, one breast CPT 77065 HC MAMMO DIAG UNI W CAD	$312.75	$417.00	—	at median	25%
Diagnostic mammogram, one breast inpatient CPT 77065 HC MAMMO DIAG UNI W CAD	$312.75	$417.00	—	—	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$741.00	$988.00	—	—	25%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$741.00	$988.00	—	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY	$958.50	$1,278.00	—	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY	$958.50	$1,278.00	—	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC PR 93306 ECHO TTE 2D W/COLOR & DOP	$558.00	$744.00	—	67% below	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC PR 93306 ECHO TTE 2D W/COLOR & DOP RHC	$558.00	$744.00	—	67% below	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO TTE 2D W DOPPLER COMPLETE	$1,512.75	$2,017.00	—	11% below	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC PR 93306 ECHO TTE 2D W/COLOR & DOP	$558.00	$744.00	—	—	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO TTE 2D W DOPPLER COMPLETE	$1,512.75	$2,017.00	—	—	25%
Elbow X-ray, 2 views CPT 73070 HC XR ELBOW 2 VIEWS	$218.25	$291.00	—	10% below	25%
Elbow X-ray, 2 views CPT 73070 HC XR ELBOW LIMITED	$218.25	$291.00	—	10% below	25%
Elbow X-ray, 2 views inpatient CPT 73070 HC XR ELBOW 2 VIEWS	$218.25	$291.00	—	—	25%
Elbow X-ray, 2 views inpatient CPT 73070 HC XR ELBOW LIMITED	$218.25	$291.00	—	—	25%
Elbow X-ray, complete, 3 or more views CPT 73080 HC XR ELBOW COMPLETE MIN 3 VIEWS	$228.00	$304.00	—	6% below	25%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC XR ELBOW COMPLETE MIN 3 VIEWS	$228.00	$304.00	—	—	25%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT/EAR/FOSSA WO CONTRAST	$837.75	$1,117.00	—	22% below	25%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT/EAR/FOSSA WO CONTRAST	$837.75	$1,117.00	—	—	25%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC XR FACIAL BONES MIN 3 VIEWS	$267.00	$356.00	—	23% below	25%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC XR FACIAL BONES MIN 3 VIEWS	$267.00	$356.00	—	—	25%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC XR FOREARM 1 VIEW	$223.50	$298.00	—	15% below	25%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC XR FOREARM 2 VIEWS	$223.50	$298.00	—	15% below	25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC XR FOREARM 1 VIEW	$223.50	$298.00	—	—	25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC XR FOREARM 2 VIEWS	$223.50	$298.00	—	—	25%
Hand X-ray, 2 views CPT 73120 HC XR HAND 1 VIEW	$213.75	$285.00	—	13% below	25%
Hand X-ray, 2 views CPT 73120 HC XR HAND 2 VIEWS	$213.75	$285.00	—	13% below	25%
Hand X-ray, 2 views inpatient CPT 73120 HC XR HAND 2 VIEWS	$213.75	$285.00	—	—	25%
Hand X-ray, 2 views inpatient CPT 73120 HC XR HAND 1 VIEW	$213.75	$285.00	—	—	25%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC XR HEEL MIN 2 VIEWS	$205.50	$274.00	—	at median	25%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC XR HEEL MIN 2 VIEWS	$205.50	$274.00	—	—	25%
Knee X-ray, 3 views CPT 73562 HC XR KNEE 3 VIEWS	$275.25	$367.00	—	3% below	25%
Knee X-ray, 3 views inpatient CPT 73562 HC XR KNEE 3 VIEWS	$275.25	$367.00	—	—	25%
Knee X-ray, complete, 4 or more views CPT 73564 HC XR KNEE 4/PLUS VIEWS	$317.25	$423.00	—	11% below	25%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC XR KNEE 4/PLUS VIEWS	$317.25	$423.00	—	—	25%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST	$1,654.50	$2,206.00	—	48% above	25%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST	$1,654.50	$2,206.00	—	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ED ABDOMEN LIMITED CDM	$455.25	$607.00	—	7% below	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED	$455.25	$607.00	—	7% below	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMEN LIMITED	$455.25	$607.00	—	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ED ABDOMEN LIMITED CDM	$455.25	$607.00	—	—	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US ED LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM	$235.50	$314.00	—	22% below	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM	$235.50	$314.00	—	22% below	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US ED LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM	$235.50	$314.00	—	—	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM	$235.50	$314.00	—	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM	$231.00	$308.00	—	22% below	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM	$231.00	$308.00	—	—	25%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC XR LOWER LEG 2 VIEWS	$229.50	$306.00	—	8% below	25%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC XR LOWER LEG 2 VIEWS	$229.50	$306.00	—	—	25%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD WO CONTRAST	$1,093.50	$1,458.00	—	42% below	25%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA HEAD WO CONTRAST	$1,093.50	$1,458.00	—	—	25%
MRI of both breasts, without and then with contrast dye CPT 77049 HC MRI BREAST W/O & W/ CONTRAST W/ CAD BIL	$2,483.25	$3,311.00	—	9% above	25%
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 HC MRI BREAST W/O & W/ CONTRAST W/ CAD BIL	$2,483.25	$3,311.00	—	—	25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST	$1,309.50	$1,746.00	—	26% below	25%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST	$1,309.50	$1,746.00	—	—	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST	$1,752.00	$2,336.00	—	34% below	25%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST	$1,752.00	$2,336.00	—	—	25%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN WO CONTRAST	$1,651.50	$2,202.00	—	10% below	25%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN W/O DYE LIMITED	$1,651.50	$2,202.00	—	10% below	25%
MRI of the abdomen without contrast CPT 74181 HC MRI MRCP ABDOMEN WO CONTRAST	$1,651.50	$2,202.00	—	10% below	25%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN WO CONTRAST	$1,651.50	$2,202.00	—	—	25%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN W/O DYE LIMITED	$1,651.50	$2,202.00	—	—	25%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI MRCP ABDOMEN WO CONTRAST	$1,651.50	$2,202.00	—	—	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN WO & W CONTRAST	$3,004.50	$4,006.00	—	2% above	25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN WO & W CONTRAST	$3,004.50	$4,006.00	—	—	25%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN W/O DYE LIMITED	$1,681.50	$2,242.00	—	9% below	25%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN STEM W/O DYE	$1,681.50	$2,242.00	—	9% below	25%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN STEM W/O DYE	$1,681.50	$2,242.00	—	—	25%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN W/O DYE LIMITED	$1,681.50	$2,242.00	—	—	25%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/O & W/DYE	$2,318.25	$3,091.00	—	25% below	25%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W/O & W/DYE	$2,318.25	$3,091.00	—	—	25%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O DYE LIMITED	$1,615.50	$2,154.00	—	14% below	25%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O DYE	$1,615.50	$2,154.00	—	14% below	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O DYE LIMITED	$1,615.50	$2,154.00	—	—	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O DYE	$1,615.50	$2,154.00	—	—	25%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE	$3,063.00	$4,084.00	—	3% above	25%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE	$3,063.00	$4,084.00	—	—	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O DYE	$1,974.75	$2,633.00	—	6% above	25%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THORACIC SPINE W/O DYE	$1,974.75	$2,633.00	—	—	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE	$2,920.50	$3,894.00	—	2% above	25%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE	$2,920.50	$3,894.00	—	—	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O DYE	$1,808.25	$2,411.00	—	1% above	25%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O DYE	$1,808.25	$2,411.00	—	—	25%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WO & W CONTRAST	$2,804.25	$3,739.00	—	2% above	25%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS WO & W CONTRAST	$2,804.25	$3,739.00	—	—	25%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST	$1,651.50	$2,202.00	—	8% below	25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS WO CONTRAST	$1,651.50	$2,202.00	—	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXTREMITY JOINT WO CONTRAST	$1,444.50	$1,926.00	—	19% below	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPER EXTREMITY JOINT WO CONTRAST	$1,444.50	$1,926.00	—	—	25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC XR SPINE CERVICAL 4 OR 5 VIEWS	$383.25	$511.00	—	2% above	25%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC XR SPINE CERVICAL 4 OR 5 VIEWS	$383.25	$511.00	—	—	25%
Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST	$1,566.75	$2,089.00	—	6% above	25%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST	$1,566.75	$2,089.00	—	—	25%
Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST	$1,509.00	$2,012.00	—	36% above	25%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST	$1,509.00	$2,012.00	—	—	25%
Neck soft tissue X-ray CPT 70360 HC XR NECK SOFT TISSUE	$186.00	$248.00	—	26% below	25%
Neck soft tissue X-ray inpatient CPT 70360 HC XR NECK SOFT TISSUE	$186.00	$248.00	—	—	25%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CONTRAST	$896.25	$1,195.00	—	25% below	25%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS WO CONTRAST	$896.25	$1,195.00	—	—	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC PR 76857 US EXAM PELVIC LIMITED	$144.00	$192.00	—	56% below	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US ED EXAM PELVIC LIMITED CDM	$389.25	$519.00	—	20% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC LIMITED	$389.25	$519.00	—	20% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US EXAM PELVIC LIMITED	$389.25	$519.00	—	—	25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US ED EXAM PELVIC LIMITED CDM	$389.25	$519.00	—	—	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIC NON-OB COMPLETE	$524.25	$699.00	—	at median	25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIC NON-OB COMPLETE	$524.25	$699.00	—	—	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC PR 76805 US OB AFTER 1ST TRIMEST 1/1ST FETUS	$386.25	$515.00	—	26% below	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS	$476.25	$635.00	—	8% below	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS	$476.25	$635.00	—	—	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC PR 76801 US OB/LESS THAN 14 WKS/SINGLE FETUS OR 1ST GEST	$335.25	$447.00	—	28% below	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby one side CPT 76801 HC US OB LT 14 WKS SINGLE FETUS CDM	$519.00	$692.00	—	11% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient one side CPT 76801 HC US OB LT 14 WKS SINGLE FETUS CDM	$519.00	$692.00	—	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC PR 76815 US OB LIMITED FETUS(S)	$232.50	$310.00	—	35% below	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US OB LIMITED FETUS(S) CDM	$292.50	$390.00	—	18% below	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US ED OB LIMITED FETUS(S) CDM	$292.50	$390.00	—	18% below	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US ED OB LIMITED FETUS(S) CDM	$292.50	$390.00	—	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US OB LIMITED FETUS(S) CDM	$292.50	$390.00	—	—	25%
Rib X-ray, one side, 2 views CPT 71100 HC XR RIBS UNI 2 VIEWS	$202.50	$270.00	—	23% below	25%
Rib X-ray, one side, 2 views inpatient CPT 71100 HC XR RIBS UNI 2 VIEWS	$202.50	$270.00	—	—	25%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC XR RIBS/CHEST UNI MIN 3 VIEWS	$342.75	$457.00	—	6% above	25%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC XR RIBS/CHEST UNI MIN 3 VIEWS	$342.75	$457.00	—	—	25%
Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN BIL W CAD	$264.75	$353.00	—	20% below	25%
Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD	$264.75	$353.00	—	20% below	25%
Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD	$264.75	$353.00	—	—	25%
Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN BIL W CAD	$264.75	$353.00	—	—	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC XR SHOULDER COMPLETE MIN 2 VIEWS	$352.50	$470.00	—	26% above	25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC XR SHOULDER COMPLETE MIN 2 VIEWS	$352.50	$470.00	—	—	25%
Sinus X-ray, complete, 3 or more views CPT 70220 HC XR SINUSES PARANASAL MIN 3 VIEWS	$307.50	$410.00	—	7% above	25%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC XR SINUSES PARANASAL MIN 3 VIEWS	$307.50	$410.00	—	—	25%
Skull X-ray, fewer than 4 views CPT 70250 HC XR SKULL 1-3 VIEWS	$97.50	$130.00	—	65% below	25%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC XR SKULL 1-3 VIEWS	$97.50	$130.00	—	—	25%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAPHY 4 OR MORE	$2,148.00	$2,864.00	—	31% below	25%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAPHY 4 OR MORE	$2,148.00	$2,864.00	—	—	25%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC PR 93351 ECHO STRESS W/INTERP REPT & MONITOR	$660.75	$881.00	—	63% below	25%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC PR 93351 ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG RHC	$660.75	$881.00	—	63% below	25%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC ECHO STRESS W/INTERP REPT & MONITOR	$1,557.75	$2,077.00	—	13% below	25%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC PR 93351 ECHO STRESS W/INTERP REPT & MONITOR	$660.75	$881.00	—	—	25%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC ECHO STRESS W/INTERP REPT & MONITOR	$1,557.75	$2,077.00	—	—	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$256.50	$342.00	—	52% below	25%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$256.50	$342.00	—	—	25%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC XR FEMUR MIN 2 VIEWS	$156.75	$209.00	—	38% below	25%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC XR FEMUR MIN 2 VIEWS	$156.75	$209.00	—	—	25%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT CHEST SPINE WO CONTRAST	$2,102.25	$2,803.00	—	73% above	25%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT CHEST SPINE WO CONTRAST	$2,102.25	$2,803.00	—	—	25%
Toe X-ray, 2 or more views CPT 73660 HC XR TOE(S) MIN 2 VIEWS	$171.00	$228.00	—	15% below	25%
Toe X-ray, 2 or more views inpatient CPT 73660 HC XR TOE(S) MIN 2 VIEWS	$171.00	$228.00	—	—	25%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON-OB	$256.50	$342.00	—	45% below	25%
Transvaginal pelvic ultrasound CPT 76830 HC PR 76830 US TRANSVAGINAL NON-OB	$339.00	$452.00	—	27% below	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON-OB	$256.50	$342.00	—	—	25%
Transvaginal ultrasound during pregnancy CPT 76817 HC US OB TRANSVAGINAL CDM	$216.00	$288.00	—	41% below	25%
Transvaginal ultrasound during pregnancy CPT 76817 HC PR 76817 US OB TRANSVAGINAL	$264.00	$352.00	—	28% below	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US OB TRANSVAGINAL CDM	$216.00	$288.00	—	—	25%
Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE	$471.00	$628.00	—	22% below	25%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US EXAM ABDOMEN COMPLETE	$471.00	$628.00	—	—	25%
Ultrasound of the scrotum and testicles CPT 76870 HC US EXAM SCROTUM & CONTENTS	$366.75	$489.00	—	31% below	25%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US EXAM SCROTUM & CONTENTS	$366.75	$489.00	—	—	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US EXAM OF HEAD AND NECK	$365.25	$487.00	—	25% below	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US ED EXAM OF HEAD AND NECK CDM	$365.25	$487.00	—	25% below	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC PR ED 76536 HEAD AND NECK SOFT TISSUES CDM	$417.75	$557.00	—	15% below	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US ED EXAM OF HEAD AND NECK CDM	$365.25	$487.00	—	—	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US EXAM OF HEAD AND NECK	$365.25	$487.00	—	—	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC XR RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY CDM	$488.25	$651.00	—	15% below	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC XR RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY CDM	$488.25	$651.00	—	—	25%
Upper arm X-ray (humerus), 2 views CPT 73060 HC XR HUMERUS 1 VIEW	$235.50	$314.00	—	10% below	25%
Upper arm X-ray (humerus), 2 views CPT 73060 HC XR HUMERUS MIN 2 VIEWS	$235.50	$314.00	—	10% below	25%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XR HUMERUS 1 VIEW	$235.50	$314.00	—	—	25%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XR HUMERUS MIN 2 VIEWS	$235.50	$314.00	—	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$637.50	$850.00	—	1% below	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$637.50	$850.00	—	—	25%
Wrist X-ray, 2 views CPT 73100 HC XR WRIST 2 VIEWS	$195.00	$260.00	—	14% below	25%
Wrist X-ray, 2 views CPT 73100 HC XR WRIST 1 VIEW	$195.00	$260.00	—	14% below	25%
Wrist X-ray, 2 views inpatient CPT 73100 HC XR WRIST 1 VIEW	$195.00	$260.00	—	—	25%
Wrist X-ray, 2 views inpatient CPT 73100 HC XR WRIST 2 VIEWS	$195.00	$260.00	—	—	25%
Wrist X-ray, complete, 3 or more views CPT 73110 HC XR WRIST COMPLETE MIN 3 VIEWS	$237.75	$317.00	—	15% below	25%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC XR WRIST COMPLETE MIN 3 VIEWS	$237.75	$317.00	—	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC XR HIPS UNI W PELVIS WHEN PERFORMED 2-3 VIEWS	$156.75	$209.00	—	42% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC XR HIPS UNI W PELVIS WHEN PERFORMED 2-3 VIEWS	$156.75	$209.00	—	—	25%
X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN PORTABLE 1 VIEW	$173.25	$231.00	—	31% below	25%
X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN 1 VIEW	$173.25	$231.00	—	31% below	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN PORTABLE 1 VIEW	$173.25	$231.00	—	—	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN 1 VIEW	$173.25	$231.00	—	—	25%
X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 2 VIEWS	$202.50	$270.00	—	20% below	25%
X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 1 VIEW	$202.50	$270.00	—	20% below	25%
X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 2 VIEWS	$202.50	$270.00	—	—	25%
X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 1 VIEW	$202.50	$270.00	—	—	25%
X-ray of the finger(s), 2 or more views CPT 73140 HC XR FINGERS(S) MIN 2 VIEWS	$192.00	$256.00	—	15% below	25%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XR FINGERS(S) MIN 2 VIEWS	$192.00	$256.00	—	—	25%
X-ray of the foot, 2 views CPT 73620 HC XR FOOT 1 VIEW	$190.50	$254.00	—	15% below	25%
X-ray of the foot, 2 views CPT 73620 HC XR FOOT 2 VIEWS	$190.50	$254.00	—	15% below	25%
X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 1 VIEW	$190.50	$254.00	—	—	25%
X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 2 VIEWS	$190.50	$254.00	—	—	25%
X-ray of the foot, complete, 3 or more views CPT 73630 HC XR FOOT MIN 3 VIEWS	$245.25	$327.00	—	9% below	25%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC XR FOOT MIN 3 VIEWS	$245.25	$327.00	—	—	25%
X-ray of the hand, 3 or more views CPT 73130 HC XR HAND MIN 3 VIEWS	$247.50	$330.00	—	20% below	25%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC XR HAND MIN 3 VIEWS	$247.50	$330.00	—	—	25%
X-ray of the knee, 1 or 2 views CPT 73560 HC XR KNEE 1-2 VIEWS	$162.00	$216.00	—	34% below	25%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC XR KNEE 1-2 VIEWS	$162.00	$216.00	—	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS	$196.50	$262.00	—	39% below	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS	$196.50	$262.00	—	—	25%
X-ray of the lower back, 4 or more views CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS	$261.00	$348.00	—	35% below	25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS	$261.00	$348.00	—	—	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC XR SPINE THORACIC 2 VIEWS	$276.75	$369.00	—	8% below	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC XR SPINE THORACIC 2 VIEWS	$276.75	$369.00	—	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 HC XR NASAL BONES MIN 3 VIEWS	$252.75	$337.00	—	12% above	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC XR NASAL BONES MIN 3 VIEWS	$252.75	$337.00	—	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC XR SPINE CERVICAL 2 OR 3 VIEWS	$222.75	$297.00	—	14% below	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC XR SPINE CERVICAL 2 OR 3 VIEWS	$222.75	$297.00	—	—	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC XR PELVIS 1-2 VIEWS NO HIP VIEWS	$111.00	$148.00	—	60% below	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC XR PELVIS 1-2 VIEWS NO HIP VIEWS	$111.00	$148.00	—	—	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XR TAILBONE MIN 2 VIEWS	$228.00	$304.00	—	9% below	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC XR TAILBONE MIN 2 VIEWS	$228.00	$304.00	—	—	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Oregon	Off list
ACTH blood test CPT 82024 HC ACTH (ARUP)	$25.50	$34.00	—	80% below	25%
ACTH blood test CPT 82024 HC ADRENOCORTICOTROPIC HORMONE ACTH CDM	$25.50	$34.00	—	80% below	25%
ACTH blood test inpatient CPT 82024 HC ACTH (ARUP)	$25.50	$34.00	—	—	25%
ACTH blood test inpatient CPT 82024 HC ADRENOCORTICOTROPIC HORMONE ACTH CDM	$25.50	$34.00	—	—	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALANINE AMINO (ALT) (SGPT)	$29.25	$39.00	—	22% above	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC SGPT (ALT)	$29.25	$39.00	—	22% above	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC SGPT / ALT	$29.25	$39.00	—	22% above	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC SGPT / ALT	$29.25	$39.00	—	—	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC SGPT (ALT)	$29.25	$39.00	—	—	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC ALANINE AMINO (ALT) (SGPT)	$29.25	$39.00	—	—	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC TRANSFERASE ASPARTATE AMINO AST SGOT	$31.50	$42.00	—	11% above	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC SGOT / AST	$31.50	$42.00	—	11% above	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC SGOT (AST)	$31.50	$42.00	—	11% above	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC SGOT / AST	$31.50	$42.00	—	—	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC SGOT (AST)	$31.50	$42.00	—	—	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC TRANSFERASE ASPARTATE AMINO AST SGOT	$31.50	$42.00	—	—	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS ACUTE PANEL	$250.50	$334.00	—	13% above	25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS ACUTE PANEL	$250.50	$334.00	—	—	25%
Albumin blood test CPT 82040 HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB	$30.00	$40.00	—	18% above	25%
Albumin blood test CPT 82040 HC ZALBUMIN SERUM (PANL)	$30.00	$40.00	—	18% above	25%
Albumin blood test CPT 82040 HC ASSAY OF SERUM ALBUMIN	$30.00	$40.00	—	18% above	25%
Albumin blood test inpatient CPT 82040 HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB	$30.00	$40.00	—	—	25%
Albumin blood test inpatient CPT 82040 HC ZALBUMIN SERUM (PANL)	$30.00	$40.00	—	—	25%
Albumin blood test inpatient CPT 82040 HC ASSAY OF SERUM ALBUMIN	$30.00	$40.00	—	—	25%
Aldosterone blood test CPT 82088 HC ALDOSTERONE(ARUP)	$39.75	$53.00	—	59% below	25%
Aldosterone blood test CPT 82088 HC ALDOSTERONE URINE(ARUP)	$39.75	$53.00	—	59% below	25%
Aldosterone blood test CPT 82088 HC ASSAY OF ALDOSTERONE PLASMA LAB	$39.75	$53.00	—	59% below	25%
Aldosterone blood test CPT 82088 HC ASSAY OF ALDOSTERONE CDM	$39.75	$53.00	—	59% below	25%
Aldosterone blood test CPT 82088 HC ALDOSTERONE BLD	$39.75	$53.00	—	59% below	25%
Aldosterone blood test inpatient CPT 82088 HC ASSAY OF ALDOSTERONE CDM	$39.75	$53.00	—	—	25%
Aldosterone blood test inpatient CPT 82088 HC ASSAY OF ALDOSTERONE PLASMA LAB	$39.75	$53.00	—	—	25%
Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE(ARUP)	$39.75	$53.00	—	—	25%
Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE BLD	$39.75	$53.00	—	—	25%
Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE URINE(ARUP)	$39.75	$53.00	—	—	25%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ZALKP TOTAL (PANL)	$13.50	$18.00	—	46% below	25%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ASSAY OF PHOSPHATASE ALKALINE LAB	$13.50	$18.00	—	46% below	25%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ALKALINE PHOS	$13.50	$18.00	—	46% below	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ASSAY OF PHOSPHATASE ALKALINE LAB	$13.50	$18.00	—	—	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ZALKP TOTAL (PANL)	$13.50	$18.00	—	—	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ALKALINE PHOS	$13.50	$18.00	—	—	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM	$10.50	$14.00	—	23% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH	$10.50	$14.00	—	23% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE	$10.50	$14.00	—	23% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN PECAN (ARUP)	$10.50	$14.00	—	23% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD CASHEW (ARUP)	$10.50	$14.00	—	23% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD HAZELNUT (ARUP)	$10.50	$14.00	—	23% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ALMOND (ARUP)	$10.50	$14.00	—	23% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WALNUT (ARUP)	$10.50	$14.00	—	23% below	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN PECAN (ARUP)	$10.50	$14.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD HAZELNUT (ARUP)	$10.50	$14.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD CASHEW (ARUP)	$10.50	$14.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE	$10.50	$14.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH	$10.50	$14.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM	$10.50	$14.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WALNUT (ARUP)	$10.50	$14.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ALMOND (ARUP)	$10.50	$14.00	—	—	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM LAB	$73.50	$98.00	—	1% above	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ZAFP(PANL)	$73.50	$98.00	—	1% above	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC AFP (ARUP)	$73.50	$98.00	—	1% above	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM	$73.50	$98.00	—	1% above	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM CDM	$73.50	$98.00	—	1% above	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ZAFP(PANL)	$73.50	$98.00	—	—	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC AFP (ARUP)	$73.50	$98.00	—	—	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA-FETOPROTEIN SERUM LAB	$73.50	$98.00	—	—	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA-FETOPROTEIN SERUM CDM	$73.50	$98.00	—	—	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA-FETOPROTEIN SERUM	$73.50	$98.00	—	—	25%
Ammonia blood test CPT 82140 HC ASSAY OF AMMONIA LAB	$84.00	$112.00	—	5% below	25%
Ammonia blood test inpatient CPT 82140 HC ASSAY OF AMMONIA LAB	$84.00	$112.00	—	—	25%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE	$50.25	$67.00	—	4% above	25%
Amylase blood test CPT 82150 HC AMYLASE	$50.25	$67.00	—	4% above	25%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE LAB	$50.25	$67.00	—	4% above	25%
Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE LAB	$50.25	$67.00	—	—	25%
Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE	$50.25	$67.00	—	—	25%
Amylase blood test inpatient CPT 82150 HC AMYLASE	$50.25	$67.00	—	—	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CCP AB IGG	$49.50	$66.00	—	13% below	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CCP AB IGG	$49.50	$66.00	—	—	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANA REFLEXIVE QUANTITATIVE	$67.50	$90.00	—	7% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA LAB	$67.50	$90.00	—	7% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES	$67.50	$90.00	—	7% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANA IGG REFLEX (ARUP)	$67.50	$90.00	—	7% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANA SCREEN QUANTITATIVE	$67.50	$90.00	—	7% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANA SCREEN BODY FLUID	$67.50	$90.00	—	7% above	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANA IGG REFLEX (ARUP)	$67.50	$90.00	—	—	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANA SCREEN BODY FLUID	$67.50	$90.00	—	—	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANA SCREEN QUANTITATIVE	$67.50	$90.00	—	—	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANA REFLEXIVE QUANTITATIVE	$67.50	$90.00	—	—	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES	$67.50	$90.00	—	—	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA LAB	$67.50	$90.00	—	—	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE	$71.25	$95.00	—	55% below	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC PRO BNP	$71.25	$95.00	—	55% below	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE LAB	$71.25	$95.00	—	55% below	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC PRO BNP	$71.25	$95.00	—	—	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE LAB	$71.25	$95.00	—	—	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE	$71.25	$95.00	—	—	25%
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 CDM	$210.75	$281.00	—	277% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE-CSF	$242.25	$323.00	—	333% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE-BODY FLUID	$242.25	$323.00	—	333% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE-IV CATH TIP	$242.25	$323.00	—	333% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE-RESPIR LOWER	$242.25	$323.00	—	333% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE-SURGICAL TISSUE	$242.25	$323.00	—	333% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE-WOUND-DEEP	$242.25	$323.00	—	333% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE-WOUND-SURFACE	$242.25	$323.00	—	333% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE-RESPIR UPPER	$242.25	$323.00	—	333% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE-GENITAL-FEMALE	$242.25	$323.00	—	333% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE-EYE SURFACE	$242.25	$323.00	—	333% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE-EAR	$242.25	$323.00	—	333% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE TRANSFUSION REACT UNIT	$242.25	$323.00	—	333% above	25%
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	$242.25	$323.00	—	333% above	25%
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 LAB	$242.25	$323.00	—	333% above	25%
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 CDM	$210.75	$281.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE-BODY FLUID	$242.25	$323.00	—	—	25%
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 LAB	$242.25	$323.00	—	—	25%
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	$242.25	$323.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE TRANSFUSION REACT UNIT	$242.25	$323.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE-EAR	$242.25	$323.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE-EYE SURFACE	$242.25	$323.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE-GENITAL-FEMALE	$242.25	$323.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE-RESPIR UPPER	$242.25	$323.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE-WOUND-SURFACE	$242.25	$323.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE-WOUND-DEEP	$242.25	$323.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE-SURGICAL TISSUE	$242.25	$323.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE-RESPIR LOWER	$242.25	$323.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE-IV CATH TIP	$242.25	$323.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE-CSF	$242.25	$323.00	—	—	25%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL	$32.25	$43.00	—	33% below	25%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL	$32.25	$43.00	—	—	25%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL	$30.00	$40.00	—	18% above	25%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL LAB	$30.00	$40.00	—	18% above	25%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL LAB	$30.00	$40.00	—	—	25%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL	$30.00	$40.00	—	—	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC PR 88305 TISSUE EXAM BY PATHOLOGIST	$206.25	$275.00	—	4% above	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC PR 88305 BILL SURG LEVEL 4	$206.25	$275.00	—	4% above	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB	$264.75	$353.00	—	34% above	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC BILL SURG LEVEL 4	$264.75	$353.00	—	34% above	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC PR 88305 BILL SURG LEVEL 4	$206.25	$275.00	—	—	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC PR 88305 TISSUE EXAM BY PATHOLOGIST	$206.25	$275.00	—	—	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB	$264.75	$353.00	—	—	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC BILL SURG LEVEL 4	$264.75	$353.00	—	—	25%
Blood culture for bacteria CPT 87040 HC CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES LAB	$84.00	$112.00	—	24% below	25%
Blood culture for bacteria CPT 87040 HC CULTURE-BLOOD	$178.50	$238.00	—	62% above	25%
Blood culture for bacteria inpatient CPT 87040 HC CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES LAB	$84.00	$112.00	—	—	25%
Blood culture for bacteria inpatient CPT 87040 HC CULTURE-BLOOD	$178.50	$238.00	—	—	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM	$18.75	$25.00	—	7% below	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM	$19.50	$26.00	—	3% below	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC PR 36415 ROUTINE VENIPUNCTURE	$19.50	$26.00	—	3% below	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM	$19.50	$26.00	—	3% below	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM	$19.50	$26.00	—	3% below	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM	$19.50	$26.00	—	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM	$19.50	$26.00	—	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM	$19.50	$26.00	—	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC PR 36415 ROUTINE VENIPUNCTURE	$19.50	$26.00	—	—	25%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE	$30.00	$40.00	—	25% above	25%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)	$30.00	$40.00	—	25% above	25%
Blood glucose (sugar) test CPT 82947 HC ASSAY GLUCOSE BLOOD QUANT	$30.00	$40.00	—	25% above	25%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)	$30.00	$40.00	—	—	25%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE	$30.00	$40.00	—	—	25%
Blood glucose (sugar) test inpatient CPT 82947 HC ASSAY GLUCOSE BLOOD QUANT	$30.00	$40.00	—	—	25%
Blood lead test CPT 83655 HC LEAD WHOLE BLOOD	$24.00	$32.00	—	26% below	25%
Blood lead test CPT 83655 HC ZLEAD BLOOD(PANL)	$24.00	$32.00	—	26% below	25%
Blood lead test CPT 83655 HC HVY MET BLD - LEAD	$24.00	$32.00	—	26% below	25%
Blood lead test CPT 83655 HC ASSAY OF LEAD LAB	$24.00	$32.00	—	26% below	25%
Blood lead test CPT 83655 HC HVY MET UR - LEAD	$24.00	$32.00	—	26% below	25%
Blood lead test inpatient CPT 83655 HC HVY MET BLD - LEAD	$24.00	$32.00	—	—	25%
Blood lead test inpatient CPT 83655 HC ZLEAD BLOOD(PANL)	$24.00	$32.00	—	—	25%
Blood lead test inpatient CPT 83655 HC LEAD WHOLE BLOOD	$24.00	$32.00	—	—	25%
Blood lead test inpatient CPT 83655 HC HVY MET UR - LEAD	$24.00	$32.00	—	—	25%
Blood lead test inpatient CPT 83655 HC ASSAY OF LEAD LAB	$24.00	$32.00	—	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE LAB	$132.75	$177.00	—	84% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC CHORIONIC GONADOTROPIN QUAL	$132.75	$177.00	—	84% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE CDM	$132.75	$177.00	—	84% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC CHORIONIC GONADOTROPIN QUAL	$132.75	$177.00	—	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE LAB	$132.75	$177.00	—	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE CDM	$132.75	$177.00	—	—	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO LAB	$45.00	$60.00	—	17% below	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO	$45.00	$60.00	—	17% below	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC ABO GROUP	$45.00	$60.00	—	17% below	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO	$45.00	$60.00	—	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC ABO GROUP	$45.00	$60.00	—	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO LAB	$45.00	$60.00	—	—	25%
Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY OF UREA NITROGEN	$30.00	$40.00	—	18% above	25%
Blood urea nitrogen (BUN) test CPT 84520 HC UREA NITROGEN BODY FLUID	$30.00	$40.00	—	18% above	25%
Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY UREA NITROGEN	$30.00	$40.00	—	18% above	25%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC ASSAY OF UREA NITROGEN	$30.00	$40.00	—	—	25%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC UREA NITROGEN BODY FLUID	$30.00	$40.00	—	—	25%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC ASSAY UREA NITROGEN	$30.00	$40.00	—	—	25%
C-peptide blood test CPT 84681 HC ASSAY OF C-PEPTIDE	$80.25	$107.00	—	11% below	25%
C-peptide blood test inpatient CPT 84681 HC ASSAY OF C-PEPTIDE	$80.25	$107.00	—	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN	$69.00	$92.00	—	81% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN	$69.00	$92.00	—	—	25%
C. difficile toxin gene test (stool PCR) CPT 87493 HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB	$154.50	$206.00	—	1% below	25%
C. difficile toxin gene test (stool PCR) CPT 87493 HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE	$154.50	$206.00	—	1% below	25%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE	$154.50	$206.00	—	—	25%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB	$154.50	$206.00	—	—	25%
CA 19-9 blood test (tumor marker) CPT 86301 HC CA 19.9	$84.00	$112.00	—	11% below	25%
CA 19-9 blood test (tumor marker) CPT 86301 HC IMMUNOASSAY TUMOR CA 19-9	$84.00	$112.00	—	11% below	25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC CA 19.9	$84.00	$112.00	—	—	25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC IMMUNOASSAY TUMOR CA 19-9	$84.00	$112.00	—	—	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 LAB	$120.75	$161.00	—	8% above	25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 LAB	$120.75	$161.00	—	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ CDM	$108.00	$144.00	—	10% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC COVID-19 AMP PRB PHS OREGON 87635	$108.00	$144.00	—	10% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB	$108.00	$144.00	—	10% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC COVID-19 AMP PRB HIGH THROUGHPUT PHS OREGON	$108.00	$144.00	—	10% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB	$108.00	$144.00	—	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC COVID-19 AMP PRB PHS OREGON 87635	$108.00	$144.00	—	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC COVID-19 AMP PRB HIGH THROUGHPUT PHS OREGON	$108.00	$144.00	—	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ CDM	$108.00	$144.00	—	—	25%
Calcium blood test, total CPT 82310 HC CALCIUM TOTAL LAB	$30.00	$40.00	—	18% above	25%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM TOTAL LAB	$30.00	$40.00	—	—	25%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CARCINOEMBRYONIC ANTIGEN CEA CDM	$139.50	$186.00	—	71% above	25%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CEA	$139.50	$186.00	—	71% above	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CARCINOEMBRYONIC ANTIGEN CEA CDM	$139.50	$186.00	—	—	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CEA	$139.50	$186.00	—	—	25%
Chickenpox (varicella) immunity blood test CPT 86787 HC ANTIBODY VARICELLA-ZOSTER CDM	$46.50	$62.00	—	23% below	25%
Chickenpox (varicella) immunity blood test CPT 86787 HC ANTIBODY VARICELLA-ZOSTER	$46.50	$62.00	—	23% below	25%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER ANTIBODY	$46.50	$62.00	—	23% below	25%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA-ZOSTER ANTIBODY - IGG	$46.50	$62.00	—	23% below	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA-ZOSTER ANTIBODY - IGG	$46.50	$62.00	—	—	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER ANTIBODY	$46.50	$62.00	—	—	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC ANTIBODY VARICELLA-ZOSTER CDM	$46.50	$62.00	—	—	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC ANTIBODY VARICELLA-ZOSTER	$46.50	$62.00	—	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA AMPLIFICATION APTIMA	$75.00	$100.00	—	20% below	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ	$75.00	$100.00	—	20% below	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA AMPLIFICATION APTIMA	$75.00	$100.00	—	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ	$75.00	$100.00	—	—	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL - REFLEX	$55.50	$74.00	—	4% below	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$55.50	$74.00	—	4% below	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL OF NMR	$55.50	$74.00	—	4% below	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL LAB	$55.50	$74.00	—	4% below	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL LAB	$55.50	$74.00	—	—	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL - REFLEX	$55.50	$74.00	—	—	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL	$55.50	$74.00	—	—	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL OF NMR	$55.50	$74.00	—	—	25%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB	$27.75	$37.00	—	33% below	25%
Complete blood count (CBC) with differential CPT 85025 HC COMPLETE CBC W/AUTO DIF WBC	$27.75	$37.00	—	33% below	25%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$27.75	$37.00	—	33% below	25%
Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$27.75	$37.00	—	—	25%
Complete blood count (CBC) with differential inpatient CPT 85025 HC COMPLETE CBC W/AUTO DIF WBC	$27.75	$37.00	—	—	25%
Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB	$27.75	$37.00	—	—	25%
Complete blood count (CBC), no differential CPT 85027 HC COMPLETE CBC AUTOMATED	$11.25	$15.00	—	64% below	25%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB	$11.25	$15.00	—	64% below	25%
Complete blood count (CBC), no differential inpatient CPT 85027 HC COMPLETE CBC AUTOMATED	$11.25	$15.00	—	—	25%
Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB	$11.25	$15.00	—	—	25%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHEN METABOLIC PANEL	$38.25	$51.00	—	31% below	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHEN METABOLIC PANEL	$38.25	$51.00	—	—	25%
Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL LAB	$110.25	$147.00	—	34% above	25%
Cortisol blood test, total CPT 82533 HC CORTISOL	$110.25	$147.00	—	34% above	25%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL TOTAL LAB	$110.25	$147.00	—	—	25%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL	$110.25	$147.00	—	—	25%
Creatine kinase (CK) blood test, total CPT 82550 HC CK TOTAL	$53.25	$71.00	—	24% above	25%
Creatine kinase (CK) blood test, total CPT 82550 HC ASSAY OF CK (CPK)	$53.25	$71.00	—	24% above	25%
Creatine kinase (CK) blood test, total CPT 82550 HC ZCK TOTAL (PANL)	$53.25	$71.00	—	24% above	25%
Creatine kinase (CK) blood test, total CPT 82550 HC CREATINE KINASE TOTAL CDM	$53.25	$71.00	—	24% above	25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC ASSAY OF CK (CPK)	$53.25	$71.00	—	—	25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC ZCK TOTAL (PANL)	$53.25	$71.00	—	—	25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CREATINE KINASE TOTAL CDM	$53.25	$71.00	—	—	25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CK TOTAL	$53.25	$71.00	—	—	25%
Creatinine blood test CPT 82565 HC ASSAY CREATININE	$30.00	$40.00	—	21% above	25%
Creatinine blood test CPT 82565 HC ASSAY OF CREATININE	$30.00	$40.00	—	21% above	25%
Creatinine blood test CPT 82565 HC CREATININE BLOOD	$30.00	$40.00	—	21% above	25%
Creatinine blood test inpatient CPT 82565 HC CREATININE BLOOD	$30.00	$40.00	—	—	25%
Creatinine blood test inpatient CPT 82565 HC ASSAY CREATININE	$30.00	$40.00	—	—	25%
Creatinine blood test inpatient CPT 82565 HC ASSAY OF CREATININE	$30.00	$40.00	—	—	25%
Cytomegalovirus (CMV) antibody test CPT 86644 HC ANTIBODY CYTOMEGALOVIRUS CMV LAB	$51.75	$69.00	—	17% below	25%
Cytomegalovirus (CMV) antibody test CPT 86644 HC CMV IGG	$51.75	$69.00	—	17% below	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC CMV IGG	$51.75	$69.00	—	—	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC ANTIBODY CYTOMEGALOVIRUS CMV LAB	$51.75	$69.00	—	—	25%
D-dimer blood test (blood clot marker) CPT 85379 HC DDIMER QUANT	$270.00	$360.00	—	108% above	25%
D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN DEGRADATION QUANT	$270.00	$360.00	—	108% above	25%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC DDIMER QUANT	$270.00	$360.00	—	—	25%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC FIBRIN DEGRADATION QUANT	$270.00	$360.00	—	—	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE	$86.25	$115.00	—	1% above	25%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DEHYDROEPIANDROSTERONE	$86.25	$115.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM	$51.00	$68.00	—	12% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB	$51.00	$68.00	—	12% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR MECONIUM PER DOS	$51.00	$68.00	—	12% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS	$51.00	$68.00	—	12% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUGS OF ABUSE URINE	$51.00	$68.00	—	12% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE	$51.00	$68.00	—	12% below	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE	$51.00	$68.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR MECONIUM PER DOS	$51.00	$68.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS	$51.00	$68.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM	$51.00	$68.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB	$51.00	$68.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUGS OF ABUSE URINE	$51.00	$68.00	—	—	25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL LAB	$64.50	$86.00	—	80% above	25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL	$64.50	$86.00	—	80% above	25%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTE PANEL LAB	$64.50	$86.00	—	—	25%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTE PANEL	$64.50	$86.00	—	—	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EBV AB VIRAL CAPSID AG IGM	$69.00	$92.00	—	7% below	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA LAB	$69.00	$92.00	—	7% below	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EBV AB VIRAL CAPSID AG IGG	$69.00	$92.00	—	7% below	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EBV AB VIRAL CAPSID AG IGM	$69.00	$92.00	—	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EBV AB VIRAL CAPSID AG IGG	$69.00	$92.00	—	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA LAB	$69.00	$92.00	—	—	25%
Estradiol blood test CPT 82670 HC ESTRADIOL BY TMS(ARUP)	$159.00	$212.00	—	42% above	25%
Estradiol blood test CPT 82670 HC ESTRADIOL	$159.00	$212.00	—	42% above	25%
Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL	$159.00	$212.00	—	42% above	25%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL	$159.00	$212.00	—	—	25%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL BY TMS(ARUP)	$159.00	$212.00	—	—	25%
Estradiol blood test inpatient CPT 82670 HC ASSAY OF ESTRADIOL	$159.00	$212.00	—	—	25%
FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE LAB	$100.50	$134.00	—	25% above	25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE LAB	$100.50	$134.00	—	—	25%
Fecal calprotectin (stool inflammation test) CPT 83993 HC ASSAY OF CALPROTECTIN FECAL CDM	$63.00	$84.00	—	47% below	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC ASSAY OF CALPROTECTIN FECAL CDM	$63.00	$84.00	—	—	25%
Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN CDM	$55.50	$74.00	—	1% below	25%
Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN	$55.50	$74.00	—	1% below	25%
Ferritin blood test (iron stores) inpatient CPT 82728 HC ASSAY OF FERRITIN	$55.50	$74.00	—	—	25%
Ferritin blood test (iron stores) inpatient CPT 82728 HC ASSAY OF FERRITIN CDM	$55.50	$74.00	—	—	25%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN	$62.25	$83.00	—	3% below	25%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN	$62.25	$83.00	—	—	25%
Folate (folic acid) blood test CPT 82746 HC BLOOD FOLIC ACID SERUM	$85.50	$114.00	—	3% below	25%
Folate (folic acid) blood test inpatient CPT 82746 HC BLOOD FOLIC ACID SERUM	$85.50	$114.00	—	—	25%
Free T3 thyroid hormone test CPT 84481 HC FREE ASSAY (FT-3)	$79.50	$106.00	—	10% above	25%
Free T3 thyroid hormone test inpatient CPT 84481 HC FREE ASSAY (FT-3)	$79.50	$106.00	—	—	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE LAB	$100.50	$134.00	—	120% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE CDM	$100.50	$134.00	—	120% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ZT4 FREE BY EQUIL DIALYSIS(ARUP)	$100.50	$134.00	—	120% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC THYROXINE FREE	$100.50	$134.00	—	120% above	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC ASSAY OF FREE THYROXINE CDM	$100.50	$134.00	—	—	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC THYROXINE FREE	$100.50	$134.00	—	—	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC ASSAY OF FREE THYROXINE LAB	$100.50	$134.00	—	—	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC ZT4 FREE BY EQUIL DIALYSIS(ARUP)	$100.50	$134.00	—	—	25%
Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE FREE	$11.25	$15.00	—	81% below	25%
Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE FREE LAB	$11.25	$15.00	—	81% below	25%
Free testosterone test inpatient CPT 84402 HC ASSAY OF TESTOSTERONE FREE LAB	$11.25	$15.00	—	—	25%
Free testosterone test inpatient CPT 84402 HC ASSAY OF TESTOSTERONE FREE	$11.25	$15.00	—	—	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GGT GLUTAMYTRANSFERASE GAMMA	$30.00	$40.00	—	at median	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC ASSAY OF GGT	$30.00	$40.00	—	at median	25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GGT GLUTAMYTRANSFERASE GAMMA	$30.00	$40.00	—	—	25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC ASSAY OF GGT	$30.00	$40.00	—	—	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GESTATIONAL GLUCOSE 1 HOUR	$135.00	$180.00	—	291% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE GESTATIONAL SCREEN	$135.00	$180.00	—	291% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE GESTATIONAL SCREEN	$135.00	$180.00	—	—	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GESTATIONAL GLUCOSE 1 HOUR	$135.00	$180.00	—	—	25%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE(3 SPEC)	$87.75	$117.00	—	12% above	25%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOL GESTATIONAL	$87.75	$117.00	—	12% above	25%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE(3 SPECIMENS)	$87.75	$117.00	—	12% above	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE(3 SPECIMENS)	$87.75	$117.00	—	—	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOL GESTATIONAL	$87.75	$117.00	—	—	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE(3 SPEC)	$87.75	$117.00	—	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM	$75.00	$100.00	—	20% below	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ	$75.00	$100.00	—	20% below	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ	$75.00	$100.00	—	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM	$75.00	$100.00	—	—	25%
H. pylori stool antigen test CPT 87338 HC IAAD IA HPYLORI STOOL CDM	$44.25	$59.00	—	38% below	25%
H. pylori stool antigen test inpatient CPT 87338 HC IAAD IA HPYLORI STOOL CDM	$44.25	$59.00	—	—	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV-1 RNA QUANTITATION	$327.00	$436.00	—	23% above	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV-1 RNA QUANTITATION	$327.00	$436.00	—	—	25%
HIV-1 and HIV-2 antibody test CPT 86703 HC RAPID HIV 1-2	$57.00	$76.00	—	14% below	25%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY	$57.00	$76.00	—	14% below	25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY	$57.00	$76.00	—	—	25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC RAPID HIV 1-2	$57.00	$76.00	—	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB	$79.50	$106.00	—	at median	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC ANTI-HIV 1/2 AB & P24 AG	$79.50	$106.00	—	at median	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC ANTI-HIV 1/2 AB & P24 AG	$79.50	$106.00	—	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB	$79.50	$106.00	—	—	25%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB	$69.75	$93.00	—	20% below	25%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB	$69.75	$93.00	—	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN A1C (CONFIRM)(ARUP)	$53.25	$71.00	—	11% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST	$53.25	$71.00	—	11% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C LAB	$53.25	$71.00	—	11% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST	$53.25	$71.00	—	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C LAB	$53.25	$71.00	—	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HEMOGLOBIN A1C (CONFIRM)(ARUP)	$53.25	$71.00	—	—	25%
Hemoglobin blood test CPT 85018 HC PR 85018 HEMOGLOBIN	$12.00	$16.00	—	31% below	25%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN	$13.50	$18.00	—	23% below	25%
Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN LAB	$13.50	$18.00	—	23% below	25%
Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN CDM	$13.50	$18.00	—	23% below	25%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN (HGB)	$13.50	$18.00	—	23% below	25%
Hemoglobin blood test inpatient CPT 85018 HC PR 85018 HEMOGLOBIN	$12.00	$16.00	—	—	25%
Hemoglobin blood test inpatient CPT 85018 HC BLOOD COUNT HEMOGLOBIN LAB	$13.50	$18.00	—	—	25%
Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN (HGB)	$13.50	$18.00	—	—	25%
Hemoglobin blood test inpatient CPT 85018 HC BLOOD COUNT HEMOGLOBIN CDM	$13.50	$18.00	—	—	25%
Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN	$13.50	$18.00	—	—	25%
Hepatitis B core antibody test (total) CPT 86704 HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL CDM	$68.25	$91.00	—	6% above	25%
Hepatitis B core antibody test (total) CPT 86704 HC HEP B CORE (IGG-IGM) ANTIBODY	$68.25	$91.00	—	6% above	25%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEP B CORE (IGG-IGM) ANTIBODY	$68.25	$91.00	—	—	25%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL CDM	$68.25	$91.00	—	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB CDM	$81.00	$108.00	—	29% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB CDM	$81.00	$108.00	—	—	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC HEP B SURF AG (HBSAG) RFLX CONFRM	$64.50	$86.00	—	17% above	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC HEP B SRF AG RFLX CNFRM(OF PANL)	$64.50	$86.00	—	17% above	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB	$64.50	$86.00	—	17% above	25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB	$64.50	$86.00	—	—	25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC HEP B SRF AG RFLX CNFRM(OF PANL)	$64.50	$86.00	—	—	25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC HEP B SURF AG (HBSAG) RFLX CONFRM	$64.50	$86.00	—	—	25%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEP C AB REFLEXIVE	$113.25	$151.00	—	55% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY LAB	$113.25	$151.00	—	55% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY CDM	$113.25	$151.00	—	55% above	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY CDM	$113.25	$151.00	—	—	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEP C AB REFLEXIVE	$113.25	$151.00	—	—	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY LAB	$113.25	$151.00	—	—	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM	$362.25	$483.00	—	85% above	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEP C PCR (QUANT)	$362.25	$483.00	—	85% above	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM	$362.25	$483.00	—	—	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEP C PCR (QUANT)	$362.25	$483.00	—	—	25%
Herpes blood test, HSV-1 antibody CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 IGG LAB	$55.50	$74.00	—	5% below	25%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX TEST - TYPE 1 IGG	$55.50	$74.00	—	5% below	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 IGG LAB	$55.50	$74.00	—	—	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES SIMPLEX TEST - TYPE 1 IGG	$55.50	$74.00	—	—	25%
Herpes blood test, HSV-2 antibody CPT 86696 HC HSV 2 ANTIBODY IGG	$81.00	$108.00	—	12% above	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HSV 2 ANTIBODY IGG	$81.00	$108.00	—	—	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM	$64.50	$86.00	—	6% above	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM	$64.50	$86.00	—	—	25%
Homocysteine blood test CPT 83090 HC ASSAY OF HOMOCYSTEINE LAB	$72.75	$97.00	—	14% below	25%
Homocysteine blood test inpatient CPT 83090 HC ASSAY OF HOMOCYSTEINE LAB	$72.75	$97.00	—	—	25%
Insulin blood test CPT 83525 HC ASSAY OF INSULIN TOTAL CDM	$54.75	$73.00	—	at median	25%
Insulin blood test CPT 83525 HC ASSAY OF INSULIN TOTAL LAB	$54.75	$73.00	—	at median	25%
Insulin blood test inpatient CPT 83525 HC ASSAY OF INSULIN TOTAL CDM	$54.75	$73.00	—	—	25%
Insulin blood test inpatient CPT 83525 HC ASSAY OF INSULIN TOTAL LAB	$54.75	$73.00	—	—	25%
Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON	$48.75	$65.00	—	20% above	25%
Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON CDM	$48.75	$65.00	—	20% above	25%
Iron blood test (serum iron) inpatient CPT 83540 HC ASSAY OF IRON	$48.75	$65.00	—	—	25%
Iron blood test (serum iron) inpatient CPT 83540 HC ASSAY OF IRON CDM	$48.75	$65.00	—	—	25%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY LAB	$38.25	$51.00	—	11% below	25%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY CDM	$38.25	$51.00	—	11% below	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY LAB	$38.25	$51.00	—	—	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY CDM	$38.25	$51.00	—	—	25%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL CDM	$58.50	$78.00	—	22% above	25%
Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL CDM	$58.50	$78.00	—	—	25%
LH (luteinizing hormone) test CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE LAB	$111.00	$148.00	—	37% above	25%
LH (luteinizing hormone) test inpatient CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE LAB	$111.00	$148.00	—	—	25%
Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTIC ACID	$78.00	$104.00	—	5% above	25%
Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTATE LAB	$78.00	$104.00	—	5% above	25%
Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTATE	$78.00	$104.00	—	5% above	25%
Lactate (lactic acid) blood test inpatient CPT 83605 HC ASSAY OF LACTIC ACID	$78.00	$104.00	—	—	25%
Lactate (lactic acid) blood test inpatient CPT 83605 HC ASSAY OF LACTATE LAB	$78.00	$104.00	—	—	25%
Lactate (lactic acid) blood test inpatient CPT 83605 HC ASSAY OF LACTATE	$78.00	$104.00	—	—	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE DEHYDROGENASE LDH CDM	$30.00	$40.00	—	4% below	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH SERUM	$30.00	$40.00	—	4% below	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE(LD)(LDH)ENZYME	$30.00	$40.00	—	4% below	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE (LD) (LDH) ENZYME	$30.00	$40.00	—	4% below	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH SERUM	$30.00	$40.00	—	—	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE (LD) (LDH) ENZYME	$30.00	$40.00	—	—	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE DEHYDROGENASE LDH CDM	$30.00	$40.00	—	—	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE(LD)(LDH)ENZYME	$30.00	$40.00	—	—	25%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE	$60.75	$81.00	—	5% below	25%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE CDM	$60.75	$81.00	—	5% below	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE	$60.75	$81.00	—	—	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE CDM	$60.75	$81.00	—	—	25%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL CDM	$51.75	$69.00	—	24% above	25%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL CDM	$51.75	$69.00	—	—	25%
Lyme disease antibody test CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI LYME DISEASE LAB	$30.00	$40.00	—	54% below	25%
Lyme disease antibody test CPT 86618 HC B BURGDORFERI AB TOTAL (ARUP)	$30.00	$40.00	—	54% below	25%
Lyme disease antibody test inpatient CPT 86618 HC B BURGDORFERI AB TOTAL (ARUP)	$30.00	$40.00	—	—	25%
Lyme disease antibody test inpatient CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI LYME DISEASE LAB	$30.00	$40.00	—	—	25%
Magnesium blood test CPT 83735 HC MAGNESIUM (RBC) (ARUP)	$30.00	$40.00	—	13% below	25%
Magnesium blood test CPT 83735 HC MAGNESIUM QUANT URINE	$30.00	$40.00	—	13% below	25%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM LAB	$30.00	$40.00	—	13% below	25%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM	$30.00	$40.00	—	13% below	25%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM CDM	$30.00	$40.00	—	13% below	25%
Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM	$30.00	$40.00	—	—	25%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM (RBC) (ARUP)	$30.00	$40.00	—	—	25%
Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM CDM	$30.00	$40.00	—	—	25%
Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM LAB	$30.00	$40.00	—	—	25%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM QUANT URINE	$30.00	$40.00	—	—	25%
Measles (rubeola) antibody test CPT 86765 HC ANTIBODY RUBEOLA IGG LAB	$51.75	$69.00	—	13% below	25%
Measles (rubeola) antibody test CPT 86765 HC MEASLES (RUBEOLA) AB IGM (ARUP)	$51.75	$69.00	—	13% below	25%
Measles (rubeola) antibody test CPT 86765 HC ANTIBODY RUBEOLA CDM	$51.75	$69.00	—	13% below	25%
Measles (rubeola) antibody test inpatient CPT 86765 HC ANTIBODY RUBEOLA CDM	$51.75	$69.00	—	—	25%
Measles (rubeola) antibody test inpatient CPT 86765 HC ANTIBODY RUBEOLA IGG LAB	$51.75	$69.00	—	—	25%
Measles (rubeola) antibody test inpatient CPT 86765 HC MEASLES (RUBEOLA) AB IGM (ARUP)	$51.75	$69.00	—	—	25%
Mono test (heterophile antibody, Monospot) CPT 86308 HC MONO TEST	$55.50	$74.00	—	12% above	25%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODIES	$55.50	$74.00	—	12% above	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE ANTIBODIES	$55.50	$74.00	—	—	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC MONO TEST	$55.50	$74.00	—	—	25%
Mumps immunity blood test CPT 86735 HC ANTIBODY MUMPS LAB	$51.75	$69.00	—	6% above	25%
Mumps immunity blood test CPT 86735 HC MUMPS VIRUS AB IGM (ARUP)	$51.75	$69.00	—	6% above	25%
Mumps immunity blood test CPT 86735 HC MUMPS ANTIBODY IGG	$51.75	$69.00	—	6% above	25%
Mumps immunity blood test CPT 86735 HC ANTIBODY MUMPS CDM	$51.75	$69.00	—	6% above	25%
Mumps immunity blood test inpatient CPT 86735 HC ANTIBODY MUMPS CDM	$51.75	$69.00	—	—	25%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS ANTIBODY IGG	$51.75	$69.00	—	—	25%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS VIRUS AB IGM (ARUP)	$51.75	$69.00	—	—	25%
Mumps immunity blood test inpatient CPT 86735 HC ANTIBODY MUMPS LAB	$51.75	$69.00	—	—	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$84.75	$113.00	—	11% above	25%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$84.75	$113.00	—	—	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGEN TOTAL	$91.50	$122.00	—	22% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB	$91.50	$122.00	—	22% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM	$91.50	$122.00	—	22% above	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATE SPECIFIC ANTIGEN TOTAL	$91.50	$122.00	—	—	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB	$91.50	$122.00	—	—	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM	$91.50	$122.00	—	—	25%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS	$86.25	$115.00	—	5% below	25%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS	$86.25	$115.00	—	—	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC PAP SUREPATH DIAGNOSTIC	$60.00	$80.00	—	25% below	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN CDM	$60.00	$80.00	—	25% below	25%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN CDM	$60.00	$80.00	—	—	25%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC PAP SUREPATH DIAGNOSTIC	$60.00	$80.00	—	—	25%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE)	$178.50	$238.00	—	8% above	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE)	$178.50	$238.00	—	—	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL	$59.25	$79.00	—	9% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC ZPTT-D (PANL)	$59.25	$79.00	—	9% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB	$59.25	$79.00	—	9% above	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC ZPTT-D (PANL)	$59.25	$79.00	—	—	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB	$59.25	$79.00	—	—	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL	$59.25	$79.00	—	—	25%
Phosphorus (phosphate) blood test CPT 84100 HC ASSAY PHOSPHORUS	$30.00	$40.00	—	at median	25%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC ASSAY PHOSPHORUS	$30.00	$40.00	—	—	25%
Potassium blood test CPT 84132 HC POTASSIUM	$30.00	$40.00	—	38% above	25%
Potassium blood test inpatient CPT 84132 HC POTASSIUM	$30.00	$40.00	—	—	25%
Progesterone blood test CPT 84144 HC ASSAY OF PROGESTERONE CDM	$143.25	$191.00	—	35% above	25%
Progesterone blood test inpatient CPT 84144 HC ASSAY OF PROGESTERONE CDM	$143.25	$191.00	—	—	25%
Prolactin blood test CPT 84146 HC ASSAY OF PROLACTIN CDM	$132.00	$176.00	—	48% above	25%
Prolactin blood test inpatient CPT 84146 HC ASSAY OF PROLACTIN CDM	$132.00	$176.00	—	—	25%
Prothrombin time (PT/INR) clotting test CPT 85610 HC ZPT-D (PANL)	$42.75	$57.00	—	52% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME	$42.75	$57.00	—	52% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME LAB	$42.75	$57.00	—	52% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME 85610	$42.75	$57.00	—	52% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PR 85610 PROTHROMBIN TIME	$45.75	$61.00	—	63% above	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME	$42.75	$57.00	—	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC ZPT-D (PANL)	$42.75	$57.00	—	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME LAB	$42.75	$57.00	—	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME 85610	$42.75	$57.00	—	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PR 85610 PROTHROMBIN TIME	$45.75	$61.00	—	—	25%
Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA B SCREEN	$21.75	$29.00	—	70% below	25%
Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA A SCREEN	$21.75	$29.00	—	70% below	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFLUENZA A SCREEN	$21.75	$29.00	—	—	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFLUENZA B SCREEN	$21.75	$29.00	—	—	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB	$39.75	$53.00	—	27% below	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC PR 87880 RAPID STREP SCREEN	$42.75	$57.00	—	22% below	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB	$47.25	$63.00	—	14% below	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP GROUP A AG RFLX CULTURE	$47.25	$63.00	—	14% below	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC PR 87880 RAPID STREP SCREEN	$42.75	$57.00	—	—	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB	$47.25	$63.00	—	—	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREP GROUP A AG RFLX CULTURE	$47.25	$63.00	—	—	25%
Renin blood test CPT 84244 HC RENIN	$37.50	$50.00	—	46% below	25%
Renin blood test CPT 84244 HC ASSAY OF RENIN CDM	$37.50	$50.00	—	46% below	25%
Renin blood test CPT 84244 HC RENIN ACTIVITY(ARUP)	$37.50	$50.00	—	46% below	25%
Renin blood test inpatient CPT 84244 HC ASSAY OF RENIN CDM	$37.50	$50.00	—	—	25%
Renin blood test inpatient CPT 84244 HC RENIN	$37.50	$50.00	—	—	25%
Renin blood test inpatient CPT 84244 HC RENIN ACTIVITY(ARUP)	$37.50	$50.00	—	—	25%
Rh blood typing CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) LAB	$51.00	$68.00	—	22% above	25%
Rh blood typing CPT 86901 HC RH (D)	$51.00	$68.00	—	22% above	25%
Rh blood typing CPT 86901 HC BLOOD TYPING SEROLOGIC RH(D)	$51.00	$68.00	—	22% above	25%
Rh blood typing inpatient CPT 86901 HC RH (D)	$51.00	$68.00	—	—	25%
Rh blood typing inpatient CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) LAB	$51.00	$68.00	—	—	25%
Rh blood typing inpatient CPT 86901 HC BLOOD TYPING SEROLOGIC RH(D)	$51.00	$68.00	—	—	25%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR	$59.25	$79.00	—	43% above	25%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR	$59.25	$79.00	—	—	25%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY (OF PANEL)	$34.50	$46.00	—	24% below	25%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY	$34.50	$46.00	—	24% below	25%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA ANTIBODY	$34.50	$46.00	—	—	25%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA ANTIBODY (OF PANEL)	$34.50	$46.00	—	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC RBC SED RATE AUTOMATED	$88.50	$118.00	—	215% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SEDIMENTATION RATE RBC AUTOMATED LAB	$88.50	$118.00	—	215% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC RBC SED RATE AUTOMATED	$88.50	$118.00	—	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SEDIMENTATION RATE RBC AUTOMATED LAB	$88.50	$118.00	—	—	25%
Sodium blood test CPT 84295 HC SODIUM	$28.50	$38.00	—	10% above	25%
Sodium blood test CPT 84295 HC SODIUM BLOOD	$28.50	$38.00	—	10% above	25%
Sodium blood test inpatient CPT 84295 HC SODIUM	$28.50	$38.00	—	—	25%
Sodium blood test inpatient CPT 84295 HC SODIUM BLOOD	$28.50	$38.00	—	—	25%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES SMEARS	$96.00	$128.00	—	78% above	25%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES EXAM	$96.00	$128.00	—	78% above	25%
Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITES SMEARS	$96.00	$128.00	—	—	25%
Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITES EXAM	$96.00	$128.00	—	—	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC PR 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER	$24.00	$32.00	—	30% below	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM	$39.00	$52.00	—	13% above	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECES	$39.00	$52.00	—	13% above	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC PR 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER	$24.00	$32.00	—	—	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD FECES	$39.00	$52.00	—	—	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM	$39.00	$52.00	—	—	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 CDM	$47.25	$63.00	—	15% below	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 CDM	$47.25	$63.00	—	—	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC TREPONEMA PALLIDUM - AB	$24.75	$33.00	—	28% below	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC MHA-TP CONFIRMATION REFLX (ARUP)	$24.75	$33.00	—	28% below	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC FTA-ABS (ARUP)	$24.75	$33.00	—	28% below	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM LAB	$24.75	$33.00	—	28% below	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM CDM	$24.75	$33.00	—	28% below	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM CDM	$24.75	$33.00	—	—	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM LAB	$24.75	$33.00	—	—	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC MHA-TP CONFIRMATION REFLX (ARUP)	$24.75	$33.00	—	—	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC TREPONEMA PALLIDUM - AB	$24.75	$33.00	—	—	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC FTA-ABS (ARUP)	$24.75	$33.00	—	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - CSF	$25.50	$34.00	—	21% below	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL	$25.50	$34.00	—	21% below	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL	$25.50	$34.00	—	21% below	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREP QUAL	$25.50	$34.00	—	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL	$25.50	$34.00	—	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - CSF	$25.50	$34.00	—	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB	$213.75	$285.00	—	22% above	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM	$213.75	$285.00	—	22% above	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB	$213.75	$285.00	—	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM	$213.75	$285.00	—	—	25%
Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL	$50.25	$67.00	—	30% below	25%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$50.25	$67.00	—	30% below	25%
Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL LAB	$50.25	$67.00	—	30% below	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL	$50.25	$67.00	—	—	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL	$50.25	$67.00	—	—	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL LAB	$50.25	$67.00	—	—	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EACH CDM	$62.25	$83.00	—	9% below	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC THYROID PEROXIDASE AB (ANTI-TPO)	$62.25	$83.00	—	9% below	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES EACH CDM	$62.25	$83.00	—	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC THYROID PEROXIDASE AB (ANTI-TPO)	$62.25	$83.00	—	—	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB	$78.75	$105.00	—	8% above	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH	$78.75	$105.00	—	8% above	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE TSH	$78.75	$105.00	—	8% above	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH REFLEX TO FT4	$78.75	$105.00	—	8% above	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH	$78.75	$105.00	—	—	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE TSH	$78.75	$105.00	—	—	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB	$78.75	$105.00	—	—	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH REFLEX TO FT4	$78.75	$105.00	—	—	25%
Total IgE blood test CPT 82785 HC ASSAY OF IGE	$63.75	$85.00	—	16% above	25%
Total IgE blood test inpatient CPT 82785 HC ASSAY OF IGE	$63.75	$85.00	—	—	25%
Total cholesterol blood test CPT 82465 HC CHOLESTEROL BODY FLUID	$30.00	$40.00	—	25% above	25%
Total cholesterol blood test CPT 82465 HC ASSAY BLD/SERUM CHOLESTEROL	$30.00	$40.00	—	25% above	25%
Total cholesterol blood test inpatient CPT 82465 HC ASSAY BLD/SERUM CHOLESTEROL	$30.00	$40.00	—	—	25%
Total cholesterol blood test inpatient CPT 82465 HC CHOLESTEROL BODY FLUID	$30.00	$40.00	—	—	25%
Total thyroxine (T4) blood test CPT 84436 HC ZT4 (PANL)	$50.25	$67.00	—	72% above	25%
Total thyroxine (T4) blood test CPT 84436 HC THYROXINE TOTAL	$50.25	$67.00	—	72% above	25%
Total thyroxine (T4) blood test CPT 84436 HC ASSAY OF THYROXINE TOTAL LAB	$50.25	$67.00	—	72% above	25%
Total thyroxine (T4) blood test inpatient CPT 84436 HC THYROXINE TOTAL	$50.25	$67.00	—	—	25%
Total thyroxine (T4) blood test inpatient CPT 84436 HC ASSAY OF THYROXINE TOTAL LAB	$50.25	$67.00	—	—	25%
Total thyroxine (T4) blood test inpatient CPT 84436 HC ZT4 (PANL)	$50.25	$67.00	—	—	25%
Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY TRIIODOTHYRONINE (T3)	$134.25	$179.00	—	79% above	25%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC ASSAY TRIIODOTHYRONINE (T3)	$134.25	$179.00	—	—	25%
Transferrin blood test CPT 84466 HC ASSAY OF TRANSFERRIN	$47.25	$63.00	—	10% below	25%
Transferrin blood test inpatient CPT 84466 HC ASSAY OF TRANSFERRIN	$47.25	$63.00	—	—	25%
Trichomonas test (NAAT) CPT 87661 HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB	$38.25	$51.00	—	25% below	25%
Trichomonas test (NAAT) inpatient CPT 87661 HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB	$38.25	$51.00	—	—	25%
Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES	$30.00	$40.00	—	18% above	25%
Triglycerides blood test CPT 84478 HC TRIGLYCERIDES	$30.00	$40.00	—	18% above	25%
Triglycerides blood test inpatient CPT 84478 HC ASSAY OF TRIGLYCERIDES	$30.00	$40.00	—	—	25%
Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDES	$30.00	$40.00	—	—	25%
Troponin test, quantitative CPT 84484 HC TROPONIN QUANTITATIVE	$121.50	$162.00	—	16% above	25%
Troponin test, quantitative CPT 84484 HC ASSAY OF TROPONIN QUANTITATIVE	$121.50	$162.00	—	16% above	25%
Troponin test, quantitative inpatient CPT 84484 HC ASSAY OF TROPONIN QUANTITATIVE	$121.50	$162.00	—	—	25%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN QUANTITATIVE	$121.50	$162.00	—	—	25%
Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID CDM	$30.00	$40.00	—	3% above	25%
Uric acid blood test inpatient CPT 84550 HC ASSAY OF BLOOD/URIC ACID CDM	$30.00	$40.00	—	—	25%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB	$45.75	$61.00	—	40% above	25%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM	$45.75	$61.00	—	40% above	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB	$45.75	$61.00	—	—	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM	$45.75	$61.00	—	—	25%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE	$17.25	$23.00	—	12% below	25%
Urinalysis without microscope exam, automated CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB	$17.25	$23.00	—	12% below	25%
Urinalysis without microscope exam, automated CPT 81003 HC PR 81003 URINALYSIS AUTO W/O SCOPE	$36.00	$48.00	—	85% above	25%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE	$40.50	$54.00	—	108% above	25%
Urinalysis without microscope exam, automated CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB	$40.50	$54.00	—	108% above	25%
Urinalysis without microscope exam, automated CPT 81003 HC PH URINE DIPSTICK AUTO W/O MICROSCOPY LAB	$40.50	$54.00	—	108% above	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC PR 81003 URINALYSIS AUTO W/O SCOPE	$36.00	$48.00	—	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB	$40.50	$54.00	—	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO W/O SCOPE	$40.50	$54.00	—	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC PH URINE DIPSTICK AUTO W/O MICROSCOPY LAB	$40.50	$54.00	—	—	25%
Urinalysis without microscope exam, manual CPT 81002 HC PR ED 81002 URINALYSIS COMPLETE CDM	$15.75	$21.00	—	34% below	25%
Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM	$43.50	$58.00	—	81% above	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM	$43.50	$58.00	—	—	25%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE-URINE	$63.75	$85.00	—	21% above	25%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB	$63.75	$85.00	—	21% above	25%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB	$63.75	$85.00	—	—	25%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE-URINE	$63.75	$85.00	—	—	25%
Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN URINE RANDOM	$53.25	$71.00	—	20% above	25%
Urine microalbumin (albumin) test inpatient CPT 82043 HC MICROALBUMIN URINE RANDOM	$53.25	$71.00	—	—	25%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST	$17.25	$23.00	—	68% below	25%
Urine pregnancy test, read by color change CPT 81025 HC PR 81025 URINE PREGNANCY TEST	$20.25	$27.00	—	63% below	25%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST	$21.75	$29.00	—	60% below	25%
Urine pregnancy test, read by color change inpatient CPT 81025 HC PR 81025 URINE PREGNANCY TEST	$20.25	$27.00	—	—	25%
Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY TEST	$21.75	$29.00	—	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B-12	$85.50	$114.00	—	10% above	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B-12	$85.50	$114.00	—	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED LAB	$88.50	$118.00	—	15% below	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM	$88.50	$118.00	—	15% below	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED LAB	$88.50	$118.00	—	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM	$88.50	$118.00	—	—	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED CDM	$50.25	$67.00	—	51% below	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC VITAMIN D 1 25-DIHYDROXY	$50.25	$67.00	—	51% below	25%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC VITAMIN D 1 25-DIHYDROXY	$50.25	$67.00	—	—	25%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED CDM	$50.25	$67.00	—	—	25%
Zinc blood test CPT 84630 HC ASSAY ZINC	$24.00	$32.00	—	31% below	25%
Zinc blood test CPT 84630 HC ZINC SERUM(ARUP)	$24.00	$32.00	—	31% below	25%
Zinc blood test CPT 84630 HC ASSAY OF ZINC CDM	$24.00	$32.00	—	31% below	25%
Zinc blood test inpatient CPT 84630 HC ASSAY OF ZINC CDM	$24.00	$32.00	—	—	25%
Zinc blood test inpatient CPT 84630 HC ASSAY ZINC	$24.00	$32.00	—	—	25%
Zinc blood test inpatient CPT 84630 HC ZINC SERUM(ARUP)	$24.00	$32.00	—	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC CHORIONIC GONADOTROPIN QUANT	$169.50	$226.00	—	137% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM	$169.50	$226.00	—	137% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC ZHCG(PANL)	$169.50	$226.00	—	137% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB	$169.50	$226.00	—	137% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE	$169.50	$226.00	—	137% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC CHORIONIC GONADOTROPIN QUANT	$169.50	$226.00	—	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM	$169.50	$226.00	—	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB	$169.50	$226.00	—	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE	$169.50	$226.00	—	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC ZHCG(PANL)	$169.50	$226.00	—	—	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Oregon	Off list
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 HC PR 29888 KNEE SCOPE,AID ANT CRUCIATE REPAIR	$2,841.75	$3,789.00	—	33% below	25%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 HC PR 29888 KNEE ARTHRO/SURG	$2,841.75	$3,789.00	—	33% below	25%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 HC PR 29888 KNEE SCOPE,AID ANT CRUCIATE REPAIR	$2,841.75	$3,789.00	—	—	25%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 HC PR 29827 SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR	$3,117.00	$4,156.00	—	18% below	25%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 HC PR 29827 ARTHROSCOP ROTATOR CUFF REPR	$3,117.00	$4,156.00	—	18% below	25%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 HC PR 29827 SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR	$3,117.00	$4,156.00	—	—	25%
Balloon dilation of the maxillary sinus opening, one side CPT 31295 HC ED SINUS ENDO W/BALLOON DILATION CDM	$11,601.00	$15,468.00	—	27% below	25%
Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 HC ED SINUS ENDO W/BALLOON DILATION CDM	$11,601.00	$15,468.00	—	—	25%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESION STEREO	$5,250.00	$7,000.00	—	32% above	25%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST 1ST LESION STEREO	$5,250.00	$7,000.00	—	—	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC ED CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM	$390.75	$521.00	—	32% below	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC PR ED 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM	$867.00	$1,156.00	—	50% above	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC PR 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ CDM	$867.00	$1,156.00	—	50% above	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC PR ED 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM	$947.25	$1,263.00	—	64% above	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC PR 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ CDM	$947.25	$1,263.00	—	64% above	25%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC ED CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM	$390.75	$521.00	—	—	25%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC PR ED 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM	$867.00	$1,156.00	—	—	25%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC PR 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ CDM	$867.00	$1,156.00	—	—	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC ED TREAT METATARSAL FRACTURE W/O MANIPULATION CDM	$390.75	$521.00	—	14% below	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC PR ED 28470 TREAT METATARSAL FRACTURE W/O MANIPULATION CDM	$654.00	$872.00	—	43% above	25%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC ED TREAT METATARSAL FRACTURE W/O MANIPULATION CDM	$390.75	$521.00	—	—	25%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 HC ED CORRECTION OF BUNION CDM	$7,381.50	$9,842.00	—	7% below	25%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 HC ED CORRECTION OF BUNION CDM	$7,381.50	$9,842.00	—	—	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC PR 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL CDM	$308.25	$411.00	—	79% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC PR 92960 CARDIOVERSION ELECTIVE EXTERNAL	$308.25	$411.00	—	79% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM	$308.25	$411.00	—	79% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM	$439.50	$586.00	—	70% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$1,886.25	$2,515.00	—	29% above	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM	$308.25	$411.00	—	—	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC PR 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL CDM	$308.25	$411.00	—	—	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC PR 92960 CARDIOVERSION ELECTIVE EXTERNAL	$308.25	$411.00	—	—	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$1,886.25	$2,515.00	—	—	25%
Carpal tunnel release, open surgery CPT 64721 HC PR 64721 CARPAL TUNNEL SURGERY, SEPARATE PROC	$1,295.25	$1,727.00	—	73% below	25%
Carpal tunnel release, open surgery CPT 64721 HC PR 64721 CARPAL TUNNEL SURGERY	$1,295.25	$1,727.00	—	73% below	25%
Carpal tunnel release, open surgery CPT 64721 HC PR 64721 CARPAL TUNNEL SURGERY	$1,317.00	$1,756.00	—	72% below	25%
Carpal tunnel release, open surgery CPT 64721 HC ED NEUROPLASTY MEDIAN NERVE AT CARP TUNNEL CDM	$4,457.25	$5,943.00	—	7% below	25%
Carpal tunnel release, open surgery inpatient CPT 64721 HC PR 64721 CARPAL TUNNEL SURGERY, SEPARATE PROC	$1,295.25	$1,727.00	—	—	25%
Carpal tunnel release, open surgery inpatient CPT 64721 HC PR 64721 CARPAL TUNNEL SURGERY	$1,295.25	$1,727.00	—	—	25%
Carpal tunnel release, open surgery inpatient CPT 64721 HC ED NEUROPLASTY MEDIAN NERVE AT CARP TUNNEL CDM	$4,457.25	$5,943.00	—	—	25%
Cervical biopsy CPT 57500 HC PR 57500 BIOPSY OF CERVIX	$218.25	$291.00	—	78% below	25%
Cervical biopsy CPT 57500 HC PR 57500 BIOPSY OF CERVIX	$434.25	$579.00	—	56% below	25%
Cervical biopsy CPT 57500 HC ED BIOPSY OF CERVIX CDM	$1,744.50	$2,326.00	—	76% above	25%
Cervical biopsy inpatient CPT 57500 HC PR 57500 BIOPSY OF CERVIX	$218.25	$291.00	—	—	25%
Cervical biopsy inpatient CPT 57500 HC ED BIOPSY OF CERVIX CDM	$1,744.50	$2,326.00	—	—	25%
Cesarean delivery, including prenatal and postpartum care CPT 59510 HC PR 59510 TOTAL OB/CESAREAN DELIVERY/PP CAR	$7,765.50	$10,354.00	—	at median	25%
Cesarean delivery, including prenatal and postpartum care CPT 59510 HC PR 59510 TOTAL OB/CESAREAN DELIVERY/PP CAR	$7,765.50	$10,354.00	—	at median	25%
Cesarean delivery, including prenatal and postpartum care CPT 59510 HC PR 59510 OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM	$7,765.50	$10,354.00	—	at median	25%
Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 HC PR 59510 TOTAL OB/CESAREAN DELIVERY/PP CAR	$7,765.50	$10,354.00	—	—	25%
Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 HC PR 59510 OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM	$7,765.50	$10,354.00	—	—	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC PR 54150 CIRCUMCISION W/REGIONAL BLOCK	$275.25	$367.00	—	43% below	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION W/REGIONL BLOCK CDM	$364.50	$486.00	—	25% below	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC PR 54150 CIRCUMCISION W/REGIONAL BLOCK	$427.50	$570.00	—	11% below	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC PR 54150 CIRCUMCISION W/REGIONAL BLOCK	$275.25	$367.00	—	—	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC CIRCUMCISION W/REGIONL BLOCK CDM	$364.50	$486.00	—	—	25%
Circumcision, surgical, older than a newborn CPT 54160 HC PR 54160 CIRCUMCISION NEONATE	$419.25	$559.00	—	13% above	25%
Circumcision, surgical, older than a newborn inpatient CPT 54160 HC PR 54160 CIRCUMCISION NEONATE	$419.25	$559.00	—	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM	$390.75	$521.00	—	26% below	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC PR 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ CDM	$991.50	$1,322.00	—	87% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC PR ED 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O MANIP CDM	$991.50	$1,322.00	—	87% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC PR 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ CDM	$1,034.25	$1,379.00	—	95% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC PR ED 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O MANIP CDM	$1,034.25	$1,379.00	—	95% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM	$390.75	$521.00	—	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC PR ED 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O MANIP CDM	$991.50	$1,322.00	—	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC PR 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ CDM	$991.50	$1,322.00	—	—	25%
Colonoscopy with polyp removal CPT 45385 HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM	$720.75	$961.00	—	69% below	25%
Colonoscopy with polyp removal CPT 45385 HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM	$1,292.25	$1,723.00	—	45% below	25%
Colonoscopy with polyp removal inpatient CPT 45385 HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM	$720.75	$961.00	—	—	25%
Colonoscopy with tissue sample CPT 45380 HC PR 45380 COLONOSCOPY FLEXIBLE W/BIOPSY SINGLE/MULTIPLE CDM	$572.25	$763.00	—	71% below	25%
Colonoscopy with tissue sample CPT 45380 HC PR 45380 COLONOSCOPY FLEXIBLE W/BIOPSY SINGLE/MULTIPLE CDM	$1,230.75	$1,641.00	—	37% below	25%
Colonoscopy with tissue sample inpatient CPT 45380 HC PR 45380 COLONOSCOPY FLEXIBLE W/BIOPSY SINGLE/MULTIPLE CDM	$572.25	$763.00	—	—	25%
Colonoscopy, diagnostic CPT 45378 HC PR 45378 DX COLONOSCOPY FLEXIBLE W/COLLTN SPEC WHEN PFRMD CDM	$525.75	$701.00	—	75% below	25%
Colonoscopy, diagnostic CPT 45378 HC PR 45378 DX COLONOSCOPY FLEXIBLE W/COLLTN SPEC WHEN PFRMD CDM	$972.75	$1,297.00	—	54% below	25%
Colonoscopy, diagnostic CPT 45378 HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM	$2,061.00	$2,748.00	—	2% below	25%
Colonoscopy, diagnostic inpatient CPT 45378 HC PR 45378 DX COLONOSCOPY FLEXIBLE W/COLLTN SPEC WHEN PFRMD CDM	$525.75	$701.00	—	—	25%
Colonoscopy, diagnostic inpatient CPT 45378 HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM	$2,061.00	$2,748.00	—	—	25%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC PR 57460 COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX CDM	$462.00	$616.00	—	73% below	25%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC PR 57460 BX OF CERVIX W/SCOPE LEEP	$462.00	$616.00	—	73% below	25%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC PR 57460 BX OF CERVIX W/SCOPE LEEP	$887.25	$1,183.00	—	49% below	25%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HC PR 57460 COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX CDM	$462.00	$616.00	—	—	25%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HC PR 57460 BX OF CERVIX W/SCOPE LEEP	$462.00	$616.00	—	—	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC PR 57454 BX/CURETT OF CERVIX W/SCOPE	$386.25	$515.00	—	7% below	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC PR 57454 BX/CURETT OF CERVIX W/SCOPE	$486.75	$649.00	—	17% above	25%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC PR 57454 BX/CURETT OF CERVIX W/SCOPE	$386.25	$515.00	—	—	25%
Cystoscopy with ureteral stent placement CPT 52332 HC PR 52332 CYSTOURETHROSCOPY W/ INSERTION OF INDWELLING URETERAL STEN	$445.50	$594.00	—	92% below	25%
Cystoscopy with ureteral stent placement inpatient CPT 52332 HC PR 52332 CYSTOURETHROSCOPY W/ INSERTION OF INDWELLING URETERAL STEN	$445.50	$594.00	—	—	25%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC PR 52000 CYSTOURETHROSCOPY	$229.50	$306.00	—	66% below	25%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC PR 52000 CYSTOURETHROSCOPY	$633.00	$844.00	—	6% below	25%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC ED CYSTOURETHROSCOPY CDM	$1,172.25	$1,563.00	—	73% above	25%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC PR 52000 CYSTOURETHROSCOPY	$229.50	$306.00	—	—	25%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC ED CYSTOURETHROSCOPY CDM	$1,172.25	$1,563.00	—	—	25%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HC PR 58120 DILATION AND CURETTAGE	$676.50	$902.00	—	84% below	25%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HC PR 58120 DILATION AND CURETTAGE	$858.00	$1,144.00	—	80% below	25%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HC ED DILATION AND CURETTAGE CDM	$7,011.00	$9,348.00	—	64% above	25%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC PR 58120 DILATION AND CURETTAGE	$676.50	$902.00	—	—	25%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC ED DILATION AND CURETTAGE CDM	$7,011.00	$9,348.00	—	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC PR 17000 DESTRUCT PREMALG LESION FIRST LESION	$159.00	$212.00	—	3% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC PR 17000 DESTRUCTION PREMALIGNANT LESION 1ST RHC	$159.00	$212.00	—	3% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC PR 17000 DESTRUCTION PREMALIGNANT LESION 1ST CDM	$159.00	$212.00	—	3% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC PR 17000 DESTRUCT PREMALG LESION FIRST LESION	$196.50	$262.00	—	20% above	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC ED DESTRUCT PREMALG LESION FIRST LESION CDM	$447.75	$597.00	—	172% above	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC PR 17000 DESTRUCTION PREMALIGNANT LESION 1ST CDM	$159.00	$212.00	—	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC PR 17000 DESTRUCT PREMALG LESION FIRST LESION	$159.00	$212.00	—	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC ED DESTRUCT PREMALG LESION FIRST LESION CDM	$447.75	$597.00	—	—	25%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 HC PR 69433 CREATE EARDRUM OPENING LOCAL ANESTHESIA	$579.75	$773.00	—	3% above	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC ED REMOVE IMPACTED EAR WAX UNI CDM	$277.50	$370.00	—	257% above	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC PR ED 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM	$45.00	$60.00	—	42% below	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC PR 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM	$45.00	$60.00	—	42% below	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC PR 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM	$45.00	$60.00	—	42% below	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC PR 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT RHC	$45.00	$60.00	—	42% below	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC PR ED 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM	$60.00	$80.00	—	23% below	25%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC ED REMOVE IMPACTED EAR WAX UNI CDM	$277.50	$370.00	—	—	25%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 HC PR 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM	$45.00	$60.00	—	—	25%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 HC PR ED 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM	$45.00	$60.00	—	—	25%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 HC PR 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM	$45.00	$60.00	—	—	25%
Earwax removal with instruments, one ear one side CPT 69210 HC PR 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM	$92.25	$123.00	—	18% below	25%
Earwax removal with instruments, one ear one side CPT 69210 HC PR ED 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM	$138.00	$184.00	—	23% above	25%
Earwax removal with instruments, one ear one side CPT 69210 HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM	$366.00	$488.00	—	227% above	25%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HC PR 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM	$92.25	$123.00	—	—	25%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM	$366.00	$488.00	—	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC PR 58100 BIOPSY OF UTERUS LINING	$181.50	$242.00	—	56% below	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC PR 58100 BIOPSY OF UTERUS LINING	$288.75	$385.00	—	30% below	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC ED ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX CDM	$441.75	$589.00	—	7% above	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC PR 58100 BIOPSY OF UTERUS LINING	$181.50	$242.00	—	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC ED ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX CDM	$441.75	$589.00	—	—	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC ED INJ INTERLAMINR CRV-THOR W IMG CDM	$1,598.25	$2,131.00	—	17% below	25%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC ED INJ INTERLAMINR CRV-THOR W IMG CDM	$1,598.25	$2,131.00	—	—	25%
Eye injection into the vitreous (intravitreal injection) CPT 67028 HC ED INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM	$717.75	$957.00	—	1% above	25%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HC ED INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM	$717.75	$957.00	—	—	25%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 HC PR 49593 RPR AA HERNIA 1ST 3-10 CM REDUCIBLE CDM	$1,656.00	$2,208.00	—	48% below	25%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 HC PR 49593 RPR AA HERNIA 1ST 3-10 CM REDUCIBLE CDM	$1,656.00	$2,208.00	—	—	25%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 HC PR 49595 RPR AA HERNIA 1ST > 10 CM REDUCIBLE CDM	$2,232.75	$2,977.00	—	at median	25%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 HC PR 49595 RPR AA HERNIA 1ST > 10 CM REDUCIBLE CDM	$2,232.75	$2,977.00	—	—	25%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 HC PR 49591 RPR AA HERNIA 1ST/LESS THAN 3 CM REDUCIBLE CDM	$990.00	$1,320.00	—	24% below	25%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 HC PR 49591 RPR AA HERNIA 1ST/LESS THAN 3 CM REDUCIBLE CDM	$990.00	$1,320.00	—	—	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC PR 45330 DIAGNOSTIC SIGMOIDOSCOPY	$164.25	$219.00	—	85% below	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC PR 45330 DIAGNOSTIC SIGMOIDOSCOPY	$534.75	$713.00	—	50% below	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC ED SIGMOID DX FLX W WO SPEC COLL CDM	$2,061.00	$2,748.00	—	93% above	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC PR 45330 DIAGNOSTIC SIGMOIDOSCOPY	$164.25	$219.00	—	—	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC ED SIGMOID DX FLX W WO SPEC COLL CDM	$2,061.00	$2,748.00	—	—	25%
Gallbladder removal, laparoscopic CPT 47562 HC PR 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$1,926.00	$2,568.00	—	83% below	25%
Gallbladder removal, laparoscopic CPT 47562 HC PR 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$1,926.00	$2,568.00	—	83% below	25%
Gallbladder removal, laparoscopic CPT 47562 HC LAPAROSCOPIC CHOLECYSTECTOMY	$11,854.50	$15,806.00	—	2% above	25%
Gallbladder removal, laparoscopic inpatient CPT 47562 HC PR 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$1,926.00	$2,568.00	—	—	25%
Gallbladder removal, laparoscopic inpatient CPT 47562 HC LAPAROSCOPIC CHOLECYSTECTOMY	$11,854.50	$15,806.00	—	—	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 HC PR 47563 LAPAROSCOPY CHOLECYSTECTOMY/GRAPH	$2,094.00	$2,792.00	—	82% below	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 HC PR 47563 LAPAROSCOPY CHOLECYSTECTOMY/GRAPH	$2,094.00	$2,792.00	—	82% below	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM	$12,924.00	$17,232.00	—	13% above	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 HC PR 47563 LAPAROSCOPY CHOLECYSTECTOMY/GRAPH	$2,094.00	$2,792.00	—	—	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM	$12,924.00	$17,232.00	—	—	25%
Hammertoe correction surgery CPT 28285 HC PR 28285 REPAIR OF HAMMERTOE	$1,140.75	$1,521.00	—	35% below	25%
Hammertoe correction surgery inpatient CPT 28285 HC PR 28285 REPAIR OF HAMMERTOE	$1,140.75	$1,521.00	—	—	25%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC PR 46221 LIGATION OF HEMORRHOID(S)	$565.50	$754.00	—	24% below	25%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC PR ED 46221 LIGATION OF HEMORRHOID(S) CDM	$827.25	$1,103.00	—	12% above	25%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC ED HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS CDM	$2,061.00	$2,748.00	—	178% above	25%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC PR 46221 LIGATION OF HEMORRHOID(S)	$565.50	$754.00	—	—	25%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC ED HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS CDM	$2,061.00	$2,748.00	—	—	25%
Hemorrhoidectomy (internal and external), one area CPT 46255 HC ED HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP CDM	$6,372.00	$8,496.00	—	11% above	25%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HC ED HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP CDM	$6,372.00	$8,496.00	—	—	25%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 HC PR 27132 TOTAL HIP ARTHROPLASTY - REPLCMNT	$4,852.50	$6,470.00	—	at median	25%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 HC PR 27132 TOTAL HIP ARTHROPLASTY - REPLCMNT	$4,852.50	$6,470.00	—	—	25%
Hysterectomy through an abdominal incision (total) CPT 58150 HC PR 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY CDM	$2,947.50	$3,930.00	—	51% below	25%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 HC PR 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY CDM	$2,947.50	$3,930.00	—	—	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$160.50	$214.00	—	43% below	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC PR 58340 CATHETER FOR HYSTEROGRAPHY	$669.75	$893.00	—	139% above	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$160.50	$214.00	—	—	25%
Hysteroscopy with endometrial ablation CPT 58563 HC PR 58563 HYSTEROSCOPY ABLATION	$706.50	$942.00	—	76% below	25%
Hysteroscopy with endometrial ablation CPT 58563 HC PR 58563 HYSTEROSCOPY ABLATION	$5,667.00	$7,556.00	—	95% above	25%
Hysteroscopy with endometrial ablation inpatient CPT 58563 HC PR 58563 HYSTEROSCOPY ABLATION	$706.50	$942.00	—	—	25%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HC PR 58558 HYSTEROSCOPY BIOPSY	$666.00	$888.00	—	76% below	25%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HC PR 58558 HYSTEROSCOPY BIOPSY	$3,582.75	$4,777.00	—	31% above	25%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HC PR 58558 HYSTEROSCOPY BIOPSY	$666.00	$888.00	—	—	25%
IUD insertion (the device itself billed separately) CPT 58300 HC PR 58300 INSERTION INTRAUTERINE DEVICE IUD RHC	$144.75	$193.00	—	67% below	25%
IUD insertion (the device itself billed separately) CPT 58300 HC PR 58300 INSERT INTRAUTERINE DEVICE	$144.75	$193.00	—	67% below	25%
IUD insertion (the device itself billed separately) CPT 58300 HC ED INSERTION INTRAUTERINE DEVICE IUD CDM	$441.75	$589.00	—	1% above	25%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC PR 58300 INSERT INTRAUTERINE DEVICE	$144.75	$193.00	—	—	25%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC ED INSERTION INTRAUTERINE DEVICE IUD CDM	$441.75	$589.00	—	—	25%
Incision and drainage of a simple or single skin abscess CPT 10060 HC PR 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE CDM	$311.25	$415.00	—	8% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 HC PR 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE RHC	$311.25	$415.00	—	8% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE	$311.25	$415.00	—	8% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM	$369.00	$492.00	—	9% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE	$369.00	$492.00	—	9% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM	$420.75	$561.00	—	25% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$420.75	$561.00	—	25% above	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC PR 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE CDM	$311.25	$415.00	—	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE	$311.25	$415.00	—	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$420.75	$561.00	—	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM	$420.75	$561.00	—	—	25%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC PR 49505 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR REDUCIBLE	$1,530.00	$2,040.00	—	83% below	25%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC PR 49505 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR REDUCIBLE	$1,530.00	$2,040.00	—	83% below	25%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM	$8,782.50	$11,710.00	—	2% below	25%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HC PR 49505 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR REDUCIBLE	$1,530.00	$2,040.00	—	—	25%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM	$8,782.50	$11,710.00	—	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PR ED 20550 INJ TENDON SHEATH/LIGAMENT CDM	$112.50	$150.00	—	53% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PR 20550 INJ TENDON SHEATH/LIGAMENT	$112.50	$150.00	—	53% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PR 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS RHC	$112.50	$150.00	—	53% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PR 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS CDM	$112.50	$150.00	—	53% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PR ED 20550 INJ TENDON SHEATH/LIGAMENT CDM	$168.00	$224.00	—	30% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC ED INJ TENDON SHEATH/LIGAMENT CDM	$408.75	$545.00	—	71% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC PR ED 20550 INJ TENDON SHEATH/LIGAMENT CDM	$112.50	$150.00	—	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC PR 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS CDM	$112.50	$150.00	—	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC PR 20550 INJ TENDON SHEATH/LIGAMENT	$112.50	$150.00	—	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC ED INJ TENDON SHEATH/LIGAMENT CDM	$408.75	$545.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM	$130.50	$174.00	—	58% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM	$130.50	$174.00	—	58% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US RHC	$130.50	$174.00	—	58% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR CDM	$130.50	$174.00	—	58% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR CDM	$188.25	$251.00	—	40% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM	$188.25	$251.00	—	40% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$885.75	$1,181.00	—	184% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM	$885.75	$1,181.00	—	184% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM	$130.50	$174.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC PR 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM	$130.50	$174.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR CDM	$130.50	$174.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM	$885.75	$1,181.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$885.75	$1,181.00	—	—	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC PR 11981 INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT RHC	$181.50	$242.00	—	29% below	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC PR 11981 INSERT DRUG IMPLANT DEVICE	$181.50	$242.00	—	29% below	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC PR 11981 INSERT DRUG IMPLANT DEVICE	$291.00	$388.00	—	14% above	25%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC PR 11981 INSERT DRUG IMPLANT DEVICE	$181.50	$242.00	—	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PR 20605 INJ MED JOINT	$105.75	$141.00	—	69% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PR 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDA	$105.75	$141.00	—	69% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PR 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US RHC	$105.75	$141.00	—	69% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PR ED 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE CDM	$105.75	$141.00	—	69% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PR ED 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE CDM	$158.25	$211.00	—	54% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE	$615.00	$820.00	—	79% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM	$615.00	$820.00	—	79% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC PR 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDA	$105.75	$141.00	—	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC PR ED 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE CDM	$105.75	$141.00	—	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC PR 20605 INJ MED JOINT	$105.75	$141.00	—	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM	$615.00	$820.00	—	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE	$615.00	$820.00	—	—	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC PR 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US RHC	$102.75	$137.00	—	67% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC PR 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDAN	$102.75	$137.00	—	67% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC PR ED 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE CDM	$102.75	$137.00	—	67% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC PR ED 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE CDM	$155.25	$207.00	—	51% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM	$615.00	$820.00	—	96% above	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC PR ED 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE CDM	$102.75	$137.00	—	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC PR 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDAN	$102.75	$137.00	—	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM	$615.00	$820.00	—	—	25%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 HC PR 29882 KNEE ARTHROSCOPY/SURGERY MENISCUS	$2,023.50	$2,698.00	—	44% below	25%
Knee arthroscopy with meniscus trim CPT 29881 HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY	$1,597.50	$2,130.00	—	50% below	25%
Knee arthroscopy with meniscus trim CPT 29881 HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY	$1,597.50	$2,130.00	—	50% below	25%
Knee arthroscopy with meniscus trim inpatient CPT 29881 HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY	$1,597.50	$2,130.00	—	—	25%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 HC PR 29880 ARTHRSCP M/L MENISECTOMY	$1,656.75	$2,209.00	—	66% below	25%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 HC PR 29880 ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING	$1,656.75	$2,209.00	—	66% below	25%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 HC PR 29880 ARTHRSCP M/L MENISECTOMY	$1,656.75	$2,209.00	—	66% below	25%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 HC PR 29880 ARTHRSCP M/L MENISECTOMY	$1,656.75	$2,209.00	—	—	25%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 HC PR 29880 ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING	$1,656.75	$2,209.00	—	—	25%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 HC PR 29877 KNEE SCOPE SHAVE ARTICULAR CARTILAGE CDM	$1,830.00	$2,440.00	—	46% below	25%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 HC PR 29877 KNEE SCOPE SHAVE ARTICULAR CARTILAGE CDM	$1,830.00	$2,440.00	—	—	25%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 HC PR 44970 LAPAROSCOPY APPENDECTOMY	$1,755.75	$2,341.00	—	85% below	25%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 HC PR 44970 LAPAROSCOPY APPENDECTOMY	$1,755.75	$2,341.00	—	85% below	25%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 HC PR 44970 LAPAROSCOPY APPENDECTOMY	$1,755.75	$2,341.00	—	—	25%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 HC PR 43280 LAPAROSCOPY FUNDOPLASTY	$3,119.25	$4,159.00	—	at median	25%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 HC PR 49650 LAPAROSCOPY INGUINAL HERNIA REPAIR, INITIAL	$1,269.00	$1,692.00	—	34% below	25%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 HC PR 49650 LAPAROSCOPY INGUINAL HERNIA REPAIR, INITIAL	$1,269.00	$1,692.00	—	—	25%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 HC PR 49651 LAPAROSCOPY INGUINAL HERNIA REPAIR, RECURRENT	$1,655.25	$2,207.00	—	at median	25%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 HC PR 49651 LAPAROSCOPY INGUINAL HERNIA REPAIR, RECURRENT	$1,655.25	$2,207.00	—	at median	25%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 HC PR 49651 LAPAROSCOPY INGUINAL HERNIA REPAIR, RECURRENT	$1,655.25	$2,207.00	—	—	25%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 HC PR 58661 LAPAROSCOPY REMOVE ADNEXA	$1,886.25	$2,515.00	—	35% below	25%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 HC PR 58661 LAPAROSCOPY REMOVE ADNEXA	$1,886.25	$2,515.00	—	35% below	25%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 HC PR 58661 LAPAROSCOPY REMOVE ADNEXA	$1,886.25	$2,515.00	—	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC PR 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< CDM	$438.75	$585.00	—	27% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC PR 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM	$438.75	$585.00	—	27% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM	$683.25	$911.00	—	13% above	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC PR 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< CDM	$750.75	$1,001.00	—	25% above	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC PR 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM	$750.75	$1,001.00	—	25% above	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC PR ED 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM	$750.75	$1,001.00	—	25% above	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC PR 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM	$438.75	$585.00	—	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC PR 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< CDM	$438.75	$585.00	—	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM	$683.25	$911.00	—	—	25%
Lower-back epidural injection, with imaging guidance CPT 62323 HC ED INJ EPI LUMB/SACRAL W IMAGING CDM	$1,598.25	$2,131.00	—	1% above	25%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC ED INJ EPI LUMB/SACRAL W IMAGING CDM	$1,598.25	$2,131.00	—	—	25%
Lower-back epidural injection, without imaging guidance CPT 62322 HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM	$2,113.50	$2,818.00	—	35% above	25%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM	$2,113.50	$2,818.00	—	—	25%
Lumpectomy (partial mastectomy) CPT 19301 HC PR 19301 PARTIAL MASTECTOMY	$1,920.75	$2,561.00	—	73% below	25%
Lumpectomy (partial mastectomy) CPT 19301 HC PR 19301 MASTECTOMY PARTIAL CDM	$1,920.75	$2,561.00	—	73% below	25%
Lumpectomy (partial mastectomy) inpatient CPT 19301 HC PR 19301 MASTECTOMY PARTIAL CDM	$1,920.75	$2,561.00	—	—	25%
Mastectomy (total removal of the breast) CPT 19303 HC PR 19303 MAST SIMPLE COMPLETE	$2,790.75	$3,721.00	—	11% below	25%
Mastectomy (total removal of the breast) CPT 19303 HC PR 19303 MAST SIMPLE COMPLETE	$2,790.75	$3,721.00	—	11% below	25%
Mastectomy (total removal of the breast) inpatient CPT 19303 HC PR 19303 MAST SIMPLE COMPLETE	$2,790.75	$3,721.00	—	—	25%
Miscarriage treatment with D&C, first trimester CPT 59820 HC PR 59820 CARE OF MISCARRIAGE	$1,125.75	$1,501.00	—	75% below	25%
Miscarriage treatment with D&C, first trimester CPT 59820 HC PR 59820 CARE OF MISCARRIAGE	$1,272.00	$1,696.00	—	72% below	25%
Miscarriage treatment with D&C, first trimester CPT 59820 HC ED SPONTANEOUS ABORTION FAC CDM	$7,011.00	$9,348.00	—	55% above	25%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC PR 59820 CARE OF MISCARRIAGE	$1,125.75	$1,501.00	—	—	25%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC ED SPONTANEOUS ABORTION FAC CDM	$7,011.00	$9,348.00	—	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS RHC	$246.75	$329.00	—	60% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS	$246.75	$329.00	—	60% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS	$369.00	$492.00	—	41% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM	$1,608.75	$2,145.00	—	158% above	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS	$246.75	$329.00	—	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM	$1,608.75	$2,145.00	—	—	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC PR 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS	$312.75	$417.00	—	54% below	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC PR 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS	$410.25	$547.00	—	40% below	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM	$1,608.75	$2,145.00	—	135% above	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC PR 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS	$312.75	$417.00	—	—	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM	$1,608.75	$2,145.00	—	—	25%
Nail removal (partial or complete), one nail CPT 11730 HC PR 11730 REMOVAL OF NAIL PLATE	$154.50	$206.00	—	24% below	25%
Nail removal (partial or complete), one nail CPT 11730 HC PR 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 RHC	$154.50	$206.00	—	24% below	25%
Nail removal (partial or complete), one nail CPT 11730 HC PR ED 11730 REMOVAL OF NAIL PLATE CDM	$154.50	$206.00	—	24% below	25%
Nail removal (partial or complete), one nail CPT 11730 HC PR ED 11730 REMOVAL OF NAIL PLATE CDM	$328.50	$438.00	—	62% above	25%
Nail removal (partial or complete), one nail CPT 11730 HC ED REMOVAL OF NAIL PLATE CDM	$636.75	$849.00	—	214% above	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC PR 11730 REMOVAL OF NAIL PLATE	$154.50	$206.00	—	—	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC PR ED 11730 REMOVAL OF NAIL PLATE CDM	$154.50	$206.00	—	—	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC ED REMOVAL OF NAIL PLATE CDM	$636.75	$849.00	—	—	25%
Paracentesis with imaging guidance CPT 49083 HC PR 49083 ABD PARACENT W/IMAG GUIDANCE	$302.25	$403.00	—	77% below	25%
Paracentesis with imaging guidance CPT 49083 HC PR 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM	$302.25	$403.00	—	77% below	25%
Paracentesis with imaging guidance CPT 49083 HC PR ED 49083 ABD PARACENT W/IMAG GUIDANCE CDM	$822.75	$1,097.00	—	37% below	25%
Paracentesis with imaging guidance CPT 49083 HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM	$1,077.00	$1,436.00	—	18% below	25%
Paracentesis with imaging guidance CPT 49083 HC ED ABD PARACENTESIS W/IMAG GUIDANCE CDM	$1,077.00	$1,436.00	—	18% below	25%
Paracentesis with imaging guidance inpatient CPT 49083 HC PR 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM	$302.25	$403.00	—	—	25%
Paracentesis with imaging guidance inpatient CPT 49083 HC PR 49083 ABD PARACENT W/IMAG GUIDANCE	$302.25	$403.00	—	—	25%
Paracentesis with imaging guidance inpatient CPT 49083 HC ED ABD PARACENTESIS W/IMAG GUIDANCE CDM	$1,077.00	$1,436.00	—	—	25%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM	$1,077.00	$1,436.00	—	—	25%
Partial knee replacement (one compartment) CPT 27446 HC PR 27446 REVISION OF KNEE JOINT	$3,347.25	$4,463.00	—	88% below	25%
Partial knee replacement (one compartment) CPT 27446 HC PR 27446 PLASTY KNEE MED OR LAT COMPARTMT (27446) CDM	$3,347.25	$4,463.00	—	88% below	25%
Partial knee replacement (one compartment) CPT 27446 HC PR 27446 REVISION OF KNEE JOINT	$3,347.25	$4,463.00	—	88% below	25%
Partial knee replacement (one compartment) inpatient CPT 27446 HC PR 27446 REVISION OF KNEE JOINT	$3,347.25	$4,463.00	—	—	25%
Partial knee replacement (one compartment) inpatient CPT 27446 HC PR 27446 PLASTY KNEE MED OR LAT COMPARTMT (27446) CDM	$3,347.25	$4,463.00	—	—	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC PR 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL CDM	$294.75	$393.00	—	51% below	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC PR 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL RHC	$294.75	$393.00	—	51% below	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC PR 11750 REMOVAL OF NAIL B CDM	$294.75	$393.00	—	51% below	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC PR ED 11750 REMOVAL OF NAIL BED CDM	$460.50	$614.00	—	23% below	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC PR 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL CDM	$294.75	$393.00	—	—	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC PR 11750 REMOVAL OF NAIL B CDM	$294.75	$393.00	—	—	25%
Prostate biopsy CPT 55700 HC PR 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH CDM	$370.50	$494.00	—	85% below	25%
Prostate biopsy inpatient CPT 55700 HC PR 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH CDM	$370.50	$494.00	—	—	25%
Removal of a breast lump, open surgery CPT 19120 HC PR 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION RHC	$1,224.75	$1,633.00	—	24% below	25%
Removal of a breast lump, open surgery CPT 19120 HC PR 19120 REMOVAL OF BREAST LESION 1 OR MORE LESIONS	$1,224.75	$1,633.00	—	24% below	25%
Removal of a breast lump, open surgery CPT 19120 HC PR 19120 REMOVAL OF BREAST LESION 1 OR MORE LESIONS	$1,515.00	$2,020.00	—	6% below	25%
Removal of a breast lump, open surgery inpatient CPT 19120 HC PR 19120 REMOVAL OF BREAST LESION 1 OR MORE LESIONS	$1,224.75	$1,633.00	—	—	25%
Removal of a foreign object under the skin, simple CPT 10120 HC PR 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE CDM	$307.50	$410.00	—	24% below	25%
Removal of a foreign object under the skin, simple CPT 10120 HC PR 10120 REMOVE FOREIGN BODY SIMPLE	$307.50	$410.00	—	24% below	25%
Removal of a foreign object under the skin, simple CPT 10120 HC PR 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE RHC	$307.50	$410.00	—	24% below	25%
Removal of a foreign object under the skin, simple CPT 10120 HC ED REMOVE FOREIGN BODY SIMPLE CDM	$327.75	$437.00	—	19% below	25%
Removal of a foreign object under the skin, simple CPT 10120 HC PR ED 10120 REMOVE FOREIGN BODY SIMPLE CDM	$436.50	$582.00	—	8% above	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC PR 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE CDM	$307.50	$410.00	—	—	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC PR 10120 REMOVE FOREIGN BODY SIMPLE	$307.50	$410.00	—	—	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC ED REMOVE FOREIGN BODY SIMPLE CDM	$327.75	$437.00	—	—	25%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 HC PR 60220 PARTIAL REMOVAL OF THYROID, W/WO ISTHMUSECTOMY	$2,054.25	$2,739.00	—	82% below	25%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 HC PR G0121 COLORECTAL SCRN NOT HI RISK IND	$527.25	$703.00	—	70% below	25%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 HC PR G0121 COLORECTAL SCRN NOT HI RISK IND	$973.50	$1,298.00	—	45% below	25%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 HC PR G0121 COLORECTAL SCRN NOT HI RISK IND	$527.25	$703.00	—	—	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HC PR G0105 COLORECTAL SCRN HI RISK IND	$525.75	$701.00	—	48% below	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HC PR G0105 COLORECTAL SCRN HI RISK IND	$972.75	$1,297.00	—	4% below	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 HC PR G0105 COLORECTAL SCRN HI RISK IND	$525.75	$701.00	—	—	25%
Septoplasty to straighten the nasal septum CPT 30520 HC ED REPAIR OF NASAL SEPTUM CDM	$7,055.25	$9,407.00	—	3% below	25%
Septoplasty to straighten the nasal septum inpatient CPT 30520 HC ED REPAIR OF NASAL SEPTUM CDM	$7,055.25	$9,407.00	—	—	25%
Short arm cast (elbow to hand) CPT 29075 HC PR 29075 APPLICATION CAST ELBOW FINGER SHORT ARM	$185.25	$247.00	—	30% below	25%
Short arm cast (elbow to hand) CPT 29075 HC PR 29075 APPLICATION CAST ELBOW FINGER SHORT ARM RHC	$185.25	$247.00	—	30% below	25%
Short arm cast (elbow to hand) CPT 29075 HC PR ED 29075 APPLICATION CAST ELBOW FINGER SHORT ARM CDM	$185.25	$247.00	—	30% below	25%
Short arm cast (elbow to hand) CPT 29075 HC PR ED 29075 APPLICATION CAST ELBOW FINGER SHORT ARM CDM	$264.00	$352.00	—	at median	25%
Short arm cast (elbow to hand) CPT 29075 HC ED SHORT ARM CAST APPLICATION CDM	$595.50	$794.00	—	126% above	25%
Short arm cast (elbow to hand) inpatient CPT 29075 HC PR ED 29075 APPLICATION CAST ELBOW FINGER SHORT ARM CDM	$185.25	$247.00	—	—	25%
Short arm cast (elbow to hand) inpatient CPT 29075 HC PR 29075 APPLICATION CAST ELBOW FINGER SHORT ARM	$185.25	$247.00	—	—	25%
Short arm cast (elbow to hand) inpatient CPT 29075 HC ED SHORT ARM CAST APPLICATION CDM	$595.50	$794.00	—	—	25%
Short arm splint (forearm and hand) CPT 29125 HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM	$117.75	$157.00	—	35% below	25%
Short arm splint (forearm and hand) CPT 29125 HC PR 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC RHC	$117.75	$157.00	—	35% below	25%
Short arm splint (forearm and hand) CPT 29125 HC PR 29125 SHORT ARM SPLINT APPLICATION	$117.75	$157.00	—	35% below	25%
Short arm splint (forearm and hand) CPT 29125 HC PR 29125 SHORT ARM SPLINT APPLICATION	$199.50	$266.00	—	11% above	25%
Short arm splint (forearm and hand) CPT 29125 HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM	$199.50	$266.00	—	11% above	25%
Short arm splint (forearm and hand) CPT 29125 HC ED SHORT ARM SPLINT APPLICATION CDM	$218.25	$291.00	—	21% above	25%
Short arm splint (forearm and hand) inpatient CPT 29125 HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM	$117.75	$157.00	—	—	25%
Short arm splint (forearm and hand) inpatient CPT 29125 HC PR 29125 SHORT ARM SPLINT APPLICATION	$117.75	$157.00	—	—	25%
Short arm splint (forearm and hand) inpatient CPT 29125 HC ED SHORT ARM SPLINT APPLICATION CDM	$218.25	$291.00	—	—	25%
Short leg cast (below the knee) CPT 29405 HC PR ED 29405 SHORT LEG CAST APPLICATION CDM	$171.75	$229.00	—	41% below	25%
Short leg cast (below the knee) CPT 29405 HC PR 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE RHC	$171.75	$229.00	—	41% below	25%
Short leg cast (below the knee) CPT 29405 HC PR 29405 SHORT LEG CAST APPLICATION	$171.75	$229.00	—	41% below	25%
Short leg cast (below the knee) CPT 29405 HC PR 29405 SHORT LEG CAST APPLICATION	$240.00	$320.00	—	18% below	25%
Short leg cast (below the knee) CPT 29405 HC PR ED 29405 SHORT LEG CAST APPLICATION CDM	$240.00	$320.00	—	18% below	25%
Short leg cast (below the knee) CPT 29405 HC ED SHORT LEG CAST APPLICATION CDM	$595.50	$794.00	—	104% above	25%
Short leg cast (below the knee) inpatient CPT 29405 HC PR ED 29405 SHORT LEG CAST APPLICATION CDM	$171.75	$229.00	—	—	25%
Short leg cast (below the knee) inpatient CPT 29405 HC PR 29405 SHORT LEG CAST APPLICATION	$171.75	$229.00	—	—	25%
Short leg cast (below the knee) inpatient CPT 29405 HC ED SHORT LEG CAST APPLICATION CDM	$595.50	$794.00	—	—	25%
Short leg splint (calf to foot) CPT 29515 HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM	$146.25	$195.00	—	38% below	25%
Short leg splint (calf to foot) CPT 29515 HC PR 29515 APPLICATION SHORT LEG SPLINT CALF FOOT RHC	$146.25	$195.00	—	38% below	25%
Short leg splint (calf to foot) CPT 29515 HC PR 29515 SHORT LEG SPLINT APPLICATION	$146.25	$195.00	—	38% below	25%
Short leg splint (calf to foot) CPT 29515 HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM	$216.75	$289.00	—	8% below	25%
Short leg splint (calf to foot) CPT 29515 HC ED SHORT LEG SPLINT APPLICATION CDM	$253.50	$338.00	—	7% above	25%
Short leg splint (calf to foot) inpatient CPT 29515 HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM	$146.25	$195.00	—	—	25%
Short leg splint (calf to foot) inpatient CPT 29515 HC PR 29515 SHORT LEG SPLINT APPLICATION	$146.25	$195.00	—	—	25%
Short leg splint (calf to foot) inpatient CPT 29515 HC ED SHORT LEG SPLINT APPLICATION CDM	$253.50	$338.00	—	—	25%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 HC PR 29824 SHOULDER ARTHROSCOPY/SURGERY	$1,994.25	$2,659.00	—	14% below	25%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 HC PR 29824 SHOULDER ARTHROSCOPY/SURGERY	$1,994.25	$2,659.00	—	—	25%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 HC PR 29826 ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE	$494.25	$659.00	—	79% below	25%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 HC PR 29826 ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE	$494.25	$659.00	—	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM	$129.00	$172.00	—	62% below	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC PR 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS	$129.00	$172.00	—	62% below	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM	$270.75	$361.00	—	20% below	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM	$522.75	$697.00	—	54% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM	$129.00	$172.00	—	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC PR 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS	$129.00	$172.00	—	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM	$522.75	$697.00	—	—	25%
Skin biopsy, punch, one lesion CPT 11104 HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION RHC	$134.25	$179.00	—	47% below	25%
Skin biopsy, punch, one lesion CPT 11104 HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION	$134.25	$179.00	—	47% below	25%
Skin biopsy, punch, one lesion CPT 11104 HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION	$354.00	$472.00	—	39% above	25%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION	$134.25	$179.00	—	—	25%
Skin tag removal, up to 15 tags CPT 11200 HC PR 11200 REMOVAL OF SKIN TAGS	$223.50	$298.00	—	11% below	25%
Skin tag removal, up to 15 tags CPT 11200 HC PR 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 RHC	$223.50	$298.00	—	11% below	25%
Skin tag removal, up to 15 tags CPT 11200 HC PR 11200 REMOVAL OF SKIN TAGS	$267.75	$357.00	—	6% above	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC PR 11200 REMOVAL OF SKIN TAGS	$223.50	$298.00	—	—	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PR 62270 DIAGNOSTIC LUMBAR SPINAL PUNCTURE CDM	$185.25	$247.00	—	81% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PR 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM	$185.25	$247.00	—	81% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PR 62270 ANES/SPINAL PUNC	$185.25	$247.00	—	81% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PR ED 62270 SPINAL FLUID TAP DIAGNOSTIC CDM	$420.75	$561.00	—	58% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PR 62270 DIAGNOSTIC LUMBAR SPINAL PUNCTURE CDM	$420.75	$561.00	—	58% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM	$688.50	$918.00	—	31% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$688.50	$918.00	—	31% below	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC PR 62270 DIAGNOSTIC LUMBAR SPINAL PUNCTURE CDM	$185.25	$247.00	—	—	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC PR 62270 ANES/SPINAL PUNC	$185.25	$247.00	—	—	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC PR 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM	$185.25	$247.00	—	—	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM	$688.50	$918.00	—	—	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$688.50	$918.00	—	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC PR 12002 REPAIR SUPERFICIAL WOUND(S) 2.6 TO 7.5CM SLP NK AX E	$168.75	$225.00	—	57% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC PR ED 12002 REPAIR SUPERFIC WOUND(S) 2.6 TO 7.5CM SLP NK AX EXGEN T CDM	$168.75	$225.00	—	57% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC PR ED 12002 REPAIR SUPERFIC WOUND(S) 2.6 TO 7.5CM SLP NK AX EXGEN T CDM	$329.25	$439.00	—	16% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC PR 12002 REPAIR SUPERFICIAL WOUND(S) 2.6 TO 7.5CM SLP NK AX E	$329.25	$439.00	—	16% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC ED REPAIR SUPERFICIAL WND(S) 2.6-7.5CM SLP NK AX EXGEN TRNK E CDM	$522.75	$697.00	—	33% above	25%
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 PR ED 12002 REPAIR SUPERFIC WOUND(S) 2.6 TO 7.5CM SLP NK AX EXGEN T CDM	$168.75	$225.00	—	—	25%
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 PR 12002 REPAIR SUPERFICIAL WOUND(S) 2.6 TO 7.5CM SLP NK AX E	$168.75	$225.00	—	—	25%
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 ED REPAIR SUPERFICIAL WND(S) 2.6-7.5CM SLP NK AX EXGEN TRNK E CDM	$522.75	$697.00	—	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC PR 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM	$160.50	$214.00	—	53% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC PR 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS	$160.50	$214.00	—	53% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC PR ED 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM	$323.25	$431.00	—	5% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC PR 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM	$323.25	$431.00	—	5% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC PR 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS	$323.25	$431.00	—	5% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair one side CPT 12011 HC ED REPAIR SUPERFICIAL WOUND(S) LT/2.5 FACE ERS EYLD NSE LPS MUC CDM	$623.25	$831.00	—	83% above	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC PR 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS	$160.50	$214.00	—	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC PR 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM	$160.50	$214.00	—	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient one side CPT 12011 HC ED REPAIR SUPERFICIAL WOUND(S) LT/2.5 FACE ERS EYLD NSE LPS MUC CDM	$623.25	$831.00	—	—	25%
TURP (transurethral resection of the prostate) CPT 52601 HC PR 52601 TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE CDM	$2,098.50	$2,798.00	—	—	25%
TURP (transurethral resection of the prostate) CPT 52601 HC PR 52601 PROSTATECTOMY (TURP)	$2,098.50	$2,798.00	—	—	25%
TURP (transurethral resection of the prostate) inpatient CPT 52601 HC PR 52601 TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE CDM	$2,098.50	$2,798.00	—	—	25%
TURP (transurethral resection of the prostate) inpatient CPT 52601 HC PR 52601 PROSTATECTOMY (TURP)	$2,098.50	$2,798.00	—	—	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC PR 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION RHC	$107.25	$143.00	—	51% below	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC PR 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION	$107.25	$143.00	—	51% below	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC PR 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION	$284.25	$379.00	—	31% above	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC ED TANGENTIAL BIOPSY SKIN SINGLE LESION CDM	$447.75	$597.00	—	106% above	25%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC PR 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION	$107.25	$143.00	—	—	25%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC ED TANGENTIAL BIOPSY SKIN SINGLE LESION CDM	$447.75	$597.00	—	—	25%
Thoracentesis with imaging guidance CPT 32555 HC PR 32555 THORANCENTESIS NEEDLE/CATH PLEURA W IMAGING	$308.25	$411.00	—	80% below	25%
Thoracentesis with imaging guidance CPT 32555 HC PR ED 32555 THORACENTESIS/ASPIR W IMG GD CDM	$408.75	$545.00	—	73% below	25%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$1,425.75	$1,901.00	—	7% below	25%
Thoracentesis with imaging guidance CPT 32555 HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM	$1,425.75	$1,901.00	—	7% below	25%
Thoracentesis with imaging guidance inpatient CPT 32555 HC PR 32555 THORANCENTESIS NEEDLE/CATH PLEURA W IMAGING	$308.25	$411.00	—	—	25%
Thoracentesis with imaging guidance inpatient CPT 32555 HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM	$1,425.75	$1,901.00	—	—	25%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$1,425.75	$1,901.00	—	—	25%
Total hip replacement CPT 27130 HC PR 27130 TOTAL HIP ARTHROPLASTY	$3,737.25	$4,983.00	—	51% below	25%
Total hip replacement CPT 27130 HC PR 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT	$3,737.25	$4,983.00	—	51% below	25%
Total hip replacement inpatient CPT 27130 HC PR 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT	$3,737.25	$4,983.00	—	—	25%
Total hip replacement inpatient CPT 27130 HC PR 27130 TOTAL HIP ARTHROPLASTY	$3,737.25	$4,983.00	—	—	25%
Total knee replacement CPT 27447 HC PR 27447 TOTAL KNEE ARTHROPLASTY	$3,732.75	$4,977.00	—	39% below	25%
Total knee replacement CPT 27447 HC PR 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS	$3,732.75	$4,977.00	—	39% below	25%
Total knee replacement CPT 27447 HC PR 27447 TOTAL KNEE ARTHROPLASTY	$3,732.75	$4,977.00	—	39% below	25%
Total knee replacement inpatient CPT 27447 HC PR 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS	$3,732.75	$4,977.00	—	—	25%
Total knee replacement inpatient CPT 27447 HC PR 27447 TOTAL KNEE ARTHROPLASTY	$3,732.75	$4,977.00	—	—	25%
Total shoulder replacement CPT 23472 HC PR 23472 RECONSTRUCT SHOULDER JOINT ARTHROPLASTY	$4,199.25	$5,599.00	—	69% below	25%
Total shoulder replacement CPT 23472 HC PR 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER	$4,199.25	$5,599.00	—	69% below	25%
Total shoulder replacement inpatient CPT 23472 HC PR 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER	$4,199.25	$5,599.00	—	—	25%
Total shoulder replacement inpatient CPT 23472 HC PR 23472 RECONSTRUCT SHOULDER JOINT ARTHROPLASTY	$4,199.25	$5,599.00	—	—	25%
Total thyroid removal (thyroidectomy) CPT 60240 HC PR 60240 REMOVAL OF THYROID	$2,659.50	$3,546.00	—	63% below	25%
Trigger finger release surgery CPT 26055 HC PR 26055 INCISE FINGER TENDON SHEATH	$873.75	$1,165.00	—	38% below	25%
Trigger finger release surgery CPT 26055 HC PR 26055 INCISE FINGER TENDON SHEATH (26055) CDM	$873.75	$1,165.00	—	38% below	25%
Trigger finger release surgery CPT 26055 HC PR 26055 INCISE FINGER TENDON SHEATH	$1,690.50	$2,254.00	—	20% above	25%
Trigger finger release surgery inpatient CPT 26055 HC PR 26055 INCISE FINGER TENDON SHEATH (26055) CDM	$873.75	$1,165.00	—	—	25%
Trigger finger release surgery inpatient CPT 26055 HC PR 26055 INCISE FINGER TENDON SHEATH	$873.75	$1,165.00	—	—	25%
Trigger point injections, 1 or 2 muscles CPT 20552 HC PR 20552 INJ TRIGGER POINT 1/2 MUSCL	$105.00	$140.00	—	56% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 HC PR 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES RHC	$105.00	$140.00	—	56% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 HC PR ED 20552 INJ TRIGGER POINT 1/2 MUSCL CDM	$105.00	$140.00	—	56% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 HC PR ED 20552 INJ TRIGGER POINT 1/2 MUSCL CDM	$150.75	$201.00	—	37% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 HC ED INJ TRIGGER POINT 1/2 MUSCL CDM	$684.75	$913.00	—	186% above	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC PR ED 20552 INJ TRIGGER POINT 1/2 MUSCL CDM	$105.00	$140.00	—	—	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC PR 20552 INJ TRIGGER POINT 1/2 MUSCL	$105.00	$140.00	—	—	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC ED INJ TRIGGER POINT 1/2 MUSCL CDM	$684.75	$913.00	—	—	25%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 HC PR 58670 LAPAROSCOPY TUBAL CAUTERY	$1,077.00	$1,436.00	—	at median	25%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 HC PR 58670 LAPAROSCOPY TUBAL CAUTERY	$1,077.00	$1,436.00	—	at median	25%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 HC PR 58670 LAPAROSCOPY TUBAL CAUTERY	$1,077.00	$1,436.00	—	—	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMAG	$4,687.50	$6,250.00	—	60% above	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US IMAG	$4,687.50	$6,250.00	—	—	25%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC PR 43249 EGD BALLOON DILATION ESOPHAGUS/LESS THAN 30MM	$436.50	$582.00	—	84% below	25%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC PR 43249 EGD BALLOON DILATION ESOPHAGUS/LESS THAN 30MM	$2,941.50	$3,922.00	—	7% above	25%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC ED UGI W DILATION ESOPHAGUS BAL CDM	$4,318.50	$5,758.00	—	57% above	25%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC PR 43249 EGD BALLOON DILATION ESOPHAGUS/LESS THAN 30MM	$436.50	$582.00	—	—	25%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC ED UGI W DILATION ESOPHAGUS BAL CDM	$4,318.50	$5,758.00	—	—	25%
Upper endoscopy (EGD) with biopsy CPT 43239 HC PR 43239 EGD BIOPSY SINGLE/MULTIPLE	$393.75	$525.00	—	74% below	25%
Upper endoscopy (EGD) with biopsy CPT 43239 HC PR 43239 EGD BIOPSY SINGLE/MULTIPLE	$1,059.75	$1,413.00	—	31% below	25%
Upper endoscopy (EGD) with biopsy CPT 43239 HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM	$2,047.50	$2,730.00	—	34% above	25%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC PR 43239 EGD BIOPSY SINGLE/MULTIPLE	$393.75	$525.00	—	—	25%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM	$2,047.50	$2,730.00	—	—	25%
Upper endoscopy (EGD) with injection into the lining CPT 43236 HC PR 43236 UPPER GI SCOPE W/SUBMUC INJ	$393.75	$525.00	—	78% below	25%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 HC PR 43236 UPPER GI SCOPE W/SUBMUC INJ	$393.75	$525.00	—	—	25%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 HC PR 43251 EGD REMOVE LESION SNARE	$556.50	$742.00	—	66% below	25%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 HC PR 43251 EGD REMOVE LESION SNARE	$1,389.00	$1,852.00	—	14% below	25%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 HC PR 43251 EGD REMOVE LESION SNARE	$556.50	$742.00	—	—	25%
Upper endoscopy (EGD), diagnostic CPT 43235 HC PR 43235 EGD DIAGNOSTIC BRUSH WASH	$350.25	$467.00	—	80% below	25%
Upper endoscopy (EGD), diagnostic CPT 43235 HC PR 43235 EGD DIAGNOSTIC BRUSH WASH	$819.75	$1,093.00	—	53% below	25%
Upper endoscopy (EGD), diagnostic CPT 43235 HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM	$2,047.50	$2,730.00	—	18% above	25%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC PR 43235 EGD DIAGNOSTIC BRUSH WASH	$350.25	$467.00	—	—	25%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM	$2,047.50	$2,730.00	—	—	25%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 HC PR 52353 CYSTO W/URETEROSCOPY W/LITHOTRIPSY CDM	$1,113.75	$1,485.00	—	at median	25%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 HC PR 52353 CYSTO W/URETEROSCOPY W/LITHOTRIPSY CDM	$1,113.75	$1,485.00	—	—	25%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 HC PR 52356 CYSTO/URETERO W/LITHOTRIPSY	$1,182.75	$1,577.00	—	83% below	25%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 HC PR 52356 CYSTO/URETERO W/LITHOTRIPSY	$1,182.75	$1,577.00	—	—	25%
Vaginal delivery, including prenatal and postpartum care CPT 59400 HC PR 59400 OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM	$6,990.75	$9,321.00	—	at median	25%
Vaginal delivery, including prenatal and postpartum care CPT 59400 HC PR 59400 TOTAL OB/VAGINAL DELIVERY/PP CARE	$6,990.75	$9,321.00	—	at median	25%
Vaginal delivery, including prenatal and postpartum care CPT 59400 HC PR 59400 TOTAL OB/VAGINAL DELIVERY/PP CARE	$6,990.75	$9,321.00	—	at median	25%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 HC PR 59400 OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM	$6,990.75	$9,321.00	—	—	25%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 HC PR 59400 TOTAL OB/VAGINAL DELIVERY/PP CARE	$6,990.75	$9,321.00	—	—	25%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 HC PR 55250 VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS CDM	$671.25	$895.00	—	—	25%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 HC PR 55250 REMOVAL OF SPERM DUCT(S)	$671.25	$895.00	—	49% below	25%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 HC PR 55250 REMOVAL OF SPERM DUCT(S)	$960.75	$1,281.00	—	27% below	25%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 HC PR 55250 VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS CDM	$671.25	$895.00	—	—	25%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 HC PR 55250 REMOVAL OF SPERM DUCT(S)	$671.25	$895.00	—	—	25%
Wart removal, up to 14 warts CPT 17110 HC PR 17110 DESTRUCT B9 LESION 1-14	$201.00	$268.00	—	12% below	25%
Wart removal, up to 14 warts CPT 17110 HC PR 17110 DESTRUCTION BENIGN LESIONS UP TO 14 RHC	$201.00	$268.00	—	12% below	25%
Wart removal, up to 14 warts CPT 17110 HC PR 17110 DESTRUCT B9 LESION 1-14	$326.25	$435.00	—	42% above	25%
Wart removal, up to 14 warts CPT 17110 HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM	$447.75	$597.00	—	95% above	25%
Wart removal, up to 14 warts inpatient CPT 17110 HC PR 17110 DESTRUCT B9 LESION 1-14	$201.00	$268.00	—	—	25%
Wart removal, up to 14 warts inpatient CPT 17110 HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM	$447.75	$597.00	—	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC PR 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM OR LESS RHC	$174.75	$233.00	—	71% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC PR 11042 DEB SUBQ TISSUE FIRST 20 SQ OR LESS	$174.75	$233.00	—	71% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC PR 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM OR LESS CDM	$174.75	$233.00	—	71% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC PR ED 11042 DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS CDM	$371.25	$495.00	—	39% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC PR 11042 DEB SUBQ TISSUE FIRST 20 SQ OR LESS	$371.25	$495.00	—	39% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC ED DEB SUBQ TISSUE 20 SQ CM OR LESS - DEBRIDE SKIN CDM	$636.75	$849.00	—	5% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC PR 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM OR LESS CDM	$174.75	$233.00	—	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC PR 11042 DEB SUBQ TISSUE FIRST 20 SQ OR LESS	$174.75	$233.00	—	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC ED DEB SUBQ TISSUE 20 SQ CM OR LESS - DEBRIDE SKIN CDM	$636.75	$849.00	—	—	25%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 HC PR 25607 TREAT FX RAD EXTRA-ARTICUL	$2,195.25	$2,927.00	—	66% below	25%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 HC PR 25607 TREAT FX RAD EXTRA-ARTICUL	$2,195.25	$2,927.00	—	66% below	25%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 HC ED TREAT FX RAD EXTRA-ARTICUL CDM	$16,403.25	$21,871.00	—	154% above	25%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 HC PR 25607 TREAT FX RAD EXTRA-ARTICUL	$2,195.25	$2,927.00	—	—	25%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 HC ED TREAT FX RAD EXTRA-ARTICUL CDM	$16,403.25	$21,871.00	—	—	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Oregon	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC PR ED 36430 BLOOD TRANSFUSION SERVICE CDM	$123.75	$165.00	—	84% below	25%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION EA UNIT CDM	$639.75	$853.00	—	19% below	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION EA UNIT CDM	$639.75	$853.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC PR 94640 NEBULIZER SMALL VOLUME	$23.25	$31.00	—	86% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC PR 94640 AIRWAY INHALATION TREATMENT RHC	$23.25	$31.00	—	86% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC ED INHALATION TREATMENT CDM	$289.50	$386.00	—	70% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHALATION TREATMENT DAILY	$289.50	$386.00	—	70% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC PR 94640 NEBULIZER SMALL VOLUME	$23.25	$31.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC ED INHALATION TREATMENT CDM	$289.50	$386.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHALATION TREATMENT DAILY	$289.50	$386.00	—	—	25%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO IV INFUSION INITIAL HR CDM	$843.00	$1,124.00	—	10% above	25%
Chemotherapy IV infusion, first hour CPT 96413 HC TYSABRI INFUSION FIRST HR	$843.00	$1,124.00	—	10% above	25%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC TYSABRI INFUSION FIRST HR	$843.00	$1,124.00	—	—	25%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO IV INFUSION INITIAL HR CDM	$843.00	$1,124.00	—	—	25%
Critical care, first 30 to 74 minutes CPT 99291 HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM	$610.50	$814.00	—	77% below	25%
Critical care, first 30 to 74 minutes CPT 99291 HC PR 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN CDM	$610.50	$814.00	—	77% below	25%
Critical care, first 30 to 74 minutes CPT 99291 HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM	$788.25	$1,051.00	—	70% below	25%
Critical care, first 30 to 74 minutes CPT 99291 HC ED CRITICAL CARE FIRST HOUR CDM	$3,801.75	$5,069.00	—	43% above	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC PR 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN CDM	$610.50	$814.00	—	—	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM	$610.50	$814.00	—	—	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC ED CRITICAL CARE FIRST HOUR CDM	$3,801.75	$5,069.00	—	—	25%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY	$584.25	$779.00	—	35% below	25%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY	$584.25	$779.00	—	—	25%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HC PR 93000 ECG ROUTINE ECG W/LEAST 12 LDS W/I&R RHC	$41.25	$55.00	—	23% below	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC PR ED 93005 ECG 12 LEAD TRACING ONLY CDM	$24.00	$32.00	—	90% below	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ECG 12 LEAD TRACING ONLY	$372.00	$496.00	—	52% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC ECG 12 LEAD TRACING ONLY	$372.00	$496.00	—	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED FAC E&M VISIT LEVEL 1 CDM	$363.00	$484.00	—	52% above	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED FAC E&M VISIT LEVEL 1 CDM	$363.00	$484.00	—	—	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED FAC E&M VISIT LEVEL 2 CDM	$729.75	$973.00	—	55% above	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED FAC E&M VISIT LEVEL 2 CDM	$729.75	$973.00	—	—	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED FAC E&M VISIT LEVEL 3 CDM	$1,059.75	$1,413.00	—	24% above	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED FAC E&M VISIT LEVEL 3 CDM	$1,059.75	$1,413.00	—	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED SEXUAL ASSAULT EXAM CDM	$630.00	$840.00	—	53% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED FAC E&M VISIT LEVEL 4 CDM	$1,553.25	$2,071.00	—	17% above	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED SEXUAL ASSAULT EXAM CDM	$630.00	$840.00	—	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED FAC E&M VISIT LEVEL 4 CDM	$1,553.25	$2,071.00	—	—	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED FAC E&M VISIT LEVEL 5 CDM	$2,474.25	$3,299.00	—	18% above	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED FAC E&M VISIT LEVEL 5 CDM	$2,474.25	$3,299.00	—	—	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY	$336.00	$448.00	—	50% below	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY	$336.00	$448.00	—	50% below	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY	$336.00	$448.00	—	—	25%
Family therapy with the patient, 50 minutes CPT 90847 HC PR 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$305.25	$407.00	—	93% above	25%
Family therapy without the patient, 50 minutes CPT 90846 HC PR 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$292.50	$390.00	—	90% above	25%
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 HC PR 93224 XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I RHC	$202.50	$270.00	—	—	25%
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 HC PRHOLTER MONITOR W/INTERP & REPT	$315.75	$421.00	—	—	25%
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient CPT 93224 HC PRHOLTER MONITOR W/INTERP & REPT	$315.75	$421.00	—	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC PR 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$89.25	$119.00	—	77% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC PR 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$89.25	$119.00	—	77% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC ED IV HYDRATION INITIAL HR CDM	$309.75	$413.00	—	22% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV HYDRATION INITIAL HR CDM	$309.75	$413.00	—	22% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC PR 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$89.25	$119.00	—	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC ED IV HYDRATION INITIAL HR CDM	$309.75	$413.00	—	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV HYDRATION INITIAL HR CDM	$309.75	$413.00	—	—	25%
IV infusion of a medicine, first hour CPT 96365 HC IV INFUSION INITIAL HR CDM	$648.00	$864.00	—	47% above	25%
IV infusion of a medicine, first hour CPT 96365 HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM	$648.00	$864.00	—	47% above	25%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INFUSION INITIAL HR CDM	$648.00	$864.00	—	—	25%
IV infusion of a medicine, first hour inpatient CPT 96365 HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM	$648.00	$864.00	—	—	25%
IV push of a medicine, first drug CPT 96374 HC PR 96374 THER/PROPH/DIAG INJ IV PUSH	$100.50	$134.00	—	60% below	25%
IV push of a medicine, first drug CPT 96374 HC INJ IV PUSH INITIAL DRUG CDM	$356.25	$475.00	—	43% above	25%
IV push of a medicine, first drug CPT 96374 HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM	$356.25	$475.00	—	43% above	25%
IV push of a medicine, first drug inpatient CPT 96374 HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM	$356.25	$475.00	—	—	25%
IV push of a medicine, first drug inpatient CPT 96374 HC INJ IV PUSH INITIAL DRUG CDM	$356.25	$475.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC PR 96372 THER/PROPH/DIAG INJ SC/IM	$41.25	$55.00	—	62% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC PR 96372 THER/PROPH/DIAG INJ SC/IM	$41.25	$55.00	—	62% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC PR 96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM RHC	$41.25	$55.00	—	62% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJ SQ OR IM CDM	$41.25	$55.00	—	62% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJ SQ OR IM CDM	$193.50	$258.00	—	79% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM	$193.50	$258.00	—	79% above	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC PR 96372 THER/PROPH/DIAG INJ SC/IM	$41.25	$55.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJ SQ OR IM CDM	$193.50	$258.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM	$193.50	$258.00	—	—	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSYCH DIAG EVAL CDM	$400.50	$534.00	—	32% above	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PR 90791 PSYCH DIAG EVAL RHC	$424.50	$566.00	—	40% above	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PR 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION	$424.50	$566.00	—	40% above	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PR 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION	$495.00	$660.00	—	63% above	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PSYCH DIAG EVAL CDM	$400.50	$534.00	—	—	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PR 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION	$424.50	$566.00	—	—	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PR 90791 PSYCH DIAG EVAL RHC	$424.50	$566.00	—	—	25%
Neuromuscular re-education, 15 minutes CPT 97112 HC VIRTUAL THERAPY NEUROMUSC REEDUCA PX 1 OR MORE AREAS EACH 15MINS CDM	$150.75	$201.00	—	48% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 HC CRISIS TELEH 97112 NEUROMUSCUL REEDUCAT EA 15 MIN CDM	$156.75	$209.00	—	54% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN	$156.75	$209.00	—	54% above	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC VIRTUAL THERAPY NEUROMUSC REEDUCA PX 1 OR MORE AREAS EACH 15MINS CDM	$150.75	$201.00	—	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN	$156.75	$209.00	—	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC CRISIS TELEH 97112 NEUROMUSCUL REEDUCAT EA 15 MIN CDM	$156.75	$209.00	—	—	25%
New patient office visit, about 30 minutes CPT 99203 HC L&D TRIAGE NEW PATIENT LVL 3 CDM	$204.75	$273.00	—	3% below	25%
New patient office visit, about 30 minutes CPT 99203 HC PR 99203 NEW PT VISIT - LEVEL 3	$235.50	$314.00	—	11% above	25%
New patient office visit, about 30 minutes CPT 99203 HC PR 99203 OFFICE OUTPATIENT NEW RHC	$235.50	$314.00	—	11% above	25%
New patient office visit, about 30 minutes CPT 99203 HC PR 99203 NEW PT VISIT - LEVEL 3	$323.25	$431.00	—	53% above	25%
New patient office visit, about 30 minutes inpatient CPT 99203 HC L&D TRIAGE NEW PATIENT LVL 3 CDM	$204.75	$273.00	—	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 HC PR 99203 NEW PT VISIT - LEVEL 3	$235.50	$314.00	—	—	25%
New patient office visit, about 45 minutes CPT 99204 HC L&D TRIAGE NEW PATIENT LVL 4 CDM	$220.50	$294.00	—	23% below	25%
New patient office visit, about 45 minutes CPT 99204 HC NEW PT VISIT - LEVEL 4	$220.50	$294.00	—	23% below	25%
New patient office visit, about 45 minutes CPT 99204 HC PR 99204 NEW PT VISIT - LEVEL 4	$383.25	$511.00	—	35% above	25%
New patient office visit, about 45 minutes CPT 99204 HC PR 99204 OFFICE OUTPATIENT NEW RHC	$383.25	$511.00	—	35% above	25%
New patient office visit, about 45 minutes CPT 99204 HC PR 99204 NEW PT VISIT - LEVEL 4	$484.50	$646.00	—	70% above	25%
New patient office visit, about 45 minutes inpatient CPT 99204 HC NEW PT VISIT - LEVEL 4	$220.50	$294.00	—	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 HC L&D TRIAGE NEW PATIENT LVL 4 CDM	$220.50	$294.00	—	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 HC PR 99204 NEW PT VISIT - LEVEL 4	$383.25	$511.00	—	—	25%
New patient office visit, about 60 minutes CPT 99205 HC NEW PT VISIT - LEVEL 5	$280.50	$374.00	—	19% below	25%
New patient office visit, about 60 minutes CPT 99205 HC L&D TRIAGE NEW PATIENT LVL 5 CDM	$282.75	$377.00	—	18% below	25%
New patient office visit, about 60 minutes CPT 99205 HC PR 99205 NEW PT VISIT - LEVEL 5	$521.25	$695.00	—	50% above	25%
New patient office visit, about 60 minutes CPT 99205 HC PR 99205 OFFICE OUTPATIENT NEW RHC	$521.25	$695.00	—	50% above	25%
New patient office visit, about 60 minutes CPT 99205 HC PR 99205 NEW PT VISIT - LEVEL 5	$640.50	$854.00	—	85% above	25%
New patient office visit, about 60 minutes inpatient CPT 99205 HC NEW PT VISIT - LEVEL 5	$280.50	$374.00	—	—	25%
New patient office visit, about 60 minutes inpatient CPT 99205 HC L&D TRIAGE NEW PATIENT LVL 5 CDM	$282.75	$377.00	—	—	25%
New patient office visit, about 60 minutes inpatient CPT 99205 HC PR 99205 NEW PT VISIT - LEVEL 5	$521.25	$695.00	—	—	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC PR 99202 OFFICE OUTPATIENT NEW RHC	$134.25	$179.00	—	4% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC PR 99202 NEW PT VISIT - LEVEL 2	$134.25	$179.00	—	4% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC L&D TRIAGE NEW PATIENT LVL 2 CDM	$149.25	$199.00	—	16% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC L&D TRIAGE NEW PATIENT LVL 1 CDM	$149.25	$199.00	—	16% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC PR 99202 NEW PT VISIT - LEVEL 2	$207.00	$276.00	—	61% above	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC PR 99202 NEW PT VISIT - LEVEL 2	$134.25	$179.00	—	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC L&D TRIAGE NEW PATIENT LVL 1 CDM	$149.25	$199.00	—	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC L&D TRIAGE NEW PATIENT LVL 2 CDM	$149.25	$199.00	—	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM	$107.25	$143.00	—	51% above	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM	$107.25	$143.00	—	—	25%
Occupational therapy evaluation, low complexity CPT 97165 HC VIRTUAL THERAPY OT EVALUATION LOW COMPLEX CDM	$366.00	$488.00	—	45% above	25%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVALUATION LOW COMPLEX	$380.25	$507.00	—	51% above	25%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC VIRTUAL THERAPY OT EVALUATION LOW COMPLEX CDM	$366.00	$488.00	—	—	25%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVALUATION LOW COMPLEX	$380.25	$507.00	—	—	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC VIRTUAL THERAPY PT EVALUATION HIGH COMPLEX CDM	$393.75	$525.00	—	31% above	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVALUATION HIGH COMPLEX	$408.75	$545.00	—	36% above	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC VIRTUAL THERAPY PT EVALUATION HIGH COMPLEX CDM	$393.75	$525.00	—	—	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVALUATION HIGH COMPLEX	$408.75	$545.00	—	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC VIRTUAL THERAPY PT EVALUATION LOW COMPLEX CDM	$393.75	$525.00	—	60% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVALUATION LOW COMPLEX CDM	$408.75	$545.00	—	66% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC CRISIS TELEH 97161 PT EVALUATION LOW COMPLEX CDM	$408.75	$545.00	—	66% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC VIRTUAL THERAPY PT EVALUATION LOW COMPLEX CDM	$393.75	$525.00	—	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC CRISIS TELEH 97161 PT EVALUATION LOW COMPLEX CDM	$408.75	$545.00	—	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVALUATION LOW COMPLEX CDM	$408.75	$545.00	—	—	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC VIRTUAL THERAPY PT EVALUATION MOD COMPLEX CDM	$393.75	$525.00	—	25% above	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVALUATION MOD COMPLEX CDM	$408.75	$545.00	—	30% above	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC VIRTUAL THERAPY PT EVALUATION MOD COMPLEX CDM	$393.75	$525.00	—	—	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVALUATION MOD COMPLEX CDM	$408.75	$545.00	—	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES	$145.50	$194.00	—	51% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES	$145.50	$194.00	—	—	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC VIRTUAL THERAPY THER EXERCISES PX 1 OR MORE AREAS EACH 15MINS CDM	$128.25	$171.00	—	32% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN	$133.50	$178.00	—	38% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM	$133.50	$178.00	—	38% above	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC VIRTUAL THERAPY THER EXERCISES PX 1 OR MORE AREAS EACH 15MINS CDM	$128.25	$171.00	—	—	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM	$133.50	$178.00	—	—	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN	$133.50	$178.00	—	—	25%
Preventive checkup, new patient aged 18–39 CPT 99385 HC PR 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS RHC	$268.50	$358.00	—	63% above	25%
Preventive checkup, new patient aged 18–39 CPT 99385 HC PR 99385 PREV VISIT NEW AGE 18-39	$268.50	$358.00	—	63% above	25%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC PR 99385 PREV VISIT NEW AGE 18-39	$268.50	$358.00	—	—	25%
Preventive checkup, new patient aged 40–64 CPT 99386 HC PR 99386 PREVENTIVE VISIT NEW 40-64 RHC	$325.50	$434.00	—	58% above	25%
Preventive checkup, new patient aged 40–64 CPT 99386 HC PR 99386 PREV VISIT NEW AGE 40-64	$325.50	$434.00	—	58% above	25%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC PR 99386 PREV VISIT NEW AGE 40-64	$325.50	$434.00	—	—	25%
Preventive checkup, new patient aged 65 or older CPT 99387 HC PR 99387 INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&> RHC	$349.50	$466.00	—	55% above	25%
Preventive checkup, new patient aged 65 or older CPT 99387 HC PR 99387 INIT PM E/M NEW PAT 65+ YRS	$349.50	$466.00	—	55% above	25%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC PR 99387 INIT PM E/M NEW PAT 65+ YRS	$349.50	$466.00	—	—	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC PR 99395 SPORT PHYSICAL EST AGE 18-39	$40.50	$54.00	—	73% below	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC PR 99395 PREVENTIVE VISIT EST 18-39 RHC	$246.00	$328.00	—	66% above	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC PR 99395 PREV VISIT EST AGE 18-39	$246.00	$328.00	—	66% above	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC PR 99395 PREV VISIT EST AGE 18-39	$338.25	$451.00	—	129% above	25%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC PR 99395 SPORT PHYSICAL EST AGE 18-39	$40.50	$54.00	—	—	25%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC PR 99395 PREV VISIT EST AGE 18-39	$246.00	$328.00	—	—	25%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC PR 99396 PREV VISIT EST AGE 40-64	$267.00	$356.00	—	55% above	25%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC PR 99396 PREVENTIVE VISIT EST 40-64 RHC	$267.00	$356.00	—	55% above	25%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC PR 99396 PREV VISIT EST AGE 40-64	$267.00	$356.00	—	—	25%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC PR 99397 PREVENTIVE VISIT EST 65 & OVER RHC	$280.50	$374.00	—	50% above	25%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC PR 99397 PER PM REEVAL EST PAT 65+ YR	$280.50	$374.00	—	50% above	25%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC PR 99397 PER PM REEVAL EST PAT 65+ YR	$280.50	$374.00	—	—	25%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC PR 90839 PSYTX FOR CRISIS INITIAL 60 MIN RHC	$387.00	$516.00	—	11% above	25%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC PR 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MIN	$441.00	$588.00	—	27% above	25%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PR 90839 PSYTX FOR CRISIS INITIAL 60 MIN RHC	$387.00	$516.00	—	—	25%
Psychotherapy session, 30 minutes CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN CDM	$99.00	$132.00	—	24% below	25%
Psychotherapy session, 30 minutes CPT 90832 HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES	$204.75	$273.00	—	57% above	25%
Psychotherapy session, 30 minutes CPT 90832 HC PR 90832 PSYTX W PT 30 MIN RHC	$204.75	$273.00	—	57% above	25%
Psychotherapy session, 30 minutes CPT 90832 HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES	$234.00	$312.00	—	79% above	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN CDM	$99.00	$132.00	—	—	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PR 90832 PSYTX W PT 30 MIN RHC	$204.75	$273.00	—	—	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES	$204.75	$273.00	—	—	25%
Psychotherapy session, 45 minutes CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN CDM	$234.00	$312.00	—	19% above	25%
Psychotherapy session, 45 minutes CPT 90834 HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES	$270.00	$360.00	—	38% above	25%
Psychotherapy session, 45 minutes CPT 90834 HC PR 90834 PSYTX W PT 45 MIN RHC	$270.00	$360.00	—	38% above	25%
Psychotherapy session, 45 minutes CPT 90834 HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES	$309.00	$412.00	—	58% above	25%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN CDM	$234.00	$312.00	—	—	25%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES	$270.00	$360.00	—	—	25%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PR 90834 PSYTX W PT 45 MIN RHC	$270.00	$360.00	—	—	25%
Psychotherapy session, 60 minutes CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN CDM	$171.75	$229.00	—	28% below	25%
Psychotherapy session, 60 minutes CPT 90837 HC PR 90837 PSYTX W PT 60 MIN RHC	$399.00	$532.00	—	67% above	25%
Psychotherapy session, 60 minutes CPT 90837 HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES	$399.00	$532.00	—	67% above	25%
Psychotherapy session, 60 minutes CPT 90837 HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES	$458.25	$611.00	—	92% above	25%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN CDM	$171.75	$229.00	—	—	25%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PR 90837 PSYTX W PT 60 MIN RHC	$399.00	$532.00	—	—	25%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES	$399.00	$532.00	—	—	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN RHC	$33.75	$45.00	—	at median	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN	$33.75	$45.00	—	at median	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN	$41.25	$55.00	—	22% above	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN	$51.00	$68.00	—	51% above	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN	$33.75	$45.00	—	—	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN	$51.00	$68.00	—	—	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC PR 99215 ESTAB PT VISIT - LEVEL 5	$411.75	$549.00	—	23% above	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC PR 99215 OFFICE OUTPATIENT VISIT RHC	$411.75	$549.00	—	23% above	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC PR 99215 ESTAB PT VISIT - LEVEL 5	$521.25	$695.00	—	55% above	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC PR 99215 ESTAB PT VISIT - LEVEL 5	$411.75	$549.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC PR 99213 ESTAB PT VISIT - LEVEL 3	$189.00	$252.00	—	at median	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC PR 99213 OFFICE OUTPATIENT VISIT RHC	$189.00	$252.00	—	at median	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC ESTAB PT VISIT - LEVEL 3	$255.00	$340.00	—	35% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC PR 99213 ESTAB PT VISIT - LEVEL 3	$264.00	$352.00	—	40% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC ET ESTAB PT VISIT - LEVEL 3	$293.25	$391.00	—	55% above	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC PR 99213 ESTAB PT VISIT - LEVEL 3	$189.00	$252.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC ESTAB PT VISIT - LEVEL 3	$255.00	$340.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC ET ESTAB PT VISIT - LEVEL 3	$293.25	$391.00	—	—	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC PR 99214 OFFICE OUTPATIENT VISIT RHC	$278.25	$371.00	—	16% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC PR 99214 ESTAB PT VISIT - LEVEL 4	$278.25	$371.00	—	16% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC ESTAB PT VISIT - LEVEL 4	$324.75	$433.00	—	36% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC PR 99214 ESTAB PT VISIT - LEVEL 4	$371.25	$495.00	—	55% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC ET ESTAB PT VISIT - LEVEL 4	$373.50	$498.00	—	56% above	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC PR 99214 ESTAB PT VISIT - LEVEL 4	$278.25	$371.00	—	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC ESTAB PT VISIT - LEVEL 4	$324.75	$433.00	—	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC ET ESTAB PT VISIT - LEVEL 4	$373.50	$498.00	—	—	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC PR 99212 ESTAB PT VISIT - LEVEL 2	$100.50	$134.00	—	at median	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC PR 99212 OFFICE OUTPATIENT VISIT RHC	$100.50	$134.00	—	at median	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC PR 99212 ESTAB PT VISIT - LEVEL 2	$163.50	$218.00	—	63% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC ESTAB PT VISIT - LEVEL 2	$210.75	$281.00	—	110% above	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC PR 99212 ESTAB PT VISIT - LEVEL 2	$100.50	$134.00	—	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC ESTAB PT VISIT - LEVEL 2	$210.75	$281.00	—	—	25%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES RHC	$383.25	$511.00	—	17% below	25%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES CDM	$462.00	$616.00	—	at median	25%
Speech and language evaluation CPT 92523 HC VIRTUAL THERAPY SPEECH SOUND LANG COMPREHEN EXTENDED CDM	$365.25	$487.00	—	4% above	25%
Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM	$365.25	$487.00	—	4% above	25%
Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM	$365.25	$487.00	—	—	25%
Speech and language evaluation inpatient CPT 92523 HC VIRTUAL THERAPY SPEECH SOUND LANG COMPREHEN EXTENDED CDM	$365.25	$487.00	—	—	25%
Speech therapy session, individual CPT 92507 HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL	$207.75	$277.00	—	28% below	25%
Speech therapy session, individual CPT 92507 HC CRISIS TELEH 92507 SPEECH/HEARING THERAPY - INDIV CDM	$207.75	$277.00	—	28% below	25%
Speech therapy session, individual CPT 92507 HC VIRTUAL THERAPY SPEECH-HEARING THERAPY INDIV CDM	$207.75	$277.00	—	28% below	25%
Speech therapy session, individual inpatient CPT 92507 HC VIRTUAL THERAPY SPEECH-HEARING THERAPY INDIV CDM	$207.75	$277.00	—	—	25%
Speech therapy session, individual inpatient CPT 92507 HC CRISIS TELEH 92507 SPEECH/HEARING THERAPY - INDIV CDM	$207.75	$277.00	—	—	25%
Speech therapy session, individual inpatient CPT 92507 HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL	$207.75	$277.00	—	—	25%
Spirometry (breathing test) CPT 94010 HC PR 94010 SPIROMETRY	$78.75	$105.00	—	69% below	25%
Spirometry (breathing test) CPT 94010 HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$599.25	$799.00	—	138% above	25%
Spirometry (breathing test) inpatient CPT 94010 HC PR 94010 SPIROMETRY	$78.75	$105.00	—	—	25%
Spirometry (breathing test) inpatient CPT 94010 HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$599.25	$799.00	—	—	25%
Spirometry before and after a bronchodilator CPT 94060 HC PR 94060 SPIROMETRY PRE POST BRONCHODILATOR	$112.50	$150.00	—	80% below	25%
Spirometry before and after a bronchodilator CPT 94060 HC SPIROMETRY PRE POST BRONCHODILATOR CDM	$676.50	$902.00	—	18% above	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC PR 94060 SPIROMETRY PRE POST BRONCHODILATOR	$112.50	$150.00	—	—	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC SPIROMETRY PRE POST BRONCHODILATOR CDM	$676.50	$902.00	—	—	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC VIRTUAL THERAPY THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15MINS CDM	$156.00	$208.00	—	70% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$162.00	$216.00	—	77% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC CRISIS TELEH 97530 THERAPEUTIC ACTIVITIES EA 15 MIN	$162.00	$216.00	—	77% above	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC VIRTUAL THERAPY THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15MINS CDM	$156.00	$208.00	—	—	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC CRISIS TELEH 97530 THERAPEUTIC ACTIVITIES EA 15 MIN	$162.00	$216.00	—	—	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$162.00	$216.00	—	—	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC ED PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE CDM	$682.50	$910.00	—	241% above	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC THERAPUTIC PHLEBOTOMY	$682.50	$910.00	—	241% above	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC THERAPUTIC PHLEBOTOMY	$682.50	$910.00	—	—	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC ED PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE CDM	$682.50	$910.00	—	—	25%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 HC PR 93015 CARDIO STRESS TESTSUPV INTERP & REPT	$210.00	$280.00	—	59% below	25%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 HC PR 93015 CARDIO STRESS TESTSUPV INTERP & REPT	$210.00	$280.00	—	—	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Oregon	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 HC PR RX INFLUENZA INACTIVATED IIV ADJUVANTED IM 0.5 ML	$284.32	$379.09	—	25% above	25%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 HC PR RX INFLUENZA INACTIVATED IIV ADJUVANTED IM 0.5 ML	$284.32	$379.09	—	25% above	25%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 INFLUENZA VAC TYPE A&B SURFACE ANT ADJ SUSP PREF SYR 0.5 ML	$349.44	$465.92	—	54% above	25%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 HC PR RX INFLUENZA INACTIVATED IIV ADJUVANTED IM 0.5 ML	$284.32	$379.09	—	—	25%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 INFLUENZA VAC TYPE A&B SURFACE ANT ADJ SUSP PREF SYR 0.5 ML	$349.44	$465.92	—	—	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 HC PR RX COVID-19 VACCINE SINGLE DOSE (PFIZER) PF TRIS-SUC IM 30 MCG/0.3 ML	$196.65	$262.20	—	at median	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 HC PR RX COVID-19 VACCINE SINGLE DOSE (PFIZER) PF TRIS-SUC IM 30 MCG/0.3 ML	$196.65	$262.20	—	at median	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COVID-19 MRNA VAC TRIS-PFIZER IM SUSP PREF SYR 30 MCG/0.3ML	$199.88	$266.50	—	2% above	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 HC PR RX COVID-19 VACCINE SINGLE DOSE (PFIZER) PF TRIS-SUC IM 30 MCG/0.3 ML	$196.65	$262.20	—	—	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COVID-19 MRNA VAC TRIS-PFIZER IM SUSP PREF SYR 30 MCG/0.3ML	$199.88	$266.50	—	—	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 HC PR RX VARICELLA VACCINE LIVE SQ 0.5 ML	$112.50	$150.00	—	52% below	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 HC PR RX VARICELLA VACCINE LIVE SQ 0.5 ML	$117.00	$156.00	—	50% below	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 HC PR RX VARICELLA VACCINE LIVE SQ 0.5 ML	$117.00	$156.00	—	—	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 HC PR RX DTAP-IPV VACCINE CHILD 4-6 YRS IM 0.5 ML	$22.50	$30.00	—	69% below	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 HC PR RX DTAP-IPV VACCINE CHILD 4-6 YRS IM 0.5 ML	$23.25	$31.00	—	68% below	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 HC PR RX DTAP-IPV VACCINE CHILD 4-6 YRS IM 0.5 ML	$23.25	$31.00	—	—	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 HC PR RX DIPHTH TETANUS TOX ACELL PERTUSSIS VACC/YOUNGER THAN 7 YRS/IM	$30.00	$40.00	—	47% below	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 HC PR RX DIPHTH TETANUS TOX ACELL PERTUSSIS VACC/YOUNGER THAN 7 YRS/IM	$31.50	$42.00	—	44% below	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 HC PR RX DIPHTH TETANUS TOX ACELL PERTUSSIS VACC/YOUNGER THAN 7 YRS/IM	$31.50	$42.00	—	—	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HC PR RX DTAP-HEPB-IPV VACCINE IM 0.5 ML	$98.25	$131.00	—	5% below	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HC PR RX DTAP-HEPB-IPV VACCINE IM 0.5 ML	$98.25	$131.00	—	5% below	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HC PR RX DTAP-HEPB-IPV VACCINE IM 0.5 ML	$98.25	$131.00	—	—	25%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 HC PR RX DTAP-IPV/HIB VACCINE IM 0.5 ML	$111.00	$148.00	—	16% below	25%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 HC PR RX DTAP-IPV/HIB VACCINE IM 0.5 ML	$111.00	$148.00	—	—	25%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 HC PR RX DTAP-IPV-HIB-HEPB VACCINE IM 1 EA	$111.00	$148.00	—	at median	25%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 HC PR RX DTAP-IPV-HIB-HEPB VACCINE IM 1 EA	$111.00	$148.00	—	at median	25%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 DIPH-TET TOX-AC PERT AD-POLIO IPV-HIB-HEP B REC SUSP PRE SYR	$466.88	$622.51	—	321% above	25%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 HC PR RX DTAP-IPV-HIB-HEPB VACCINE IM 1 EA	$111.00	$148.00	—	—	25%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 DIPH-TET TOX-AC PERT AD-POLIO IPV-HIB-HEP B REC SUSP PRE SYR	$466.88	$622.51	—	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACCINE SPLIT PF SUSP PREF SYRINGE 0.5 ML	$79.99	$106.65	—	127% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC PR RX INFLUENZA TRIVALENT IIV3 SPLIT VIRUS PF IM 0.5 ML	$85.39	$113.85	—	142% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC PR RX INFLUENZA TRIVALENT IIV3 SPLIT VIRUS PF IM 0.5 ML	$85.39	$113.85	—	142% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACCINE SPLIT PF SUSP PREF SYRINGE 0.5 ML	$79.99	$106.65	—	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 HC PR RX INFLUENZA TRIVALENT IIV3 SPLIT VIRUS PF IM 0.5 ML	$85.39	$113.85	—	—	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HC PR RX 9VHPV VACCINE 2/3 DOSE IM 0.5 ML	$200.25	$267.00	—	38% below	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HC PR RX 9VHPV VACCINE 2/3 DOSE IM 0.5 ML	$200.25	$267.00	—	—	25%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HC PR RX HEPATITIS A & B VACCINE ADULT IM 1 ML	$112.50	$150.00	—	26% below	25%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HC PR RX HEPATITIS A & B VACCINE ADULT IM 1 ML	$112.50	$150.00	—	—	25%
Hepatitis A vaccine, adult dose CPT 90632 HC PR RX HEPATITIS A VACCINE ADULT IM 1 ML	$70.50	$94.00	—	32% below	25%
Hepatitis A vaccine, adult dose CPT 90632 HC PR RX HEPATITIS A VACCINE ADULT IM 1 ML	$128.25	$171.00	—	24% above	25%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML	$633.23	$844.31	—	513% above	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HC PR RX HEPATITIS A VACCINE ADULT IM 1 ML	$70.50	$94.00	—	—	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML	$633.23	$844.31	—	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HC PR RX HEPATITIS A VACCINE PEDIATRIC 2 DOSE IM 0.5 ML	$42.75	$57.00	—	24% below	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HC PR RX HEPATITIS A VACCINE PEDIATRIC 2 DOSE IM 0.5 ML	$48.75	$65.00	—	13% below	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HC PR RX HEPATITIS A VACCINE PEDIATRIC 2 DOSE IM 0.5 ML	$48.75	$65.00	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC PR RX HEPB VACCINE ADULT 3 DOSE IM 1 ML	$54.00	$72.00	—	49% below	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC PR RX HEPB VACCINE ADULT 3 DOSE IM 1 ML	$66.00	$88.00	—	37% below	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE (RECOMBINANT) SUSP 20 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML	$306.16	$408.21	—	190% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/ML	$339.29	$452.39	—	222% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HC PR RX HEPB VACCINE ADULT 3 DOSE IM 1 ML	$66.00	$88.00	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE (RECOMBINANT) SUSP 20 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML	$306.16	$408.21	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/ML	$339.29	$452.39	—	—	25%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HC PR RX HEPB VACCINE ADULT 2 DOSE IM 1 EA	$175.43	$233.90	—	1% above	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HC PR RX HEPB VACCINE PED/ADOLESC 3 DOSE IM 0.5 ML	$30.00	$40.00	—	53% below	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HC PR RX HEPB VACCINE PED/ADOLESC 3 DOSE IM 0.5 ML	$30.00	$40.00	—	53% below	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/0.5ML	$71.09	$94.78	—	12% above	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VACCINE (RECOMBINANT) SUSP 5 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 5 MCG/0.5ML	$71.09	$94.78	—	12% above	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HC PR RX HEPB VACCINE PED/ADOLESC 3 DOSE IM 0.5 ML	$30.00	$40.00	—	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/0.5ML	$71.09	$94.78	—	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VACCINE (RECOMBINANT) SUSP 5 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 5 MCG/0.5ML	$71.09	$94.78	—	—	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HC PR RX HIB PRP-OMP VACCINE 3 DOSE IM 0.5 ML	$24.75	$33.00	—	38% below	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HC PR RX HIB PRP-OMP VACCINE 3 DOSE IM 0.5 ML	$25.50	$34.00	—	36% below	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HC PR RX HIB PRP-OMP VACCINE 3 DOSE IM 0.5 ML	$25.50	$34.00	—	—	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HC PR RX HIB PRP-T VACCINE 4 DOSE IM 1 EA	$42.00	$56.00	—	at median	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HC PR RX HIB PRP-T VACCINE 4 DOSE IM 1 EA	$42.00	$56.00	—	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC PR RX IIV VACCINE PF INCREASED AG CONTENT IM 1 EA	$24.00	$32.00	—	67% below	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC PR RX IIV VACCINE PF INCREASED AG CONTENT IM 1 EA	$24.00	$32.00	—	67% below	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 HC PR RX IIV VACCINE PF INCREASED AG CONTENT IM 1 EA	$24.00	$32.00	—	—	25%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 HC PR RX JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM 0.5 ML	$251.25	$335.00	—	36% below	25%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule inpatient CPT 90738 HC PR RX JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM 0.5 ML	$251.25	$335.00	—	—	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 HC PR RX MEASLES MUMPS RUBELLA VACCINE LIVE SQ 1 EA	$69.75	$93.00	—	54% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 HC PR RX MEASLES MUMPS RUBELLA VACCINE LIVE SQ 1 EA	$72.00	$96.00	—	53% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN	$517.38	$689.84	—	239% above	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 HC PR RX MEASLES MUMPS RUBELLA VACCINE LIVE SQ 1 EA	$69.75	$93.00	—	—	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN	$517.38	$689.84	—	—	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 HC PR RX MEASLES MUMPS RUBELLA VARICELLA VACCINE LIVE SQ 0.5 ML	$87.00	$116.00	—	70% below	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 HC PR RX MEASLES MUMPS RUBELLA VARICELLA VACCINE LIVE SQ 0.5 ML	$87.00	$116.00	—	—	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 HC PR RX MENACWYD/MENACWY-CRM CONJ VACCINE GRPS ACYW IM 0.5 ML	$105.75	$141.00	—	41% below	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 HC PR RX MENACWYD/MENACWY-CRM CONJ VACCINE GRPS ACYW IM 0.5 ML	$108.00	$144.00	—	39% below	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL (A, C, Y, AND W-135) TETANUS CONJUGATE VACCINE	$886.68	$1,182.24	—	399% above	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 HC PR RX MENACWYD/MENACWY-CRM CONJ VACCINE GRPS ACYW IM 0.5 ML	$105.75	$141.00	—	—	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL (A, C, Y, AND W-135) TETANUS CONJUGATE VACCINE	$886.68	$1,182.24	—	—	25%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 HC PR RX MENINGOCOCCAL CONJ QUADRIVALENT (MENQUADFI) IM 1 EA	$222.75	$297.00	—	5% above	25%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 HC PR RX MENINGOCOCCAL CONJ QUADRIVALENT (MENQUADFI) IM 1 EA	$222.75	$297.00	—	—	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 HC PR RX MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM 0.5 ML	$195.75	$261.00	—	27% below	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 HC PR RX MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM 0.5 ML	$195.75	$261.00	—	—	25%
Meningococcal B vaccine (Trumenba) CPT 90621 HC PR RX MENB-FHBP RECOMBNT LIPOPROTEIN VACCINE 2/3 DOSE IM 0.5 ML	$168.75	$225.00	—	12% below	25%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 HC PR RX MENB-FHBP RECOMBNT LIPOPROTEIN VACCINE 2/3 DOSE IM 0.5 ML	$168.75	$225.00	—	—	25%
Nasal spray flu vaccine, live (FluMist) CPT 90660 HC PR RX INFLUENZA TRIVALENT LAIV3 INH 0.2 ML	$49.08	$65.44	—	58% above	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 HC PR RX PNEUMOCOCCAL VACCINE 13 VALENT IM 0.5 ML	$92.25	$123.00	—	73% below	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 HC PR RX PNEUMOCOCCAL VACCINE 13 VALENT IM 0.5 ML	$92.25	$123.00	—	73% below	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE INJ	$689.58	$919.44	—	103% above	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 HC PR RX PNEUMOCOCCAL VACCINE 13 VALENT IM 0.5 ML	$92.25	$123.00	—	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE INJ	$689.58	$919.44	—	—	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 HC PR RX PNEUMOCOCCAL CONJ 20 VALENT VACCINE (PCV20) IM 1 EA	$166.50	$222.00	—	51% below	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 HC PR RX PNEUMOCOCCAL CONJ 20 VALENT VACCINE (PCV20) IM 1 EA	$166.50	$222.00	—	51% below	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML	$1,010.84	$1,347.78	—	196% above	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 HC PR RX PNEUMOCOCCAL CONJ 20 VALENT VACCINE (PCV20) IM 1 EA	$166.50	$222.00	—	—	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML	$1,010.84	$1,347.78	—	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC PR RX PNEUMOCOCCAL VACCINE 23 VALENT 2 YRS OR OLDER SQ/IM 0.5	$24.00	$32.00	—	86% below	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC PR RX PNEUMOCOCCAL VACCINE 23 VALENT 2 YRS OR OLDER SQ/IM 0.5	$54.00	$72.00	—	69% below	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACCINE POLYVALENT SOLN PREF SYR 25 MCG/0.5ML	$648.27	$864.36	—	268% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HC PR RX PNEUMOCOCCAL VACCINE 23 VALENT 2 YRS OR OLDER SQ/IM 0.5	$54.00	$72.00	—	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACCINE POLYVALENT SOLN PREF SYR 25 MCG/0.5ML	$648.27	$864.36	—	—	25%
Polio vaccine, inactivated (IPV) CPT 90713 HC PR RX POLIOVIRUS VACCINE INACTIVATED SQ/IM 0.5 ML	$34.50	$46.00	—	67% below	25%
Polio vaccine, inactivated (IPV) CPT 90713 HC PR RX POLIOVIRUS VACCINE INACTIVATED SQ/IM 0.5 ML	$52.50	$70.00	—	50% below	25%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 HC PR RX POLIOVIRUS VACCINE INACTIVATED SQ/IM 0.5 ML	$34.50	$46.00	—	—	25%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 HC PR RX RSV MONOCLONAL ANTIBODY IM 1 ML	$2,150.97	$2,867.96	—	240% above	25%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 HC PR RX RSV MONOCLONAL ANTIBODY IM 1 ML	$2,150.97	$2,867.96	—	240% above	25%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 HC PR RX RSV MONOCLONAL ANTIBODY IM 1 ML	$2,150.97	$2,867.96	—	—	25%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 HC PR RX RSV MONOCLONAL ANTIBODY IM 0.5 ML	$1,251.54	$1,668.72	—	2% above	25%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 HC PR RX RSV MONOCLONAL ANTIBODY IM 0.5 ML	$1,251.54	$1,668.72	—	2% above	25%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP IM SOLN PREFILLED SYRINGE 50 MG/0.5ML	$2,130.33	$2,840.44	—	74% above	25%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 HC PR RX RSV MONOCLONAL ANTIBODY IM 0.5 ML	$1,251.54	$1,668.72	—	—	25%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP IM SOLN PREFILLED SYRINGE 50 MG/0.5ML	$2,130.33	$2,840.44	—	—	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 HC PR RX RSV PREF BIVALENT IM 1 EA	$1,563.42	$2,084.56	—	233% above	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV PRE-FUSION F A&B VAC RECOMB FOR IM SOLN 120 MCG/0.5ML	$1,563.44	$2,084.58	—	233% above	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 HC PR RX RSV PREF BIVALENT IM 1 EA	$1,563.42	$2,084.56	—	—	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV PRE-FUSION F A&B VAC RECOMB FOR IM SOLN 120 MCG/0.5ML	$1,563.44	$2,084.58	—	—	25%
Rabies vaccine, one dose CPT 90675 HC PR RX RABIES VACCINE IM 1 ML	$238.50	$318.00	—	56% below	25%
Rabies vaccine, one dose CPT 90675 HC PR RX RABIES VACCINE IM 1 ML	$238.50	$318.00	—	56% below	25%
Rabies vaccine, one dose CPT 90675 RABIES VIRUS VACCINE, HDC FOR INJ SUSP	$1,431.98	$1,909.31	—	163% above	25%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC FOR INJ	$1,647.32	$2,196.43	—	203% above	25%
Rabies vaccine, one dose inpatient CPT 90675 HC PR RX RABIES VACCINE IM 1 ML	$238.50	$318.00	—	—	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VIRUS VACCINE, HDC FOR INJ SUSP	$1,431.98	$1,909.31	—	—	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC FOR INJ	$1,647.32	$2,196.43	—	—	25%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 HC PR RX ROTOVIRUS VACCINE (RV1) 2 DOSE ORAL 1 EA	$58.50	$78.00	—	57% below	25%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 HC PR RX ROTOVIRUS VACCINE (RV1) 2 DOSE ORAL 1 EA	$58.50	$78.00	—	—	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 HC PR RX ROTOVIRUS VACCINE (RV5) 3 DOSE ORAL 2 ML	$141.75	$189.00	—	14% above	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 HC PR RX ROTOVIRUS VACCINE (RV5) 3 DOSE ORAL 2 ML	$148.50	$198.00	—	20% above	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 HC PR RX ROTOVIRUS VACCINE (RV5) 3 DOSE ORAL 2 ML	$148.50	$198.00	—	—	25%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HC PR RX HZV ZOSTER VACCINE RECOMBINANT ADJUVANTED IM 0.5 ML	$112.50	$150.00	—	46% below	25%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HC PR RX HZV ZOSTER VACCINE RECOMBINANT ADJUVANTED IM 0.5 ML	$112.50	$150.00	—	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 HC PR RX TD VACCINE PF 7 YRS OR OLDER IM 0.5 ML	$39.00	$52.00	—	5% below	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 2-2 LF/0.5ML	$111.37	$148.49	—	171% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 HC PR RX TD VACCINE PF 7 YRS OR OLDER IM 0.5 ML	$169.50	$226.00	—	312% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML	$370.58	$494.11	—	802% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 2-2 LF/0.5ML	$111.37	$148.49	—	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 HC PR RX TD VACCINE PF 7 YRS OR OLDER IM 0.5 ML	$169.50	$226.00	—	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML	$370.58	$494.11	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC PR RX TDAP VACCINE 7 YRS OR OLDER IM 0.5 ML	$36.75	$49.00	—	42% below	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC PR RX TDAP VACCINE 7 YRS OR OLDER IM 0.5 ML	$36.75	$49.00	—	42% below	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML	$220.76	$294.35	—	247% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 HC PR RX TDAP VACCINE 7 YRS OR OLDER IM 0.5 ML	$36.75	$49.00	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML	$220.76	$294.35	—	—	25%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 HC PR RX TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM 0.5 ML	$75.75	$101.00	—	49% below	25%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 HC PR RX TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM 0.5 ML	$75.75	$101.00	—	—	25%
Typhoid vaccine, oral capsules (Vivotif) CPT 90690 HC PR RX TYPHOID VACCINE LIVE ORAL 1 EA	$55.50	$74.00	—	24% below	25%
Typhoid vaccine, oral capsules (Vivotif) inpatient CPT 90690 HC PR RX TYPHOID VACCINE LIVE ORAL 1 EA	$55.50	$74.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMIN CDM	$22.50	$30.00	—	61% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN INFLUENZA VIRUS VAC CDM	$22.50	$30.00	—	61% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN HEPATITIS B VACCINE CDM	$22.50	$30.00	—	61% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE CDM	$22.50	$30.00	—	61% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE PNEUMONIA CDM	$59.25	$79.00	—	2% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE INFLUENZA CDM	$59.25	$79.00	—	2% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE INFLUENZA CDM	$59.25	$79.00	—	2% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE INITIAL CDM	$59.25	$79.00	—	2% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE INITIAL CDM	$59.25	$79.00	—	2% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE HEPATITIS B CDM	$59.25	$79.00	—	2% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE HEPATITIS B CDM	$59.25	$79.00	—	2% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE PNEUMONIA CDM	$59.25	$79.00	—	2% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE CDM	$22.50	$30.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN INFLUENZA VIRUS VAC CDM	$22.50	$30.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN HEPATITIS B VACCINE CDM	$22.50	$30.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMIN CDM	$22.50	$30.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC PR ADMIN VACCINE HEPATITIS B CDM	$59.25	$79.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC PR ADMIN VACCINE INITIAL CDM	$59.25	$79.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC PR ADMIN VACCINE INFLUENZA CDM	$59.25	$79.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC PR ADMIN VACCINE PNEUMONIA CDM	$59.25	$79.00	—	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMIN EACH ADD CDM	$22.50	$30.00	—	41% below	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC PR 90472 ADMIN VACCINE EA ADDL CDM	$42.00	$56.00	—	9% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC PR 90472 ADMIN VACCINE EA ADDL CDM	$42.00	$56.00	—	9% above	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADMIN EACH ADD CDM	$22.50	$30.00	—	—	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC PR 90472 ADMIN VACCINE EA ADDL CDM	$42.00	$56.00	—	—	25%

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://pricetransparency.providence.org/oregon/live/930796090_providence-seaside-hospital_standardcharges.json