Hospital Los Angeles-Long Beach-Anaheim, CA

Providence Holy Cross Medical Center

Listed in its price file as “Providence Health System - Southern California”.

Providence Holy Cross Medical Center in Mission Hills, CA publishes cash prices for 355 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 California median for 286 of 352 procedures and above it for 65. By typical cash price it ranks #57 of 226 California hospitals and #18 of 55 hospitals in the Los Angeles, CA area, cheapest first. Select a procedure to compare it with other hospitals nearby.

15031 Rinaldi St, Mission Hills, CA 91345 Collected Sep 23, 2026 Source price file Check a bill from this hospital (818) 365-8051

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 050278 · CMS hospital register NPI 1477587632

Financial assistance

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

Providence Holy Cross Medical Center 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

California law (Health and Safety Code §127405): if you are uninsured or have high medical costs and your family income is at or below 400% of the federal poverty level, a hospital may not expect you to pay more than it would expect from Medicare or Medi-Cal, whichever is greater. That can be less than the cash prices below; ask the hospital for its discount payment policy. A separate physician fee may still apply. Other states' laws.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN W & W/O CONTRAST	$700.35	$2,001.00	—	75% below	65%
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN W & W/O CONTRAST	$2,338.00	$6,680.00	—	17% below	65%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN W & W/O CONTRAST	$2,338.00	$6,680.00	—	—	65%
Abdominal X-ray, 2 views CPT 74019 HC XR ABDOMEN 2 VIEWS	$407.75	$1,165.00	—	5% below	65%
Abdominal X-ray, 2 views inpatient CPT 74019 HC XR ABDOMEN 2 VIEWS	$407.75	$1,165.00	—	—	65%
Ankle X-ray, complete, 3 or more views CPT 73610 HC XR ANKLE COMPLETE MIN 3 VIEWS	$418.60	$1,196.00	—	19% below	65%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC XR ANKLE COMPLETE MIN 3 VIEWS	$418.60	$1,196.00	—	—	65%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$669.90	$1,914.00	—	20% above	65%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$669.90	$1,914.00	—	—	65%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY WO CONTRAST	$392.00	$1,120.00	—	83% below	65%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY WO CONTRAST	$649.60	$1,856.00	—	71% below	65%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREMITY WO CONTRAST	$649.60	$1,856.00	—	—	65%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC XR ESOPHAGUS W CONTRAST	$778.40	$2,224.00	—	29% above	65%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC XR ESOPHAGUS W CONTRAST	$778.40	$2,224.00	—	—	65%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE AND OR JOINT IMAGING WHOLE BODY CDM	$737.45	$2,107.00	—	65% below	65%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE AND OR JOINT IMAGING WHOLE BODY CDM	$737.45	$2,107.00	—	—	65%
Breast ultrasound, complete, one breast CPT 76641 HC US BREAST UNI COMPLETE	$442.05	$1,263.00	—	37% below	65%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST UNI COMPLETE	$442.05	$1,263.00	—	—	65%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US ED BREAST UNI LIMITED CDM	$331.10	$946.00	—	38% below	65%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST UNI LIMITED	$331.10	$946.00	—	38% below	65%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST UNI LIMITED	$331.10	$946.00	—	—	65%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US ED BREAST UNI LIMITED CDM	$331.10	$946.00	—	—	65%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CTA ABDOMEN PELVIS	$1,073.10	$3,066.00	—	80% below	65%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CTA ABDOMEN PELVIS	$2,922.15	$8,349.00	—	46% below	65%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CTA ABDOMEN PELVIS	$2,922.15	$8,349.00	—	—	65%
CT angiography (CTA) of the head CPT 70496 HC CT ANGIOGRAPHY HEAD W CONTRAST	$1,097.60	$3,136.00	—	63% below	65%
CT angiography (CTA) of the head CPT 70496 HC CT ANGIOGRAPHY HEAD W CONTRAST	$3,754.45	$10,727.00	—	26% above	65%
CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIOGRAPHY HEAD W CONTRAST	$3,754.45	$10,727.00	—	—	65%
CT angiography (CTA) of the neck CPT 70498 HC CT ANGIOGRAPHY NECK W CONTRAST	$1,097.60	$3,136.00	—	63% below	65%
CT angiography (CTA) of the neck CPT 70498 HC CT ANGIOGRAPHY NECK W CONTRAST	$3,754.45	$10,727.00	—	27% above	65%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIOGRAPHY NECK W CONTRAST	$3,754.45	$10,727.00	—	—	65%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIOGRAPHY CHEST	$715.05	$2,043.00	—	79% below	65%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIOGRAPHY CHEST	$1,711.15	$4,889.00	—	50% below	65%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIOGRAPHY CHEST	$1,711.15	$4,889.00	—	—	65%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD & PELVIS WO CONTRAST	$768.60	$2,196.00	—	76% below	65%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD & PELVIS WO CONTRAST	$2,238.25	$6,395.00	—	30% below	65%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD & PELVIS WO CONTRAST	$2,238.25	$6,395.00	—	—	65%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST	$1,023.75	$2,925.00	—	75% below	65%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST	$2,744.00	$7,840.00	—	34% below	65%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST	$2,744.00	$7,840.00	—	—	65%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN & PELVIS W & W/O CONTRAST	$1,339.80	$3,828.00	—	72% below	65%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN & PELVIS W & W/O CONTRAST	$4,352.60	$12,436.00	—	7% below	65%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABDOMEN & PELVIS W & W/O CONTRAST	$4,352.60	$12,436.00	—	—	65%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST	$544.95	$1,557.00	—	78% below	65%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST	$1,570.10	$4,486.00	—	38% below	65%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W CONTRAST	$1,570.10	$4,486.00	—	—	65%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CONTRAST	$382.55	$1,093.00	—	80% below	65%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CONTRAST	$1,174.25	$3,355.00	—	38% below	65%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN WO CONTRAST	$1,174.25	$3,355.00	—	—	65%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST	$627.90	$1,794.00	—	71% below	65%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL W/O DYE LIMITED	$627.90	$1,794.00	—	71% below	65%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL W/O DYE LIMITED	$2,249.80	$6,428.00	—	3% above	65%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST	$2,249.80	$6,428.00	—	3% above	65%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST	$2,249.80	$6,428.00	—	—	65%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL W/O DYE LIMITED	$2,249.80	$6,428.00	—	—	65%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN WO CONTRAST	$482.65	$1,379.00	—	79% below	65%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN WO CONTRAST	$2,127.65	$6,079.00	—	7% below	65%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN WO CONTRAST	$2,127.65	$6,079.00	—	—	65%
CT scan of the head with contrast CPT 70460 HC CT HEAD/BRAIN W CONTRAST	$623.70	$1,782.00	—	77% below	65%
CT scan of the head with contrast CPT 70460 HC CT HEAD/BRAIN W CONTRAST	$2,667.70	$7,622.00	—	1% below	65%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD/BRAIN W CONTRAST	$2,667.70	$7,622.00	—	—	65%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD/BRAIN W & W/O CONTRAST	$768.25	$2,195.00	—	75% below	65%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD/BRAIN W & W/O CONTRAST	$3,768.10	$10,766.00	—	22% above	65%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD/BRAIN W & W/O CONTRAST	$3,768.10	$10,766.00	—	—	65%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONTRAST	$406.70	$1,162.00	—	86% below	65%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONTRAST	$1,556.10	$4,446.00	—	46% below	65%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE WO CONTRAST	$1,556.10	$4,446.00	—	—	65%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT NECK SPINE WO CONTRAST	$626.50	$1,790.00	—	78% below	65%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT NECK SPINE WO CONTRAST	$3,364.90	$9,614.00	—	16% above	65%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT NECK SPINE WO CONTRAST	$3,364.90	$9,614.00	—	—	65%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST	$478.80	$1,368.00	—	81% below	65%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST	$1,174.25	$3,355.00	—	54% below	65%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST	$1,174.25	$3,355.00	—	—	65%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$824.60	$2,356.00	—	—	65%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$824.60	$2,356.00	—	—	65%
Chest CT scan without and with contrast CPT 71270 HC CT THORAX W & W/O CONTRAST	$636.65	$1,819.00	—	81% below	65%
Chest CT scan without and with contrast CPT 71270 HC CT THORAX W & W/O CONTRAST	$1,747.90	$4,994.00	—	47% below	65%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT THORAX W & W/O CONTRAST	$1,747.90	$4,994.00	—	—	65%
Chest X-ray, 2 views CPT 71046 HC XR CHEST 2 VIEWS	$466.55	$1,333.00	—	15% above	65%
Chest X-ray, 2 views inpatient CPT 71046 HC XR CHEST 2 VIEWS	$466.55	$1,333.00	—	—	65%
Chest X-ray, single view CPT 71045 HC XR CHEST 1 VIEW	$292.25	$835.00	—	20% below	65%
Chest X-ray, single view CPT 71045 HC XR CHEST PORTABLE 1 VIEW	$292.25	$835.00	—	20% below	65%
Chest X-ray, single view inpatient CPT 71045 HC XR CHEST 1 VIEW	$292.25	$835.00	—	—	65%
Chest X-ray, single view inpatient CPT 71045 HC XR CHEST PORTABLE 1 VIEW	$292.25	$835.00	—	—	65%
Collarbone (clavicle) X-ray, complete CPT 73000 HC XR CLAVICLE COMPLETE	$358.40	$1,024.00	—	26% below	65%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC XR CLAVICLE COMPLETE	$358.40	$1,024.00	—	—	65%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE	$502.60	$1,436.00	—	41% below	65%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE	$502.60	$1,436.00	—	—	65%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC XR DXA BONE DENSITY STUDY AXIAL	$248.50	$710.00	—	51% below	65%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC XR DXA BONE DENSITY STUDY AXIAL	$248.50	$710.00	—	—	65%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US OB DETAILED SINGLE FETUS CDM	$352.80	$1,008.00	—	61% below	65%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US OB DETAILED SINGLE FETUS CDM	$352.80	$1,008.00	—	—	65%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX W/O DYE F/U LUNG SCREENING	$406.70	$1,162.00	—	80% below	65%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX WO CONTRAST	$406.70	$1,162.00	—	80% below	65%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX WO CONTRAST	$1,420.30	$4,058.00	—	30% below	65%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX W/O DYE F/U LUNG SCREENING	$1,420.30	$4,058.00	—	30% below	65%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX WO CONTRAST	$1,420.30	$4,058.00	—	—	65%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX W/O DYE F/U LUNG SCREENING	$1,420.30	$4,058.00	—	—	65%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W CONTRAST	$504.70	$1,442.00	—	82% below	65%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W CONTRAST	$1,570.10	$4,486.00	—	46% below	65%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX W CONTRAST	$1,570.10	$4,486.00	—	—	65%
Diagnostic mammogram, both breasts CPT 77066 HC MAMMO DIAG BIL W CAD	$420.35	$1,201.00	—	14% below	65%
Diagnostic mammogram, both breasts inpatient CPT 77066 HC MAMMO DIAG BIL W CAD	$420.35	$1,201.00	—	—	65%
Diagnostic mammogram, one breast CPT 77065 HC MAMMO DIAG UNI W CAD	$294.70	$842.00	—	21% below	65%
Diagnostic mammogram, one breast inpatient CPT 77065 HC MAMMO DIAG UNI W CAD	$294.70	$842.00	—	—	65%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$448.35	$1,281.00	—	—	65%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$448.35	$1,281.00	—	—	65%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY	$1,194.90	$3,414.00	—	—	65%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY	$1,194.90	$3,414.00	—	—	65%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO TTE 2D W DOPPLER COMPLETE	$2,338.00	$6,680.00	—	13% below	65%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO TTE 2D W DOPPLER COMPLETE	$2,338.00	$6,680.00	—	—	65%
Elbow X-ray, 2 views CPT 73070 HC XR ELBOW 2 VIEWS	$293.30	$838.00	—	26% below	65%
Elbow X-ray, 2 views CPT 73070 HC XR ELBOW LIMITED	$293.30	$838.00	—	26% below	65%
Elbow X-ray, 2 views inpatient CPT 73070 HC XR ELBOW 2 VIEWS	$293.30	$838.00	—	—	65%
Elbow X-ray, 2 views inpatient CPT 73070 HC XR ELBOW LIMITED	$293.30	$838.00	—	—	65%
Elbow X-ray, complete, 3 or more views CPT 73080 HC XR ELBOW COMPLETE MIN 3 VIEWS	$418.60	$1,196.00	—	14% below	65%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC XR ELBOW COMPLETE MIN 3 VIEWS	$418.60	$1,196.00	—	—	65%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT/EAR/FOSSA WO CONTRAST	$627.90	$1,794.00	—	73% below	65%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT/EAR/FOSSA WO CONTRAST	$1,869.35	$5,341.00	—	18% below	65%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT/EAR/FOSSA WO CONTRAST	$1,869.35	$5,341.00	—	—	65%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC XR FACIAL BONES MIN 3 VIEWS	$511.00	$1,460.00	—	3% above	65%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC XR FACIAL BONES MIN 3 VIEWS	$511.00	$1,460.00	—	—	65%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC XR FOREARM 1 VIEW	$386.40	$1,104.00	—	10% below	65%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC XR FOREARM 2 VIEWS	$386.40	$1,104.00	—	10% below	65%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC XR FOREARM 2 VIEWS	$386.40	$1,104.00	—	—	65%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC XR FOREARM 1 VIEW	$386.40	$1,104.00	—	—	65%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBILIARY SYSTEM	$595.35	$1,701.00	—	67% below	65%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM HEPATOBILIARY SYSTEM	$595.35	$1,701.00	—	—	65%
Hand X-ray, 2 views CPT 73120 HC XR HAND 2 VIEWS	$220.85	$631.00	—	46% below	65%
Hand X-ray, 2 views CPT 73120 HC XR HAND 1 VIEW	$220.85	$631.00	—	46% below	65%
Hand X-ray, 2 views inpatient CPT 73120 HC XR HAND 2 VIEWS	$220.85	$631.00	—	—	65%
Hand X-ray, 2 views inpatient CPT 73120 HC XR HAND 1 VIEW	$220.85	$631.00	—	—	65%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC XR HEEL MIN 2 VIEWS	$239.05	$683.00	—	32% below	65%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC XR HEEL MIN 2 VIEWS	$239.05	$683.00	—	—	65%
Knee X-ray, 3 views CPT 73562 HC XR KNEE 3 VIEWS	$475.30	$1,358.00	—	4% above	65%
Knee X-ray, 3 views inpatient CPT 73562 HC XR KNEE 3 VIEWS	$475.30	$1,358.00	—	—	65%
Knee X-ray, complete, 4 or more views CPT 73564 HC XR KNEE 4/PLUS VIEWS	$475.30	$1,358.00	—	19% below	65%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC XR KNEE 4/PLUS VIEWS	$475.30	$1,358.00	—	—	65%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST	$392.70	$1,122.00	—	82% below	65%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST	$649.60	$1,856.00	—	70% below	65%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST	$649.60	$1,856.00	—	—	65%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED	$321.30	$918.00	—	61% below	65%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ED ABDOMEN LIMITED CDM	$321.30	$918.00	—	61% below	65%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMEN LIMITED	$321.30	$918.00	—	—	65%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ED ABDOMEN LIMITED CDM	$321.30	$918.00	—	—	65%
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	$302.40	$864.00	—	45% below	65%
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	$302.40	$864.00	—	45% below	65%
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	$302.40	$864.00	—	—	65%
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	$302.40	$864.00	—	—	65%
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	$369.95	$1,057.00	—	4% above	65%
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	$1,291.50	$3,690.00	—	263% above	65%
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	$1,291.50	$3,690.00	—	—	65%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC XR LOWER LEG LIMITED	$596.40	$1,704.00	—	38% above	65%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC XR LOWER LEG 2 VIEWS	$596.40	$1,704.00	—	38% above	65%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC XR LOWER LEG 2 VIEWS	$596.40	$1,704.00	—	—	65%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC XR LOWER LEG LIMITED	$596.40	$1,704.00	—	—	65%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD WO CONTRAST	$783.65	$2,239.00	—	73% below	65%
MRI of both breasts, without and then with contrast dye CPT 77049 HC MRI BREAST W/O & W/ CONTRAST W/ CAD BIL	$1,551.90	$4,434.00	—	53% below	65%
MRI of both breasts, without and then with contrast dye CPT 77049 HC MRI BREAST W/O & W/ CONTRAST W/ CAD BIL	$3,769.85	$10,771.00	—	13% above	65%
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 HC MRI BREAST W/O & W/ CONTRAST W/ CAD BIL	$3,769.85	$10,771.00	—	—	65%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST	$783.65	$2,239.00	—	74% below	65%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST	$2,280.25	$6,515.00	—	25% below	65%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST	$2,280.25	$6,515.00	—	—	65%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST	$1,199.80	$3,428.00	—	74% below	65%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST	$3,769.85	$10,771.00	—	18% below	65%
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	$3,769.85	$10,771.00	—	—	65%
MRI of the abdomen without contrast CPT 74181 HC MRI MRCP ABDOMEN WO CONTRAST	$783.65	$2,239.00	—	72% below	65%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN WO CONTRAST	$783.65	$2,239.00	—	72% below	65%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN WO CONTRAST	$3,480.05	$9,943.00	—	24% above	65%
MRI of the abdomen without contrast CPT 74181 HC MRI MRCP ABDOMEN WO CONTRAST	$3,480.05	$9,943.00	—	24% above	65%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI MRCP ABDOMEN WO CONTRAST	$3,480.05	$9,943.00	—	—	65%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN WO CONTRAST	$3,480.05	$9,943.00	—	—	65%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN WO & W CONTRAST	$1,199.80	$3,428.00	—	73% below	65%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN WO & W CONTRAST	$6,729.10	$19,226.00	—	54% above	65%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN WO & W CONTRAST	$6,729.10	$19,226.00	—	—	65%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN STEM W/O DYE	$783.65	$2,239.00	—	73% below	65%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN W/O DYE LIMITED	$3,023.30	$8,638.00	—	4% above	65%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN STEM W/O DYE	$3,023.30	$8,638.00	—	4% above	65%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN W/O DYE LIMITED	$3,023.30	$8,638.00	—	—	65%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN STEM W/O DYE	$3,023.30	$8,638.00	—	—	65%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/O & W/DYE	$1,199.80	$3,428.00	—	72% below	65%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/O & W/DYE	$4,590.60	$13,116.00	—	6% above	65%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W/O & W/DYE	$4,590.60	$13,116.00	—	—	65%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O DYE	$783.65	$2,239.00	—	74% below	65%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O DYE	$3,473.05	$9,923.00	—	13% above	65%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O DYE	$3,473.05	$9,923.00	—	—	65%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE	$1,199.80	$3,428.00	—	73% below	65%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE	$4,739.70	$13,542.00	—	5% above	65%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE	$4,739.70	$13,542.00	—	—	65%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O DYE	$783.65	$2,239.00	—	73% below	65%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O DYE	$3,473.05	$9,923.00	—	20% above	65%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THORACIC SPINE W/O DYE	$3,473.05	$9,923.00	—	—	65%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE	$1,199.80	$3,428.00	—	73% below	65%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE	$4,739.70	$13,542.00	—	7% above	65%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE	$4,739.70	$13,542.00	—	—	65%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O DYE	$783.65	$2,239.00	—	74% below	65%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O DYE	$3,473.05	$9,923.00	—	16% above	65%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O DYE	$3,473.05	$9,923.00	—	—	65%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WO & W CONTRAST	$1,199.80	$3,428.00	—	71% below	65%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WO & W CONTRAST	$4,561.20	$13,032.00	—	10% above	65%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS WO & W CONTRAST	$4,561.20	$13,032.00	—	—	65%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST	$783.65	$2,239.00	—	69% below	65%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST	$3,023.30	$8,638.00	—	18% above	65%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS WO CONTRAST	$3,023.30	$8,638.00	—	—	65%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXTREMITY JOINT WO CONTRAST	$783.65	$2,239.00	—	70% below	65%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXTREMITY JOINT WO CONTRAST	$2,280.25	$6,515.00	—	13% below	65%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPER EXTREMITY JOINT WO CONTRAST	$2,280.25	$6,515.00	—	—	65%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC XR SPINE CERVICAL 4 OR 5 VIEWS	$609.70	$1,742.00	—	5% below	65%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC XR SPINE CERVICAL 4 OR 5 VIEWS	$609.70	$1,742.00	—	—	65%
Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST	$741.30	$2,118.00	—	73% below	65%
Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST	$2,987.95	$8,537.00	—	9% above	65%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST	$2,987.95	$8,537.00	—	—	65%
Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST	$596.40	$1,704.00	—	72% below	65%
Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST	$2,520.70	$7,202.00	—	19% above	65%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST	$2,520.70	$7,202.00	—	—	65%
Neck soft tissue X-ray CPT 70360 HC XR NECK SOFT TISSUE	$302.40	$864.00	—	7% below	65%
Neck soft tissue X-ray inpatient CPT 70360 HC XR NECK SOFT TISSUE	$302.40	$864.00	—	—	65%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM MYCARD PERFUS SPECT MULTIPLE	$2,931.25	$8,375.00	—	28% below	65%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM MYCARD PERFUS SPECT MULTIPLE	$2,931.25	$8,375.00	—	—	65%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET IMAGE W CT SKULL MID THIGH	$1,801.80	$5,148.00	—	75% below	65%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC PET IMAGE W CT SKULL MID THIGH	$1,801.80	$5,148.00	—	—	65%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CONTRAST	$385.70	$1,102.00	—	80% below	65%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CONTRAST	$1,064.70	$3,042.00	—	46% below	65%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS WO CONTRAST	$1,064.70	$3,042.00	—	—	65%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC FOLLICLE LIMITED	$321.30	$918.00	—	40% below	65%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US ED EXAM PELVIC LIMITED CDM	$321.30	$918.00	—	40% below	65%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC LIMITED	$321.30	$918.00	—	40% below	65%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US EXAM PELVIC FOLLICLE LIMITED	$321.30	$918.00	—	—	65%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US ED EXAM PELVIC LIMITED CDM	$321.30	$918.00	—	—	65%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US EXAM PELVIC LIMITED	$321.30	$918.00	—	—	65%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIC NON-OB COMPLETE	$502.60	$1,436.00	—	47% below	65%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIC NON-OB COMPLETE	$502.60	$1,436.00	—	—	65%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS	$544.25	$1,555.00	—	37% below	65%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS	$544.25	$1,555.00	—	—	65%
Pregnancy ultrasound before 14 weeks, through the belly, one baby one side CPT 76801 HC US OB LT 14 WKS SINGLE FETUS CDM	$486.15	$1,389.00	—	37% below	65%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient one side CPT 76801 HC US OB LT 14 WKS SINGLE FETUS CDM	$486.15	$1,389.00	—	—	65%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US OB LIMITED FETUS(S) CDM	$434.70	$1,242.00	—	28% below	65%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US ED OB LIMITED FETUS(S) CDM	$434.70	$1,242.00	—	28% below	65%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US ED OB LIMITED FETUS(S) CDM	$434.70	$1,242.00	—	—	65%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US OB LIMITED FETUS(S) CDM	$434.70	$1,242.00	—	—	65%
Rib X-ray, one side, 2 views CPT 71100 HC XR RIBS UNI 2 VIEWS	$391.30	$1,118.00	—	15% below	65%
Rib X-ray, one side, 2 views inpatient CPT 71100 HC XR RIBS UNI 2 VIEWS	$391.30	$1,118.00	—	—	65%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC XR RIBS/CHEST UNI MIN 3 VIEWS	$411.25	$1,175.00	—	33% below	65%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC XR RIBS/CHEST UNI MIN 3 VIEWS	$411.25	$1,175.00	—	—	65%
Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN BIL W CAD	$193.20	$552.00	—	39% below	65%
Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD	$193.20	$552.00	—	39% below	65%
Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN BIL W CAD	$193.20	$552.00	—	—	65%
Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD	$193.20	$552.00	—	—	65%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC XR SHOULDER COMPLETE MIN 2 VIEWS	$471.80	$1,348.00	—	14% below	65%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC XR SHOULDER COMPLETE MIN 2 VIEWS	$471.80	$1,348.00	—	—	65%
Sinus X-ray, complete, 3 or more views CPT 70220 HC XR SINUSES PARANASAL MIN 3 VIEWS	$620.90	$1,774.00	—	36% above	65%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC XR SINUSES PARANASAL MIN 3 VIEWS	$620.90	$1,774.00	—	—	65%
Skull X-ray, fewer than 4 views CPT 70250 HC XR SKULL 1-3 VIEWS	$441.00	$1,260.00	—	9% above	65%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC XR SKULL 1-3 VIEWS	$441.00	$1,260.00	—	—	65%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$695.45	$1,987.00	—	5% above	65%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$695.45	$1,987.00	—	—	65%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC XR FEMUR MIN 2 VIEWS	$596.40	$1,704.00	—	46% above	65%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC XR FEMUR MIN 2 VIEWS	$596.40	$1,704.00	—	—	65%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT CHEST SPINE WO CONTRAST	$407.75	$1,165.00	—	85% below	65%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT CHEST SPINE WO CONTRAST	$1,556.10	$4,446.00	—	45% below	65%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT CHEST SPINE WO CONTRAST	$1,556.10	$4,446.00	—	—	65%
Toe X-ray, 2 or more views CPT 73660 HC XR TOE(S) MIN 2 VIEWS	$336.70	$962.00	—	2% above	65%
Toe X-ray, 2 or more views inpatient CPT 73660 HC XR TOE(S) MIN 2 VIEWS	$336.70	$962.00	—	—	65%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON-OB	$442.05	$1,263.00	—	38% below	65%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON-OB	$442.05	$1,263.00	—	—	65%
Transvaginal ultrasound during pregnancy CPT 76817 HC US OB TRANSVAGINAL CDM	$394.80	$1,128.00	—	41% below	65%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US OB TRANSVAGINAL CDM	$394.80	$1,128.00	—	—	65%
Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE	$586.25	$1,675.00	—	46% below	65%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US EXAM ABDOMEN COMPLETE	$586.25	$1,675.00	—	—	65%
Ultrasound of the scrotum and testicles CPT 76870 HC US EXAM SCROTUM & CONTENTS	$531.30	$1,518.00	—	40% below	65%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US EXAM SCROTUM & CONTENTS	$531.30	$1,518.00	—	—	65%
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	$442.05	$1,263.00	—	47% below	65%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US EXAM OF HEAD AND NECK	$442.05	$1,263.00	—	47% below	65%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US EXAM OF HEAD AND NECK	$442.05	$1,263.00	—	—	65%
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	$442.05	$1,263.00	—	—	65%
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	$840.70	$2,402.00	—	36% above	65%
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	$840.70	$2,402.00	—	—	65%
Upper arm X-ray (humerus), 2 views CPT 73060 HC XR HUMERUS MIN 2 VIEWS	$386.40	$1,104.00	—	10% below	65%
Upper arm X-ray (humerus), 2 views CPT 73060 HC XR HUMERUS 1 VIEW	$386.40	$1,104.00	—	10% below	65%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XR HUMERUS 1 VIEW	$386.40	$1,104.00	—	—	65%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XR HUMERUS MIN 2 VIEWS	$386.40	$1,104.00	—	—	65%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$668.50	$1,910.00	—	26% below	65%
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	$668.50	$1,910.00	—	—	65%
Wrist X-ray, 2 views CPT 73100 HC XR WRIST 2 VIEWS	$300.30	$858.00	—	23% below	65%
Wrist X-ray, 2 views CPT 73100 HC XR WRIST 1 VIEW	$300.30	$858.00	—	23% below	65%
Wrist X-ray, 2 views inpatient CPT 73100 HC XR WRIST 1 VIEW	$300.30	$858.00	—	—	65%
Wrist X-ray, 2 views inpatient CPT 73100 HC XR WRIST 2 VIEWS	$300.30	$858.00	—	—	65%
Wrist X-ray, complete, 3 or more views CPT 73110 HC XR WRIST COMPLETE MIN 3 VIEWS	$441.00	$1,260.00	—	12% below	65%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC XR WRIST COMPLETE MIN 3 VIEWS	$441.00	$1,260.00	—	—	65%
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	$546.00	$1,560.00	—	36% above	65%
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	$546.00	$1,560.00	—	—	65%
X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN 1 VIEW	$357.00	$1,020.00	—	17% above	65%
X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN PORTABLE 1 VIEW	$357.00	$1,020.00	—	17% above	65%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN PORTABLE 1 VIEW	$357.00	$1,020.00	—	—	65%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN 1 VIEW	$357.00	$1,020.00	—	—	65%
X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 2 VIEWS	$247.10	$706.00	—	37% below	65%
X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 1 VIEW	$247.10	$706.00	—	37% below	65%
X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 2 VIEWS	$247.10	$706.00	—	—	65%
X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 1 VIEW	$247.10	$706.00	—	—	65%
X-ray of the finger(s), 2 or more views CPT 73140 HC XR FINGERS(S) MIN 2 VIEWS	$336.70	$962.00	—	8% below	65%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XR FINGERS(S) MIN 2 VIEWS	$336.70	$962.00	—	—	65%
X-ray of the foot, 2 views CPT 73620 HC XR FOOT 2 VIEWS	$247.10	$706.00	—	39% below	65%
X-ray of the foot, 2 views CPT 73620 HC XR FOOT 1 VIEW	$247.10	$706.00	—	39% below	65%
X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 1 VIEW	$247.10	$706.00	—	—	65%
X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 2 VIEWS	$247.10	$706.00	—	—	65%
X-ray of the foot, complete, 3 or more views CPT 73630 HC XR FOOT MIN 3 VIEWS	$418.60	$1,196.00	—	15% below	65%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC XR FOOT MIN 3 VIEWS	$418.60	$1,196.00	—	—	65%
X-ray of the hand, 3 or more views CPT 73130 HC XR HAND MIN 3 VIEWS	$358.40	$1,024.00	—	30% below	65%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC XR HAND MIN 3 VIEWS	$358.40	$1,024.00	—	—	65%
X-ray of the knee, 1 or 2 views CPT 73560 HC XR KNEE 1-2 VIEWS	$247.10	$706.00	—	38% below	65%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC XR KNEE 1-2 VIEWS	$247.10	$706.00	—	—	65%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS	$281.75	$805.00	—	40% below	65%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS	$281.75	$805.00	—	—	65%
X-ray of the lower back, 4 or more views CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS	$812.35	$2,321.00	—	25% above	65%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS	$812.35	$2,321.00	—	—	65%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC XR SPINE THORACIC 2 VIEWS	$331.10	$946.00	—	28% below	65%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC XR SPINE THORACIC 2 VIEWS	$331.10	$946.00	—	—	65%
X-ray of the nasal bones, 3 or more views CPT 70160 HC XR NASAL BONES MIN 3 VIEWS	$572.60	$1,636.00	—	32% above	65%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC XR NASAL BONES MIN 3 VIEWS	$572.60	$1,636.00	—	—	65%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC XR SPINE CERVICAL 2 OR 3 VIEWS	$294.35	$841.00	—	35% below	65%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC XR SPINE CERVICAL 2 OR 3 VIEWS	$294.35	$841.00	—	—	65%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC XR PELVIS 1-2 VIEWS NO HIP VIEWS	$341.95	$977.00	—	11% below	65%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC XR PELVIS 1-2 VIEWS NO HIP VIEWS	$341.95	$977.00	—	—	65%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XR TAILBONE MIN 2 VIEWS	$374.50	$1,070.00	—	20% below	65%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC XR TAILBONE MIN 2 VIEWS	$374.50	$1,070.00	—	—	65%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs California	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALANINE AMINO (ALT) (SGPT)	$18.20	$52.00	—	58% below	65%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC SGPT (ALT)	$18.20	$52.00	—	58% below	65%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALANINE AMINO (ALT) (SGPT)	$64.75	$185.00	—	50% above	65%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC SGPT (ALT)	$64.75	$185.00	—	50% above	65%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC ALANINE AMINO (ALT) (SGPT)	$64.75	$185.00	—	—	65%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC SGPT (ALT)	$64.75	$185.00	—	—	65%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC TRANSFERASE ASPARTATE AMINO AST SGOT	$18.20	$52.00	—	60% below	65%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC SGOT (AST)	$18.20	$52.00	—	60% below	65%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC SGOT (AST)	$64.75	$185.00	—	43% above	65%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC TRANSFERASE ASPARTATE AMINO AST SGOT	$64.75	$185.00	—	43% above	65%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC SGOT (AST)	$64.75	$185.00	—	—	65%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC TRANSFERASE ASPARTATE AMINO AST SGOT	$64.75	$185.00	—	—	65%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS ACUTE PANEL	$93.10	$266.00	—	66% below	65%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS ACUTE PANEL	$481.95	$1,377.00	—	77% above	65%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS ACUTE PANEL	$481.95	$1,377.00	—	—	65%
Albumin blood test CPT 82040 HC ASSAY OF SERUM ALBUMIN	$18.20	$52.00	—	27% below	65%
Albumin blood test CPT 82040 HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB	$18.20	$52.00	—	27% below	65%
Albumin blood test CPT 82040 HC ASSAY OF SERUM ALBUMIN	$64.75	$185.00	—	159% above	65%
Albumin blood test CPT 82040 HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB	$64.75	$185.00	—	159% above	65%
Albumin blood test inpatient CPT 82040 HC ASSAY OF SERUM ALBUMIN	$64.75	$185.00	—	—	65%
Albumin blood test inpatient CPT 82040 HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB	$64.75	$185.00	—	—	65%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ALKALINE PHOS	$18.20	$52.00	—	51% below	65%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ASSAY OF PHOSPHATASE ALKALINE LAB	$18.20	$52.00	—	51% below	65%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ASSAY OF PHOSPHATASE ALKALINE LAB	$64.75	$185.00	—	75% above	65%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ALKALINE PHOS	$64.75	$185.00	—	75% above	65%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ALKALINE PHOS	$64.75	$185.00	—	—	65%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ASSAY OF PHOSPHATASE ALKALINE LAB	$64.75	$185.00	—	—	65%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM LAB	$65.10	$186.00	—	15% below	65%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM CDM	$65.10	$186.00	—	15% below	65%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM CDM	$150.85	$431.00	—	96% above	65%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM LAB	$150.85	$431.00	—	96% above	65%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA-FETOPROTEIN SERUM LAB	$150.85	$431.00	—	—	65%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA-FETOPROTEIN SERUM CDM	$150.85	$431.00	—	—	65%
Ammonia blood test CPT 82140 HC ASSAY OF AMMONIA LAB	$112.70	$322.00	—	38% below	65%
Ammonia blood test CPT 82140 HC ASSAY OF AMMONIA LAB	$178.85	$511.00	—	1% below	65%
Ammonia blood test inpatient CPT 82140 HC ASSAY OF AMMONIA LAB	$178.85	$511.00	—	—	65%
Amylase blood test CPT 82150 HC AMYLASE	$34.30	$98.00	—	33% below	65%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE LAB	$34.30	$98.00	—	33% below	65%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE	$34.30	$98.00	—	33% below	65%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE LAB	$148.40	$424.00	—	190% above	65%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE	$148.40	$424.00	—	190% above	65%
Amylase blood test CPT 82150 HC AMYLASE	$148.40	$424.00	—	190% above	65%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE CDM	$167.30	$478.00	—	227% above	65%
Amylase blood test CPT 82150 HC ASSAY AMYLASE URINE	$167.30	$478.00	—	227% above	65%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE FLUID	$167.30	$478.00	—	227% above	65%
Amylase blood test CPT 82150 HC AMYLASE URINE	$167.30	$478.00	—	227% above	65%
Amylase blood test inpatient CPT 82150 HC AMYLASE	$148.40	$424.00	—	—	65%
Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE LAB	$148.40	$424.00	—	—	65%
Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE	$148.40	$424.00	—	—	65%
Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE FLUID	$167.30	$478.00	—	—	65%
Amylase blood test inpatient CPT 82150 HC ASSAY AMYLASE URINE	$167.30	$478.00	—	—	65%
Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE CDM	$167.30	$478.00	—	—	65%
Amylase blood test inpatient CPT 82150 HC AMYLASE URINE	$167.30	$478.00	—	—	65%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CCP ANTIBODY	$31.50	$90.00	—	55% above	65%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CCP ANTIBODY	$31.50	$90.00	—	—	65%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA LAB	$29.40	$84.00	—	9% below	65%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA	$29.40	$84.00	—	9% below	65%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANA SCREEN BODY FLUID	$32.90	$94.00	—	2% above	65%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA LAB	$152.25	$435.00	—	372% above	65%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANA SCREEN BODY FLUID	$152.25	$435.00	—	372% above	65%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA	$152.25	$435.00	—	372% above	65%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA LAB	$152.25	$435.00	—	—	65%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANA SCREEN BODY FLUID	$152.25	$435.00	—	—	65%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA	$152.25	$435.00	—	—	65%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE LAB	$305.20	$872.00	—	65% above	65%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE	$305.20	$872.00	—	65% above	65%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE	$305.20	$872.00	—	—	65%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE LAB	$305.20	$872.00	—	—	65%
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	$18.20	$52.00	—	85% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE BACTERIA OTHER	$18.20	$52.00	—	85% below	65%
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	$22.40	$64.00	—	81% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE BACTERIA OTHER	$105.00	$300.00	—	13% below	65%
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	$105.00	$300.00	—	13% below	65%
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	$22.40	$64.00	—	—	65%
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	$105.00	$300.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE BACTERIA OTHER	$105.00	$300.00	—	—	65%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL	$28.70	$82.00	—	85% below	65%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL	$238.70	$682.00	—	21% above	65%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL	$238.70	$682.00	—	—	65%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL LAB	$18.20	$52.00	—	60% below	65%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL	$18.20	$52.00	—	60% below	65%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL	$64.75	$185.00	—	43% above	65%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL LAB	$64.75	$185.00	—	43% above	65%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL	$64.75	$185.00	—	—	65%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL LAB	$64.75	$185.00	—	—	65%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB	$134.75	$385.00	—	4% above	65%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB	$134.75	$385.00	—	—	65%
Blood culture for bacteria CPT 87040 HC BLOOD CULTURE FOR BACTERIA	$23.80	$68.00	—	91% below	65%
Blood culture for bacteria CPT 87040 HC BLOOD CULTURE FOR BACTERIA	$137.90	$394.00	—	49% below	65%
Blood culture for bacteria inpatient CPT 87040 HC BLOOD CULTURE FOR BACTERIA	$137.90	$394.00	—	—	65%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - REFERRAL DRAW FEE	$9.80	$28.00	—	53% below	65%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - REFERRAL PROCESSING	$9.80	$28.00	—	53% below	65%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM	$9.80	$28.00	—	53% below	65%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM	$9.80	$28.00	—	53% below	65%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM	$21.00	$60.00	—	at median	65%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM	$21.00	$60.00	—	at median	65%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM	$21.00	$60.00	—	at median	65%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - REFERRAL DRAW FEE	$21.00	$60.00	—	at median	65%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - REFERRAL PROCESSING	$21.00	$60.00	—	at median	65%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM	$21.00	$60.00	—	—	65%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE - REFERRAL PROCESSING	$21.00	$60.00	—	—	65%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM	$21.00	$60.00	—	—	65%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM	$21.00	$60.00	—	—	65%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE - REFERRAL DRAW FEE	$21.00	$60.00	—	—	65%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP	$10.50	$30.00	—	72% below	65%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)	$18.20	$52.00	—	51% below	65%
Blood glucose (sugar) test CPT 82947 HC ASSAY GLUCOSE BLOOD QUANT	$18.20	$52.00	—	51% below	65%
Blood glucose (sugar) test CPT 82947 HC ASSAY GLUCOSE BLOOD QUANT	$64.75	$185.00	—	73% above	65%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)	$64.75	$185.00	—	73% above	65%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP	$10.50	$30.00	—	—	65%
Blood glucose (sugar) test inpatient CPT 82947 HC ASSAY GLUCOSE BLOOD QUANT	$64.75	$185.00	—	—	65%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)	$64.75	$185.00	—	—	65%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE CDM	$277.90	$794.00	—	74% above	65%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE	$277.90	$794.00	—	74% above	65%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE	$277.90	$794.00	—	—	65%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE CDM	$277.90	$794.00	—	—	65%
Blood urea nitrogen (BUN) test CPT 84520 HC BUN	$18.20	$52.00	—	45% below	65%
Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB	$18.20	$52.00	—	45% below	65%
Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY OF UREA NITROGEN	$18.20	$52.00	—	45% below	65%
Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB	$64.75	$185.00	—	95% above	65%
Blood urea nitrogen (BUN) test CPT 84520 HC BUN	$64.75	$185.00	—	95% above	65%
Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY OF UREA NITROGEN	$64.75	$185.00	—	95% above	65%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC BUN	$64.75	$185.00	—	—	65%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC ASSAY OF UREA NITROGEN	$64.75	$185.00	—	—	65%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB	$64.75	$185.00	—	—	65%
C-peptide blood test CPT 84681 HC ASSAY OF C PEPTIDE LAB	$56.70	$162.00	—	11% below	65%
C-peptide blood test CPT 84681 HC ASSAY OF C-PEPTIDE CDM	$67.90	$194.00	—	6% above	65%
C-peptide blood test CPT 84681 HC ASSAY OF C-PEPTIDE	$67.90	$194.00	—	6% above	65%
C-peptide blood test CPT 84681 HC ASSAY OF C PEPTIDE LAB	$106.40	$304.00	—	67% above	65%
C-peptide blood test CPT 84681 HC ASSAY OF C-PEPTIDE CDM	$127.75	$365.00	—	100% above	65%
C-peptide blood test CPT 84681 HC ASSAY OF C-PEPTIDE	$127.75	$365.00	—	100% above	65%
C-peptide blood test inpatient CPT 84681 HC ASSAY OF C PEPTIDE LAB	$106.40	$304.00	—	—	65%
C-peptide blood test inpatient CPT 84681 HC ASSAY OF C-PEPTIDE	$127.75	$365.00	—	—	65%
C-peptide blood test inpatient CPT 84681 HC ASSAY OF C-PEPTIDE CDM	$127.75	$365.00	—	—	65%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN LAB	$22.40	$64.00	—	58% below	65%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN	$22.40	$64.00	—	58% below	65%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN LAB	$45.50	$130.00	—	16% below	65%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN	$45.50	$130.00	—	16% below	65%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN	$45.50	$130.00	—	—	65%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN LAB	$45.50	$130.00	—	—	65%
C. difficile toxin gene test (stool PCR) CPT 87493 HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB	$112.35	$321.00	—	27% below	65%
C. difficile toxin gene test (stool PCR) CPT 87493 HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE	$112.35	$321.00	—	27% below	65%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE	$112.35	$321.00	—	—	65%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB	$112.35	$321.00	—	—	65%
CA 19-9 blood test (tumor marker) CPT 86301 HC IMMUNOASSAY TUMOR CA 19-9	$49.35	$141.00	—	1% below	65%
CA 19-9 blood test (tumor marker) CPT 86301 HC IMMUNOASSAY TUMOR CA 19-9	$146.65	$419.00	—	193% above	65%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC IMMUNOASSAY TUMOR CA 19-9	$146.65	$419.00	—	—	65%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM	$49.35	$141.00	—	64% below	65%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM	$146.65	$419.00	—	6% above	65%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM	$146.65	$419.00	—	—	65%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ CDM	$45.50	$130.00	—	52% below	65%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB	$49.00	$140.00	—	48% below	65%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB	$83.30	$238.00	—	12% below	65%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ CDM	$45.50	$130.00	—	—	65%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB	$83.30	$238.00	—	—	65%
Calcium blood test, total CPT 82310 HC CALCIUM TOTAL LAB	$18.20	$52.00	—	71% below	65%
Calcium blood test, total CPT 82310 HC CALCIUM SERUM	$18.20	$52.00	—	71% below	65%
Calcium blood test, total CPT 82310 HC CALCIUM SERUM	$64.75	$185.00	—	5% above	65%
Calcium blood test, total CPT 82310 HC CALCIUM TOTAL LAB	$64.75	$185.00	—	5% above	65%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM SERUM	$64.75	$185.00	—	—	65%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM TOTAL LAB	$64.75	$185.00	—	—	65%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CARCINOEMBRYONIC ANTIGEN	$148.40	$424.00	—	77% above	65%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CARCINOEMBRYONIC ANTIGEN CEA CDM	$148.40	$424.00	—	77% above	65%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CARCINOEMBRYONIC ANTIGEN	$148.40	$424.00	—	—	65%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CARCINOEMBRYONIC ANTIGEN CEA CDM	$148.40	$424.00	—	—	65%
Chickenpox (varicella) immunity blood test CPT 86787 HC ANTIBODY VARICELLA-ZOSTER CDM	$12.95	$37.00	—	62% below	65%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA-ZOSTER ANTIBODY - AB	$14.00	$40.00	—	59% below	65%
Chickenpox (varicella) immunity blood test CPT 86787 HC ANTIBODY VARICELLA-ZOSTER CDM	$38.50	$110.00	—	13% above	65%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA-ZOSTER ANTIBODY - AB	$42.70	$122.00	—	26% above	65%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC ANTIBODY VARICELLA-ZOSTER CDM	$38.50	$110.00	—	—	65%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA-ZOSTER ANTIBODY - AB	$42.70	$122.00	—	—	65%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB	$43.05	$123.00	—	21% below	65%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB	$43.05	$123.00	—	—	65%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$37.45	$107.00	—	63% below	65%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL LAB	$37.45	$107.00	—	63% below	65%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL LAB	$92.05	$263.00	—	9% below	65%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$92.05	$263.00	—	9% below	65%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL	$92.05	$263.00	—	—	65%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL LAB	$92.05	$263.00	—	—	65%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB	$29.05	$83.00	—	74% below	65%
Complete blood count (CBC) with differential CPT 85025 HC CBC WITH DIFF AUTO	$29.05	$83.00	—	74% below	65%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$29.05	$83.00	—	74% below	65%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB	$115.50	$330.00	—	4% above	65%
Complete blood count (CBC) with differential CPT 85025 HC CBC WITH DIFF AUTO	$115.50	$330.00	—	4% above	65%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$115.50	$330.00	—	4% above	65%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC WITH DIFF AUTO	$115.50	$330.00	—	—	65%
Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$115.50	$330.00	—	—	65%
Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB	$115.50	$330.00	—	—	65%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED	$20.65	$59.00	—	77% below	65%
Complete blood count (CBC), no differential CPT 85027 HC COMPLETE CBC AUTOMATED	$20.65	$59.00	—	77% below	65%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB	$20.65	$59.00	—	77% below	65%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED	$91.00	$260.00	—	3% above	65%
Complete blood count (CBC), no differential CPT 85027 HC COMPLETE CBC AUTOMATED	$91.00	$260.00	—	3% above	65%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB	$91.00	$260.00	—	3% above	65%
Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED	$91.00	$260.00	—	—	65%
Complete blood count (CBC), no differential inpatient CPT 85027 HC COMPLETE CBC AUTOMATED	$91.00	$260.00	—	—	65%
Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB	$91.00	$260.00	—	—	65%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHEN METABOLIC PANEL	$37.45	$107.00	—	85% below	65%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHEN METABOLIC PANEL	$415.45	$1,187.00	—	63% above	65%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHEN METABOLIC PANEL	$415.45	$1,187.00	—	—	65%
Cortisol blood test, total CPT 82533 HC CORTISOL	$148.40	$424.00	—	55% above	65%
Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL	$148.40	$424.00	—	55% above	65%
Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL LAB	$148.40	$424.00	—	55% above	65%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL	$148.40	$424.00	—	—	65%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL TOTAL	$148.40	$424.00	—	—	65%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL TOTAL LAB	$148.40	$424.00	—	—	65%
Creatine kinase (CK) blood test, total CPT 82550 HC ASSAY OF CK (CPK)	$31.15	$89.00	—	64% below	65%
Creatine kinase (CK) blood test, total CPT 82550 HC CREATINE KINASE TOTAL LAB	$31.15	$89.00	—	64% below	65%
Creatine kinase (CK) blood test, total CPT 82550 HC CK TOTAL	$31.15	$89.00	—	64% below	65%
Creatine kinase (CK) blood test, total CPT 82550 HC CK TOTAL	$166.60	$476.00	—	91% above	65%
Creatine kinase (CK) blood test, total CPT 82550 HC ASSAY OF CK (CPK)	$166.60	$476.00	—	91% above	65%
Creatine kinase (CK) blood test, total CPT 82550 HC CREATINE KINASE TOTAL LAB	$166.60	$476.00	—	91% above	65%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CREATINE KINASE TOTAL LAB	$166.60	$476.00	—	—	65%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC ASSAY OF CK (CPK)	$166.60	$476.00	—	—	65%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CK TOTAL	$166.60	$476.00	—	—	65%
Creatinine blood test CPT 82565 HC ASSAY CREATININE	$18.20	$52.00	—	61% below	65%
Creatinine blood test CPT 82565 HC ASSAY OF CREATININE	$18.20	$52.00	—	61% below	65%
Creatinine blood test CPT 82565 HC ASSAY OF CREATININE	$64.75	$185.00	—	40% above	65%
Creatinine blood test CPT 82565 HC ASSAY CREATININE	$64.75	$185.00	—	40% above	65%
Creatinine blood test inpatient CPT 82565 HC ASSAY CREATININE	$64.75	$185.00	—	—	65%
Creatinine blood test inpatient CPT 82565 HC ASSAY OF CREATININE	$64.75	$185.00	—	—	65%
Cytomegalovirus (CMV) antibody test CPT 86644 HC CMV ANTIBODY	$14.28	$40.80	—	48% below	65%
Cytomegalovirus (CMV) antibody test CPT 86644 HC ARC CMV SCREEN	$14.28	$40.80	—	48% below	65%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC ARC CMV SCREEN	$14.28	$40.80	—	—	65%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC CMV ANTIBODY	$14.28	$40.80	—	—	65%
D-dimer blood test (blood clot marker) CPT 85379 HC DDIMER QUANT	$164.15	$469.00	—	14% above	65%
D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN DEGRADATION QUANT	$164.15	$469.00	—	14% above	65%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC DDIMER QUANT	$164.15	$469.00	—	—	65%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC FIBRIN DEGRADATION QUANT	$164.15	$469.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE	$261.80	$748.00	—	322% above	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS	$314.30	$898.00	—	407% above	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUGS OF ABUSE URINE	$314.30	$898.00	—	407% above	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE	$261.80	$748.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUGS OF ABUSE URINE	$314.30	$898.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS	$314.30	$898.00	—	—	65%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL	$20.30	$58.00	—	76% below	65%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL	$119.70	$342.00	—	42% above	65%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTE PANEL	$119.70	$342.00	—	—	65%
Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL	$68.95	$197.00	—	22% below	65%
Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL	$182.35	$521.00	—	107% above	65%
Estradiol blood test inpatient CPT 82670 HC ASSAY OF ESTRADIOL	$182.35	$521.00	—	—	65%
FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE LAB	$57.05	$163.00	—	44% below	65%
FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM	$57.05	$163.00	—	44% below	65%
FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM	$182.35	$521.00	—	79% above	65%
FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE LAB	$182.35	$521.00	—	79% above	65%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM	$182.35	$521.00	—	—	65%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE LAB	$182.35	$521.00	—	—	65%
Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN CDM	$173.60	$496.00	—	63% above	65%
Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN	$173.60	$496.00	—	63% above	65%
Ferritin blood test (iron stores) inpatient CPT 82728 HC ASSAY OF FERRITIN CDM	$173.60	$496.00	—	—	65%
Ferritin blood test (iron stores) inpatient CPT 82728 HC ASSAY OF FERRITIN	$173.60	$496.00	—	—	65%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN	$98.70	$282.00	—	26% below	65%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN	$98.70	$282.00	—	—	65%
Folate (folic acid) blood test CPT 82746 HC BLOOD FOLIC ACID SERUM	$173.60	$496.00	—	59% above	65%
Folate (folic acid) blood test CPT 82746 HC ASSAY OF FOLIC ACID SERUM CDM	$173.60	$496.00	—	59% above	65%
Folate (folic acid) blood test inpatient CPT 82746 HC ASSAY OF FOLIC ACID SERUM CDM	$173.60	$496.00	—	—	65%
Folate (folic acid) blood test inpatient CPT 82746 HC BLOOD FOLIC ACID SERUM	$173.60	$496.00	—	—	65%
Free T3 thyroid hormone test CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB	$206.15	$589.00	—	154% above	65%
Free T3 thyroid hormone test CPT 84481 HC FREE ASSAY (FT-3)	$206.15	$589.00	—	154% above	65%
Free T3 thyroid hormone test CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE CDM	$206.15	$589.00	—	154% above	65%
Free T3 thyroid hormone test inpatient CPT 84481 HC FREE ASSAY (FT-3)	$206.15	$589.00	—	—	65%
Free T3 thyroid hormone test inpatient CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB	$206.15	$589.00	—	—	65%
Free T3 thyroid hormone test inpatient CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE CDM	$206.15	$589.00	—	—	65%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE CDM	$116.90	$334.00	—	72% above	65%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC THYROXINE FREE	$116.90	$334.00	—	72% above	65%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE LAB	$116.90	$334.00	—	72% above	65%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC ASSAY OF FREE THYROXINE LAB	$116.90	$334.00	—	—	65%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC ASSAY OF FREE THYROXINE CDM	$116.90	$334.00	—	—	65%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC THYROXINE FREE	$116.90	$334.00	—	—	65%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC ASSAY OF GGT	$18.20	$52.00	—	60% below	65%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GAMMA GT TOTAL	$18.20	$52.00	—	60% below	65%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GAMMA GT TOTAL	$64.75	$185.00	—	42% above	65%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC ASSAY OF GGT	$64.75	$185.00	—	42% above	65%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC ASSAY OF GGT	$64.75	$185.00	—	—	65%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GAMMA GT TOTAL	$64.75	$185.00	—	—	65%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE TEST 1HR PP LAB	$50.75	$145.00	—	2% below	65%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GESTATIONAL GLUCOSE 1 HOUR	$50.75	$145.00	—	2% below	65%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE POST GLUCOSE DOSE LAB	$148.40	$424.00	—	185% above	65%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE 2HR POST GLUCOSE DOSE	$148.40	$424.00	—	185% above	65%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE POST GLUCOSE DOSE	$148.40	$424.00	—	185% above	65%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE TEST 1HR PP LAB	$50.75	$145.00	—	—	65%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GESTATIONAL GLUCOSE 1 HOUR	$50.75	$145.00	—	—	65%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE 2HR POST GLUCOSE DOSE	$148.40	$424.00	—	—	65%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE POST GLUCOSE DOSE LAB	$148.40	$424.00	—	—	65%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE POST GLUCOSE DOSE	$148.40	$424.00	—	—	65%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE(3 SPEC)	$46.90	$134.00	—	66% below	65%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE(3 SPECIMENS)	$46.90	$134.00	—	66% below	65%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE(3 SPECIMENS)	$257.95	$737.00	—	88% above	65%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE(3 SPEC)	$257.95	$737.00	—	88% above	65%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE(3 SPEC)	$257.95	$737.00	—	—	65%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE(3 SPECIMENS)	$257.95	$737.00	—	—	65%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB	$43.05	$123.00	—	28% below	65%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB	$43.05	$123.00	—	—	65%
H. pylori stool antigen test CPT 87338 HC IAAD IA HPYLORI STOOL CDM	$74.20	$212.00	—	7% below	65%
H. pylori stool antigen test CPT 87338 HC IAAD IA HPYLORI STOOL CDM	$230.30	$658.00	—	189% above	65%
H. pylori stool antigen test inpatient CPT 87338 HC IAAD IA HPYLORI STOOL CDM	$230.30	$658.00	—	—	65%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY	$29.40	$84.00	—	50% below	65%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE	$35.00	$100.00	—	40% below	65%
HIV-1 and HIV-2 antibody test CPT 86703 HC RAPID HIV 1-2	$60.20	$172.00	—	2% above	65%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY	$96.25	$275.00	—	64% above	65%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE	$35.00	$100.00	—	—	65%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC RAPID HIV 1-2	$60.20	$172.00	—	—	65%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY	$96.25	$275.00	—	—	65%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB	$26.60	$76.00	—	70% below	65%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB	$86.80	$248.00	—	1% below	65%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB	$86.80	$248.00	—	—	65%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES	$21.35	$61.00	—	84% below	65%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB	$21.35	$61.00	—	84% below	65%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES	$34.30	$98.00	—	75% below	65%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB	$34.30	$98.00	—	75% below	65%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB	$34.30	$98.00	—	—	65%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES	$34.30	$98.00	—	—	65%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C CDM	$39.90	$114.00	—	39% below	65%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST	$39.90	$114.00	—	39% below	65%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C CDM	$196.70	$562.00	—	201% above	65%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST	$196.70	$562.00	—	201% above	65%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C CDM	$196.70	$562.00	—	—	65%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST	$196.70	$562.00	—	—	65%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN	$10.50	$30.00	—	74% below	65%
Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN	$10.50	$30.00	—	74% below	65%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN (HGB)	$10.50	$30.00	—	74% below	65%
Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN LAB	$10.50	$30.00	—	74% below	65%
Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN CDM	$15.05	$43.00	—	63% below	65%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN	$46.20	$132.00	—	15% above	65%
Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN LAB	$46.20	$132.00	—	15% above	65%
Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN	$46.20	$132.00	—	15% above	65%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN (HGB)	$46.20	$132.00	—	15% above	65%
Hemoglobin blood test inpatient CPT 85018 HC BLOOD COUNT HEMOGLOBIN CDM	$15.05	$43.00	—	—	65%
Hemoglobin blood test inpatient CPT 85018 HC BLOOD COUNT HEMOGLOBIN LAB	$46.20	$132.00	—	—	65%
Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN (HGB)	$46.20	$132.00	—	—	65%
Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN	$46.20	$132.00	—	—	65%
Hemoglobin blood test inpatient CPT 85018 HC BLOOD COUNT HEMOGLOBIN	$46.20	$132.00	—	—	65%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB CDM	$26.60	$76.00	—	38% below	65%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB LAB	$26.60	$76.00	—	38% below	65%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB LAB	$136.85	$391.00	—	220% above	65%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB CDM	$136.85	$391.00	—	220% above	65%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB CDM	$136.85	$391.00	—	—	65%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB LAB	$136.85	$391.00	—	—	65%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM	$24.15	$69.00	—	66% below	65%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB	$24.15	$69.00	—	66% below	65%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM	$123.20	$352.00	—	72% above	65%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB	$123.20	$352.00	—	72% above	65%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB	$123.20	$352.00	—	—	65%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM	$123.20	$352.00	—	—	65%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY	$32.90	$94.00	—	40% below	65%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY LAB	$32.90	$94.00	—	40% below	65%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY CDM	$32.90	$94.00	—	40% below	65%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY LAB	$171.15	$489.00	—	213% above	65%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY	$171.15	$489.00	—	213% above	65%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY CDM	$171.15	$489.00	—	213% above	65%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY LAB	$171.15	$489.00	—	—	65%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY CDM	$171.15	$489.00	—	—	65%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY	$171.15	$489.00	—	—	65%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX TEST - TYPE 1 IGG	$30.10	$86.00	—	55% above	65%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES SIMPLEX TEST - TYPE 1 IGG	$30.10	$86.00	—	—	65%
Herpes blood test, HSV-2 antibody CPT 86696 HC ANTIBODY HERPES SMPLX TYPE 2 CDM	$30.10	$86.00	—	28% above	65%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC ANTIBODY HERPES SMPLX TYPE 2 CDM	$30.10	$86.00	—	—	65%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM	$18.55	$53.00	—	70% below	65%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM	$47.95	$137.00	—	21% below	65%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM	$47.95	$137.00	—	—	65%
Homocysteine blood test CPT 83090 HC ASSAY OF HOMOCYSTEINE LAB	$73.85	$211.00	—	3% below	65%
Homocysteine blood test CPT 83090 HC ASSAY OF HOMOCYSTEINE LAB	$157.85	$451.00	—	107% above	65%
Homocysteine blood test inpatient CPT 83090 HC ASSAY OF HOMOCYSTEINE LAB	$157.85	$451.00	—	—	65%
Insulin blood test CPT 83525 HC ASSAY OF INSULIN TOTAL CDM	$45.50	$130.00	—	18% above	65%
Insulin blood test CPT 83525 HC ASSAY OF INSULIN TOTAL CDM	$85.75	$245.00	—	123% above	65%
Insulin blood test inpatient CPT 83525 HC ASSAY OF INSULIN TOTAL CDM	$85.75	$245.00	—	—	65%
Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON CDM	$148.40	$424.00	—	155% above	65%
Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON	$148.40	$424.00	—	155% above	65%
Iron blood test (serum iron) CPT 83540 HC IRON	$148.40	$424.00	—	155% above	65%
Iron blood test (serum iron) inpatient CPT 83540 HC ASSAY OF IRON	$148.40	$424.00	—	—	65%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON	$148.40	$424.00	—	—	65%
Iron blood test (serum iron) inpatient CPT 83540 HC ASSAY OF IRON CDM	$148.40	$424.00	—	—	65%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY CDM	$158.20	$452.00	—	117% above	65%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY LAB	$158.20	$452.00	—	117% above	65%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY LAB	$158.20	$452.00	—	—	65%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY CDM	$158.20	$452.00	—	—	65%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL CDM	$17.50	$50.00	—	88% below	65%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL CDM	$298.20	$852.00	—	110% above	65%
Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL CDM	$298.20	$852.00	—	—	65%
LH (luteinizing hormone) test CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE CDM	$57.05	$163.00	—	45% below	65%
LH (luteinizing hormone) test CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE LAB	$57.05	$163.00	—	45% below	65%
LH (luteinizing hormone) test CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE CDM	$182.35	$521.00	—	75% above	65%
LH (luteinizing hormone) test CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE LAB	$182.35	$521.00	—	75% above	65%
LH (luteinizing hormone) test inpatient CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE LAB	$182.35	$521.00	—	—	65%
LH (luteinizing hormone) test inpatient CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE CDM	$182.35	$521.00	—	—	65%
Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTATE LAB	$248.50	$710.00	—	86% above	65%
Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTIC ACID	$298.20	$852.00	—	123% above	65%
Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTATE	$298.20	$852.00	—	123% above	65%
Lactate (lactic acid) blood test inpatient CPT 83605 HC ASSAY OF LACTATE LAB	$248.50	$710.00	—	—	65%
Lactate (lactic acid) blood test inpatient CPT 83605 HC ASSAY OF LACTATE	$298.20	$852.00	—	—	65%
Lactate (lactic acid) blood test inpatient CPT 83605 HC ASSAY OF LACTIC ACID	$298.20	$852.00	—	—	65%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH BODY FLUID	$22.40	$64.00	—	38% below	65%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE (LD) (LDH) ENZYME	$31.15	$89.00	—	14% below	65%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH-CSF	$120.40	$344.00	—	233% above	65%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH BODY FLUID	$134.40	$384.00	—	272% above	65%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE (LD) (LDH) ENZYME	$135.10	$386.00	—	274% above	65%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH SERUM	$142.80	$408.00	—	295% above	65%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH FLUID	$166.25	$475.00	—	360% above	65%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH-CSF	$120.40	$344.00	—	—	65%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH BODY FLUID	$134.40	$384.00	—	—	65%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE (LD) (LDH) ENZYME	$135.10	$386.00	—	—	65%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH SERUM	$142.80	$408.00	—	—	65%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH FLUID	$166.25	$475.00	—	—	65%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE CDM	$47.60	$136.00	—	51% below	65%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE	$47.60	$136.00	—	51% below	65%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE LAB	$47.60	$136.00	—	51% below	65%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE LAB	$148.40	$424.00	—	54% above	65%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE CDM	$148.40	$424.00	—	54% above	65%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE	$148.40	$424.00	—	54% above	65%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE LAB	$148.40	$424.00	—	—	65%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE CDM	$148.40	$424.00	—	—	65%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE	$148.40	$424.00	—	—	65%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL CDM	$26.25	$75.00	—	83% below	65%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL CDM	$207.55	$593.00	—	37% above	65%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL CDM	$207.55	$593.00	—	—	65%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM CDM	$34.30	$98.00	—	46% below	65%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM	$34.30	$98.00	—	46% below	65%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM CDM	$148.40	$424.00	—	134% above	65%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM	$148.40	$424.00	—	134% above	65%
Magnesium blood test CPT 83735 HC MAGNESIUM-URINE	$166.25	$475.00	—	162% above	65%
Magnesium blood test CPT 83735 HC MAGNESIUM QUANT URINE	$237.65	$679.00	—	275% above	65%
Magnesium blood test CPT 83735 HC MAGNESIUM 24HR URINE	$237.65	$679.00	—	275% above	65%
Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM	$148.40	$424.00	—	—	65%
Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM CDM	$148.40	$424.00	—	—	65%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM-URINE	$166.25	$475.00	—	—	65%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM QUANT URINE	$237.65	$679.00	—	—	65%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM 24HR URINE	$237.65	$679.00	—	—	65%
Measles (rubeola) antibody test CPT 86765 HC ANTIBODY RUBEOLA CDM	$14.00	$40.00	—	55% below	65%
Measles (rubeola) antibody test CPT 86765 HC ANTIBODY RUBEOLA CDM	$42.70	$122.00	—	36% above	65%
Measles (rubeola) antibody test inpatient CPT 86765 HC ANTIBODY RUBEOLA CDM	$42.70	$122.00	—	—	65%
Mumps immunity blood test CPT 86735 HC ANTIBODY MUMPS CDM	$12.95	$37.00	—	19% below	65%
Mumps immunity blood test CPT 86735 HC ANTIBODY MUMPS LAB	$12.95	$37.00	—	19% below	65%
Mumps immunity blood test CPT 86735 HC ANTIBODY MUMPS	$12.95	$37.00	—	19% below	65%
Mumps immunity blood test CPT 86735 HC MUMPS ANTIBODY IGG	$14.00	$40.00	—	13% below	65%
Mumps immunity blood test CPT 86735 HC ANTIBODY MUMPS LAB	$38.50	$110.00	—	140% above	65%
Mumps immunity blood test CPT 86735 HC ANTIBODY MUMPS	$38.50	$110.00	—	140% above	65%
Mumps immunity blood test CPT 86735 HC ANTIBODY MUMPS CDM	$38.50	$110.00	—	140% above	65%
Mumps immunity blood test CPT 86735 HC MUMPS ANTIBODY IGG	$42.70	$122.00	—	167% above	65%
Mumps immunity blood test inpatient CPT 86735 HC ANTIBODY MUMPS LAB	$38.50	$110.00	—	—	65%
Mumps immunity blood test inpatient CPT 86735 HC ANTIBODY MUMPS	$38.50	$110.00	—	—	65%
Mumps immunity blood test inpatient CPT 86735 HC ANTIBODY MUMPS CDM	$38.50	$110.00	—	—	65%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS ANTIBODY IGG	$42.70	$122.00	—	—	65%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$45.50	$130.00	—	24% below	65%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$88.20	$252.00	—	46% above	65%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$88.20	$252.00	—	—	65%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB	$109.55	$313.00	—	83% above	65%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGEN TOTAL	$131.60	$376.00	—	120% above	65%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM	$131.60	$376.00	—	120% above	65%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB	$109.55	$313.00	—	—	65%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM	$131.60	$376.00	—	—	65%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATE SPECIFIC ANTIGEN TOTAL	$131.60	$376.00	—	—	65%
Parathyroid hormone (PTH) blood test CPT 83970 HC ASSAY OF PARATHORMONE LAB	$175.70	$502.00	—	60% above	65%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE)	$175.70	$502.00	—	60% above	65%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE)	$175.70	$502.00	—	—	65%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC ASSAY OF PARATHORMONE LAB	$175.70	$502.00	—	—	65%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL	$43.40	$124.00	—	31% below	65%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB	$43.40	$124.00	—	31% below	65%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB	$144.90	$414.00	—	132% above	65%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL	$144.90	$414.00	—	132% above	65%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL	$144.90	$414.00	—	—	65%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB	$144.90	$414.00	—	—	65%
Phosphorus (phosphate) blood test CPT 84100 HC ASSAY PHOSPHORUS	$18.20	$52.00	—	76% below	65%
Phosphorus (phosphate) blood test CPT 84100 HC ASSAY PHOSPHORUS	$64.75	$185.00	—	14% below	65%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC ASSAY PHOSPHORUS	$64.75	$185.00	—	—	65%
Potassium blood test CPT 84132 HC POTASSIUM SERUM PLASMA/WHOLE BLOOD	$11.90	$34.00	—	84% below	65%
Potassium blood test CPT 84132 HC POTASSIUM	$18.20	$52.00	—	75% below	65%
Potassium blood test CPT 84132 HC POTASSIUM	$64.75	$185.00	—	11% below	65%
Potassium blood test inpatient CPT 84132 HC POTASSIUM SERUM PLASMA/WHOLE BLOOD	$11.90	$34.00	—	—	65%
Potassium blood test inpatient CPT 84132 HC POTASSIUM	$64.75	$185.00	—	—	65%
Progesterone blood test CPT 84144 HC ASSAY OF PROGESTERONE CDM	$57.40	$164.00	—	30% below	65%
Progesterone blood test CPT 84144 HC ASSAY OF PROGESTERONE CDM	$176.40	$504.00	—	114% above	65%
Progesterone blood test inpatient CPT 84144 HC ASSAY OF PROGESTERONE CDM	$176.40	$504.00	—	—	65%
Prolactin blood test CPT 84146 HC ASSAY OF PROLACTIN CDM	$57.05	$163.00	—	47% below	65%
Prolactin blood test CPT 84146 HC ASSAY OF PROLACTIN CDM	$182.35	$521.00	—	70% above	65%
Prolactin blood test inpatient CPT 84146 HC ASSAY OF PROLACTIN CDM	$182.35	$521.00	—	—	65%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME LAB	$21.00	$60.00	—	62% below	65%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME	$22.75	$65.00	—	59% below	65%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME 85610	$22.75	$65.00	—	59% below	65%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME LAB	$91.70	$262.00	—	67% above	65%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME 85610	$98.70	$282.00	—	80% above	65%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME	$98.70	$282.00	—	80% above	65%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME LAB	$91.70	$262.00	—	—	65%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME	$98.70	$282.00	—	—	65%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME 85610	$98.70	$282.00	—	—	65%
Rapid flu test (influenza antigen) CPT 87804 HC IAADIADOO INFLUENZA CDM	$22.05	$63.00	—	71% below	65%
Rapid flu test (influenza antigen) CPT 87804 HC IAADIADOO INFLUENZA CDM	$60.20	$172.00	—	20% below	65%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC IAADIADOO INFLUENZA CDM	$60.20	$172.00	—	—	65%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP GROUP A AG	$11.55	$33.00	—	89% below	65%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB	$11.55	$33.00	—	89% below	65%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP GROUP A AG	$69.65	$199.00	—	35% below	65%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB	$69.65	$199.00	—	35% below	65%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB	$69.65	$199.00	—	—	65%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREP GROUP A AG	$69.65	$199.00	—	—	65%
Rh blood typing CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) LAB	$6.13	$17.50	—	89% below	65%
Rh blood typing inpatient CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) LAB	$6.13	$17.50	—	—	65%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANTITATIVE LAB	$15.40	$44.00	—	17% above	65%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANT	$15.40	$44.00	—	17% above	65%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANT	$42.35	$121.00	—	221% above	65%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANTITATIVE LAB	$42.35	$121.00	—	221% above	65%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR QUANT	$42.35	$121.00	—	—	65%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR QUANTITATIVE LAB	$42.35	$121.00	—	—	65%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY	$12.95	$37.00	—	74% below	65%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY	$38.50	$110.00	—	24% below	65%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA ANTIBODY	$38.50	$110.00	—	—	65%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC RBC SED RATE AUTOMATED	$16.45	$47.00	—	71% below	65%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC RBC SED RATE AUTOMATED	$115.50	$330.00	—	106% above	65%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC RBC SED RATE AUTOMATED	$115.50	$330.00	—	—	65%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS	$57.05	$163.00	—	59% below	65%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS	$201.60	$576.00	—	45% above	65%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC SEMEN ANALYSIS	$201.60	$576.00	—	—	65%
Sodium blood test CPT 84295 HC SODIUM SERUM PLASMA OR WHOLE BLOOD CDM	$12.25	$35.00	—	81% below	65%
Sodium blood test CPT 84295 HC SODIUM BLOOD	$18.20	$52.00	—	72% below	65%
Sodium blood test CPT 84295 HC SODIUM	$18.20	$52.00	—	72% below	65%
Sodium blood test CPT 84295 HC SODIUM BLOOD	$64.75	$185.00	—	1% below	65%
Sodium blood test CPT 84295 HC SODIUM	$64.75	$185.00	—	1% below	65%
Sodium blood test inpatient CPT 84295 HC SODIUM SERUM PLASMA OR WHOLE BLOOD CDM	$12.25	$35.00	—	—	65%
Sodium blood test inpatient CPT 84295 HC SODIUM BLOOD	$64.75	$185.00	—	—	65%
Sodium blood test inpatient CPT 84295 HC SODIUM	$64.75	$185.00	—	—	65%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES SMEARS	$18.20	$52.00	—	13% below	65%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES SMEARS	$103.60	$296.00	—	396% above	65%
Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITES SMEARS	$103.60	$296.00	—	—	65%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM	$25.55	$73.00	—	34% below	65%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM	$145.25	$415.00	—	272% above	65%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM	$145.25	$415.00	—	—	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - CSF	$21.00	$60.00	—	56% above	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB	$21.00	$60.00	—	56% above	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL	$21.00	$60.00	—	56% above	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL CDM	$21.00	$60.00	—	56% above	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - CSF	$78.05	$223.00	—	482% above	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB	$78.05	$223.00	—	482% above	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL	$78.05	$223.00	—	482% above	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL CDM	$78.05	$223.00	—	482% above	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB	$78.05	$223.00	—	—	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL CDM	$78.05	$223.00	—	—	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - CSF	$78.05	$223.00	—	—	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREP QUAL	$78.05	$223.00	—	—	65%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM	$61.95	$177.00	—	27% below	65%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB	$61.95	$177.00	—	27% below	65%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC QUANTIFERON TB GOLD	$61.95	$177.00	—	27% below	65%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$61.95	$177.00	—	27% below	65%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC QUANTIFERON TB GOLD	$109.90	$314.00	—	30% above	65%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM	$109.90	$314.00	—	30% above	65%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB	$109.90	$314.00	—	30% above	65%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$109.90	$314.00	—	30% above	65%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM	$109.90	$314.00	—	—	65%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB	$109.90	$314.00	—	—	65%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC QUANTIFERON TB GOLD	$109.90	$314.00	—	—	65%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$109.90	$314.00	—	—	65%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$63.00	$180.00	—	57% above	65%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE	$63.00	$180.00	—	57% above	65%
Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL LAB	$63.00	$180.00	—	57% above	65%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$166.25	$475.00	—	315% above	65%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE	$166.25	$475.00	—	315% above	65%
Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL LAB	$166.25	$475.00	—	315% above	65%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE	$166.25	$475.00	—	—	65%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL	$166.25	$475.00	—	—	65%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL LAB	$166.25	$475.00	—	—	65%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EACH CDM	$33.25	$95.00	—	45% above	65%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EACH LAB	$33.25	$95.00	—	45% above	65%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EACH LAB	$101.85	$291.00	—	345% above	65%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EACH CDM	$101.85	$291.00	—	345% above	65%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES EACH CDM	$101.85	$291.00	—	—	65%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES EACH LAB	$101.85	$291.00	—	—	65%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH REFLEX TO FT4	$59.50	$170.00	—	36% below	65%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE (TSH)	$59.50	$170.00	—	36% below	65%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB	$59.50	$170.00	—	36% below	65%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH	$59.50	$170.00	—	36% below	65%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE TSH	$59.50	$170.00	—	36% below	65%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH REFLEX TO FT4	$242.20	$692.00	—	162% above	65%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH	$242.20	$692.00	—	162% above	65%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE TSH	$242.20	$692.00	—	162% above	65%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE (TSH)	$242.20	$692.00	—	162% above	65%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB	$242.20	$692.00	—	162% above	65%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB	$242.20	$692.00	—	—	65%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE (TSH)	$242.20	$692.00	—	—	65%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH REFLEX TO FT4	$242.20	$692.00	—	—	65%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH	$242.20	$692.00	—	—	65%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE TSH	$242.20	$692.00	—	—	65%
Total IgE blood test CPT 82785 HC ASSAY OF IGE	$57.40	$164.00	—	9% below	65%
Total IgE blood test CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE LAB	$57.40	$164.00	—	9% below	65%
Total IgE blood test CPT 82785 HC IGE SERUM TOTAL	$57.40	$164.00	—	9% below	65%
Total IgE blood test CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE	$57.40	$164.00	—	9% below	65%
Total IgE blood test CPT 82785 HC ASSAY OF IGE	$176.40	$504.00	—	181% above	65%
Total IgE blood test CPT 82785 HC IGE SERUM TOTAL	$176.40	$504.00	—	181% above	65%
Total IgE blood test CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE LAB	$176.40	$504.00	—	181% above	65%
Total IgE blood test CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE	$176.40	$504.00	—	181% above	65%
Total IgE blood test inpatient CPT 82785 HC IGE SERUM TOTAL	$176.40	$504.00	—	—	65%
Total IgE blood test inpatient CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE	$176.40	$504.00	—	—	65%
Total IgE blood test inpatient CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE LAB	$176.40	$504.00	—	—	65%
Total IgE blood test inpatient CPT 82785 HC ASSAY OF IGE	$176.40	$504.00	—	—	65%
Total cholesterol blood test CPT 82465 HC ASSAY BLD/SERUM CHOLESTEROL	$18.20	$52.00	—	57% below	65%
Total cholesterol blood test CPT 82465 HC CHOLESTEROL	$18.20	$52.00	—	57% below	65%
Total cholesterol blood test CPT 82465 HC CHOLESTEROL	$64.75	$185.00	—	54% above	65%
Total cholesterol blood test CPT 82465 HC ASSAY BLD/SERUM CHOLESTEROL	$64.75	$185.00	—	54% above	65%
Total cholesterol blood test inpatient CPT 82465 HC ASSAY BLD/SERUM CHOLESTEROL	$64.75	$185.00	—	—	65%
Total cholesterol blood test inpatient CPT 82465 HC CHOLESTEROL	$64.75	$185.00	—	—	65%
Total thyroxine (T4) blood test CPT 84436 HC ASSAY OF THYROXINE TOTAL LAB	$42.70	$122.00	—	9% above	65%
Total thyroxine (T4) blood test CPT 84436 HC THYROXINE T4	$42.70	$122.00	—	9% above	65%
Total thyroxine (T4) blood test CPT 84436 HC THYROXINE TOTAL	$42.70	$122.00	—	9% above	65%
Total thyroxine (T4) blood test CPT 84436 HC THYROXINE T4	$211.75	$605.00	—	440% above	65%
Total thyroxine (T4) blood test CPT 84436 HC THYROXINE TOTAL	$211.75	$605.00	—	440% above	65%
Total thyroxine (T4) blood test CPT 84436 HC ASSAY OF THYROXINE TOTAL LAB	$211.75	$605.00	—	440% above	65%
Total thyroxine (T4) blood test inpatient CPT 84436 HC THYROXINE TOTAL	$211.75	$605.00	—	—	65%
Total thyroxine (T4) blood test inpatient CPT 84436 HC THYROXINE T4	$211.75	$605.00	—	—	65%
Total thyroxine (T4) blood test inpatient CPT 84436 HC ASSAY OF THYROXINE TOTAL LAB	$211.75	$605.00	—	—	65%
Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 CDM	$42.70	$122.00	—	45% below	65%
Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB	$42.70	$122.00	—	45% below	65%
Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3	$42.70	$122.00	—	45% below	65%
Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY TRIIODOTHYRONINE (T3)	$42.70	$122.00	—	45% below	65%
Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3	$211.75	$605.00	—	171% above	65%
Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 CDM	$211.75	$605.00	—	171% above	65%
Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB	$211.75	$605.00	—	171% above	65%
Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY TRIIODOTHYRONINE (T3)	$211.75	$605.00	—	171% above	65%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC ASSAY TRIIODOTHYRONINE (T3)	$211.75	$605.00	—	—	65%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 CDM	$211.75	$605.00	—	—	65%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3	$211.75	$605.00	—	—	65%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB	$211.75	$605.00	—	—	65%
Triglycerides blood test CPT 84478 HC TRIGLCERIDES - HFPA	$12.25	$35.00	—	70% below	65%
Triglycerides blood test CPT 84478 HC TRIGLYCERIDES	$18.20	$52.00	—	56% below	65%
Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES	$18.20	$52.00	—	56% below	65%
Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES LAB	$18.20	$52.00	—	56% below	65%
Triglycerides blood test CPT 84478 HC TRIGLCERIDES - HFPA	$63.00	$180.00	—	53% above	65%
Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES	$68.60	$196.00	—	67% above	65%
Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES LAB	$68.60	$196.00	—	67% above	65%
Triglycerides blood test CPT 84478 HC TRIGLYCERIDES	$68.60	$196.00	—	67% above	65%
Triglycerides blood test inpatient CPT 84478 HC TRIGLCERIDES - HFPA	$63.00	$180.00	—	—	65%
Triglycerides blood test inpatient CPT 84478 HC ASSAY OF TRIGLYCERIDES LAB	$68.60	$196.00	—	—	65%
Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDES	$68.60	$196.00	—	—	65%
Triglycerides blood test inpatient CPT 84478 HC ASSAY OF TRIGLYCERIDES	$68.60	$196.00	—	—	65%
Troponin test, quantitative CPT 84484 HC ASSAY OF TROPONIN QUANTITATIVE	$168.70	$482.00	—	6% below	65%
Troponin test, quantitative CPT 84484 HC TROPONIN QUANTITATIVE	$168.70	$482.00	—	6% below	65%
Troponin test, quantitative CPT 84484 HC ASSAY OF TROPONIN QUANTITATIVE LAB	$168.70	$482.00	—	6% below	65%
Troponin test, quantitative CPT 84484 HC TROPONIN-T	$168.70	$482.00	—	6% below	65%
Troponin test, quantitative inpatient CPT 84484 HC ASSAY OF TROPONIN QUANTITATIVE LAB	$168.70	$482.00	—	—	65%
Troponin test, quantitative inpatient CPT 84484 HC ASSAY OF TROPONIN QUANTITATIVE	$168.70	$482.00	—	—	65%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN-T	$168.70	$482.00	—	—	65%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN QUANTITATIVE	$168.70	$482.00	—	—	65%
Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID LAB	$18.20	$52.00	—	72% below	65%
Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID CDM	$18.20	$52.00	—	72% below	65%
Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID CDM	$64.75	$185.00	—	2% below	65%
Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID LAB	$64.75	$185.00	—	2% below	65%
Uric acid blood test inpatient CPT 84550 HC ASSAY OF BLOOD/URIC ACID CDM	$64.75	$185.00	—	—	65%
Uric acid blood test inpatient CPT 84550 HC ASSAY OF BLOOD/URIC ACID LAB	$64.75	$185.00	—	—	65%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB	$35.00	$100.00	—	58% below	65%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM	$42.00	$120.00	—	49% below	65%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB	$150.85	$431.00	—	82% above	65%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM	$180.95	$517.00	—	118% above	65%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB	$150.85	$431.00	—	—	65%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM	$180.95	$517.00	—	—	65%
Urinalysis without microscope exam, automated CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB	$22.75	$65.00	—	59% below	65%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE	$27.30	$78.00	—	51% below	65%
Urinalysis without microscope exam, automated CPT 81003 HC PH URINE DIPSTICK AUTO W/O MICROSCOPY LAB	$43.75	$125.00	—	22% below	65%
Urinalysis without microscope exam, automated CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB	$107.10	$306.00	—	91% above	65%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE	$128.45	$367.00	—	129% above	65%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC PH URINE DIPSTICK AUTO W/O MICROSCOPY LAB	$43.75	$125.00	—	—	65%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB	$107.10	$306.00	—	—	65%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO W/O SCOPE	$128.45	$367.00	—	—	65%
Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP LAB	$4.90	$14.00	—	86% below	65%
Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM	$33.60	$96.00	—	2% below	65%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP LAB	$4.90	$14.00	—	—	65%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM	$33.60	$96.00	—	—	65%
Urine culture for bacteria, with colony count CPT 87086 HC URINE CULTURE/COLONY COUNT	$18.20	$52.00	—	87% below	65%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB	$18.20	$52.00	—	87% below	65%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB	$103.95	$297.00	—	25% below	65%
Urine culture for bacteria, with colony count CPT 87086 HC URINE CULTURE/COLONY COUNT	$103.95	$297.00	—	25% below	65%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB	$103.95	$297.00	—	—	65%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC URINE CULTURE/COLONY COUNT	$103.95	$297.00	—	—	65%
Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN QUANTITATIVE	$31.15	$89.00	—	15% below	65%
Urine microalbumin (albumin) test CPT 82043 HC URINE ALBUMIN QUANTITATIVE LAB	$31.15	$89.00	—	15% below	65%
Urine microalbumin (albumin) test CPT 82043 HC URINE ALBUMIN QUANTITATIVE LAB	$111.30	$318.00	—	203% above	65%
Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN QUANTITATIVE	$111.30	$318.00	—	203% above	65%
Urine microalbumin (albumin) test inpatient CPT 82043 HC MICROALBUMIN QUANTITATIVE	$111.30	$318.00	—	—	65%
Urine microalbumin (albumin) test inpatient CPT 82043 HC URINE ALBUMIN QUANTITATIVE LAB	$111.30	$318.00	—	—	65%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST	$64.75	$185.00	—	26% below	65%
Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY TEST	$64.75	$185.00	—	—	65%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B-12	$173.60	$496.00	—	84% above	65%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN-B12	$173.60	$496.00	—	84% above	65%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN-B12	$173.60	$496.00	—	—	65%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B-12	$173.60	$496.00	—	—	65%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM	$51.10	$146.00	—	20% below	65%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM	$91.70	$262.00	—	43% above	65%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM	$91.70	$262.00	—	—	65%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC (HCG) QUANTITATIVE	$178.85	$511.00	—	at median	65%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB	$178.85	$511.00	—	at median	65%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB	$178.85	$511.00	—	—	65%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC (HCG) QUANTITATIVE	$178.85	$511.00	—	—	65%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Balloon dilation of the maxillary sinus opening, one side CPT 31295 HC ED SINUS ENDO W/BALLOON DILATION CDM	$2,717.75	$7,765.00	—	43% below	65%
Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 HC ED SINUS ENDO W/BALLOON DILATION CDM	$2,717.75	$7,765.00	—	—	65%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESION STEREO	$4,898.60	$13,996.00	—	13% above	65%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST 1ST LESION STEREO	$4,898.60	$13,996.00	—	—	65%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC ED CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM	$189.00	$540.00	—	65% below	65%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC ED CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM	$189.00	$540.00	—	—	65%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC ED TREAT METATARSAL FRACTURE W/O MANIPULATION CDM	$189.00	$540.00	—	65% below	65%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC ED TREAT METATARSAL FRACTURE W/O MANIPULATION CDM	$189.00	$540.00	—	—	65%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 HC ED CORRECTION OF BUNION CDM	$2,738.05	$7,823.00	—	35% below	65%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 HC ED CORRECTION OF BUNION CDM	$2,738.05	$7,823.00	—	—	65%
Cardiac catheterization with coronary angiogram CPT 93458 HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I	$5,987.10	$17,106.00	—	54% below	65%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I	$5,987.10	$17,106.00	—	—	65%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$1,095.50	$3,130.00	—	43% below	65%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$1,095.50	$3,130.00	—	—	65%
Carpal tunnel release, open surgery CPT 64721 HC ED NEUROPLASTY MEDIAN NERVE AT CARP TUNNEL CDM	$992.25	$2,835.00	—	73% below	65%
Carpal tunnel release, open surgery inpatient CPT 64721 HC ED NEUROPLASTY MEDIAN NERVE AT CARP TUNNEL CDM	$992.25	$2,835.00	—	—	65%
Catheter ablation for atrial fibrillation CPT 93656 HC COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION	$11,144.70	$31,842.00	—	67% below	65%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION	$11,144.70	$31,842.00	—	—	65%
Cervical biopsy CPT 57500 HC ED BIOPSY OF CERVIX CDM	$705.25	$2,015.00	—	64% below	65%
Cervical biopsy inpatient CPT 57500 HC ED BIOPSY OF CERVIX CDM	$705.25	$2,015.00	—	—	65%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION W/REGIONL BLOCK CDM	$1,990.45	$5,687.00	—	19% above	65%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC CIRCUMCISION W/REGIONL BLOCK CDM	$1,990.45	$5,687.00	—	—	65%
Circumcision, surgical, older than a newborn CPT 54160 HC CIRCUMCISION NEONATE	$639.80	$1,828.00	—	18% above	65%
Circumcision, surgical, older than a newborn inpatient CPT 54160 HC CIRCUMCISION NEONATE	$639.80	$1,828.00	—	—	65%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM	$189.00	$540.00	—	66% below	65%
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	$189.00	$540.00	—	—	65%
Colonoscopy, diagnostic CPT 45378 HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM	$610.75	$1,745.00	—	71% below	65%
Colonoscopy, diagnostic inpatient CPT 45378 HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM	$610.75	$1,745.00	—	—	65%
Coronary stent placement, one artery CPT 92928 HC INSERT COR STENT PERC TRLUML W/ANGIO ONE ART/BRNCH	$6,809.95	$19,457.00	—	54% below	65%
Coronary stent placement, one artery inpatient CPT 92928 HC INSERT COR STENT PERC TRLUML W/ANGIO ONE ART/BRNCH	$6,809.95	$19,457.00	—	—	65%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC ED CYSTOURETHROSCOPY CDM	$256.55	$733.00	—	84% below	65%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC ED CYSTOURETHROSCOPY CDM	$256.55	$733.00	—	—	65%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HC ED DILATION AND CURETTAGE CDM	$2,537.15	$7,249.00	—	40% below	65%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC ED DILATION AND CURETTAGE CDM	$2,537.15	$7,249.00	—	—	65%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC ED DESTRUCT PREMALG LESION FIRST LESION CDM	$164.50	$470.00	—	49% below	65%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC ED DESTRUCT PREMALG LESION FIRST LESION CDM	$164.50	$470.00	—	—	65%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC ED REMOVE IMPACTED EAR WAX UNI CDM	$101.50	$290.00	—	43% below	65%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC ED REMOVE IMPACTED EAR WAX UNI CDM	$101.50	$290.00	—	—	65%
Earwax removal with instruments, one ear one side CPT 69210 HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM	$101.50	$290.00	—	46% below	65%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM	$101.50	$290.00	—	—	65%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC ED ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX CDM	$164.50	$470.00	—	70% below	65%
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	$164.50	$470.00	—	—	65%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC ED INJ INTERLAMINR CRV-THOR W IMG CDM	$967.05	$2,763.00	—	60% below	65%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG	$967.05	$2,763.00	—	60% below	65%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC ED INJ INTERLAMINR CRV-THOR W IMG CDM	$967.05	$2,763.00	—	—	65%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG	$967.05	$2,763.00	—	—	65%
Eye injection into the vitreous (intravitreal injection) CPT 67028 HC ED INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM	$307.30	$878.00	—	65% below	65%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HC ED INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM	$307.30	$878.00	—	—	65%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV	$1,723.40	$4,924.00	—	16% below	65%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV	$1,723.40	$4,924.00	—	—	65%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC ED SIGMOID DX FLX W WO SPEC COLL CDM	$610.75	$1,745.00	—	67% below	65%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC ED SIGMOID DX FLX W WO SPEC COLL CDM	$610.75	$1,745.00	—	—	65%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM	$2,747.15	$7,849.00	—	70% below	65%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM	$2,747.15	$7,849.00	—	—	65%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC ED HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS CDM	$767.55	$2,193.00	—	59% below	65%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC ED HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS CDM	$767.55	$2,193.00	—	—	65%
Hemorrhoidectomy (internal and external), one area CPT 46255 HC ED HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP CDM	$1,418.55	$4,053.00	—	69% below	65%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HC ED HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP CDM	$1,418.55	$4,053.00	—	—	65%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$446.95	$1,277.00	—	29% below	65%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$446.95	$1,277.00	—	—	65%
IUD insertion (the device itself billed separately) CPT 58300 HC ED INSERTION INTRAUTERINE DEVICE IUD CDM	$197.75	$565.00	—	66% below	65%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC ED INSERTION INTRAUTERINE DEVICE IUD CDM	$197.75	$565.00	—	—	65%
Incision and drainage of a simple or single skin abscess CPT 10060 HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM	$189.00	$540.00	—	60% below	65%
Incision and drainage of a simple or single skin abscess CPT 10060 HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$189.00	$540.00	—	60% below	65%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$189.00	$540.00	—	—	65%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM	$189.00	$540.00	—	—	65%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM	$1,955.10	$5,586.00	—	74% below	65%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM	$1,955.10	$5,586.00	—	—	65%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC ED INJ TENDON SHEATH/LIGAMENT CDM	$359.80	$1,028.00	—	46% below	65%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC ED INJ TENDON SHEATH/LIGAMENT CDM	$359.80	$1,028.00	—	—	65%
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	$480.90	$1,374.00	—	49% below	65%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC INJ MAJOR JOINT - SHOULDER/HIP/KNEE	$480.90	$1,374.00	—	49% below	65%
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	$480.90	$1,374.00	—	49% below	65%
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	$480.90	$1,374.00	—	—	65%
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	$480.90	$1,374.00	—	—	65%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC INJ MAJOR JOINT - SHOULDER/HIP/KNEE	$480.90	$1,374.00	—	—	65%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE	$480.90	$1,374.00	—	21% below	65%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM	$480.90	$1,374.00	—	21% below	65%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERMED	$480.90	$1,374.00	—	21% below	65%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM	$480.90	$1,374.00	—	—	65%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE	$480.90	$1,374.00	—	—	65%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERMED	$480.90	$1,374.00	—	—	65%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM	$474.60	$1,356.00	—	35% below	65%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE	$474.60	$1,356.00	—	35% below	65%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE	$474.60	$1,356.00	—	—	65%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM	$474.60	$1,356.00	—	—	65%
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	$384.65	$1,099.00	—	56% below	65%
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	$384.65	$1,099.00	—	—	65%
Left heart catheterization, diagnostic one side CPT 93452 HC LEFT HRT CATH W/VENTRCLGRPHY	$3,971.45	$11,347.00	—	60% below	65%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC LEFT HRT CATH W/VENTRCLGRPHY	$3,971.45	$11,347.00	—	—	65%
Lower-back epidural injection, with imaging guidance CPT 62323 HC ED INJ EPI LUMB/SACRAL W IMAGING CDM	$790.30	$2,258.00	—	64% below	65%
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG	$790.30	$2,258.00	—	64% below	65%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC ED INJ EPI LUMB/SACRAL W IMAGING CDM	$790.30	$2,258.00	—	—	65%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG	$790.30	$2,258.00	—	—	65%
Lower-back epidural injection, without imaging guidance CPT 62322 HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM	$796.25	$2,275.00	—	56% below	65%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM	$796.25	$2,275.00	—	—	65%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ FORAMEN EPIDURAL L/S	$915.60	$2,616.00	—	55% below	65%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ FORAMEN EPIDURAL L/S	$915.60	$2,616.00	—	—	65%
Miscarriage treatment with D&C, first trimester CPT 59820 HC ED SPONTANEOUS ABORTION FAC CDM	$2,537.15	$7,249.00	—	50% below	65%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC ED SPONTANEOUS ABORTION FAC CDM	$2,537.15	$7,249.00	—	—	65%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS CDM	$691.95	$1,977.00	—	48% below	65%
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	$691.95	$1,977.00	—	48% below	65%
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	$691.95	$1,977.00	—	—	65%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS CDM	$691.95	$1,977.00	—	—	65%
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	$602.00	$1,720.00	—	59% below	65%
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	$602.00	$1,720.00	—	—	65%
Nail removal (partial or complete), one nail CPT 11730 HC ED REMOVAL OF NAIL PLATE CDM	$189.00	$540.00	—	62% below	65%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC ED REMOVAL OF NAIL PLATE CDM	$189.00	$540.00	—	—	65%
Occipital nerve block (injection for headaches) CPT 64405 HC ED NERVE BLOCK INJ OCCIPITAL CDM	$290.50	$830.00	—	67% below	65%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC ED NERVE BLOCK INJ OCCIPITAL CDM	$290.50	$830.00	—	—	65%
Pacemaker implant (dual chamber) CPT 33208 HC INSERTION PERM AV PACER	$5,530.00	$15,800.00	—	71% below	65%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC INSERTION PERM AV PACER	$5,530.00	$15,800.00	—	—	65%
Paracentesis with imaging guidance CPT 49083 HC ED ABD PARACENTESIS W/IMAG GUIDANCE CDM	$2,656.50	$7,590.00	—	45% above	65%
Paracentesis with imaging guidance CPT 49083 HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM	$2,656.50	$7,590.00	—	45% above	65%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM	$2,656.50	$7,590.00	—	—	65%
Paracentesis with imaging guidance inpatient CPT 49083 HC ED ABD PARACENTESIS W/IMAG GUIDANCE CDM	$2,656.50	$7,590.00	—	—	65%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC ED REMOVAL OF NAIL BED CDM	$384.65	$1,099.00	—	70% below	65%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC ED REMOVAL OF NAIL BED CDM	$384.65	$1,099.00	—	—	65%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	$5,104.75	$14,585.00	—	7% above	65%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	$5,104.75	$14,585.00	—	—	65%
Removal of a breast lump, open surgery CPT 19120 HC EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION CDM	$3,510.50	$10,030.00	—	30% below	65%
Removal of a breast lump, open surgery inpatient CPT 19120 HC EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION CDM	$3,510.50	$10,030.00	—	—	65%
Removal of a foreign object under the skin, simple CPT 10120 HC ED REMOVE FOREIGN BODY SIMPLE CDM	$384.65	$1,099.00	—	61% below	65%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC ED REMOVE FOREIGN BODY SIMPLE CDM	$384.65	$1,099.00	—	—	65%
Septoplasty to straighten the nasal septum CPT 30520 HC ED REPAIR OF NASAL SEPTUM CDM	$1,731.10	$4,946.00	—	65% below	65%
Septoplasty to straighten the nasal septum inpatient CPT 30520 HC ED REPAIR OF NASAL SEPTUM CDM	$1,731.10	$4,946.00	—	—	65%
Short arm cast (elbow to hand) CPT 29075 HC ED SHORT ARM CAST APPLICATION CDM	$233.45	$667.00	—	53% below	65%
Short arm cast (elbow to hand) inpatient CPT 29075 HC ED SHORT ARM CAST APPLICATION CDM	$233.45	$667.00	—	—	65%
Short arm splint (forearm and hand) CPT 29125 HC ED SHORT ARM SPLINT APPLICATION CDM	$189.00	$540.00	—	55% below	65%
Short arm splint (forearm and hand) inpatient CPT 29125 HC ED SHORT ARM SPLINT APPLICATION CDM	$189.00	$540.00	—	—	65%
Short leg cast (below the knee) CPT 29405 HC ED SHORT LEG CAST APPLICATION CDM	$233.45	$667.00	—	53% below	65%
Short leg cast (below the knee) inpatient CPT 29405 HC ED SHORT LEG CAST APPLICATION CDM	$233.45	$667.00	—	—	65%
Short leg splint (calf to foot) CPT 29515 HC ED SHORT LEG SPLINT APPLICATION CDM	$189.00	$540.00	—	62% below	65%
Short leg splint (calf to foot) inpatient CPT 29515 HC ED SHORT LEG SPLINT APPLICATION CDM	$189.00	$540.00	—	—	65%
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	$189.00	$540.00	—	66% below	65%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS	$189.00	$540.00	—	66% below	65%
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	$189.00	$540.00	—	—	65%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS	$189.00	$540.00	—	—	65%
Skin biopsy, punch, one lesion CPT 11104 HC ED PUNCH BIOPSY SKIN SINGLE LESION CDM	$406.00	$1,160.00	—	44% below	65%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION	$406.00	$1,160.00	—	44% below	65%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION	$406.00	$1,160.00	—	—	65%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC ED PUNCH BIOPSY SKIN SINGLE LESION CDM	$406.00	$1,160.00	—	—	65%
Skin tag removal, up to 15 tags CPT 11200 HC ED REMOVAL OF SKIN TAGS CDM	$199.85	$571.00	—	49% below	65%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC ED REMOVAL OF SKIN TAGS CDM	$199.85	$571.00	—	—	65%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM	$705.95	$2,017.00	—	47% below	65%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$705.95	$2,017.00	—	47% below	65%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$705.95	$2,017.00	—	—	65%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM	$705.95	$2,017.00	—	—	65%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC REPAIR SUPERFICIAL WOUND(S) 2.5 TO 7.5 CM	$199.85	$571.00	—	73% below	65%
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	$199.85	$571.00	—	73% below	65%
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	$199.85	$571.00	—	—	65%
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 REPAIR SUPERFICIAL WOUND(S) 2.5 TO 7.5 CM	$199.85	$571.00	—	—	65%
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	$189.00	$540.00	—	71% below	65%
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	$189.00	$540.00	—	—	65%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC ED TANGENTIAL BIOPSY SKIN SINGLE LESION CDM	$233.80	$668.00	—	58% below	65%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$233.80	$668.00	—	58% below	65%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC ED TANGENTIAL BIOPSY SKIN SINGLE LESION CDM	$233.80	$668.00	—	—	65%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$233.80	$668.00	—	—	65%
Thoracentesis with imaging guidance CPT 32555 HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM	$1,246.70	$3,562.00	—	39% below	65%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$1,246.70	$3,562.00	—	39% below	65%
Thoracentesis with imaging guidance inpatient CPT 32555 HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM	$1,246.70	$3,562.00	—	—	65%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$1,246.70	$3,562.00	—	—	65%
Trigger point injections, 1 or 2 muscles CPT 20552 HC ED INJ TRIGGER POINT 1/2 MUSCL CDM	$616.35	$1,761.00	—	3% below	65%
Trigger point injections, 1 or 2 muscles CPT 20552 HC IR INJ TRIGGER POINT(S)1TO2 MUSC	$616.35	$1,761.00	—	3% below	65%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC ED INJ TRIGGER POINT 1/2 MUSCL CDM	$616.35	$1,761.00	—	—	65%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC IR INJ TRIGGER POINT(S)1TO2 MUSC	$616.35	$1,761.00	—	—	65%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMAG	$2,079.70	$5,942.00	—	35% below	65%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US IMAG	$2,079.70	$5,942.00	—	—	65%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC ED UGI W DILATION ESOPHAGUS BAL CDM	$1,086.75	$3,105.00	—	56% below	65%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC ED UGI W DILATION ESOPHAGUS BAL CDM	$1,086.75	$3,105.00	—	—	65%
Upper endoscopy (EGD) with biopsy CPT 43239 HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM	$622.65	$1,779.00	—	65% below	65%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM	$622.65	$1,779.00	—	—	65%
Upper endoscopy (EGD), diagnostic CPT 43235 HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM	$622.65	$1,779.00	—	67% below	65%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM	$622.65	$1,779.00	—	—	65%
Wart removal, up to 14 warts CPT 17110 HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM	$215.25	$615.00	—	40% below	65%
Wart removal, up to 14 warts inpatient CPT 17110 HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM	$215.25	$615.00	—	—	65%
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	$384.65	$1,099.00	—	44% below	65%
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	$384.65	$1,099.00	—	—	65%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 HC ED TREAT FX RAD EXTRA-ARTICUL CDM	$3,965.50	$11,330.00	—	35% below	65%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 HC ED TREAT FX RAD EXTRA-ARTICUL CDM	$3,965.50	$11,330.00	—	—	65%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION EA UNIT CDM	$289.80	$828.00	—	67% below	65%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION EA UNIT CDM	$289.80	$828.00	—	—	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC ED INHALATION TREATMENT CDM	$326.90	$934.00	—	1% above	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHALATION TREATMENT DAILY	$326.90	$934.00	—	1% above	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHALATION TREATMENT DAILY	$326.90	$934.00	—	—	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC ED INHALATION TREATMENT CDM	$326.90	$934.00	—	—	65%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO IV INFUSION INITIAL HR CDM	$937.30	$2,678.00	—	7% above	65%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO IV INFUSION INITIAL HR CDM	$937.30	$2,678.00	—	—	65%
Critical care, first 30 to 74 minutes CPT 99291 HC ED CRITICAL CARE FIRST HOUR CDM	$2,722.30	$7,778.00	—	50% below	65%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC ED CRITICAL CARE FIRST HOUR CDM	$2,722.30	$7,778.00	—	—	65%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE AND DROWSY PEDIATRIC	$977.20	$2,792.00	—	5% below	65%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY	$977.20	$2,792.00	—	5% below	65%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG AWAKE AND DROWSY PEDIATRIC	$977.20	$2,792.00	—	—	65%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY	$977.20	$2,792.00	—	—	65%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ECG 12 LEAD TRACING ONLY	$221.20	$632.00	—	35% below	65%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC ECG 12 LEAD TRACING ONLY	$221.20	$632.00	—	—	65%
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	$380.80	$1,088.00	—	9% below	65%
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	$380.80	$1,088.00	—	—	65%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED FAC E&M VISIT LEVEL 2 CDM	$622.30	$1,778.00	—	29% below	65%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED FAC E&M VISIT LEVEL 2 CDM	$622.30	$1,778.00	—	—	65%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED FAC E&M VISIT LEVEL 3 CDM	$918.05	$2,623.00	—	39% below	65%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED FAC E&M VISIT LEVEL 3 CDM	$918.05	$2,623.00	—	—	65%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED FAC E&M VISIT LEVEL 4 CDM	$1,221.85	$3,491.00	—	55% below	65%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED FAC E&M VISIT LEVEL 4 CDM	$1,221.85	$3,491.00	—	—	65%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED FAC E&M VISIT LEVEL 5 CDM	$1,823.50	$5,210.00	—	49% below	65%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED FAC E&M VISIT LEVEL 5 CDM	$1,823.50	$5,210.00	—	—	65%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIO STRESS TEST MEDICINE	$1,026.90	$2,934.00	—	27% below	65%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY	$1,026.90	$2,934.00	—	27% below	65%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY	$1,026.90	$2,934.00	—	—	65%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CARDIO STRESS TEST MEDICINE	$1,026.90	$2,934.00	—	—	65%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC ED IV HYDRATION INITIAL HR CDM	$456.40	$1,304.00	—	8% below	65%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV HYDRATION INITIAL HR CDM	$456.40	$1,304.00	—	8% below	65%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC ED IV HYDRATION INITIAL HR CDM	$456.40	$1,304.00	—	—	65%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV HYDRATION INITIAL HR CDM	$456.40	$1,304.00	—	—	65%
IV infusion of a medicine, first hour CPT 96365 HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM	$508.55	$1,453.00	—	13% below	65%
IV infusion of a medicine, first hour CPT 96365 HC IV INFUSION INITIAL HR CDM	$534.10	$1,526.00	—	9% below	65%
IV infusion of a medicine, first hour inpatient CPT 96365 HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM	$508.55	$1,453.00	—	—	65%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INFUSION INITIAL HR CDM	$534.10	$1,526.00	—	—	65%
IV push of a medicine, first drug CPT 96374 HC INJ IV PUSH INITIAL DRUG CDM	$252.35	$721.00	—	29% below	65%
IV push of a medicine, first drug CPT 96374 HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM	$252.35	$721.00	—	29% below	65%
IV push of a medicine, first drug inpatient CPT 96374 HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM	$252.35	$721.00	—	—	65%
IV push of a medicine, first drug inpatient CPT 96374 HC INJ IV PUSH INITIAL DRUG CDM	$252.35	$721.00	—	—	65%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM	$186.20	$532.00	—	4% above	65%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJ SQ OR IM CDM	$186.20	$532.00	—	4% above	65%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJ SQ OR IM CDM	$186.20	$532.00	—	—	65%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM	$186.20	$532.00	—	—	65%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NERVE CONDUCTION STUDIES 7-8 STUDIES CDM	$484.75	$1,385.00	—	48% below	65%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC NERVE CONDUCTION STUDIES 7-8 STUDIES CDM	$484.75	$1,385.00	—	—	65%
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN	$89.95	$257.00	—	29% below	65%
Neuromuscular re-education, 15 minutes CPT 97112 HC CRISIS TELEH 97112 NEUROMUSCUL REEDUCAT EA 15 MIN CDM	$89.95	$257.00	—	29% below	65%
Neuromuscular re-education, 15 minutes CPT 97112 HC VIRTUAL THERAPY NEUROMUSC REEDUCA PX 1 OR MORE AREAS EACH 15MINS CDM	$89.95	$257.00	—	29% below	65%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN	$89.95	$257.00	—	—	65%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC VIRTUAL THERAPY NEUROMUSC REEDUCA PX 1 OR MORE AREAS EACH 15MINS CDM	$89.95	$257.00	—	—	65%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC CRISIS TELEH 97112 NEUROMUSCUL REEDUCAT EA 15 MIN CDM	$89.95	$257.00	—	—	65%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC CRISIS TELEH 97802 MEDICAL NUTRITION INDIV INIT THERAPY EA 15 MIN CDM	$52.85	$151.00	—	47% below	65%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM	$52.85	$151.00	—	47% below	65%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC CRISIS PHONE 97802 MED NUTRITION INDIV INIT EA 15 MIN CDM	$52.85	$151.00	—	47% below	65%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC CRISIS PHONE 97802 MED NUTRITION INDIV INIT EA 15 MIN CDM	$52.85	$151.00	—	—	65%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC CRISIS TELEH 97802 MEDICAL NUTRITION INDIV INIT THERAPY EA 15 MIN CDM	$52.85	$151.00	—	—	65%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM	$52.85	$151.00	—	—	65%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVALUATION LOW COMPLEX	$214.20	$612.00	—	18% below	65%
Occupational therapy evaluation, low complexity CPT 97165 HC VIRTUAL THERAPY OT EVALUATION LOW COMPLEX CDM	$214.20	$612.00	—	18% below	65%
Occupational therapy evaluation, low complexity CPT 97165 HC CRISIS TELEH 97165 OT EVALUATION LOW COMPLEX CDM	$214.20	$612.00	—	18% below	65%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC VIRTUAL THERAPY OT EVALUATION LOW COMPLEX CDM	$214.20	$612.00	—	—	65%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC CRISIS TELEH 97165 OT EVALUATION LOW COMPLEX CDM	$214.20	$612.00	—	—	65%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVALUATION LOW COMPLEX	$214.20	$612.00	—	—	65%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC CRISIS TELEH 97163 PT EVALUATION HIGH COMPLEX CDM	$218.75	$625.00	—	44% below	65%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC VIRTUAL THERAPY PT EVALUATION HIGH COMPLEX CDM	$218.75	$625.00	—	44% below	65%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVALUATION HIGH COMPLEX	$218.75	$625.00	—	44% below	65%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC VIRTUAL THERAPY PT EVALUATION HIGH COMPLEX CDM	$218.75	$625.00	—	—	65%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVALUATION HIGH COMPLEX	$218.75	$625.00	—	—	65%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC CRISIS TELEH 97163 PT EVALUATION HIGH COMPLEX CDM	$218.75	$625.00	—	—	65%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC VIRTUAL THERAPY PT EVALUATION LOW COMPLEX CDM	$212.45	$607.00	—	10% below	65%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC CRISIS TELEH 97161 PT EVALUATION LOW COMPLEX CDM	$212.45	$607.00	—	10% below	65%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVALUATION LOW COMPLEX CDM	$212.45	$607.00	—	10% below	65%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC VIRTUAL THERAPY PT EVALUATION LOW COMPLEX CDM	$212.45	$607.00	—	—	65%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC CRISIS TELEH 97161 PT EVALUATION LOW COMPLEX CDM	$212.45	$607.00	—	—	65%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVALUATION LOW COMPLEX CDM	$212.45	$607.00	—	—	65%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC VIRTUAL THERAPY PT EVALUATION MOD COMPLEX CDM	$215.95	$617.00	—	39% below	65%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVALUATION MOD COMPLEX CDM	$215.95	$617.00	—	39% below	65%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC CRISIS TELEH 97162 PT EVALUATION MOD COMPLEX CDM	$215.95	$617.00	—	39% below	65%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC VIRTUAL THERAPY PT EVALUATION MOD COMPLEX CDM	$215.95	$617.00	—	—	65%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVALUATION MOD COMPLEX CDM	$215.95	$617.00	—	—	65%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC CRISIS TELEH 97162 PT EVALUATION MOD COMPLEX CDM	$215.95	$617.00	—	—	65%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES	$89.95	$257.00	—	25% below	65%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES	$89.95	$257.00	—	—	65%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN	$89.95	$257.00	—	30% below	65%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM	$89.95	$257.00	—	30% below	65%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC VIRTUAL THERAPY THER EXERCISES PX 1 OR MORE AREAS EACH 15MINS CDM	$89.95	$257.00	—	30% below	65%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC VIRTUAL THERAPY THER EXERCISES PX 1 OR MORE AREAS EACH 15MINS CDM	$89.95	$257.00	—	—	65%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM	$89.95	$257.00	—	—	65%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN	$89.95	$257.00	—	—	65%
Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM	$362.95	$1,037.00	—	21% below	65%
Speech and language evaluation CPT 92523 HC VIRTUAL THERAPY SPEECH SOUND LANG COMPREHEN EXTENDED CDM	$362.95	$1,037.00	—	21% below	65%
Speech and language evaluation CPT 92523 HC CRISIS TELEH 92523 SPEECH SOUND LANG COMPREHEN CDM	$362.95	$1,037.00	—	21% below	65%
Speech and language evaluation inpatient CPT 92523 HC CRISIS TELEH 92523 SPEECH SOUND LANG COMPREHEN CDM	$362.95	$1,037.00	—	—	65%
Speech and language evaluation inpatient CPT 92523 HC VIRTUAL THERAPY SPEECH SOUND LANG COMPREHEN EXTENDED CDM	$362.95	$1,037.00	—	—	65%
Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM	$362.95	$1,037.00	—	—	65%
Speech therapy session, individual CPT 92507 HC VIRTUAL THERAPY SPEECH-HEARING THERAPY INDIV CDM	$187.60	$536.00	—	32% below	65%
Speech therapy session, individual CPT 92507 HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL	$187.60	$536.00	—	32% below	65%
Speech therapy session, individual CPT 92507 HC CRISIS TELEH 92507 SPEECH/HEARING THERAPY - INDIV CDM	$187.60	$536.00	—	32% below	65%
Speech therapy session, individual inpatient CPT 92507 HC VIRTUAL THERAPY SPEECH-HEARING THERAPY INDIV CDM	$187.60	$536.00	—	—	65%
Speech therapy session, individual inpatient CPT 92507 HC CRISIS TELEH 92507 SPEECH/HEARING THERAPY - INDIV CDM	$187.60	$536.00	—	—	65%
Speech therapy session, individual inpatient CPT 92507 HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL	$187.60	$536.00	—	—	65%
Spirometry (breathing test) CPT 94010 HC BEDSIDE SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ CDM	$441.00	$1,260.00	—	16% above	65%
Spirometry (breathing test) CPT 94010 HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$441.00	$1,260.00	—	16% above	65%
Spirometry (breathing test) inpatient CPT 94010 HC BEDSIDE SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ CDM	$441.00	$1,260.00	—	—	65%
Spirometry (breathing test) inpatient CPT 94010 HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$441.00	$1,260.00	—	—	65%
Spirometry before and after a bronchodilator CPT 94060 HC SPIROMETRY PRE POST BRONCHODILATOR CDM	$585.20	$1,672.00	—	27% below	65%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC SPIROMETRY PRE POST BRONCHODILATOR CDM	$585.20	$1,672.00	—	—	65%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC VIRTUAL THERAPY THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15MINS CDM	$89.95	$257.00	—	34% below	65%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$89.95	$257.00	—	34% below	65%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$89.95	$257.00	—	—	65%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC VIRTUAL THERAPY THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15MINS CDM	$89.95	$257.00	—	—	65%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC ED PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE CDM	$164.50	$470.00	—	49% below	65%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC THERAPUTIC PHLEBOTOMY	$164.50	$470.00	—	49% below	65%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC THERAPUTIC PHLEBOTOMY	$164.50	$470.00	—	—	65%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC ED PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE CDM	$164.50	$470.00	—	—	65%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs California	Off list
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH, ACELLULAR PERT & TET TOX INJ 25 LF-58 MCG-10 LF/0.5ML	$93.61	$267.46	—	31% above	65%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPH, ACELLULAR PERT & TET TOX INJ 25 LF-58 MCG-10 LF/0.5ML	$93.61	$267.46	—	—	65%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DIPH-TET TOX-ACELL PERT-HEP B-POLIO IPV VAC SUSP PREF SYR	$333.06	$951.60	—	102% above	65%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DIPH-TET TOX-ACELL PERT-HEP B-POLIO IPV VAC SUSP PREF SYR	$333.06	$951.60	—	—	65%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DIPH-AC PER-TET TOX AD-POLIOV-HAEMOPH B POLY VAC FOR IM SUSP	$283.30	$809.44	—	36% above	65%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DIPH-AC PER-TET TOX AD-POLIOV-HAEMOPH B POLY VAC FOR IM SUSP	$283.30	$809.44	—	—	65%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML	$271.85	$776.70	—	95% above	65%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML	$271.85	$776.70	—	—	65%
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	$54.50	$155.70	—	6% below	65%
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	$79.04	$225.84	—	37% above	65%
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	$54.50	$155.70	—	—	65%
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	$79.04	$225.84	—	—	65%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSACCHARIDE CONJUGATE VAC FOR INJ 10 MCG	$44.37	$126.76	—	6% above	65%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSACCHARIDE CONJUGATE VAC FOR INJ 10 MCG	$44.37	$126.76	—	—	65%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN	$350.71	$1,002.04	—	151% above	65%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN	$350.71	$1,002.04	—	—	65%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL VAC B (RECOMB OMV ADJUV) INJ PREFILLED SYRINGE	$627.39	$1,792.54	—	42% above	65%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL VAC B (RECOMB OMV ADJUV) INJ PREFILLED SYRINGE	$627.39	$1,792.54	—	—	65%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE INJ	$467.44	$1,335.55	—	50% above	65%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE INJ	$467.44	$1,335.55	—	—	65%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML	$834.65	$2,384.71	—	61% above	65%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML	$834.65	$2,384.71	—	—	65%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP IM SOLN PREFILLED SYRINGE 50 MG/0.5ML	$1,830.15	$5,229.01	—	89% above	65%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP IM SOLN PREFILLED SYRINGE 50 MG/0.5ML	$1,830.15	$5,229.01	—	—	65%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC FOR INJ	$1,116.66	$3,190.47	—	58% above	65%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC FOR INJ	$1,116.66	$3,190.47	—	—	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 2-2 LF/0.5ML	$79.41	$226.88	—	2% below	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML	$159.09	$454.54	—	95% above	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 2-2 LF/0.5ML	$79.41	$226.88	—	—	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML	$159.09	$454.54	—	—	65%
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	$157.41	$449.75	—	36% above	65%
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	$157.41	$449.75	—	—	65%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN HEPATITIS B VACCINE CDM	$88.20	$252.00	—	16% below	65%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMIN CDM	$88.20	$252.00	—	16% below	65%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE CDM	$88.20	$252.00	—	16% below	65%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN INFLUENZA VIRUS VAC CDM	$88.20	$252.00	—	16% below	65%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN HEPATITIS B VACCINE CDM	$88.20	$252.00	—	—	65%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN INFLUENZA VIRUS VAC CDM	$88.20	$252.00	—	—	65%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE CDM	$88.20	$252.00	—	—	65%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMIN CDM	$88.20	$252.00	—	—	65%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMIN EACH ADD CDM	$88.20	$252.00	—	10% above	65%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADMIN EACH ADD CDM	$88.20	$252.00	—	—	65%

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/socal/live/954582647_providence-holy-cross-medical-center_standardcharges.json