Hospital Charlotte-Concord-Gastonia, NC-SC

Piedmont Medical Center

Listed in its price file as “Amisub of South Carolina, Inc.”.

Piedmont Medical Center in Rock Hill, SC publishes cash prices for 324 common procedures listed here, from its own machine-readable price file updated Sep 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the South Carolina median for 278 of 318 procedures and below it for 30. By typical cash price it ranks #39 of 43 South Carolina hospitals and #17 of 17 hospitals in the Charlotte, NC area, cheapest first. Select a procedure to compare it with other hospitals nearby.

222 S Herlong Ave, Rock Hill, SC 29732 Collected Sep 23, 2026 Source price file Check a bill from this hospital (803) 329-1234

Acute care hospital For-profit hospital Emergency department CMS star rating 2 of 5 CCN 420002 · CMS hospital register NPI 1457382483

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs South Carolina	Off list
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN WO/W CM	$4,014.75	$5,353.00	$1.00–$4,068.28	118% above	25%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN WO/W CM	$4,014.75	$5,353.00	$1.00–$4,068.28	—	25%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN 2 VIEWS	$868.50	$1,158.00	$15.92–$880.08	134% above	25%
Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN 2 VIEWS	$868.50	$1,158.00	$15.92–$880.08	—	25%
Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE 3 VIEWS MINIMUM	$1,028.25	$1,371.00	$1.00–$1,041.96	185% above	25%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 ANKLE 3 VIEWS MINIMUM	$1,028.25	$1,371.00	$1.00–$1,041.96	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UE/LE ART STUD LTD 1-2LV	$1,010.25	$1,347.00	$304.62–$508.15	92% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UE/LE ART STUD LTD 1-2LV	$1,010.25	$1,347.00	$304.62–$508.15	—	25%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTRMTY W/O CM	$3,213.75	$4,285.00	$1.00–$3,256.60	110% above	25%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTRMTY W/O CM	$3,213.75	$4,285.00	$1.00–$3,256.60	—	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 X-RAY ESOPHAGUS SNGL CM STDY	$942.00	$1,256.00	$1.00–$954.56	102% above	25%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 X-RAY ESOPHAGUS SNGL CM STDY	$942.00	$1,256.00	$1.00–$954.56	—	25%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE IMAGING WHOLE BODY	$2,653.50	$3,538.00	$1.00–$2,688.88	82% above	25%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE IMAGING WHOLE BODY	$2,653.50	$3,538.00	$1.00–$2,688.88	—	25%
Breast ultrasound, complete, one breast CPT 76641 US BREAST UNI COMPLETE	$738.00	$984.00	$1.00–$747.84	48% above	25%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST UNI COMPLETE	$738.00	$984.00	$1.00–$747.84	—	25%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST UNI LTD	$873.75	$1,165.00	$1.00–$885.40	73% above	25%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST UNI LTD	$873.75	$1,165.00	$1.00–$885.40	—	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD/PEL WO/W CM	$5,628.75	$7,505.00	$1.00–$5,703.80	118% above	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD/PEL W CONTRAST	$6,238.50	$8,318.00	$1.00–$6,321.68	141% above	25%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD/PEL WO/W CM	$5,628.75	$7,505.00	$1.00–$5,703.80	—	25%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD/PEL W CONTRAST	$6,238.50	$8,318.00	$1.00–$6,321.68	—	25%
CT angiography (CTA) of the head CPT 70496 CTA HEAD W CONTRAST ONLY	$5,860.50	$7,814.00	$1.00–$5,938.64	183% above	25%
CT angiography (CTA) of the head CPT 70496 CTA HEAD WO/W CONTRAST	$5,860.50	$7,814.00	$1.00–$5,938.64	183% above	25%
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD WO/W CONTRAST	$5,860.50	$7,814.00	$1.00–$5,938.64	—	25%
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD W CONTRAST ONLY	$5,860.50	$7,814.00	$1.00–$5,938.64	—	25%
CT angiography (CTA) of the neck CPT 70498 CTA NECK WO/W CONTRAST	$5,643.75	$7,525.00	$1.00–$5,719.00	178% above	25%
CT angiography (CTA) of the neck CPT 70498 CTA NECK W CONTRAST ONLY	$5,643.75	$7,525.00	$1.00–$5,719.00	178% above	25%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK WO/W CONTRAST	$5,643.75	$7,525.00	$1.00–$5,719.00	—	25%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK W CONTRAST ONLY	$5,643.75	$7,525.00	$1.00–$5,719.00	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST (NONCOR) WO/W	$5,764.50	$7,686.00	$1.00–$5,841.36	193% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST (NONCOR) W CM	$5,924.25	$7,899.00	$1.00–$6,003.24	201% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST W CONTRST ONLY	$5,924.25	$7,899.00	$1.00–$6,003.24	201% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST (NONCOR) WO/W	$5,764.50	$7,686.00	$1.00–$5,841.36	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST W CONTRST ONLY	$5,924.25	$7,899.00	$1.00–$6,003.24	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST (NONCOR) W CM	$5,924.25	$7,899.00	$1.00–$6,003.24	—	25%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA HEART W CONTRAST	$5,085.00	$6,780.00	$143.90–$5,152.80	204% above	25%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA HEART W CONTRAST	$5,085.00	$6,780.00	$143.90–$5,152.80	—	25%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT CARD SCORING WO CONT	$2,087.25	$2,783.00	$27.78–$2,115.08	1821% above	25%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT CARD SCORING WO CONT	$2,087.25	$2,783.00	$27.78–$2,115.08	—	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CM	$4,665.00	$6,220.00	$1.00–$4,727.20	58% above	25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CM	$4,665.00	$6,220.00	$1.00–$4,727.20	—	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CM	$8,496.75	$11,329.00	$1.00–$8,610.04	129% above	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CM	$8,496.75	$11,329.00	$1.00–$8,610.04	—	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD & PELVIS WO/W CM	$11,587.50	$15,450.00	$1.00–$11,742.00	181% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD & PELVIS WO/W CM	$11,587.50	$15,450.00	$1.00–$11,742.00	—	25%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ CM	$3,935.25	$5,247.00	$1.00–$3,987.72	154% above	25%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/ CM	$3,935.25	$5,247.00	$1.00–$3,987.72	—	25%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CM	$3,008.25	$4,011.00	$1.00–$3,048.36	135% above	25%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CM	$3,008.25	$4,011.00	$1.00–$3,048.36	—	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CM	$3,155.25	$4,207.00	$1.00–$3,197.32	147% above	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS W/O CONTRAST	$3,155.25	$4,207.00	$1.00–$3,197.32	147% above	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CM	$3,155.25	$4,207.00	$1.00–$3,197.32	—	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS W/O CONTRAST	$3,155.25	$4,207.00	$1.00–$3,197.32	—	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN WO CONTRST	$3,563.25	$4,751.00	$1.00–$3,610.76	161% above	25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN WO CONTRST	$3,563.25	$4,751.00	$1.00–$3,610.76	—	25%
CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W CONTRAST	$2,572.50	$3,430.00	$1.00–$2,606.80	50% above	25%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD/BRAIN W CONTRAST	$2,572.50	$3,430.00	$1.00–$2,606.80	—	25%
CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN WO/W CONTR	$4,705.50	$6,274.00	$1.00–$4,768.24	141% above	25%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN WO/W CONTR	$4,705.50	$6,274.00	$1.00–$4,768.24	—	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SPINE LUMBAR W/O CM	$3,217.50	$4,290.00	$1.00–$3,260.40	86% above	25%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT SPINE LUMBAR W/O CM	$3,217.50	$4,290.00	$1.00–$3,260.40	—	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SPINE CERVICAL W/O CM	$3,217.50	$4,290.00	$1.00–$3,260.40	118% above	25%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT SPINE CERVICAL W/O CM	$3,217.50	$4,290.00	$1.00–$3,260.40	—	25%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS WITH CONTRAST	$4,032.00	$5,376.00	$1.00–$4,085.76	132% above	25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS WITH CONTRAST	$4,032.00	$5,376.00	$1.00–$4,085.76	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUPLEX CAROTID BI/COMP	$2,616.75	$3,489.00	$250.85–$822.36	—	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUPLEX CAROTID BI/COMP	$2,616.75	$3,489.00	$250.85–$822.36	—	25%
Chest CT scan without and with contrast CPT 71270 CT THORAX WO/W CONTRAST	$4,616.25	$6,155.00	$1.00–$4,677.80	122% above	25%
Chest CT scan without and with contrast inpatient CPT 71270 CT THORAX WO/W CONTRAST	$4,616.25	$6,155.00	$1.00–$4,677.80	—	25%
Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS	$725.25	$967.00	$14.34–$734.92	186% above	25%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS	$725.25	$967.00	$14.34–$734.92	—	25%
Chest X-ray, single view CPT 71045 CHEST 1 VIEW	$503.25	$671.00	$7.78–$509.96	141% above	25%
Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW	$503.25	$671.00	$7.78–$509.96	—	25%
Collarbone (clavicle) X-ray, complete CPT 73000 CLAVICLE COMPLETE	$969.00	$1,292.00	$1.00–$981.92	205% above	25%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 CLAVICLE COMPLETE	$969.00	$1,292.00	$1.00–$981.92	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMP	$1,688.25	$2,251.00	$1.00–$1,710.76	200% above	25%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL COMP	$1,688.25	$2,251.00	$1.00–$1,710.76	—	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA AXIAL SKELETON	$798.75	$1,065.00	$1.00–$809.40	90% above	25%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA AXIAL SKELETON	$798.75	$1,065.00	$1.00–$809.40	—	25%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMP W FETL ANATMY	$1,654.50	$2,206.00	$1.00–$1,676.56	94% above	25%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMP W FETL ANATMY	$1,654.50	$2,206.00	$1.00–$1,676.56	—	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX W/O CONTRAST	$3,668.25	$4,891.00	$1.00–$3,717.16	186% above	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX W/O CONTRAST	$3,668.25	$4,891.00	$1.00–$3,717.16	—	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX WITH CONTRAST	$3,376.50	$4,502.00	$1.00–$3,421.52	76% above	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX WITH CONTRAST	$3,376.50	$4,502.00	$1.00–$3,421.52	—	25%
Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO+CAD BILAT	$763.50	$1,018.00	$1.00–$773.68	—	25%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO+CAD BILAT	$763.50	$1,018.00	$1.00–$773.68	—	25%
Diagnostic mammogram, one breast one side CPT 77065 DX MAMMO+CAD UNILAT	$653.25	$871.00	$1.00–$661.96	94% above	25%
Diagnostic mammogram, one breast inpatient one side CPT 77065 DX MAMMO+CAD UNILAT	$653.25	$871.00	$1.00–$661.96	—	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 LE ART IMAGING COMP BILAT	$2,240.25	$2,987.00	$301.56–$822.36	—	25%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 LE ART IMAGING COMP BILAT	$2,240.25	$2,987.00	$301.56–$822.36	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 UE/LE IMG VEINS COMP BILAT	$3,261.75	$4,349.00	$273.62–$822.36	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 UE/LE IMG VEINS COMP BILAT	$3,261.75	$4,349.00	$273.62–$822.36	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO2D SPECTR/COLOR FLO	$5,496.00	$7,328.00	$963.72–$2,084.45	227% above	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO2D SPECTR/COLOR FLO	$5,496.00	$7,328.00	$963.72–$2,084.45	—	25%
Elbow X-ray, 2 views CPT 73070 ELBOW 2 VIEWS	$564.00	$752.00	$1.00–$571.52	119% above	25%
Elbow X-ray, 2 views inpatient CPT 73070 ELBOW 2 VIEWS	$564.00	$752.00	$1.00–$571.52	—	25%
Elbow X-ray, complete, 3 or more views CPT 73080 ELBOW 3 VIEW MINIMUM	$1,006.50	$1,342.00	$1.00–$1,019.92	180% above	25%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 ELBOW 3 VIEW MINIMUM	$1,006.50	$1,342.00	$1.00–$1,019.92	—	25%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORB/EAR/FOSSA W/O CM	$4,300.50	$5,734.00	$1.00–$4,357.84	179% above	25%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORB/EAR/FOSSA W/O CM	$4,300.50	$5,734.00	$1.00–$4,357.84	—	25%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES 3VW MIN	$831.75	$1,109.00	$1.00–$842.84	132% above	25%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES 3VW MIN	$831.75	$1,109.00	$1.00–$842.84	—	25%
Forearm X-ray (radius and ulna), 2 views CPT 73090 FOREARM 2 VIEWS	$1,086.75	$1,449.00	$1.00–$1,101.24	234% above	25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 FOREARM 2 VIEWS	$1,086.75	$1,449.00	$1.00–$1,101.24	—	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SYSTEM IMG	$2,937.00	$3,916.00	$1.00–$2,976.16	43% above	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SYSTEM IMG	$2,937.00	$3,916.00	$1.00–$2,976.16	—	25%
Hand X-ray, 2 views CPT 73120 HAND 2 VIEWS	$521.25	$695.00	$1.00–$528.20	130% above	25%
Hand X-ray, 2 views inpatient CPT 73120 HAND 2 VIEWS	$521.25	$695.00	$1.00–$528.20	—	25%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 OS CALCIS 2 VIEWS	$537.75	$717.00	$1.00–$544.92	120% above	25%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 OS CALCIS 2 VIEWS	$537.75	$717.00	$1.00–$544.92	—	25%
Knee X-ray, 3 views CPT 73562 KNEE 3 VIEWS	$1,167.75	$1,557.00	$1.00–$1,183.32	289% above	25%
Knee X-ray, 3 views inpatient CPT 73562 KNEE 3 VIEWS	$1,167.75	$1,557.00	$1.00–$1,183.32	—	25%
Knee X-ray, complete, 4 or more views CPT 73564 KNEE COMP 4 VW MIN	$1,026.75	$1,369.00	$1.00–$1,040.44	156% above	25%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 KNEE COMP 4 VW MIN	$1,026.75	$1,369.00	$1.00–$1,040.44	—	25%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTRMTY W/O CM	$3,285.00	$4,380.00	$1.00–$3,328.80	122% above	25%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTRMTY W/O CM	$3,285.00	$4,380.00	$1.00–$3,328.80	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LTD/QUAD/FU	$1,907.25	$2,543.00	$1.00–$1,932.68	190% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LTD SNGLE/QUAD/FU	$1,951.50	$2,602.00	$1.00–$1,977.52	197% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LTD/QUAD/FU	$1,907.25	$2,543.00	$1.00–$1,932.68	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LTD SNGLE/QUAD/FU	$1,951.50	$2,602.00	$1.00–$1,977.52	—	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US XTR SOFT TISSUE LMTD	$1,279.50	$1,706.00	$1.00–$1,296.56	116% above	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US XTR JOINT LMTD	$1,279.50	$1,706.00	$1.00–$1,296.56	116% above	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US XTR SOFT TISSUE LMTD	$1,279.50	$1,706.00	$1.00–$1,296.56	—	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US XTR JOINT LMTD	$1,279.50	$1,706.00	$1.00–$1,296.56	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG SCREENING	$1,617.75	$2,157.00	$0.29–$1,639.32	651% above	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG SCREENING	$1,617.75	$2,157.00	$0.29–$1,639.32	—	25%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 TIBIA/FIBULA 2 VIEWS	$675.00	$900.00	$1.00–$684.00	107% above	25%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 TIBIA/FIBULA 2 VIEWS	$675.00	$900.00	$1.00–$684.00	—	25%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRAST	$5,621.25	$7,495.00	$1.00–$5,696.20	193% above	25%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CONTRAST	$5,621.25	$7,495.00	$1.00–$5,696.20	—	25%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BRST WO&W CM+CAD BI	$8,019.00	$10,692.00	$1.00–$8,125.92	—	25%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI BRST WO&W CM+CAD BI	$8,019.00	$10,692.00	$1.00–$8,125.92	—	25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWR EXT JNT W/O CM	$6,081.75	$8,109.00	$1.00–$6,162.84	149% above	25%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWR EXT JNT W/O CM	$6,081.75	$8,109.00	$1.00–$6,162.84	—	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LE JNT WO/W CM	$7,902.00	$10,536.00	$1.00–$8,007.36	179% above	25%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LE JNT WO/W CM	$7,902.00	$10,536.00	$1.00–$8,007.36	—	25%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CM	$5,709.75	$7,613.00	$1.00–$5,785.88	198% above	25%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CM	$5,709.75	$7,613.00	$1.00–$5,785.88	—	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WO/W CM	$8,019.00	$10,692.00	$1.00–$8,125.92	228% above	25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN WO/W CM	$8,019.00	$10,692.00	$1.00–$8,125.92	—	25%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$6,333.75	$8,445.00	$1.00–$6,418.20	202% above	25%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST	$6,333.75	$8,445.00	$1.00–$6,418.20	—	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO/W CONTRAST	$7,258.50	$9,678.00	$1.00–$7,355.28	220% above	25%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WO/W CONTRAST	$7,258.50	$9,678.00	$1.00–$7,355.28	—	25%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINE LUMBAR W/O CM	$5,794.50	$7,726.00	$1.00–$5,871.76	164% above	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI SPINE LUMBAR W/O CM	$5,794.50	$7,726.00	$1.00–$5,871.76	—	25%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI SPINE LUMBAR WO/W CM	$5,721.75	$7,629.00	$1.00–$5,798.04	102% above	25%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI SPINE LUMBAR WO/W CM	$5,721.75	$7,629.00	$1.00–$5,798.04	—	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SPINE THORAC W/O CM	$5,709.75	$7,613.00	$1.00–$5,785.88	164% above	25%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI SPINE THORAC W/O CM	$5,709.75	$7,613.00	$1.00–$5,785.88	—	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SPINE CERV WO/W CM	$5,721.75	$7,629.00	$1.00–$5,798.04	102% above	25%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI SPINE CERV WO/W CM	$5,721.75	$7,629.00	$1.00–$5,798.04	—	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI SPINE CERVICL W/O CM	$6,805.50	$9,074.00	$1.00–$6,896.24	233% above	25%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI SPINE CERVICL W/O CM	$6,805.50	$9,074.00	$1.00–$6,896.24	—	25%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WO/W CONTRAST	$4,851.00	$6,468.00	$1.00–$4,915.68	74% above	25%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WO/W CONTRAST	$4,851.00	$6,468.00	$1.00–$4,915.68	—	25%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$4,688.25	$6,251.00	$1.00–$4,750.76	153% above	25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$4,688.25	$6,251.00	$1.00–$4,750.76	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UP EXT JNT W/O CM	$7,138.50	$9,518.00	$1.00–$7,233.68	210% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UP EXT JNT W/O CM	$7,138.50	$9,518.00	$1.00–$7,233.68	—	25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 SPINE CERVICAL 4 OR 5 VW	$1,672.50	$2,230.00	$1.00–$1,694.80	277% above	25%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 SPINE CERVICAL 4 OR 5 VW	$1,672.50	$2,230.00	$1.00–$1,694.80	—	25%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISS NECK W CM	$3,747.75	$4,997.00	$1.00–$3,797.72	115% above	25%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISS NECK W CM	$3,747.75	$4,997.00	$1.00–$3,797.72	—	25%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISS NECK WO CM	$2,451.75	$3,269.00	$1.00–$2,484.44	84% above	25%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISS NECK WO CM	$2,451.75	$3,269.00	$1.00–$2,484.44	—	25%
Neck soft tissue X-ray CPT 70360 NECK FOR SOFT TISSUES	$819.75	$1,093.00	$1.00–$830.68	206% above	25%
Neck soft tissue X-ray inpatient CPT 70360 NECK FOR SOFT TISSUES	$819.75	$1,093.00	$1.00–$830.68	—	25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MC PERF SPECT WM EF MULT	$5,847.75	$7,797.00	$1.00–$5,925.72	53% above	25%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MC PERF SPECT WM EF MULT	$5,847.75	$7,797.00	$1.00–$5,925.72	—	25%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT SKULL TO THIGH	$10,567.50	$14,090.00	$1,480.34–$10,708.40	146% above	25%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT SKULL TO THIGH	$10,567.50	$14,090.00	$1,480.34–$10,708.40	—	25%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST	$2,697.75	$3,597.00	$1.00–$2,733.72	110% above	25%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST	$2,697.75	$3,597.00	$1.00–$2,733.72	—	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LTD/FU	$1,359.75	$1,813.00	$1.00–$1,377.88	148% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LTD/FU	$1,359.75	$1,813.00	$1.00–$1,377.88	—	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE	$2,164.50	$2,886.00	$1.00–$2,193.36	234% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE	$2,164.50	$2,886.00	$1.00–$2,193.36	—	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMP>14WK SGL GEST	$2,998.50	$3,998.00	$1.00–$3,038.48	308% above	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMP>14WK SGL GEST	$2,998.50	$3,998.00	$1.00–$3,038.48	—	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB COMP<14WKS 1STGEST	$1,938.75	$2,585.00	$1.00–$1,964.60	268% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB COMP<14WKS 1STGEST	$1,938.75	$2,585.00	$1.00–$1,964.60	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LTD 1OR> FETUS	$834.00	$1,112.00	$1.00–$845.12	88% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LTD 1OR> FETUS	$834.00	$1,112.00	$1.00–$845.12	—	25%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNILAT 2VW	$755.25	$1,007.00	$1.00–$765.32	152% above	25%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNILAT 2VW	$755.25	$1,007.00	$1.00–$765.32	—	25%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 RIBS UNI 3V MIN W/PA CXR	$1,180.50	$1,574.00	$1.00–$1,196.24	190% above	25%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 RIBS UNI 3V MIN W/PA CXR	$1,180.50	$1,574.00	$1.00–$1,196.24	—	25%
Screening mammogram, both breasts both sides CPT 77067 SCRN MAMMO+CAD BILAT	$533.25	$711.00	$1.00–$540.36	—	25%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCRN MAMMO+CAD BILAT	$533.25	$711.00	$1.00–$540.36	—	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 SHOULDER 2 VWS MINIMUM	$1,130.25	$1,507.00	$1.00–$1,145.32	262% above	25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 SHOULDER 2 VWS MINIMUM	$1,130.25	$1,507.00	$1.00–$1,145.32	—	25%
Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES 3VW MIN	$1,273.50	$1,698.00	$1.00–$1,290.48	244% above	25%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES 3VW MIN	$1,273.50	$1,698.00	$1.00–$1,290.48	—	25%
Skull X-ray, fewer than 4 views CPT 70250 SKULL < 4 VIEWS	$1,180.50	$1,574.00	$1.00–$1,196.24	353% above	25%
Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL < 4 VIEWS	$1,180.50	$1,574.00	$1.00–$1,196.24	—	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 SWAL FUNC W/CINE/VIDEO+CM STDY	$834.00	$1,112.00	$1.00–$845.12	87% above	25%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 SWAL FUNC W/CINE/VIDEO+CM STDY	$834.00	$1,112.00	$1.00–$845.12	—	25%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 FEMUR 2 VIEWS MIN	$741.75	$989.00	$1.00–$751.64	126% above	25%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 FEMUR 2 VIEWS MIN	$741.75	$989.00	$1.00–$751.64	—	25%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT SPINE THORACIC W/O CM	$2,572.50	$3,430.00	$1.00–$2,606.80	67% above	25%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT SPINE THORACIC W/O CM	$2,572.50	$3,430.00	$1.00–$2,606.80	—	25%
Toe X-ray, 2 or more views CPT 73660 TOE(S) 2 VIEWS	$754.50	$1,006.00	$1.00–$764.56	180% above	25%
Toe X-ray, 2 or more views inpatient CPT 73660 TOE(S) 2 VIEWS	$754.50	$1,006.00	$1.00–$764.56	—	25%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NOT OB	$1,983.75	$2,645.00	$1.00–$2,010.20	172% above	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NOT OB	$1,983.75	$2,645.00	$1.00–$2,010.20	—	25%
Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL	$1,797.75	$2,397.00	$1.00–$1,821.72	165% above	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB TRANSVAGINAL	$1,797.75	$2,397.00	$1.00–$1,821.72	—	25%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$2,626.50	$3,502.00	$1.00–$2,661.52	182% above	25%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$2,626.50	$3,502.00	$1.00–$2,661.52	—	25%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM CONTENTS	$1,570.50	$2,094.00	$1.00–$1,591.44	162% above	25%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM CONTENTS	$1,570.50	$2,094.00	$1.00–$1,591.44	—	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD/NECK	$1,432.50	$1,910.00	$1.00–$1,451.60	120% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD/NECK	$1,432.50	$1,910.00	$1.00–$1,451.60	—	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI W/SNGL CM STDY	$1,605.00	$2,140.00	$1.00–$1,626.40	103% above	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI W/SNGL CM STDY	$1,605.00	$2,140.00	$1.00–$1,626.40	—	25%
Upper arm X-ray (humerus), 2 views CPT 73060 HUMERUS 2 VIEW MINIMUM	$1,047.75	$1,397.00	$1.00–$1,061.72	307% above	25%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HUMERUS 2 VIEW MINIMUM	$1,047.75	$1,397.00	$1.00–$1,061.72	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 UE/LE IMG VEINS UNI/LTD	$2,456.25	$3,275.00	$219.33–$524.97	133% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 UE/LE IMG VEINS UNI/LTD	$2,456.25	$3,275.00	$219.33–$524.97	—	25%
Wrist X-ray, 2 views CPT 73100 WRIST 2 VIEWS	$630.75	$841.00	$1.00–$639.16	170% above	25%
Wrist X-ray, 2 views inpatient CPT 73100 WRIST 2 VIEWS	$630.75	$841.00	$1.00–$639.16	—	25%
Wrist X-ray, complete, 3 or more views CPT 73110 WRIST 3 VIEWS MINIMUM	$1,070.25	$1,427.00	$1.00–$1,084.52	193% above	25%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 WRIST 3 VIEWS MINIMUM	$1,070.25	$1,427.00	$1.00–$1,084.52	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIP UNI W/PELV 2-3 VWS	$1,509.00	$2,012.00	$1.00–$1,529.12	504% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP UNILATERAL 2-3 VWS	$1,509.00	$2,012.00	$1.00–$1,529.12	504% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP UNILATERAL 2-3VWS	$1,518.00	$2,024.00	$1.00–$1,538.24	507% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HIP UNI W/PELV 2-3 VWS	$1,509.00	$2,012.00	$1.00–$1,529.12	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP UNILATERAL 2-3 VWS	$1,509.00	$2,012.00	$1.00–$1,529.12	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP UNILATERAL 2-3VWS	$1,518.00	$2,024.00	$1.00–$1,538.24	—	25%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW	$773.25	$1,031.00	$13.29–$783.56	129% above	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 VIEW	$773.25	$1,031.00	$13.29–$783.56	—	25%
X-ray of the ankle, 2 views CPT 73600 ANKLE 2 VIEWS	$683.25	$911.00	$1.00–$692.36	133% above	25%
X-ray of the ankle, 2 views inpatient CPT 73600 ANKLE 2 VIEWS	$683.25	$911.00	$1.00–$692.36	—	25%
X-ray of the finger(s), 2 or more views CPT 73140 FINGER(S) 2 VIEWS	$783.00	$1,044.00	$1.00–$793.44	203% above	25%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 FINGER(S) 2 VIEWS	$783.00	$1,044.00	$1.00–$793.44	—	25%
X-ray of the foot, 2 views CPT 73620 FOOT 2 VIEWS	$522.75	$697.00	$1.00–$529.72	94% above	25%
X-ray of the foot, 2 views inpatient CPT 73620 FOOT 2 VIEWS	$522.75	$697.00	$1.00–$529.72	—	25%
X-ray of the foot, complete, 3 or more views CPT 73630 FOOT 3 VIEWS MINIMUM	$1,023.00	$1,364.00	$1.00–$1,036.64	143% above	25%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT 3 VIEWS MINIMUM	$1,023.00	$1,364.00	$1.00–$1,036.64	—	25%
X-ray of the hand, 3 or more views CPT 73130 HAND 3 VIEWS MINIMUM	$1,083.00	$1,444.00	$1.00–$1,097.44	212% above	25%
X-ray of the hand, 3 or more views inpatient CPT 73130 HAND 3 VIEWS MINIMUM	$1,083.00	$1,444.00	$1.00–$1,097.44	—	25%
X-ray of the knee, 1 or 2 views CPT 73560 KNEE 1-2 VIEWS	$725.25	$967.00	$1.00–$734.92	172% above	25%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 KNEE 1-2 VIEWS	$725.25	$967.00	$1.00–$734.92	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBAR 3 VIEWS	$1,299.00	$1,732.00	$1.00–$1,316.32	271% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBAR 2 VIEWS	$1,299.00	$1,732.00	$1.00–$1,316.32	271% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE LUMBAR 2 VIEWS	$1,299.00	$1,732.00	$1.00–$1,316.32	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE LUMBAR 3 VIEWS	$1,299.00	$1,732.00	$1.00–$1,316.32	—	25%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR MIN 4VWS	$996.00	$1,328.00	$1.00–$1,009.28	87% above	25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR MIN 4VWS	$996.00	$1,328.00	$1.00–$1,009.28	—	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 SPINE THORACIC 2 VIEWS	$1,147.50	$1,530.00	$1.00–$1,162.80	317% above	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 SPINE THORACIC 2 VIEWS	$1,147.50	$1,530.00	$1.00–$1,162.80	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES 3VW MIN	$1,033.50	$1,378.00	$1.00–$1,047.28	212% above	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES 3VW MIN	$1,033.50	$1,378.00	$1.00–$1,047.28	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE CERVICAL 3 VIEWS	$1,037.25	$1,383.00	$1.00–$1,051.08	202% above	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE CERVICAL 2 VIEWS	$1,083.00	$1,444.00	$1.00–$1,097.44	215% above	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE CERVICAL 3 VIEWS	$1,037.25	$1,383.00	$1.00–$1,051.08	—	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE CERVICAL 2 VIEWS	$1,083.00	$1,444.00	$1.00–$1,097.44	—	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 VIEW	$605.25	$807.00	$1.00–$613.32	149% above	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 2 VIEWS	$605.25	$807.00	$1.00–$613.32	149% above	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 2 VIEWS	$605.25	$807.00	$1.00–$613.32	—	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1 VIEW	$605.25	$807.00	$1.00–$613.32	—	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM COCCYX 2 VWS	$903.00	$1,204.00	$1.00–$915.04	229% above	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM COCCYX 2 VWS	$903.00	$1,204.00	$1.00–$915.04	—	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs South Carolina	Off list
ACTH blood test CPT 82024 ACTH	$293.25	$391.00	$1.00–$538.57	15% above	25%
ACTH blood test inpatient CPT 82024 ACTH	$293.25	$391.00	$1.00–$538.57	—	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSAMINASE-SGPT (ALT)	$135.00	$180.00	$1.00–$180.00	200% above	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSAMINASE-SGPT (ALT)	$135.00	$180.00	$1.00–$180.00	—	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSTERASE AST(SGOT)	$135.00	$180.00	$1.00–$180.00	204% above	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSTERASE AST(SGOT)	$135.00	$180.00	$1.00–$180.00	—	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$645.00	$860.00	$1.00–$860.00	133% above	25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$645.00	$860.00	$1.00–$860.00	—	25%
Albumin blood test CPT 82040 ALBUMIN SERUM	$43.50	$58.00	$1.00–$58.00	7% above	25%
Albumin blood test inpatient CPT 82040 ALBUMIN SERUM	$43.50	$58.00	$1.00–$58.00	—	25%
Aldosterone blood test CPT 82088 ALDOSTERONE	$270.00	$360.00	$1.00–$360.00	25% above	25%
Aldosterone blood test CPT 82088 ALDOSTERONE/2	$270.00	$360.00	$1.00–$360.00	25% above	25%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE	$270.00	$360.00	$1.00–$360.00	—	25%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE/2	$270.00	$360.00	$1.00–$360.00	—	25%
Alkaline phosphatase (ALP) blood test CPT 84075 PHOSPHATASE ALKALINE	$41.25	$55.00	$1.00–$55.76	12% below	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 PHOSPHATASE ALKALINE	$41.25	$55.00	$1.00–$55.76	—	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLRGN SPEC IGE EA/16	$36.75	$49.00	$1.00–$70.61	9% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLRGN SPEC IGE EA/22	$58.50	$78.00	$1.00–$78.00	45% above	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLRGN SPEC IGE EA/16	$36.75	$49.00	$1.00–$70.61	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLRGN SPEC IGE EA/22	$58.50	$78.00	$1.00–$78.00	—	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA FETO PROTEIN SERUM/2	$168.75	$225.00	$1.00–$241.06	48% above	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA FETO PROTEIN SERUM	$287.25	$383.00	$1.00–$383.00	152% above	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA FETO PROTEIN SERUM/2	$168.75	$225.00	$1.00–$241.06	—	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA FETO PROTEIN SERUM	$287.25	$383.00	$1.00–$383.00	—	25%
Ammonia blood test CPT 82140 AMMONIA	$176.25	$235.00	$1.00–$235.00	69% above	25%
Ammonia blood test inpatient CPT 82140 AMMONIA	$176.25	$235.00	$1.00–$235.00	—	25%
Amylase blood test CPT 82150 AMYLASE/5	$63.00	$84.00	$1.00–$86.16	33% below	25%
Amylase blood test CPT 82150 AMYLASE/4	$66.75	$89.00	$1.00–$89.00	29% below	25%
Amylase blood test CPT 82150 AMYLASE/2	$237.75	$317.00	$1.00–$317.00	152% above	25%
Amylase blood test CPT 82150 AMYLASE	$372.00	$496.00	$1.00–$496.00	294% above	25%
Amylase blood test inpatient CPT 82150 AMYLASE/5	$63.00	$84.00	$1.00–$86.16	—	25%
Amylase blood test inpatient CPT 82150 AMYLASE/4	$66.75	$89.00	$1.00–$89.00	—	25%
Amylase blood test inpatient CPT 82150 AMYLASE/2	$237.75	$317.00	$1.00–$317.00	—	25%
Amylase blood test inpatient CPT 82150 AMYLASE	$372.00	$496.00	$1.00–$496.00	—	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYC CITRULLINATED PEP AB	$591.00	$788.00	$1.00–$788.00	621% above	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYC CITRULLINATED PEP AB	$591.00	$788.00	$1.00–$788.00	—	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB(ANA)	$52.50	$70.00	$1.00–$106.32	24% below	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB(ANA)/2	$183.00	$244.00	$1.00–$244.00	165% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB(ANA)/3	$291.00	$388.00	$1.00–$388.00	322% above	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR AB(ANA)	$52.50	$70.00	$1.00–$106.32	—	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR AB(ANA)/2	$183.00	$244.00	$1.00–$244.00	—	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR AB(ANA)/3	$291.00	$388.00	$1.00–$388.00	—	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-TYP NATRIURETC PEPTIDE	$381.75	$509.00	$1.00–$509.00	108% above	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-TYP NATRIURETC PEPTIDE/2	$546.75	$729.00	$1.00–$729.00	197% above	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-TYP NATRIURETC PEPTIDE	$381.75	$509.00	$1.00–$509.00	—	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-TYP NATRIURETC PEPTIDE/2	$546.75	$729.00	$1.00–$729.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/10	$28.50	$38.00	$1.00–$155.28	74% below	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/7	$41.25	$55.00	$1.00–$155.28	62% below	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/3	$85.50	$114.00	$1.00–$155.28	21% below	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/13	$269.25	$359.00	$1.00–$359.00	148% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/14	$269.25	$359.00	$1.00–$359.00	148% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/11	$272.25	$363.00	$1.00–$363.00	151% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE	$291.00	$388.00	$1.00–$388.00	168% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/15	$300.75	$401.00	$1.00–$401.00	177% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/16	$300.75	$401.00	$1.00–$401.00	177% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/22	$300.75	$401.00	$1.00–$401.00	177% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/5	$398.25	$531.00	$1.00–$531.00	267% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/2	$401.25	$535.00	$1.00–$535.00	269% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/25	$401.25	$535.00	$1.00–$535.00	269% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/8	$423.00	$564.00	$1.00–$564.00	290% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/20	$453.00	$604.00	$1.00–$604.00	317% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACT OTH SOURCE/6	$492.75	$657.00	$1.00–$657.00	354% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/10	$28.50	$38.00	$1.00–$155.28	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/7	$41.25	$55.00	$1.00–$155.28	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/3	$85.50	$114.00	$1.00–$155.28	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/13	$269.25	$359.00	$1.00–$359.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/14	$269.25	$359.00	$1.00–$359.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/11	$272.25	$363.00	$1.00–$363.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE	$291.00	$388.00	$1.00–$388.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/15	$300.75	$401.00	$1.00–$401.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/16	$300.75	$401.00	$1.00–$401.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/22	$300.75	$401.00	$1.00–$401.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/5	$398.25	$531.00	$1.00–$531.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/25	$401.25	$535.00	$1.00–$535.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/2	$401.25	$535.00	$1.00–$535.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/8	$423.00	$564.00	$1.00–$564.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/20	$453.00	$604.00	$1.00–$604.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACT OTH SOURCE/6	$492.75	$657.00	$1.00–$657.00	—	25%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$429.00	$572.00	$1.00–$572.00	100% above	25%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$429.00	$572.00	$1.00–$572.00	—	25%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$25.50	$34.00	$1.00–$41.61	39% below	25%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL/2	$76.50	$102.00	$1.00–$102.00	82% above	25%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL	$25.50	$34.00	$1.00–$41.61	—	25%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL/2	$76.50	$102.00	$1.00–$102.00	—	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATH LEVEL IV	$556.50	$742.00	$1.00–$742.00	192% above	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATH LEVEL IV	$556.50	$742.00	$1.00–$742.00	—	25%
Blood culture for bacteria CPT 87040 CULTURE BLOOD	$539.25	$719.00	$1.00–$719.00	251% above	25%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD	$539.25	$719.00	$1.00–$719.00	—	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE/4	$48.00	$64.00	$3.00–$64.00	111% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE/3	$48.00	$64.00	$3.00–$64.00	111% above	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE/4	$48.00	$64.00	$3.00–$64.00	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE/3	$48.00	$64.00	$3.00–$64.00	—	25%
Blood glucose (sugar) test CPT 82947 GLUCOSE QUANTITATIVE	$55.50	$74.00	$1.00–$74.00	65% above	25%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANTITATIVE	$55.50	$74.00	$1.00–$74.00	—	25%
Blood lead test CPT 83655 LEAD QUANTITATIVE/2	$72.75	$97.00	$1.00–$115.21	7% below	25%
Blood lead test CPT 83655 LEAD QUANTITATIVE	$208.50	$278.00	$1.00–$278.00	165% above	25%
Blood lead test inpatient CPT 83655 LEAD QUANTITATIVE/2	$72.75	$97.00	$1.00–$115.21	—	25%
Blood lead test inpatient CPT 83655 LEAD QUANTITATIVE	$208.50	$278.00	$1.00–$278.00	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADTOPN CHRONC(HCG)QL	$282.75	$377.00	$1.00–$377.00	82% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 GONADTOPN CHRONC(HCG)QL	$282.75	$377.00	$1.00–$377.00	—	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLD TYPE ABO	$164.25	$219.00	$1.00–$219.00	169% above	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLD TYPE ABO	$164.25	$219.00	$1.00–$219.00	—	25%
Blood urea nitrogen (BUN) test CPT 84520 BLD UREA NITROGEN QUAN	$28.50	$38.00	$1.00–$38.00	37% below	25%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BLD UREA NITROGEN QUAN	$28.50	$38.00	$1.00–$38.00	—	25%
C-peptide blood test CPT 84681 C-PEPTIDE	$68.25	$91.00	$1.00–$170.83	39% below	25%
C-peptide blood test inpatient CPT 84681 C-PEPTIDE	$68.25	$91.00	$1.00–$170.83	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN/2	$26.25	$35.00	$1.00–$71.64	61% below	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$75.75	$101.00	$1.00–$101.00	13% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN/2	$26.25	$35.00	$1.00–$71.64	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$75.75	$101.00	$1.00–$101.00	—	25%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF TOXIN AMP PROBE	$573.00	$764.00	$1.00–$764.00	196% above	25%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF TOXIN AMP PROBE	$573.00	$764.00	$1.00–$764.00	—	25%
CA 19-9 blood test (tumor marker) CPT 86301 IA TUMOR CA 19-9 QUAN	$394.50	$526.00	$1.00–$526.00	172% above	25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 IA TUMOR CA 19-9 QUAN	$394.50	$526.00	$1.00–$526.00	—	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 IA TUMOR CA 125 QUAN	$385.50	$514.00	$1.00–$514.00	131% above	25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IA TUMOR CA 125 QUAN	$385.50	$514.00	$1.00–$514.00	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARSCOV2 COVID19 AMP PRB	$212.25	$283.00	$51.31–$283.00	160% above	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARSCOV2 COVID19 AMP PRB	$212.25	$283.00	$51.31–$283.00	—	25%
Calcium blood test, total CPT 82310 CALCIUM/2	$36.75	$49.00	$1.00–$49.00	17% below	25%
Calcium blood test, total CPT 82310 CALCIUM	$53.25	$71.00	$1.00–$71.00	20% above	25%
Calcium blood test, total inpatient CPT 82310 CALCIUM/2	$36.75	$49.00	$1.00–$49.00	—	25%
Calcium blood test, total inpatient CPT 82310 CALCIUM	$53.25	$71.00	$1.00–$71.00	—	25%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINO-EMBRYONIC AG	$211.50	$282.00	$1.00–$282.00	35% above	25%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINO-EMBRYONIC AG/2	$327.00	$436.00	$1.00–$436.00	108% above	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINO-EMBRYONIC AG	$211.50	$282.00	$1.00–$282.00	—	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINO-EMBRYONIC AG/2	$327.00	$436.00	$1.00–$436.00	—	25%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB	$81.00	$108.00	$1.00–$143.82	at median	25%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB/3	$87.75	$117.00	$1.00–$143.82	8% above	25%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB/2	$142.50	$190.00	$1.00–$190.00	76% above	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB	$81.00	$108.00	$1.00–$143.82	—	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB/3	$87.75	$117.00	$1.00–$143.82	—	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB/2	$142.50	$190.00	$1.00–$190.00	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA AMP PROBE/2	$466.50	$622.00	$1.00–$622.00	199% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA AMP PROBE	$582.00	$776.00	$1.00–$776.00	273% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA AMP PROBE/2	$466.50	$622.00	$1.00–$622.00	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA AMP PROBE	$582.00	$776.00	$1.00–$776.00	—	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL/2	$93.00	$124.00	$1.00–$181.84	at median	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$373.50	$498.00	$1.00–$498.00	302% above	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL/2	$93.00	$124.00	$1.00–$181.84	—	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$373.50	$498.00	$1.00–$498.00	—	25%
Complete blood count (CBC) with differential CPT 85025 CBC WITH AUTO DIFF	$300.00	$400.00	$1.00–$400.00	156% above	25%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH AUTO DIFF	$300.00	$400.00	$1.00–$400.00	—	25%
Complete blood count (CBC), no differential CPT 85027 CBC AUTO W/O DIFF	$214.50	$286.00	$1.00–$286.00	150% above	25%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC AUTO W/O DIFF	$214.50	$286.00	$1.00–$286.00	—	25%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL	$712.50	$950.00	$1.00–$950.00	188% above	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL	$712.50	$950.00	$1.00–$950.00	—	25%
Cortisol blood test, total CPT 82533 CORTISOL TOTAL	$188.25	$251.00	$1.00–$251.00	38% above	25%
Cortisol blood test, total CPT 82533 CORTISOL TOTAL/3	$207.75	$277.00	$1.00–$277.00	53% above	25%
Cortisol blood test, total CPT 82533 CORTISOL TOTAL/2	$297.00	$396.00	$1.00–$396.00	118% above	25%
Cortisol blood test, total CPT 82533 CORTISOL TOTAL/4	$342.75	$457.00	$1.00–$457.00	152% above	25%
Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL	$188.25	$251.00	$1.00–$251.00	—	25%
Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL/3	$207.75	$277.00	$1.00–$277.00	—	25%
Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL/2	$297.00	$396.00	$1.00–$396.00	—	25%
Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL/4	$342.75	$457.00	$1.00–$457.00	—	25%
Creatine kinase (CK) blood test, total CPT 82550 CREATINE KINASE TOTAL	$245.25	$327.00	$1.00–$327.00	372% above	25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CREATINE KINASE TOTAL	$245.25	$327.00	$1.00–$327.00	—	25%
Creatinine blood test CPT 82565 CREATININE BLOOD	$25.50	$34.00	$1.00–$41.61	43% below	25%
Creatinine blood test CPT 82565 CREATININE BLOOD/2	$51.00	$68.00	$1.00–$68.00	13% above	25%
Creatinine blood test inpatient CPT 82565 CREATININE BLOOD	$25.50	$34.00	$1.00–$41.61	—	25%
Creatinine blood test inpatient CPT 82565 CREATININE BLOOD/2	$51.00	$68.00	$1.00–$68.00	—	25%
Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGALOVIRUS AB/4	$72.75	$97.00	$1.00–$189.50	21% below	25%
Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGALOVIRUS AB/5	$117.75	$157.00	$1.00–$189.50	27% above	25%
Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGALOVIRUS AB	$117.75	$157.00	$1.00–$189.50	27% above	25%
Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGALOVIRUS AB/2	$228.75	$305.00	$1.00–$305.00	147% above	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGALOVIRUS AB/4	$72.75	$97.00	$1.00–$189.50	—	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGALOVIRUS AB	$117.75	$157.00	$1.00–$189.50	—	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGALOVIRUS AB/5	$117.75	$157.00	$1.00–$189.50	—	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGALOVIRUS AB/2	$228.75	$305.00	$1.00–$305.00	—	25%
D-dimer blood test (blood clot marker) CPT 85379 FDP D-DIMER QNT	$467.25	$623.00	$1.00–$623.00	226% above	25%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FDP D-DIMER QNT	$467.25	$623.00	$1.00–$623.00	—	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDRST SULFATE	$192.00	$256.00	$1.00–$330.76	8% above	25%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDRST SULFATE	$192.00	$256.00	$1.00–$330.76	—	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/16	$117.75	$157.00	$1.00–$831.50	at median	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/38	$164.25	$219.00	$1.00–$831.50	39% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/4	$203.25	$271.00	$1.00–$831.50	73% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/45	$207.00	$276.00	$1.00–$831.50	76% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$219.00	$292.00	$1.00–$831.50	86% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/6	$233.25	$311.00	$1.00–$831.50	98% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/23	$323.25	$431.00	$1.00–$831.50	175% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/36	$335.25	$447.00	$1.00–$831.50	185% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/46	$344.25	$459.00	$1.00–$831.50	192% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/27	$374.25	$499.00	$1.00–$831.50	218% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/53	$418.50	$558.00	$1.00–$831.50	255% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/51	$418.50	$558.00	$1.00–$831.50	255% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/19	$420.00	$560.00	$1.00–$831.50	257% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/12	$420.00	$560.00	$1.00–$831.50	257% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/14	$420.00	$560.00	$1.00–$831.50	257% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/17	$420.00	$560.00	$1.00–$831.50	257% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/3	$420.00	$560.00	$1.00–$831.50	257% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/2	$420.00	$560.00	$1.00–$831.50	257% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/21	$420.00	$560.00	$1.00–$831.50	257% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/54	$436.50	$582.00	$1.00–$831.50	271% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/24	$545.25	$727.00	$1.00–$831.50	363% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/10	$579.00	$772.00	$1.00–$831.50	392% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/9	$579.00	$772.00	$1.00–$831.50	392% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/13	$605.25	$807.00	$1.00–$831.50	414% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/32	$616.50	$822.00	$1.00–$831.50	424% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/52	$646.50	$862.00	$1.00–$862.00	449% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/20	$711.00	$948.00	$1.00–$948.00	504% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/8	$748.50	$998.00	$1.00–$998.00	536% above	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/16	$117.75	$157.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/38	$164.25	$219.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/4	$203.25	$271.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/45	$207.00	$276.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$219.00	$292.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/6	$233.25	$311.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/23	$323.25	$431.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/36	$335.25	$447.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/46	$344.25	$459.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/27	$374.25	$499.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/51	$418.50	$558.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/53	$418.50	$558.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/19	$420.00	$560.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/21	$420.00	$560.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/17	$420.00	$560.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/2	$420.00	$560.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/12	$420.00	$560.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/14	$420.00	$560.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/3	$420.00	$560.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/54	$436.50	$582.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/24	$545.25	$727.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/9	$579.00	$772.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/10	$579.00	$772.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/13	$605.25	$807.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/32	$616.50	$822.00	$1.00–$831.50	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/52	$646.50	$862.00	$1.00–$862.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/20	$711.00	$948.00	$1.00–$948.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/8	$748.50	$998.00	$1.00–$998.00	—	25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL	$166.50	$222.00	$1.00–$222.00	61% above	25%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL	$166.50	$222.00	$1.00–$222.00	—	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN-BARR VIRUS VCA AB/3	$117.00	$156.00	$1.00–$196.94	10% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN-BARR VIRUS VCA AB/4	$174.00	$232.00	$1.00–$232.00	64% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN-BARR VIRUS VCA AB	$205.50	$274.00	$1.00–$274.00	94% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN-BARR VIRUS VCA AB/5	$228.00	$304.00	$1.00–$304.00	115% above	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN-BARR VIRUS VCA AB/3	$117.00	$156.00	$1.00–$196.94	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN-BARR VIRUS VCA AB/4	$174.00	$232.00	$1.00–$232.00	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN-BARR VIRUS VCA AB	$205.50	$274.00	$1.00–$274.00	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN-BARR VIRUS VCA AB/5	$228.00	$304.00	$1.00–$304.00	—	25%
Estradiol blood test CPT 82670 ESTRADIOL	$144.75	$193.00	$1.00–$234.09	19% above	25%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$144.75	$193.00	$1.00–$234.09	—	25%
FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIMLAT HORMONE	$309.00	$412.00	$1.00–$412.00	126% above	25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE STIMLAT HORMONE	$309.00	$412.00	$1.00–$412.00	—	25%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL	$643.50	$858.00	$1.00–$858.00	243% above	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN FECAL	$643.50	$858.00	$1.00–$858.00	—	25%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$437.25	$583.00	$1.00–$583.00	290% above	25%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$437.25	$583.00	$1.00–$583.00	—	25%
Fibrinogen blood test CPT 85384 FIBRINOGEN ACTIVITY	$207.75	$277.00	$1.00–$277.00	60% above	25%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN ACTIVITY	$207.75	$277.00	$1.00–$277.00	—	25%
Folate (folic acid) blood test CPT 82746 FOLIC ACID	$192.00	$256.00	$1.00–$256.00	62% above	25%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID	$192.00	$256.00	$1.00–$256.00	—	25%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$185.25	$247.00	$1.00–$247.00	57% above	25%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE	$185.25	$247.00	$1.00–$247.00	—	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE	$201.75	$269.00	$1.00–$269.00	100% above	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE	$201.75	$269.00	$1.00–$269.00	—	25%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$132.75	$177.00	$1.00–$211.83	22% above	25%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$132.75	$177.00	$1.00–$211.83	—	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT	$111.75	$149.00	$1.00–$149.00	89% above	25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT	$111.75	$149.00	$1.00–$149.00	—	25%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GEN HEALTH PANEL	$696.75	$929.00	$45.36–$706.04	476% above	25%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GEN HEALTH PANEL	$696.75	$929.00	$45.36–$706.04	—	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST DOSE	$158.25	$211.00	$1.00–$211.00	161% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST DOSE	$158.25	$211.00	$1.00–$211.00	—	25%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 3SPEC	$357.75	$477.00	$1.00–$477.00	179% above	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 3SPEC	$357.75	$477.00	$1.00–$477.00	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC DNA AMP PROBE	$573.00	$764.00	$1.00–$764.00	281% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC DNA AMP PROBE	$573.00	$764.00	$1.00–$764.00	—	25%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI AB/3	$140.25	$187.00	$1.00–$187.00	20% above	25%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI AB	$199.50	$266.00	$1.00–$266.00	71% above	25%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI AB/2	$253.50	$338.00	$1.00–$338.00	118% above	25%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI AB/4	$441.00	$588.00	$1.00–$588.00	279% above	25%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI AB/3	$140.25	$187.00	$1.00–$187.00	—	25%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI AB	$199.50	$266.00	$1.00–$266.00	—	25%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI AB/2	$253.50	$338.00	$1.00–$338.00	—	25%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI AB/4	$441.00	$588.00	$1.00–$588.00	—	25%
H. pylori stool antigen test CPT 87338 H. PYLORI STOOL IA	$252.00	$336.00	$1.00–$336.00	23% above	25%
H. pylori stool antigen test inpatient CPT 87338 H. PYLORI STOOL IA	$252.00	$336.00	$1.00–$336.00	—	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT/2	$442.50	$590.00	$1.00–$696.54	1% above	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT	$735.75	$981.00	$1.00–$981.00	67% above	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT/5	$1,015.50	$1,354.00	$1.00–$1,354.00	131% above	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANT/2	$442.50	$590.00	$1.00–$696.54	—	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANT	$735.75	$981.00	$1.00–$981.00	—	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANT/5	$1,015.50	$1,354.00	$1.00–$1,354.00	—	25%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/HIV 2 SNGL RESULT	$155.25	$207.00	$1.00–$207.00	28% above	25%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/HIV 2 SNGL RESULT/2	$198.00	$264.00	$1.00–$264.00	63% above	25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1/HIV 2 SNGL RESULT	$155.25	$207.00	$1.00–$207.00	—	25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1/HIV 2 SNGL RESULT/2	$198.00	$264.00	$1.00–$264.00	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV I AG HIV I HIV II AB	$183.00	$244.00	$1.00–$244.00	88% above	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV I AG HIV I HIV II AB/2	$225.75	$301.00	$1.00–$301.00	132% above	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV I AG HIV I HIV II AB	$183.00	$244.00	$1.00–$244.00	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV I AG HIV I HIV II AB/2	$225.75	$301.00	$1.00–$301.00	—	25%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH RISK	$300.00	$400.00	$1.00–$400.00	149% above	25%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HIGH RISK	$300.00	$400.00	$1.00–$400.00	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCATED	$482.25	$643.00	$1.00–$643.00	457% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCATED	$482.25	$643.00	$1.00–$643.00	—	25%
Hemoglobin blood test CPT 85018 BLOOD HEMOGLBN	$126.00	$168.00	$1.00–$168.00	294% above	25%
Hemoglobin blood test inpatient CPT 85018 BLOOD HEMOGLBN	$126.00	$168.00	$1.00–$168.00	—	25%
Hepatitis B core antibody test (total) CPT 86704 HEP B CORE AB TOTAL	$72.75	$97.00	$1.00–$148.64	5% above	25%
Hepatitis B core antibody test (total) CPT 86704 HEP B CORE AB TOTAL/2	$92.25	$123.00	$1.00–$148.64	33% above	25%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEP B CORE AB TOTAL	$72.75	$97.00	$1.00–$148.64	—	25%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEP B CORE AB TOTAL/2	$92.25	$123.00	$1.00–$148.64	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE AB	$168.75	$225.00	$1.00–$225.00	101% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE AB/2	$299.25	$399.00	$1.00–$399.00	256% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE AB	$168.75	$225.00	$1.00–$225.00	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE AB/2	$299.25	$399.00	$1.00–$399.00	—	25%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$157.50	$210.00	$1.00–$210.00	94% above	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY	$157.50	$210.00	$1.00–$210.00	—	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C QUANT	$408.00	$544.00	$1.00–$544.00	3% above	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C QUANT/2	$1,006.50	$1,342.00	$1.00–$1,342.00	154% above	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C QUANT	$408.00	$544.00	$1.00–$544.00	—	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C QUANT/2	$1,006.50	$1,342.00	$1.00–$1,342.00	—	25%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES AB SMPLX TYPE 1	$105.75	$141.00	$1.00–$141.00	45% above	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES AB SMPLX TYPE 1	$105.75	$141.00	$1.00–$141.00	—	25%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES AB SMPLX TYPE 2/7	$92.25	$123.00	$1.00–$157.67	13% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES AB SMPLX TYPE 2	$105.75	$141.00	$1.00–$157.67	30% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES AB SMPLX TYPE 2/2	$261.00	$348.00	$1.00–$348.00	220% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES AB SMPLX TYPE 2/3	$739.50	$986.00	$1.00–$986.00	807% above	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES AB SMPLX TYPE 2/7	$92.25	$123.00	$1.00–$157.67	—	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES AB SMPLX TYPE 2	$105.75	$141.00	$1.00–$157.67	—	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES AB SMPLX TYPE 2/2	$261.00	$348.00	$1.00–$348.00	—	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES AB SMPLX TYPE 2/3	$739.50	$986.00	$1.00–$986.00	—	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP HI SENSITIVITY	$156.75	$209.00	$1.00–$209.00	60% above	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP HI SENSITIVITY	$156.75	$209.00	$1.00–$209.00	—	25%
Homocysteine blood test CPT 83090 HOMOCYSTEINE QUANT/2	$246.00	$328.00	$1.00–$328.00	5% below	25%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE QUANT/2	$246.00	$328.00	$1.00–$328.00	—	25%
Insulin blood test CPT 83525 INSULIN TOTAL	$124.50	$166.00	$1.00–$166.00	29% above	25%
Insulin blood test inpatient CPT 83525 INSULIN TOTAL	$124.50	$166.00	$1.00–$166.00	—	25%
Iron blood test (serum iron) CPT 83540 IRON ASSAY	$213.00	$284.00	$1.00–$284.00	261% above	25%
Iron blood test (serum iron) CPT 83540 IRON ASSAY/2	$657.75	$877.00	$1.00–$877.00	1015% above	25%
Iron blood test (serum iron) inpatient CPT 83540 IRON ASSAY	$213.00	$284.00	$1.00–$284.00	—	25%
Iron blood test (serum iron) inpatient CPT 83540 IRON ASSAY/2	$657.75	$877.00	$1.00–$877.00	—	25%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPCTY	$212.25	$283.00	$1.00–$283.00	178% above	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPCTY	$212.25	$283.00	$1.00–$283.00	—	25%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$241.50	$322.00	$1.00–$322.00	76% above	25%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$241.50	$322.00	$1.00–$322.00	—	25%
LH (luteinizing hormone) test CPT 83002 LUTEINING HORMONE	$243.00	$324.00	$1.00–$324.00	53% above	25%
LH (luteinizing hormone) test inpatient CPT 83002 LUTEINING HORMONE	$243.00	$324.00	$1.00–$324.00	—	25%
Lactate (lactic acid) blood test CPT 83605 LACTATE(LACTIC ACID)/2	$117.75	$157.00	$1.00–$157.00	27% above	25%
Lactate (lactic acid) blood test CPT 83605 LACTATE(LACTIC ACID)	$330.00	$440.00	$1.00–$440.00	255% above	25%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE(LACTIC ACID)/2	$117.75	$157.00	$1.00–$157.00	—	25%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE(LACTIC ACID)	$330.00	$440.00	$1.00–$440.00	—	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH-LACTIC DEHYDROGENASE	$225.75	$301.00	$1.00–$301.00	283% above	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH-LACTIC DEHYDROGENASE	$225.75	$301.00	$1.00–$301.00	—	25%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE/2	$86.25	$115.00	$1.00–$115.00	at median	25%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$262.50	$350.00	$1.00–$350.00	204% above	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE/2	$86.25	$115.00	$1.00–$115.00	—	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$262.50	$350.00	$1.00–$350.00	—	25%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$373.50	$498.00	$1.00–$498.00	140% above	25%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$373.50	$498.00	$1.00–$498.00	—	25%
Lyme disease antibody test CPT 86618 LYME DISEASE AB/3	$60.75	$81.00	$1.00–$243.79	53% below	25%
Lyme disease antibody test CPT 86618 LYME DISEASE AB	$110.25	$147.00	$1.00–$243.79	15% below	25%
Lyme disease antibody test CPT 86618 LYME DISEASE AB/2	$426.75	$569.00	$1.00–$569.00	228% above	25%
Lyme disease antibody test CPT 86618 LYME DISEASE AB/5	$426.75	$569.00	$1.00–$569.00	228% above	25%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB/3	$60.75	$81.00	$1.00–$243.79	—	25%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB	$110.25	$147.00	$1.00–$243.79	—	25%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB/2	$426.75	$569.00	$1.00–$569.00	—	25%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB/5	$426.75	$569.00	$1.00–$569.00	—	25%
Magnesium blood test CPT 83735 MAGNESIUM/2	$66.75	$89.00	$1.00–$96.13	24% above	25%
Magnesium blood test CPT 83735 MAGNESIUM/4	$233.25	$311.00	$1.00–$311.00	334% above	25%
Magnesium blood test CPT 83735 MAGNESIUM	$237.75	$317.00	$1.00–$317.00	342% above	25%
Magnesium blood test inpatient CPT 83735 MAGNESIUM/2	$66.75	$89.00	$1.00–$96.13	—	25%
Magnesium blood test inpatient CPT 83735 MAGNESIUM/4	$233.25	$311.00	$1.00–$311.00	—	25%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$237.75	$317.00	$1.00–$317.00	—	25%
Measles (rubeola) antibody test CPT 86765 RUBEOLA AB	$247.50	$330.00	$1.00–$330.00	215% above	25%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA AB	$247.50	$330.00	$1.00–$330.00	—	25%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE AB SCREEN	$444.75	$593.00	$1.00–$593.00	606% above	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE AB SCREEN	$444.75	$593.00	$1.00–$593.00	—	25%
Mumps immunity blood test CPT 86735 MUMPS AB/2	$87.00	$116.00	$1.00–$116.00	1% above	25%
Mumps immunity blood test CPT 86735 MUMPS AB	$247.50	$330.00	$1.00–$330.00	188% above	25%
Mumps immunity blood test inpatient CPT 86735 MUMPS AB/2	$87.00	$116.00	$1.00–$116.00	—	25%
Mumps immunity blood test inpatient CPT 86735 MUMPS AB	$247.50	$330.00	$1.00–$330.00	—	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$93.00	$124.00	$1.00–$200.71	21% below	25%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE	$93.00	$124.00	$1.00–$200.71	—	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL	$96.00	$128.00	$1.00–$224.33	12% below	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL	$96.00	$128.00	$1.00–$224.33	—	25%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTO C/V PREP AUTO	$153.00	$204.00	$1.00–$216.84	88% above	25%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO C/V PREP AUTO	$153.00	$204.00	$1.00–$216.84	—	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTO PRESERV FLD AUTO TL	$172.50	$230.00	$1.00–$230.00	43% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTO C/V PREP SCREEN	$219.00	$292.00	$1.00–$292.00	81% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTO PRESERV FLD AUTO TL	$172.50	$230.00	$1.00–$230.00	—	25%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTO C/V PREP SCREEN	$219.00	$292.00	$1.00–$292.00	—	25%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PTH)/5	$214.50	$286.00	$1.00–$598.31	7% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PTH)	$310.50	$414.00	$1.00–$598.31	55% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PTH)/2	$478.50	$638.00	$1.00–$638.00	139% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PTH)/4	$691.50	$922.00	$1.00–$922.00	245% above	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE (PTH)/5	$214.50	$286.00	$1.00–$598.31	—	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE (PTH)	$310.50	$414.00	$1.00–$598.31	—	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE (PTH)/2	$478.50	$638.00	$1.00–$638.00	—	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE (PTH)/4	$691.50	$922.00	$1.00–$922.00	—	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$225.00	$300.00	$1.00–$300.00	317% above	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$225.00	$300.00	$1.00–$300.00	—	25%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS	$133.50	$178.00	$1.00–$178.00	200% above	25%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS	$133.50	$178.00	$1.00–$178.00	—	25%
Potassium blood test CPT 84132 POTASSIUM	$126.00	$168.00	$1.00–$168.00	180% above	25%
Potassium blood test inpatient CPT 84132 POTASSIUM	$126.00	$168.00	$1.00–$168.00	—	25%
Progesterone blood test CPT 84144 PROGESTERONE	$218.25	$291.00	$1.00–$291.00	51% above	25%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$218.25	$291.00	$1.00–$291.00	—	25%
Prolactin blood test CPT 84146 PROLACTIN	$69.00	$92.00	$1.00–$171.96	50% below	25%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$69.00	$92.00	$1.00–$171.96	—	25%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$177.75	$237.00	$1.00–$237.00	362% above	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$177.75	$237.00	$1.00–$237.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRGSCRN DIRECT OPT OBS	$51.00	$68.00	$0.29–$77.73	29% above	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRGSCRN DIRCT OPT OBS	$64.50	$86.00	$0.29–$86.00	63% above	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRGSCRN DIRECT OPT OBS	$51.00	$68.00	$0.29–$77.73	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRGSCRN DIRCT OPT OBS	$64.50	$86.00	$0.29–$86.00	—	25%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA DIR OPT/2	$85.50	$114.00	$1.00–$114.00	at median	25%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA DIR OPT	$85.50	$114.00	$1.00–$114.00	at median	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA DIR OPT/2	$85.50	$114.00	$1.00–$114.00	—	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA DIR OPT	$85.50	$114.00	$1.00–$114.00	—	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREPTOCOCCUS A DIR OPT	$419.25	$559.00	$1.00–$559.00	379% above	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREPTOCOCCUS A DIR OPT	$419.25	$559.00	$1.00–$559.00	—	25%
Renin blood test CPT 84244 RENIN	$230.25	$307.00	$1.00–$307.00	48% above	25%
Renin blood test inpatient CPT 84244 RENIN	$230.25	$307.00	$1.00–$307.00	—	25%
Rh blood typing CPT 86901 BLD TYPE RH (D)	$128.25	$171.00	$1.00–$171.00	160% above	25%
Rh blood typing inpatient CPT 86901 BLD TYPE RH (D)	$128.25	$171.00	$1.00–$171.00	—	25%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT	$130.50	$174.00	$1.00–$174.00	89% above	25%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT	$130.50	$174.00	$1.00–$174.00	—	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB/2	$124.50	$166.00	$1.00–$166.00	92% above	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB/4	$140.25	$187.00	$1.00–$187.00	116% above	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB/3	$180.00	$240.00	$1.00–$240.00	177% above	25%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB/2	$124.50	$166.00	$1.00–$166.00	—	25%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB/4	$140.25	$187.00	$1.00–$187.00	—	25%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB/3	$180.00	$240.00	$1.00–$240.00	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE AUTO	$188.25	$251.00	$1.00–$251.00	245% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE AUTO	$188.25	$251.00	$1.00–$251.00	—	25%
Sodium blood test CPT 84295 SODIUM	$36.75	$49.00	$1.00–$49.00	15% below	25%
Sodium blood test inpatient CPT 84295 SODIUM	$36.75	$49.00	$1.00–$49.00	—	25%
Stool ova and parasites exam CPT 87177 OVA & PARASITES SMEARS	$11.25	$15.00	$1.00–$120.73	89% below	25%
Stool ova and parasites exam CPT 87177 OVA & PARASITES SMEARS/2	$14.25	$19.00	$1.00–$120.73	87% below	25%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES SMEARS	$11.25	$15.00	$1.00–$120.73	—	25%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES SMEARS/2	$14.25	$19.00	$1.00–$120.73	—	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLD STL 1-3	$130.50	$174.00	$1.00–$174.00	335% above	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLD STL 1-3	$130.50	$174.00	$1.00–$174.00	—	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM AB/2	$76.50	$102.00	$1.00–$102.00	13% above	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM AB/4	$128.25	$171.00	$1.00–$171.00	90% above	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM AB	$198.00	$264.00	$1.00–$264.00	193% above	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM AB/2	$76.50	$102.00	$1.00–$102.00	—	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM AB/4	$128.25	$171.00	$1.00–$171.00	—	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM AB	$198.00	$264.00	$1.00–$264.00	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS NONTREP QUAL	$134.25	$179.00	$1.00–$179.00	187% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS NONTREP QUAL	$134.25	$179.00	$1.00–$179.00	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL AG RESPONSE	$219.00	$292.00	$1.00–$531.35	5% above	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL AG RESPONSE	$219.00	$292.00	$1.00–$531.35	—	25%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$58.50	$78.00	$1.00–$275.01	48% below	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL	$58.50	$78.00	$1.00–$275.01	—	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EA/3	$47.25	$63.00	$1.00–$118.26	56% below	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EA	$160.50	$214.00	$1.00–$214.00	51% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EA/2	$269.25	$359.00	$1.00–$359.00	153% above	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODY EA/3	$47.25	$63.00	$1.00–$118.26	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODY EA	$160.50	$214.00	$1.00–$214.00	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODY EA/2	$269.25	$359.00	$1.00–$359.00	—	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$450.00	$600.00	$1.00–$600.00	222% above	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$450.00	$600.00	$1.00–$600.00	—	25%
Total IgE blood test CPT 82785 IG-E SERUM/3	$92.25	$123.00	$1.00–$135.81	32% below	25%
Total IgE blood test CPT 82785 IG-E SERUM	$107.25	$143.00	$1.00–$143.00	21% below	25%
Total IgE blood test inpatient CPT 82785 IG-E SERUM/3	$92.25	$123.00	$1.00–$135.81	—	25%
Total IgE blood test inpatient CPT 82785 IG-E SERUM	$107.25	$143.00	$1.00–$143.00	—	25%
Total cholesterol blood test CPT 82465 CHOLESTEROL TOTAL	$79.50	$106.00	$1.00–$106.00	102% above	25%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL TOTAL	$79.50	$106.00	$1.00–$106.00	—	25%
Total thyroxine (T4) blood test CPT 84436 THYROXINE TOTAL	$164.25	$219.00	$1.00–$219.00	145% above	25%
Total thyroxine (T4) blood test inpatient CPT 84436 THYROXINE TOTAL	$164.25	$219.00	$1.00–$219.00	—	25%
Total triiodothyronine (T3) blood test CPT 84480 TRIIODTHYRNINE TOTAL T3	$73.50	$98.00	$1.00–$116.11	39% below	25%
Total triiodothyronine (T3) blood test inpatient CPT 84480 TRIIODTHYRNINE TOTAL T3	$73.50	$98.00	$1.00–$116.11	—	25%
Transferrin blood test CPT 84466 TRANSFERRIN	$213.00	$284.00	$1.00–$284.00	85% above	25%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$213.00	$284.00	$1.00–$284.00	—	25%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS AMP PROBE	$143.25	$191.00	$1.00–$191.00	5% above	25%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS AMP PROBE	$143.25	$191.00	$1.00–$191.00	—	25%
Triglycerides blood test CPT 84478 TRIGLYCERIDES/2	$84.75	$113.00	$1.00–$113.00	90% above	25%
Triglycerides blood test CPT 84478 TRIGLYCERIDES	$99.75	$133.00	$1.00–$133.00	124% above	25%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES/2	$84.75	$113.00	$1.00–$113.00	—	25%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES	$99.75	$133.00	$1.00–$133.00	—	25%
Troponin test, quantitative CPT 84484 TROPONIN QUAN	$384.00	$512.00	$1.00–$512.00	176% above	25%
Troponin test, quantitative inpatient CPT 84484 TROPONIN QUAN	$384.00	$512.00	$1.00–$512.00	—	25%
Uric acid blood test CPT 84550 URIC ACID BLOOD	$177.75	$237.00	$1.00–$237.00	201% above	25%
Uric acid blood test inpatient CPT 84550 URIC ACID BLOOD	$177.75	$237.00	$1.00–$237.00	—	25%
Urinalysis with microscope exam, automated CPT 81001 UA AUTO W/MICRO	$207.75	$277.00	$1.00–$277.00	217% above	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA AUTO W/MICRO	$207.75	$277.00	$1.00–$277.00	—	25%
Urinalysis with microscope exam, manual CPT 81000 UA NON-AUTO W/MICRO	$21.75	$29.00	$1.00–$33.41	19% below	25%
Urinalysis with microscope exam, manual inpatient CPT 81000 UA NON-AUTO W/MICRO	$21.75	$29.00	$1.00–$33.41	—	25%
Urinalysis without microscope exam, automated CPT 81003 UA AUTO W/O MICRO/2	$85.50	$114.00	$1.00–$114.00	116% above	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA AUTO W/O MICRO/2	$85.50	$114.00	$1.00–$114.00	—	25%
Urinalysis without microscope exam, manual CPT 81002 UA NON-AUTO W/O MICRO	$83.25	$111.00	$1.00–$111.00	218% above	25%
Urinalysis without microscope exam, manual CPT 81002 UA NON-AUTO W/O MICRO/4	$100.50	$134.00	$1.00–$134.00	283% above	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA NON-AUTO W/O MICRO	$83.25	$111.00	$1.00–$111.00	—	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA NON-AUTO W/O MICRO/4	$100.50	$134.00	$1.00–$134.00	—	25%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE COLONY CT	$302.25	$403.00	$1.00–$403.00	196% above	25%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE COLONY CT	$302.25	$403.00	$1.00–$403.00	—	25%
Urine microalbumin (albumin) test CPT 82043 MICRO ALBUMIN URINE QNT	$29.25	$39.00	$1.00–$74.36	60% below	25%
Urine microalbumin (albumin) test CPT 82043 MICRO ALBUMIN URINE QNT/3	$87.75	$117.00	$1.00–$117.00	21% above	25%
Urine microalbumin (albumin) test inpatient CPT 82043 MICRO ALBUMIN URINE QNT	$29.25	$39.00	$1.00–$74.36	—	25%
Urine microalbumin (albumin) test inpatient CPT 82043 MICRO ALBUMIN URINE QNT/3	$87.75	$117.00	$1.00–$117.00	—	25%
Urine pregnancy test, read by color change CPT 81025 URINE PREG TEST QUAL	$45.75	$61.00	$1.00–$86.16	45% below	25%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREG TEST QUAL	$45.75	$61.00	$1.00–$86.16	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBLMN(VIT B12)	$276.00	$368.00	$1.00–$368.00	152% above	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBLMN(VIT B12)	$276.00	$368.00	$1.00–$368.00	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D/25 HYDROXY/3	$153.75	$205.00	$1.00–$243.12	at median	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D/25 HYDROXY/2	$394.50	$526.00	$1.00–$526.00	157% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D/25 HYDROXY	$417.00	$556.00	$1.00–$556.00	171% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D/25 HYDROXY/3	$153.75	$205.00	$1.00–$243.12	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D/25 HYDROXY/2	$394.50	$526.00	$1.00–$526.00	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D/25 HYDROXY	$417.00	$556.00	$1.00–$556.00	—	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D1 25-DIHYDROXY	$366.00	$488.00	$1.00–$488.00	131% above	25%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D1 25-DIHYDROXY	$366.00	$488.00	$1.00–$488.00	—	25%
Zinc blood test CPT 84630 ZINC	$84.75	$113.00	$1.00–$141.22	40% below	25%
Zinc blood test CPT 84630 ZINC/2	$105.75	$141.00	$1.00–$141.22	26% below	25%
Zinc blood test inpatient CPT 84630 ZINC	$84.75	$113.00	$1.00–$141.22	—	25%
Zinc blood test inpatient CPT 84630 ZINC/2	$105.75	$141.00	$1.00–$141.22	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADTOPN CHORNC(HCG)QNT	$454.50	$606.00	$1.00–$606.00	416% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADTOPN CHORNC(HCG)QNT	$454.50	$606.00	$1.00–$606.00	—	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs South Carolina	Off list
Cardiac catheterization with coronary angiogram CPT 93458 CATH L HRT ARTERY/VENTR	$41,122.50	$54,830.00	$1.00–$53,943.00	263% above	25%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 CATH L HRT ARTERY/VENTR	$41,122.50	$54,830.00	$1.00–$53,943.00	—	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELEC	$2,760.00	$3,680.00	$1.00–$3,000.00	99% above	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELEC/SCHED	$2,760.00	$3,680.00	$1.00–$3,000.00	99% above	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE	$2,760.00	$3,680.00	$1.00–$3,000.00	99% above	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CONVERSION ARRHYTHMIA	$2,760.00	$3,680.00	$1.00–$3,000.00	99% above	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CONVERSION ARRHYTHMIA	$2,760.00	$3,680.00	$1.00–$3,000.00	—	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTIVE	$2,760.00	$3,680.00	$1.00–$3,000.00	—	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELEC/SCHED	$2,760.00	$3,680.00	$1.00–$3,000.00	—	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELEC	$2,760.00	$3,680.00	$1.00–$3,000.00	—	25%
Catheter ablation for atrial fibrillation CPT 93656 CMP EP ABL INTRA AFIB PVI EP3D	$53,433.75	$71,245.00	$1.00–$67,682.75	35% above	25%
Catheter ablation for atrial fibrillation inpatient CPT 93656 CMP EP ABL INTRA AFIB PVI EP3D	$53,433.75	$71,245.00	$1.00–$67,682.75	—	25%
Coronary stent placement, one artery CPT 92928 COR STNT ANGIO INIT	$37,125.75	$49,501.00	$1.00–$55,456.00	183% above	25%
Coronary stent placement, one artery inpatient CPT 92928 COR STNT ANGIO INIT	$37,125.75	$49,501.00	$1.00–$55,456.00	—	25%
Left heart catheterization, diagnostic one side CPT 93452 CATH LT HRT W/LTVENT	$30,087.00	$40,116.00	$1.00–$53,943.00	293% above	25%
Left heart catheterization, diagnostic inpatient one side CPT 93452 CATH LT HRT W/LTVENT	$30,087.00	$40,116.00	$1.00–$53,943.00	—	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs South Carolina	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION 1-2 UNITS	$1,078.50	$1,438.00	$1.00–$4,882.00	5% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION 3-4 UNITS	$1,183.50	$1,578.00	$1.00–$4,882.00	16% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION 5-6 UNITS	$1,307.25	$1,743.00	$1.00–$4,882.00	28% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION 7-8 UNITS	$1,435.50	$1,914.00	$1.00–$4,882.00	40% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION 9-10 UNIT	$1,580.25	$2,107.00	$1.00–$4,882.00	54% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION >10 UNITS	$1,738.50	$2,318.00	$1.00–$4,882.00	70% above	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION 1-2 UNITS	$1,078.50	$1,438.00	$1.00–$4,882.00	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION 3-4 UNITS	$1,183.50	$1,578.00	$1.00–$4,882.00	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION 5-6 UNITS	$1,307.25	$1,743.00	$1.00–$4,882.00	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION 7-8 UNITS	$1,435.50	$1,914.00	$1.00–$4,882.00	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION 9-10 UNIT	$1,580.25	$2,107.00	$1.00–$4,882.00	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION >10 UNITS	$1,738.50	$2,318.00	$1.00–$4,882.00	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB TX	$1,239.00	$1,652.00	$8.92–$142.72	693% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI TREATMENT	$1,239.00	$1,652.00	$8.92–$142.72	693% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HAND HELD NEB TREATMENT	$1,239.00	$1,652.00	$8.92–$142.72	693% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM INDUCTION	$1,239.00	$1,652.00	$8.92–$142.72	693% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB TX	$1,239.00	$1,652.00	$8.92–$142.72	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HAND HELD NEB TREATMENT	$1,239.00	$1,652.00	$8.92–$142.72	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI TREATMENT	$1,239.00	$1,652.00	$8.92–$142.72	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM INDUCTION	$1,239.00	$1,652.00	$8.92–$142.72	—	25%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV <=1H INIT	$324.00	$432.00	$248.41–$1,009.21	58% below	25%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV <=1H INIT	$324.00	$432.00	$248.41–$1,009.21	—	25%
Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE E&M 30-74 MIN	$3,288.75	$4,385.00	$0.29–$2,565.00	17% above	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRIT CARE E&M 30-74 MIN	$3,288.75	$4,385.00	$0.29–$2,565.00	—	25%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE/DROWSY	$1,725.75	$2,301.00	$492.94–$821.72	129% above	25%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE/DROWSY	$1,725.75	$2,301.00	$492.94–$821.72	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACE ONLY	$690.75	$921.00	$84.19–$140.04	169% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACE ONLY	$690.75	$921.00	$84.19–$140.04	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER VISIT LVL I	$659.25	$879.00	$0.29–$311.00	120% above	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER VISIT LVL I	$659.25	$879.00	$0.29–$311.00	—	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 OB ER VISIT LVL II	$620.25	$827.00	$0.29–$311.00	19% above	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER VISIT LVL II	$1,182.00	$1,576.00	$0.29–$311.00	127% above	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 OB ER VISIT LVL II	$620.25	$827.00	$0.29–$311.00	—	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER VISIT LVL II	$1,182.00	$1,576.00	$0.29–$311.00	—	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER VISIT LVL III	$1,840.50	$2,454.00	$0.29–$920.00	109% above	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 OB ER VISIT LVL III	$1,840.50	$2,454.00	$0.29–$920.00	109% above	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER VISIT LVL III	$1,840.50	$2,454.00	$0.29–$920.00	—	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 OB ER VISIT LVL III	$1,840.50	$2,454.00	$0.29–$920.00	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 OB ER VISIT LVL IV	$2,415.75	$3,221.00	$0.29–$1,994.00	62% above	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER VISIT LVL IV	$3,372.00	$4,496.00	$0.29–$1,994.00	126% above	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 OB ER VISIT LVL IV	$2,415.75	$3,221.00	$0.29–$1,994.00	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER VISIT LVL IV	$3,372.00	$4,496.00	$0.29–$1,994.00	—	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 OB ER VISIT LVL V	$2,762.25	$3,683.00	$0.29–$1,994.00	27% above	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER VISIT LVL V	$4,026.00	$5,368.00	$0.29–$1,994.00	85% above	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 OB ER VISIT LVL V	$2,762.25	$3,683.00	$0.29–$1,994.00	—	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER VISIT LVL V	$4,026.00	$5,368.00	$0.29–$1,994.00	—	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIO STRESS TRACE ONLY	$1,907.25	$2,543.00	$27.43–$918.03	85% above	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIO STRESS TRACE ONLY	$1,907.25	$2,543.00	$27.43–$918.03	—	25%
Family therapy with the patient, 50 minutes CPT 90847 FMLY THRPY 30 MIN	$420.75	$561.00	$524.37–$793.51	29% above	25%
Family therapy with the patient, 50 minutes CPT 90847 FMLY THRPY 45 MIN	$610.50	$814.00	$524.37–$793.51	88% above	25%
Family therapy with the patient, 50 minutes CPT 90847 FMLY THRPY 60 MIN	$886.50	$1,182.00	$524.37–$793.51	173% above	25%
Family therapy with the patient, 50 minutes CPT 90847 FMLY THRPY 90 MIN	$1,786.50	$2,382.00	$524.37–$793.51	450% above	25%
Family therapy with the patient, 50 minutes CPT 90847 FMLY THRPY 120MIN	$2,376.00	$3,168.00	$524.37–$793.51	631% above	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FMLY THRPY 30 MIN	$420.75	$561.00	$524.37–$793.51	—	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FMLY THRPY 45 MIN	$610.50	$814.00	$524.37–$793.51	—	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FMLY THRPY 60 MIN	$886.50	$1,182.00	$524.37–$793.51	—	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FMLY THRPY 90 MIN	$1,786.50	$2,382.00	$524.37–$793.51	—	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FMLY THRPY 120MIN	$2,376.00	$3,168.00	$524.37–$793.51	—	25%
Family therapy without the patient, 50 minutes CPT 90846 FMLY THRPY W/O PT 50MIN	$597.75	$797.00	$524.37–$793.51	60% above	25%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FMLY THRPY W/O PT 50MIN	$597.75	$797.00	$524.37–$793.51	—	25%
Group psychotherapy session CPT 90853 GRP PSYCHTHRPY 30 MIN	$357.00	$476.00	$206.72–$312.83	116% above	25%
Group psychotherapy session CPT 90853 GRP PSYCHTHRPY 45 MIN	$594.00	$792.00	$206.72–$312.83	259% above	25%
Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY	$664.50	$886.00	$206.72–$312.83	301% above	25%
Group psychotherapy session CPT 90853 GRP PSYCHTHRPY 60 MIN	$714.75	$953.00	$206.72–$312.83	332% above	25%
Group psychotherapy session CPT 90853 GRP PSYCHTHRPY 90 MIN	$1,015.50	$1,354.00	$206.72–$312.83	513% above	25%
Group psychotherapy session inpatient CPT 90853 GRP PSYCHTHRPY 30 MIN	$357.00	$476.00	$206.72–$312.83	—	25%
Group psychotherapy session inpatient CPT 90853 GRP PSYCHTHRPY 45 MIN	$594.00	$792.00	$206.72–$312.83	—	25%
Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY	$664.50	$886.00	$206.72–$312.83	—	25%
Group psychotherapy session inpatient CPT 90853 GRP PSYCHTHRPY 60 MIN	$714.75	$953.00	$206.72–$312.83	—	25%
Group psychotherapy session inpatient CPT 90853 GRP PSYCHTHRPY 90 MIN	$1,015.50	$1,354.00	$206.72–$312.83	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INF HYD INIT 31-60MIN	$897.75	$1,197.00	$42.68–$395.52	106% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INF HYD INIT 31-60MIN	$897.75	$1,197.00	$42.68–$395.52	—	25%
IV infusion of a medicine, first hour CPT 96365 IV INF TX INIT <=1 HR	$705.75	$941.00	$52.36–$690.57	43% above	25%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF TX INIT <=1 HR	$705.75	$941.00	$52.36–$690.57	—	25%
IV push of a medicine, first drug CPT 96374 INJ TX/PRPH/DX IVP INT	$301.50	$402.00	$33.12–$193.96	29% above	25%
IV push of a medicine, first drug inpatient CPT 96374 INJ TX/PRPH/DX IVP INT	$301.50	$402.00	$33.12–$193.96	—	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ ANTIBIOTIC IM	$191.25	$255.00	$4.00–$133.64	48% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ TX/PROPH/DX SQ/IM	$191.25	$255.00	$4.00–$133.64	48% above	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ TX/PROPH/DX SQ/IM	$191.25	$255.00	$4.00–$133.64	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ ANTIBIOTIC IM	$191.25	$255.00	$4.00–$133.64	—	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAG EVAL	$834.75	$1,113.00	$344.18–$520.83	171% above	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAG EVAL	$834.75	$1,113.00	$344.18–$520.83	—	25%
New patient office visit, about 30 minutes CPT 99203 E&M-NEW PATIENT-LVL III	$683.25	$911.00	$0.29–$136.36	227% above	25%
New patient office visit, about 30 minutes CPT 99203 L&D TRIAGE NEW PT	$717.00	$956.00	$0.29–$136.36	244% above	25%
New patient office visit, about 30 minutes inpatient CPT 99203 E&M-NEW PATIENT-LVL III	$683.25	$911.00	$0.29–$136.36	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 L&D TRIAGE NEW PT	$717.00	$956.00	$0.29–$136.36	—	25%
New patient office visit, about 45 minutes CPT 99204 E&M-NEW PATIENT-LVL IV	$1,302.75	$1,737.00	$0.29–$188.70	481% above	25%
New patient office visit, about 45 minutes inpatient CPT 99204 E&M-NEW PATIENT-LVL IV	$1,302.75	$1,737.00	$0.29–$188.70	—	25%
New patient office visit, about 60 minutes CPT 99205 E&M-NEW PATIENT-LVL V	$1,490.25	$1,987.00	$0.29–$255.41	369% above	25%
New patient office visit, about 60 minutes inpatient CPT 99205 E&M-NEW PATIENT-LVL V	$1,490.25	$1,987.00	$0.29–$255.41	—	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 E&M-NEW PATIENT-LVL II	$476.25	$635.00	$0.29–$93.65	148% above	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 E&M-NEW PATIENT-LVL II	$476.25	$635.00	$0.29–$93.65	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUTRTN TH INIT 15MIN	$61.50	$82.00	$1.00–$32.48	28% above	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUTRTN TH INIT 15MIN	$61.50	$82.00	$1.00–$32.48	—	25%
Psychotherapy session, 30 minutes CPT 90832 PSY THRPY 30 MIN PT	$324.00	$432.00	$276.26–$418.06	109% above	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSY THRPY 30 MIN PT	$324.00	$432.00	$276.26–$418.06	—	25%
Psychotherapy session, 45 minutes CPT 90834 PSY THRPY 45MIN PT	$770.25	$1,027.00	$344.18–$520.83	262% above	25%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSY THRPY 45MIN PT	$770.25	$1,027.00	$344.18–$520.83	—	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMKE/TOBAC CNSL 3-10MIN	$120.00	$160.00	$36.47–$55.19	129% above	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMKE/TOBAC CNSL 3-10MIN	$120.00	$160.00	$36.47–$55.19	—	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E&M-EST. PATIENT-LVL V	$889.50	$1,186.00	$0.29–$198.55	229% above	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E&M-EST. PATIENT-LVL V	$889.50	$1,186.00	$0.29–$198.55	—	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M-EST. PATIENT-LVL III	$398.25	$531.00	$0.29–$108.50	267% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 L&D TRIAGE EST PT	$636.75	$849.00	$0.29–$108.50	486% above	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E&M-EST. PATIENT-LVL III	$398.25	$531.00	$0.29–$108.50	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 L&D TRIAGE EST PT	$636.75	$849.00	$0.29–$108.50	—	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E&M-EST. PATIENT-LVL IV	$665.25	$887.00	$0.29–$145.87	227% above	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E&M-EST. PATIENT-LVL IV	$665.25	$887.00	$0.29–$145.87	—	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M-EST. PATIENT-LVL II	$285.00	$380.00	$0.29–$81.66	110% above	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E&M-EST. PATIENT-LVL II	$285.00	$380.00	$0.29–$81.66	—	25%
Spirometry (breathing test) CPT 94010 SPIROMETRY	$856.50	$1,142.00	$177.24–$295.31	268% above	25%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY	$856.50	$1,142.00	$177.24–$295.31	—	25%
Spirometry before and after a bronchodilator CPT 94060 BRONCHOSPASM EVAL PRE/PS	$2,310.75	$3,081.00	$295.76–$493.11	426% above	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHOSPASM EVAL PRE/PS	$2,310.75	$3,081.00	$295.76–$493.11	—	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC	$270.00	$360.00	$127.47–$8,013.00	at median	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY/THERAPEUTIC	$270.00	$360.00	$127.47–$8,013.00	at median	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC	$270.00	$360.00	$127.47–$8,013.00	—	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY/THERAPEUTIC	$270.00	$360.00	$127.47–$8,013.00	—	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs South Carolina	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACC IJ	$1,039.50	$1,386.00	$0.29–$179.95	255% above	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACC IJ	$1,039.50	$1,386.00	$0.29–$179.95	—	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP VACC <7YR IJ	$156.00	$208.00	$28.75	80% above	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP VACC <7YR IJ	$156.00	$208.00	$28.75	—	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP/HEP B/IPV VAC.5MLIJ	$330.00	$440.00	$0.29–$101.34	6% above	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP/HEP B/IPV VAC.5MLIJ	$330.00	$440.00	$0.29–$101.34	—	25%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-HIB-IP VACCINE IJ	$212.25	$283.00	$117.52	24% above	25%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP-HIB-IP VACCINE IJ	$212.25	$283.00	$117.52	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VAC > 3 YRS IM PF IJ	$45.00	$60.00	$0.29–$19.29	98% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VAC > 3 YRS IM PF IJ	$45.00	$60.00	$0.29–$19.29	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VAC ADULT IJ	$1,912.50	$2,550.00	$0.29–$97.48	1240% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VAC ADULT IJ	$1,912.50	$2,550.00	$0.29–$97.48	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B VAC PED/ADOL3DS IJ	$72.00	$96.00	$0.29–$39.88	15% above	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B VAC PED/ADOL3DS IJ	$72.00	$96.00	$0.29–$39.88	—	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPH B PRP-T VAC IJ	$72.75	$97.00	$12.83	43% above	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPH B PRP-T VAC IJ	$72.75	$97.00	$12.83	—	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES/MUMPS/RUB VACCIJ	$525.00	$700.00	$93.31	262% above	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES/MUMPS/RUB VACCIJ	$525.00	$700.00	$93.31	—	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL VAC IM IJ	$450.00	$600.00	$0.29–$163.96	106% above	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL VAC IM IJ	$450.00	$600.00	$0.29–$163.96	—	25%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENINGOOCCAL-TT VAC IM IJ	$219.75	$293.00	$169.10	at median	25%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENINGOOCCAL-TT VAC IM IJ	$219.75	$293.00	$169.10	—	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B OMV VAC PFSIJ	$830.25	$1,107.00	$233.21–$264.08	at median	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B OMV VAC PFSIJ	$830.25	$1,107.00	$233.21–$264.08	—	25%
Meningococcal B vaccine (Trumenba) CPT 90621 MENINGO VAC IM RCMB LIPO PFSIJ	$454.50	$606.00	$190.10–$203.88	1% above	25%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 MENINGO VAC IM RCMB LIPO PFSIJ	$454.50	$606.00	$190.10–$203.88	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOC 13 VAL VACC IJ	$843.00	$1,124.00	$0.29–$225.97	123% above	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOC 13 VAL VACC IJ	$843.00	$1,124.00	$0.29–$225.97	—	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT VACCINE	$843.75	$1,125.00	$270.08	53% above	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT VACCINE	$843.75	$1,125.00	$270.08	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOC23 VAL VACC IJ	$267.00	$356.00	$56.95–$115.21	69% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOC23 VAL VACC IJ	$267.00	$356.00	$56.95–$115.21	—	25%
Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VAC IM/SQ IJ	$87.00	$116.00	$43.89	37% above	25%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOVIRUS VAC IM/SQ IJ	$87.00	$116.00	$43.89	—	25%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 NIRSEVIMAB-ALIP RSV MAB 1ML IJ	$243.00	$324.00	$1.00–$669.20	68% below	25%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 NIRSEVIMAB-ALIP RSV MAB 1ML IJ	$243.00	$324.00	$1.00–$669.20	—	25%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM IJ	$2,138.25	$2,851.00	$0.29–$317.67	at median	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM IJ	$2,138.25	$2,851.00	$0.29–$317.67	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 DIPHTHER TET >7YR PF IJ	$189.00	$252.00	$33.96	122% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 DIPHTHER TET >7YR PF IJ	$189.00	$252.00	$33.96	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP > 7YR VAC IJ	$315.75	$421.00	$39.07	166% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP > 7YR VAC IJ	$315.75	$421.00	$39.07	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMM ADMIN SNGL/COMBO VAC	$165.00	$220.00	$79.76–$133.64	199% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMM ADMIN SNGL/COMBO VAC	$165.00	$220.00	$79.76–$133.64	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMM ADM EA ADDL VACCINE	$233.25	$311.00	$79.48–$120.27	452% above	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMM ADM EA ADDL VACCINE	$233.25	$311.00	$79.48–$120.27	—	25%

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

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

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

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

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

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

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

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

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

Source file: https://mrfs.hyvehealthcare.com/TenetHealth/953561198_amisub-of-south-carolina%2C-inc._standardcharges.json