Kaiser Foundation Hospital - Moanalua
Kaiser Foundation Hospital - Moanalua in Honolulu, HI publishes cash prices for 443 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Hawaii median for 213 of 413 procedures and below it for 167. By typical cash price it ranks #10 of 13 Hawaii hospitals and #7 of 8 hospitals in the Urban Honolulu, HI area, cheapest first. Select a procedure to compare it with other hospitals nearby.
"3288 MOANALUA ROAD, HONOLULU, HAWAII 96819" Collected Sep 23, 2026 Source price file Check a bill from this hospital (808) 432-0000
Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 120011 · CMS hospital register NPI 1396813861
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Kaiser Foundation Hospital - Moanalua is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.
You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.
Source: IRS, section 501(r) requirements for nonprofit hospitals.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Hawaii | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W/O & W/CONTRAST MATERIAL | $2,182.50 | $2,910.00 | $267.00–$859.00 | 19% above | 25% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/O & W/CONTRAST MATERIAL | $2,182.50 | $2,910.00 | $267.00–$859.00 | — | 25% |
| Abdominal X-ray, 2 views CPT 74019 RADIOLOGIC EXAM ABDOMEN 2 VIEWS | $276.75 | $369.00 | $109.00–$350.00 | 3% below | 25% |
| Abdominal X-ray, 2 views inpatient CPT 74019 RADIOLOGIC EXAM ABDOMEN 2 VIEWS | $276.75 | $369.00 | $109.00–$350.00 | — | 25% |
| Ankle X-ray, complete, 3 or more views CPT 73610 RADEX ANKLE COMPLETE MINIMUM 3 VIEWS | $284.25 | $379.00 | $90.00–$290.00 | 18% above | 25% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RADEX ANKLE COMPLETE MINIMUM 3 VIEWS | $284.25 | $379.00 | $90.00–$290.00 | — | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL | $373.50 | $498.00 | — | 32% above | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL | $373.50 | $498.00 | — | — | 25% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTREMITY W/O CONTRAST MATERIAL | $1,380.00 | $1,840.00 | $160.00–$513.00 | 8% above | 25% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTREMITY W/O CONTRAST MATERIAL | $1,380.00 | $1,840.00 | $160.00–$513.00 | — | 25% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY | $458.25 | $611.00 | $184.00–$590.00 | 6% below | 25% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY | $458.25 | $611.00 | $184.00–$590.00 | — | 25% |
| Bone scan, whole body (nuclear medicine) CPT 78306 BONE &/JOINT IMAGING WHOLE BODY | $1,056.00 | $1,408.00 | $414.00–$1,330.00 | 2% below | 25% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE &/JOINT IMAGING WHOLE BODY | $1,056.00 | $1,408.00 | $414.00–$1,330.00 | — | 25% |
| Breast ultrasound, complete, one breast CPT 76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE | $840.00 | $1,120.00 | $109.00–$350.00 | 115% above | 25% |
| Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE | $840.00 | $1,120.00 | $109.00–$350.00 | — | 25% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED | $435.00 | $580.00 | $90.00–$290.00 | at median | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED | $435.00 | $580.00 | $90.00–$290.00 | — | 25% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG | $3,427.50 | $4,570.00 | $411.00–$1,322.00 | 11% above | 25% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG | $3,427.50 | $4,570.00 | $411.00–$1,322.00 | — | 25% |
| CT angiography (CTA) of the head CPT 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST | $2,040.00 | $2,720.00 | $268.00–$860.00 | 16% above | 25% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST | $2,040.00 | $2,720.00 | $268.00–$860.00 | — | 25% |
| CT angiography (CTA) of the neck CPT 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST | $1,965.00 | $2,620.00 | $268.00–$860.00 | 14% above | 25% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST | $1,965.00 | $2,620.00 | $268.00–$860.00 | — | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST | $1,912.50 | $2,550.00 | $268.00–$860.00 | 9% above | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST | $1,912.50 | $2,550.00 | $268.00–$860.00 | — | 25% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST | $1,965.00 | $2,620.00 | $367.00–$1,180.00 | at median | 25% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST | $1,965.00 | $2,620.00 | $367.00–$1,180.00 | — | 25% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM | $292.50 | $390.00 | $109.00–$349.00 | 133% above | 25% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM | $292.50 | $390.00 | $109.00–$349.00 | — | 25% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL | $2,400.00 | $3,200.00 | $249.00–$800.00 | 15% above | 25% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL | $2,400.00 | $3,200.00 | $249.00–$800.00 | — | 25% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN & PELVIS W/CONTRAST MATERIAL | $2,692.50 | $3,590.00 | $367.00–$1,180.00 | 16% above | 25% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN & PELVIS W/CONTRAST MATERIAL | $2,692.50 | $3,590.00 | $367.00–$1,180.00 | — | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE | $3,472.50 | $4,630.00 | $367.00–$1,180.00 | 7% above | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE | $3,472.50 | $4,630.00 | $367.00–$1,180.00 | — | 25% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST MATERIAL | $1,965.00 | $2,620.00 | $254.00–$817.00 | 8% above | 25% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST MATERIAL | $1,965.00 | $2,620.00 | $254.00–$817.00 | — | 25% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST MATERIAL | $1,747.50 | $2,330.00 | $120.00–$387.00 | 25% above | 25% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST MATERIAL | $1,747.50 | $2,330.00 | $120.00–$387.00 | — | 25% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST MATERIAL | $1,335.00 | $1,780.00 | $131.00–$420.00 | 12% above | 25% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CONTRAST MATERIAL | $1,335.00 | $1,780.00 | $131.00–$420.00 | — | 25% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O CONTRAST MATERIAL | $1,380.00 | $1,840.00 | $109.00–$350.00 | 8% above | 25% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O CONTRAST MATERIAL | $1,380.00 | $1,840.00 | $109.00–$350.00 | — | 25% |
| CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W/CONTRAST MATERIAL | $1,530.00 | $2,040.00 | $184.00–$590.00 | 9% below | 25% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD/BRAIN W/CONTRAST MATERIAL | $1,530.00 | $2,040.00 | $184.00–$590.00 | — | 25% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL | $1,747.50 | $2,330.00 | $184.00–$590.00 | 4% below | 25% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL | $1,747.50 | $2,330.00 | $184.00–$590.00 | — | 25% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O CONTRAST MATERIAL | $1,597.50 | $2,130.00 | $124.00–$397.00 | 17% above | 25% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O CONTRAST MATERIAL | $1,597.50 | $2,130.00 | $124.00–$397.00 | — | 25% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O CONTRAST MATERIAL | $1,530.00 | $2,040.00 | $125.00–$400.00 | 12% above | 25% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O CONTRAST MATERIAL | $1,530.00 | $2,040.00 | $125.00–$400.00 | — | 25% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST MATERIAL | $1,597.50 | $2,130.00 | $256.00–$823.00 | 12% above | 25% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST MATERIAL | $1,597.50 | $2,130.00 | $256.00–$823.00 | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY | $822.75 | $1,097.00 | — | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY | $822.75 | $1,097.00 | — | — | 25% |
| Chest CT scan without and with contrast CPT 71270 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+ | $1,965.00 | $2,620.00 | $204.00–$657.00 | 5% above | 25% |
| Chest CT scan without and with contrast inpatient CPT 71270 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+ | $1,965.00 | $2,620.00 | $204.00–$657.00 | — | 25% |
| Chest X-ray, 2 views CPT 71046 RADIOLOGIC EXAM CHEST 2 VIEWS | $285.00 | $380.00 | $90.00–$290.00 | 11% above | 25% |
| Chest X-ray, 2 views inpatient CPT 71046 RADIOLOGIC EXAM CHEST 2 VIEWS | $285.00 | $380.00 | $90.00–$290.00 | — | 25% |
| Chest X-ray, single view CPT 71045 RADIOLOGIC EXAM CHEST SINGLE VIEW | $246.75 | $329.00 | $90.00–$290.00 | 13% above | 25% |
| Chest X-ray, single view inpatient CPT 71045 RADIOLOGIC EXAM CHEST SINGLE VIEW | $246.75 | $329.00 | $90.00–$290.00 | — | 25% |
| Collarbone (clavicle) X-ray, complete CPT 73000 RADEX CLAVICLE COMPLETE | $264.75 | $353.00 | $90.00–$290.00 | 11% above | 25% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 RADEX CLAVICLE COMPLETE | $264.75 | $353.00 | $90.00–$290.00 | — | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE | $630.00 | $840.00 | $109.00–$350.00 | 2% below | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE | $630.00 | $840.00 | $109.00–$350.00 | — | 25% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL | $320.25 | $427.00 | $109.00–$350.00 | 10% above | 25% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL | $320.25 | $427.00 | $109.00–$350.00 | — | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL | $232.50 | $310.00 | $90.00–$290.00 | 59% above | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL | $232.50 | $310.00 | $90.00–$290.00 | — | 25% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION | $748.50 | $998.00 | $249.00–$800.00 | 18% above | 25% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION | $748.50 | $998.00 | $249.00–$800.00 | — | 25% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST | $1,552.50 | $2,070.00 | $123.00–$395.00 | 16% above | 25% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST | $1,552.50 | $2,070.00 | $123.00–$395.00 | — | 25% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST | $1,747.50 | $2,330.00 | $184.00–$590.00 | 17% above | 25% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST | $1,747.50 | $2,330.00 | $184.00–$590.00 | — | 25% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI | $540.75 | $721.00 | $109.00–$350.00 | — | 25% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI | $540.75 | $721.00 | $109.00–$350.00 | — | 25% |
| Diagnostic mammogram, one breast CPT 77065 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI | $393.00 | $524.00 | $86.00–$275.00 | 24% above | 25% |
| Diagnostic mammogram, one breast inpatient CPT 77065 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI | $393.00 | $524.00 | $86.00–$275.00 | — | 25% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY | $807.00 | $1,076.00 | — | — | 25% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY | $807.00 | $1,076.00 | — | — | 25% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY | $764.25 | $1,019.00 | — | — | 25% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY | $764.25 | $1,019.00 | — | — | 25% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D | $1,425.00 | $1,900.00 | — | 18% above | 25% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D | $1,425.00 | $1,900.00 | — | — | 25% |
| Elbow X-ray, 2 views CPT 73070 RADEX ELBOW 2 VIEWS | $232.50 | $310.00 | $90.00–$290.00 | 16% above | 25% |
| Elbow X-ray, 2 views inpatient CPT 73070 RADEX ELBOW 2 VIEWS | $232.50 | $310.00 | $90.00–$290.00 | — | 25% |
| Elbow X-ray, complete, 3 or more views CPT 73080 RADEX ELBOW COMPLETE MINIMUM 3 VIEWS | $277.50 | $370.00 | $90.00–$290.00 | 10% above | 25% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 RADEX ELBOW COMPLETE MINIMUM 3 VIEWS | $277.50 | $370.00 | $90.00–$290.00 | — | 25% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL | $1,455.00 | $1,940.00 | $147.00–$473.00 | 7% above | 25% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL | $1,455.00 | $1,940.00 | $147.00–$473.00 | — | 25% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS | $298.50 | $398.00 | $109.00–$350.00 | 16% below | 25% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS | $298.50 | $398.00 | $109.00–$350.00 | — | 25% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 RADEX FOREARM 2 VIEWS | $248.25 | $331.00 | $90.00–$290.00 | 10% above | 25% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 RADEX FOREARM 2 VIEWS | $248.25 | $331.00 | $90.00–$290.00 | — | 25% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER | $1,056.00 | $1,408.00 | $414.00–$1,330.00 | 32% above | 25% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER | $1,056.00 | $1,408.00 | $414.00–$1,330.00 | — | 25% |
| Hand X-ray, 2 views CPT 73120 RADEX HAND 2 VIEWS | $334.50 | $446.00 | $109.00–$350.00 | 39% above | 25% |
| Hand X-ray, 2 views inpatient CPT 73120 RADEX HAND 2 VIEWS | $334.50 | $446.00 | $109.00–$350.00 | — | 25% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 RADEX CALCANEUS MINIMUM 2 VIEWS | $232.50 | $310.00 | $90.00–$290.00 | 36% above | 25% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 RADEX CALCANEUS MINIMUM 2 VIEWS | $232.50 | $310.00 | $90.00–$290.00 | — | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND | $3,529.50 | $4,706.00 | — | 5% below | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND | $3,529.50 | $4,706.00 | — | — | 25% |
| Knee X-ray, 3 views CPT 73562 RADIOLOGIC EXAMINATION KNEE 3 VIEWS | $342.75 | $457.00 | $90.00–$290.00 | 19% above | 25% |
| Knee X-ray, 3 views inpatient CPT 73562 RADIOLOGIC EXAMINATION KNEE 3 VIEWS | $342.75 | $457.00 | $90.00–$290.00 | — | 25% |
| Knee X-ray, complete, 4 or more views CPT 73564 RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS | $380.25 | $507.00 | $109.00–$350.00 | 22% above | 25% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS | $380.25 | $507.00 | $109.00–$350.00 | — | 25% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTREMITY W/O CONTRAST MATERIAL | $1,380.00 | $1,840.00 | $124.00–$398.00 | 16% above | 25% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTREMITY W/O CONTRAST MATERIAL | $1,380.00 | $1,840.00 | $124.00–$398.00 | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMINAL REAL TIME W/IMAGE LIMITED | $600.00 | $800.00 | $109.00–$350.00 | 8% above | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMINAL REAL TIME W/IMAGE LIMITED | $600.00 | $800.00 | $109.00–$350.00 | — | 25% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG | $300.00 | $400.00 | $109.00–$350.00 | 14% below | 25% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG | $300.00 | $400.00 | $109.00–$350.00 | — | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C- | $652.50 | $870.00 | $129.00–$416.00 | 19% above | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C- | $652.50 | $870.00 | $129.00–$416.00 | — | 25% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS | $242.25 | $323.00 | $90.00–$290.00 | 8% above | 25% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS | $242.25 | $323.00 | $90.00–$290.00 | — | 25% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRST MATERIAL | $2,092.50 | $2,790.00 | $249.00–$800.00 | at median | 25% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CONTRST MATERIAL | $2,092.50 | $2,790.00 | $249.00–$800.00 | — | 25% |
| MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL | $1,822.50 | $2,430.00 | $347.00–$1,116.00 | — | 25% |
| MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL | $1,822.50 | $2,430.00 | $347.00–$1,116.00 | — | 25% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL | $1,747.50 | $2,330.00 | $249.00–$800.00 | 16% above | 25% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL | $1,747.50 | $2,330.00 | $249.00–$800.00 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL | $2,400.00 | $3,200.00 | $419.00–$1,347.00 | at median | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL | $2,400.00 | $3,200.00 | $419.00–$1,347.00 | — | 25% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST MATERIAL | $2,107.50 | $2,810.00 | $249.00–$800.00 | at median | 25% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST MATERIAL | $2,107.50 | $2,810.00 | $249.00–$800.00 | — | 25% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/O & W/CONTRAST MATERIAL | $2,872.50 | $3,830.00 | $367.00–$1,180.00 | 8% above | 25% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/O & W/CONTRAST MATERIAL | $2,872.50 | $3,830.00 | $367.00–$1,180.00 | — | 25% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL | $1,672.50 | $2,230.00 | $249.00–$800.00 | 18% above | 25% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL | $1,672.50 | $2,230.00 | $249.00–$800.00 | — | 25% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL | $2,272.50 | $3,030.00 | $367.00–$1,180.00 | 17% above | 25% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL | $2,272.50 | $3,030.00 | $367.00–$1,180.00 | — | 25% |
| MRI of the lower back, no contrast dye CPT 72148 MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL | $1,747.50 | $2,330.00 | $249.00–$800.00 | 14% above | 25% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL | $1,747.50 | $2,330.00 | $249.00–$800.00 | — | 25% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL | $2,610.00 | $3,480.00 | $367.00–$1,180.00 | 6% above | 25% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL | $2,610.00 | $3,480.00 | $367.00–$1,180.00 | — | 25% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL | $1,965.00 | $2,620.00 | $249.00–$800.00 | at median | 25% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL | $1,965.00 | $2,620.00 | $249.00–$800.00 | — | 25% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL | $2,182.50 | $2,910.00 | $367.00–$1,180.00 | at median | 25% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL | $2,182.50 | $2,910.00 | $367.00–$1,180.00 | — | 25% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL | $1,635.00 | $2,180.00 | $249.00–$800.00 | 12% above | 25% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL | $1,635.00 | $2,180.00 | $249.00–$800.00 | — | 25% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST MATERIAL | $2,040.00 | $2,720.00 | $249.00–$800.00 | at median | 25% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST MATERIAL | $2,040.00 | $2,720.00 | $249.00–$800.00 | — | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL | $2,407.50 | $3,210.00 | $249.00–$800.00 | 5% above | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL | $2,407.50 | $3,210.00 | $249.00–$800.00 | — | 25% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 RADEX SPINE CERVICAL 4 OR 5 VIEWS | $372.75 | $497.00 | $109.00–$350.00 | 17% above | 25% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 RADEX SPINE CERVICAL 4 OR 5 VIEWS | $372.75 | $497.00 | $109.00–$350.00 | — | 25% |
| Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W/CONTRAST MATERIAL | $1,747.50 | $2,330.00 | $184.00–$590.00 | 35% above | 25% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W/CONTRAST MATERIAL | $1,747.50 | $2,330.00 | $184.00–$590.00 | — | 25% |
| Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST MATERIAL | $1,552.50 | $2,070.00 | $134.00–$431.00 | 10% above | 25% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST MATERIAL | $1,552.50 | $2,070.00 | $134.00–$431.00 | — | 25% |
| Neck soft tissue X-ray CPT 70360 RADIOLOGIC EXAMINATION NECK SOFT TISSUE | $240.00 | $320.00 | $90.00–$290.00 | 17% below | 25% |
| Neck soft tissue X-ray inpatient CPT 70360 RADIOLOGIC EXAMINATION NECK SOFT TISSUE | $240.00 | $320.00 | $90.00–$290.00 | — | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MYOCARDIAL SPECT MULTIPLE STUDIES | $3,311.25 | $4,415.00 | $1,343.00–$4,315.00 | 28% above | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYOCARDIAL SPECT MULTIPLE STUDIES | $3,311.25 | $4,415.00 | $1,343.00–$4,315.00 | — | 25% |
| OCT scan of the retina (optical coherence tomography) both sides CPT 92134 CPTRIZED OPH DX IMG PST SEGMENT UNI/BI RETINA | $82.50 | $110.00 | — | — | 25% |
| OCT scan of the retina (optical coherence tomography) inpatient both sides CPT 92134 CPTRIZED OPH DX IMG PST SEGMENT UNI/BI RETINA | $82.50 | $110.00 | — | — | 25% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH | $3,890.25 | $5,187.00 | $1,502.00–$4,825.00 | 10% above | 25% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH | $3,890.25 | $5,187.00 | $1,502.00–$4,825.00 | — | 25% |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST MATERIAL | $1,485.00 | $1,980.00 | $123.00–$394.00 | 16% above | 25% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST MATERIAL | $1,485.00 | $1,980.00 | $123.00–$394.00 | — | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U | $435.00 | $580.00 | $109.00–$350.00 | 3% above | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U | $435.00 | $580.00 | $109.00–$350.00 | — | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE | $600.00 | $800.00 | $109.00–$350.00 | 23% above | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE | $600.00 | $800.00 | $109.00–$350.00 | — | 25% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | $528.00 | $704.00 | $109.00–$350.00 | 4% below | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | $528.00 | $704.00 | $109.00–$350.00 | — | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT | $467.25 | $623.00 | $109.00–$350.00 | 5% above | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT | $467.25 | $623.00 | $109.00–$350.00 | — | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANT UTERUS LIMITED 1/> FETUSES | $305.25 | $407.00 | $109.00–$350.00 | 25% below | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREGNANT UTERUS LIMITED 1/> FETUSES | $305.25 | $407.00 | $109.00–$350.00 | — | 25% |
| Rib X-ray, one side, 2 views one side CPT 71100 RADEX RIBS UNILATERAL 2 VIEWS | $298.50 | $398.00 | $90.00–$290.00 | 25% above | 25% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RADEX RIBS UNILATERAL 2 VIEWS | $298.50 | $398.00 | $90.00–$290.00 | — | 25% |
| Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS | $299.25 | $399.00 | $109.00–$350.00 | 13% above | 25% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS | $299.25 | $399.00 | $109.00–$350.00 | — | 25% |
| Screening mammogram, both breasts both sides CPT 77067 SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $317.25 | $423.00 | $90.00–$290.00 | — | 25% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $317.25 | $423.00 | $90.00–$290.00 | — | 25% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS | $270.75 | $361.00 | $90.00–$290.00 | 22% above | 25% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS | $270.75 | $361.00 | $90.00–$290.00 | — | 25% |
| Sinus X-ray, complete, 3 or more views CPT 70220 RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS | $240.00 | $320.00 | $90.00–$290.00 | 20% below | 25% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS | $240.00 | $320.00 | $90.00–$290.00 | — | 25% |
| Skull X-ray, fewer than 4 views CPT 70250 RADIOLOGIC EXAMINATION SKULL 4< VIEWS | $298.50 | $398.00 | $109.00–$350.00 | 1% above | 25% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 RADIOLOGIC EXAMINATION SKULL 4< VIEWS | $298.50 | $398.00 | $109.00–$350.00 | — | 25% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND | $2,749.50 | $3,666.00 | — | 6% above | 25% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND | $2,749.50 | $3,666.00 | — | — | 25% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG | $1,462.50 | $1,950.00 | — | 6% above | 25% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG | $1,462.50 | $1,950.00 | — | — | 25% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY | $483.00 | $644.00 | $184.00–$590.00 | 12% above | 25% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY | $483.00 | $644.00 | $184.00–$590.00 | — | 25% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS | $330.00 | $440.00 | $90.00–$290.00 | 17% above | 25% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS | $330.00 | $440.00 | $90.00–$290.00 | — | 25% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE W/O CONTRAST MATERIAL | $1,312.50 | $1,750.00 | $124.00–$398.00 | 7% above | 25% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE W/O CONTRAST MATERIAL | $1,312.50 | $1,750.00 | $124.00–$398.00 | — | 25% |
| Toe X-ray, 2 or more views CPT 73660 RADEX TOE MINIMUM 2 VIEWS | $232.50 | $310.00 | $90.00–$290.00 | 49% above | 25% |
| Toe X-ray, 2 or more views inpatient CPT 73660 RADEX TOE MINIMUM 2 VIEWS | $232.50 | $310.00 | $90.00–$290.00 | — | 25% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $559.50 | $746.00 | $109.00–$350.00 | 23% above | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL | $559.50 | $746.00 | $109.00–$350.00 | — | 25% |
| Transvaginal ultrasound during pregnancy CPT 76817 US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG | $532.50 | $710.00 | $109.00–$350.00 | 32% above | 25% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG | $532.50 | $710.00 | $109.00–$350.00 | — | 25% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION | $637.50 | $850.00 | $109.00–$350.00 | 14% above | 25% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION | $637.50 | $850.00 | $109.00–$350.00 | — | 25% |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM & CONTENTS | $457.50 | $610.00 | $109.00–$350.00 | 1% above | 25% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM & CONTENTS | $457.50 | $610.00 | $109.00–$350.00 | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM | $585.00 | $780.00 | $109.00–$350.00 | 8% above | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM | $585.00 | $780.00 | $109.00–$350.00 | — | 25% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY | $509.25 | $679.00 | $184.00–$590.00 | 8% above | 25% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY | $509.25 | $679.00 | $184.00–$590.00 | — | 25% |
| Upper arm X-ray (humerus), 2 views CPT 73060 RADEX HUMERUS MINIMUM 2 VIEWS | $232.50 | $310.00 | $90.00–$290.00 | 31% above | 25% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 RADEX HUMERUS MINIMUM 2 VIEWS | $232.50 | $310.00 | $90.00–$290.00 | — | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY | $600.00 | $800.00 | — | 35% above | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY | $600.00 | $800.00 | — | — | 25% |
| Wrist X-ray, 2 views CPT 73100 RADEX WRIST 2 VIEWS | $240.00 | $320.00 | $90.00–$290.00 | 6% above | 25% |
| Wrist X-ray, 2 views inpatient CPT 73100 RADEX WRIST 2 VIEWS | $240.00 | $320.00 | $90.00–$290.00 | — | 25% |
| Wrist X-ray, complete, 3 or more views CPT 73110 RADEX WRIST COMPLETE MINIMUM 3 VIEWS | $319.50 | $426.00 | $90.00–$290.00 | 22% above | 25% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RADEX WRIST COMPLETE MINIMUM 3 VIEWS | $319.50 | $426.00 | $90.00–$290.00 | — | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS | $359.25 | $479.00 | $90.00–$290.00 | 23% above | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS | $359.25 | $479.00 | $90.00–$290.00 | — | 25% |
| X-ray of the abdomen, 1 view CPT 74018 RADIOLOGIC EXAM ABDOMEN 1 VIEW | $232.50 | $310.00 | $90.00–$290.00 | 6% above | 25% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 RADIOLOGIC EXAM ABDOMEN 1 VIEW | $232.50 | $310.00 | $90.00–$290.00 | — | 25% |
| X-ray of the ankle, 2 views CPT 73600 RADIOLOGIC EXAMINATION ANKLE 2 VIEWS | $232.50 | $310.00 | $90.00–$290.00 | 24% above | 25% |
| X-ray of the ankle, 2 views inpatient CPT 73600 RADIOLOGIC EXAMINATION ANKLE 2 VIEWS | $232.50 | $310.00 | $90.00–$290.00 | — | 25% |
| X-ray of the finger(s), 2 or more views CPT 73140 RADEX FINGR MINIMUM 2 VIEWS | $232.50 | $310.00 | $90.00–$290.00 | 40% above | 25% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 RADEX FINGR MINIMUM 2 VIEWS | $232.50 | $310.00 | $90.00–$290.00 | — | 25% |
| X-ray of the foot, 2 views CPT 73620 RADIOLOGIC EXAMINATION FOOT 2 VIEWS | $255.75 | $341.00 | $90.00–$290.00 | 30% above | 25% |
| X-ray of the foot, 2 views inpatient CPT 73620 RADIOLOGIC EXAMINATION FOOT 2 VIEWS | $255.75 | $341.00 | $90.00–$290.00 | — | 25% |
| X-ray of the foot, complete, 3 or more views CPT 73630 RADEX FOOT COMPLETE MINIMUM 3 VIEWS | $298.50 | $398.00 | $90.00–$290.00 | 27% above | 25% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RADEX FOOT COMPLETE MINIMUM 3 VIEWS | $298.50 | $398.00 | $90.00–$290.00 | — | 25% |
| X-ray of the hand, 3 or more views CPT 73130 RADEX HAND MINIMUM 3 VIEWS | $338.25 | $451.00 | $90.00–$290.00 | 23% above | 25% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 RADEX HAND MINIMUM 3 VIEWS | $338.25 | $451.00 | $90.00–$290.00 | — | 25% |
| X-ray of the knee, 1 or 2 views CPT 73560 RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS | $250.50 | $334.00 | $90.00–$290.00 | 16% above | 25% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS | $250.50 | $334.00 | $90.00–$290.00 | — | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RADEX SPINE LUMBOSACRAL 2/3 VIEWS | $325.50 | $434.00 | $109.00–$350.00 | 16% above | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 RADEX SPINE LUMBOSACRAL 2/3 VIEWS | $325.50 | $434.00 | $109.00–$350.00 | — | 25% |
| X-ray of the lower back, 4 or more views CPT 72110 RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS | $436.50 | $582.00 | $109.00–$350.00 | 1% below | 25% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS | $436.50 | $582.00 | $109.00–$350.00 | — | 25% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 RADEX SPINE THORACIC 2 VIEWS | $282.00 | $376.00 | $109.00–$350.00 | 16% above | 25% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 RADEX SPINE THORACIC 2 VIEWS | $282.00 | $376.00 | $109.00–$350.00 | — | 25% |
| X-ray of the nasal bones, 3 or more views CPT 70160 RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS | $240.00 | $320.00 | $90.00–$290.00 | 5% below | 25% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS | $240.00 | $320.00 | $90.00–$290.00 | — | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RADEX SPINE CERVICAL 2 OR 3 VIEWS | $306.00 | $408.00 | $90.00–$290.00 | 10% above | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 RADEX SPINE CERVICAL 2 OR 3 VIEWS | $306.00 | $408.00 | $90.00–$290.00 | — | 25% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS | $276.75 | $369.00 | $109.00–$350.00 | 40% above | 25% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS | $276.75 | $369.00 | $109.00–$350.00 | — | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RADEX SACRUM & COCCYX MINIMUM 2 VIEWS | $268.50 | $358.00 | $90.00–$290.00 | 16% above | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 RADEX SACRUM & COCCYX MINIMUM 2 VIEWS | $268.50 | $358.00 | $90.00–$290.00 | — | 25% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Hawaii | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ADRENOCORTICOTROPIC HORMONE ACTH | $243.00 | $324.00 | $39.00–$188.00 | 15% above | 25% |
| ACTH blood test inpatient CPT 82024 ADRENOCORTICOTROPIC HORMONE ACTH | $243.00 | $324.00 | $39.00–$188.00 | — | 25% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT | $41.25 | $55.00 | $5.00–$26.00 | 13% below | 25% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT | $41.25 | $55.00 | $5.00–$26.00 | — | 25% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE ASPARTATE AMINO AST SGOT | $39.75 | $53.00 | $5.00–$25.00 | 21% below | 25% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE ASPARTATE AMINO AST SGOT | $39.75 | $53.00 | $5.00–$25.00 | — | 25% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $366.75 | $489.00 | $48.00–$233.00 | 26% below | 25% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL | $366.75 | $489.00 | $48.00–$233.00 | — | 25% |
| Albumin blood test CPT 82040 ALBUMIN SERUM PLASMA/WHOLE BLOOD | $39.00 | $52.00 | $5.00–$25.00 | 14% above | 25% |
| Albumin blood test inpatient CPT 82040 ALBUMIN SERUM PLASMA/WHOLE BLOOD | $39.00 | $52.00 | $5.00–$25.00 | — | 25% |
| Aldosterone blood test CPT 82088 ASSAY OF ALDOSTERONE | $168.75 | $225.00 | $41.00–$198.00 | 36% below | 25% |
| Aldosterone blood test inpatient CPT 82088 ASSAY OF ALDOSTERONE | $168.75 | $225.00 | $41.00–$198.00 | — | 25% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ASSAY OF PHOSPHATASE ALKALINE | $39.75 | $53.00 | $5.00–$25.00 | 21% below | 25% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ASSAY OF PHOSPHATASE ALKALINE | $39.75 | $53.00 | $5.00–$25.00 | — | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH | $25.50 | $34.00 | $5.00–$25.00 | 42% below | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH | $25.50 | $34.00 | $5.00–$25.00 | — | 25% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN SERUM | $126.00 | $168.00 | $17.00–$81.00 | 2% below | 25% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN SERUM | $126.00 | $168.00 | $17.00–$81.00 | — | 25% |
| Ammonia blood test CPT 82140 ASSAY OF AMMONIA | $135.00 | $180.00 | $15.00–$71.00 | 1% below | 25% |
| Ammonia blood test inpatient CPT 82140 ASSAY OF AMMONIA | $135.00 | $180.00 | $15.00–$71.00 | — | 25% |
| Amylase blood test CPT 82150 ASSAY OF AMYLASE | $53.25 | $71.00 | $6.00–$31.00 | 22% below | 25% |
| Amylase blood test inpatient CPT 82150 ASSAY OF AMYLASE | $53.25 | $71.00 | $6.00–$31.00 | — | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE ANTIBODY | $102.00 | $136.00 | $13.00–$63.00 | at median | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE ANTIBODY | $102.00 | $136.00 | $13.00–$63.00 | — | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES ANA | $98.25 | $131.00 | $12.00–$59.00 | 23% below | 25% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES ANA | $98.25 | $131.00 | $12.00–$59.00 | — | 25% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE | $248.25 | $331.00 | $39.00–$191.00 | 2% below | 25% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE | $248.25 | $331.00 | $39.00–$191.00 | — | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL | $73.50 | $98.00 | $8.00–$41.00 | 19% below | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL | $73.50 | $98.00 | $8.00–$41.00 | — | 25% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL CALCIUM TOTAL | $83.25 | $111.00 | $8.00–$41.00 | 1% below | 25% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL CALCIUM TOTAL | $83.25 | $111.00 | $8.00–$41.00 | — | 25% |
| Bilirubin blood test, total CPT 82247 "BILIRUBIN, TOTAL, NEONATAL" | $29.25 | $39.00 | $5.00–$25.00 | 38% below | 25% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL | $31.50 | $42.00 | $5.00–$25.00 | 33% below | 25% |
| Bilirubin blood test, total inpatient CPT 82247 "BILIRUBIN, TOTAL, NEONATAL" | $29.25 | $39.00 | $5.00–$25.00 | — | 25% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL | $31.50 | $42.00 | $5.00–$25.00 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV SURG PATH GROSS AND MICRO EXAM (HC) BKR | $325.50 | $434.00 | $40.00–$193.00 | 28% above | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | $328.50 | $438.00 | $40.00–$193.00 | 29% above | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV SURG PATH GROSS AND MICRO EXAM (HC) BKR | $325.50 | $434.00 | $40.00–$193.00 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | $328.50 | $438.00 | $40.00–$193.00 | — | 25% |
| Blood culture for bacteria CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES | $161.25 | $215.00 | $10.00–$50.00 | 61% above | 25% |
| Blood culture for bacteria inpatient CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES | $161.25 | $215.00 | $10.00–$50.00 | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION VENOUS BLOOD VENIPUNCTURE | $13.50 | $18.00 | — | 2% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION VENOUS BLOOD VENIPUNCTURE | $13.50 | $18.00 | — | — | 25% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP | $55.50 | $74.00 | $4.00–$20.00 | 52% above | 25% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP | $55.50 | $74.00 | $4.00–$20.00 | — | 25% |
| Blood lead test CPT 83655 ASSAY OF LEAD | $50.25 | $67.00 | $12.00–$59.00 | 56% below | 25% |
| Blood lead test inpatient CPT 83655 ASSAY OF LEAD | $50.25 | $67.00 | $12.00–$59.00 | — | 25% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN CHORIONIC QUALITATIVE | $71.25 | $95.00 | $7.00–$36.00 | 10% below | 25% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 GONADOTROPIN CHORIONIC QUALITATIVE | $71.25 | $95.00 | $7.00–$36.00 | — | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO | $84.75 | $113.00 | $3.00–$15.00 | 21% below | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO | $84.75 | $113.00 | $3.00–$15.00 | — | 25% |
| Blood urea nitrogen (BUN) test CPT 84520 ASSAY OF UREA NITROGEN QUANTITATIVE | $32.25 | $43.00 | $4.00–$20.00 | 14% below | 25% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 ASSAY OF UREA NITROGEN QUANTITATIVE | $32.25 | $43.00 | $4.00–$20.00 | — | 25% |
| C-peptide blood test CPT 84681 ASSAY OF C-PEPTIDE | $130.50 | $174.00 | $21.00–$101.00 | 18% below | 25% |
| C-peptide blood test inpatient CPT 84681 ASSAY OF C-PEPTIDE | $130.50 | $174.00 | $21.00–$101.00 | — | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $53.25 | $71.00 | $5.00–$25.00 | 69% above | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN | $53.25 | $71.00 | $5.00–$25.00 | — | 25% |
| C. difficile toxin gene test (stool PCR) CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE | $225.75 | $301.00 | $37.00–$182.00 | 25% below | 25% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE | $225.75 | $301.00 | $37.00–$182.00 | — | 25% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9 | $167.25 | $223.00 | $21.00–$101.00 | 12% above | 25% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9 | $167.25 | $223.00 | $21.00–$101.00 | — | 25% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 | $132.00 | $176.00 | $21.00–$101.00 | 9% below | 25% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 | $132.00 | $176.00 | $21.00–$101.00 | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ | $127.50 | $170.00 | $51.00–$249.00 | 70% above | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ | $127.50 | $170.00 | $51.00–$249.00 | — | 25% |
| Calcium blood test, total CPT 82310 CALCIUM TOTAL | $40.50 | $54.00 | $5.00–$25.00 | 19% below | 25% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM TOTAL | $40.50 | $54.00 | $5.00–$25.00 | — | 25% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CARCINOEMBRYONIC ANTIGEN CEA | $132.75 | $177.00 | $19.00–$92.00 | at median | 25% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINOEMBRYONIC ANTIGEN CEA | $132.75 | $177.00 | $19.00–$92.00 | — | 25% |
| Chickenpox (varicella) immunity blood test CPT 86787 ANTIBODY VARICELLA-ZOSTER | $93.75 | $125.00 | $13.00–$63.00 | 4% below | 25% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 ANTIBODY VARICELLA-ZOSTER | $93.75 | $125.00 | $13.00–$63.00 | — | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | $260.25 | $347.00 | $35.00–$172.00 | 135% above | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | $260.25 | $347.00 | $35.00–$172.00 | — | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $120.75 | $161.00 | $14.00–$66.00 | 3% above | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $120.75 | $161.00 | $14.00–$66.00 | — | 25% |
| Complete blood count (CBC) with differential CPT 85025 BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $63.75 | $85.00 | $8.00–$38.00 | 3% above | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $63.75 | $85.00 | $8.00–$38.00 | — | 25% |
| Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT COMPLETE AUTOMATED | $52.50 | $70.00 | $6.00–$31.00 | 10% above | 25% |
| Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT COMPLETE AUTOMATED | $52.50 | $70.00 | $6.00–$31.00 | — | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $90.00 | $120.00 | $10.00–$51.00 | 7% below | 25% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $90.00 | $120.00 | $10.00–$51.00 | — | 25% |
| Cortisol blood test, total CPT 82533 CORTISOL TOTAL | $129.75 | $173.00 | $16.00–$79.00 | 5% below | 25% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL | $129.75 | $173.00 | $16.00–$79.00 | — | 25% |
| Creatine kinase (CK) blood test, total CPT 82550 CREATINE KINASE TOTAL | $57.00 | $76.00 | $6.00–$31.00 | 16% below | 25% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CREATINE KINASE TOTAL | $57.00 | $76.00 | $6.00–$31.00 | — | 25% |
| Creatinine blood test CPT 82565 CREATININE BLOOD | $32.25 | $43.00 | $5.00–$25.00 | 8% below | 25% |
| Creatinine blood test inpatient CPT 82565 CREATININE BLOOD | $32.25 | $43.00 | $5.00–$25.00 | — | 25% |
| Cytomegalovirus (CMV) antibody test CPT 86644 ANTIBODY CYTOMEGALOVIRUS CMV | $124.50 | $166.00 | $14.00–$69.00 | at median | 25% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 ANTIBODY CYTOMEGALOVIRUS CMV | $124.50 | $166.00 | $14.00–$69.00 | — | 25% |
| D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE | $164.25 | $219.00 | $10.00–$50.00 | 54% above | 25% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE | $164.25 | $219.00 | $10.00–$50.00 | — | 25% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE-SULFATE | $139.50 | $186.00 | $22.00–$109.00 | 18% below | 25% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE-SULFATE | $139.50 | $186.00 | $22.00–$109.00 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE | $585.00 | $780.00 | $62.00–$302.00 | 514% above | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE | $585.00 | $780.00 | $62.00–$302.00 | — | 25% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL | $58.50 | $78.00 | $7.00–$35.00 | 8% below | 25% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL | $58.50 | $78.00 | $7.00–$35.00 | — | 25% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA | $89.25 | $119.00 | $18.00–$89.00 | 36% below | 25% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EBV VCA AB (IGG) | $89.25 | $119.00 | $18.00–$89.00 | 36% below | 25% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EBV VCA AB (IGM) | $92.25 | $123.00 | $18.00–$89.00 | 34% below | 25% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA | $89.25 | $119.00 | $18.00–$89.00 | — | 25% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV VCA AB (IGG) | $89.25 | $119.00 | $18.00–$89.00 | — | 25% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV VCA AB (IGM) | $92.25 | $123.00 | $18.00–$89.00 | — | 25% |
| Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL | $174.75 | $233.00 | $28.00–$135.00 | 18% below | 25% |
| Estradiol blood test inpatient CPT 82670 ASSAY OF TOTAL ESTRADIOL | $174.75 | $233.00 | $28.00–$135.00 | — | 25% |
| FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE | $117.00 | $156.00 | $19.00–$91.00 | 10% below | 25% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE | $117.00 | $156.00 | $19.00–$91.00 | — | 25% |
| Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY OF CALPROTECTIN FECAL | $130.50 | $174.00 | $20.00–$96.00 | 8% above | 25% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 ASSAY OF CALPROTECTIN FECAL | $130.50 | $174.00 | $20.00–$96.00 | — | 25% |
| Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN | $87.00 | $116.00 | $14.00–$66.00 | 28% below | 25% |
| Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN | $87.00 | $116.00 | $14.00–$66.00 | — | 25% |
| Fibrinogen blood test CPT 85384 FIBRINOGEN ACTIVITY | $80.25 | $107.00 | $10.00–$48.00 | at median | 25% |
| Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN ACTIVITY | $80.25 | $107.00 | $10.00–$48.00 | — | 25% |
| Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM | $104.25 | $139.00 | $15.00–$71.00 | 22% below | 25% |
| Folate (folic acid) blood test inpatient CPT 82746 ASSAY OF FOLIC ACID SERUM | $104.25 | $139.00 | $15.00–$71.00 | — | 25% |
| Free T3 thyroid hormone test CPT 84481 ASSAY OF TRIIODOTHYRONINE T3 FREE | $146.25 | $195.00 | $17.00–$83.00 | at median | 25% |
| Free T3 thyroid hormone test inpatient CPT 84481 ASSAY OF TRIIODOTHYRONINE T3 FREE | $146.25 | $195.00 | $17.00–$83.00 | — | 25% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE | $60.75 | $81.00 | $9.00–$45.00 | 23% below | 25% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE | $60.75 | $81.00 | $9.00–$45.00 | — | 25% |
| Free testosterone test CPT 84402 ASSAY OF TESTOSTERONE FREE | $85.50 | $114.00 | $25.00–$124.00 | 56% below | 25% |
| Free testosterone test inpatient CPT 84402 ASSAY OF TESTOSTERONE FREE | $85.50 | $114.00 | $25.00–$124.00 | — | 25% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 ASSAY OF GLUTAMYLTRASE GAMMA | $55.50 | $74.00 | $7.00–$35.00 | 13% below | 25% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 ASSAY OF GLUTAMYLTRASE GAMMA | $55.50 | $74.00 | $7.00–$35.00 | — | 25% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL | $168.00 | $224.00 | $45.00–$219.00 | 19% below | 25% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL | $168.00 | $224.00 | $45.00–$219.00 | — | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST GLUCOSE DOSE | $23.25 | $31.00 | $5.00–$23.00 | 31% below | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST GLUCOSE DOSE | $23.25 | $31.00 | $5.00–$23.00 | — | 25% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS | $64.50 | $86.00 | $13.00–$63.00 | 45% below | 25% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS | $64.50 | $86.00 | $13.00–$63.00 | — | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | $337.50 | $450.00 | $35.00–$172.00 | 205% above | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | $337.50 | $450.00 | $35.00–$172.00 | — | 25% |
| H. pylori antibody blood test CPT 86677 ANTIBODY HELICOBACTER PYLORI | $99.75 | $133.00 | $17.00–$83.00 | 31% below | 25% |
| H. pylori antibody blood test inpatient CPT 86677 ANTIBODY HELICOBACTER PYLORI | $99.75 | $133.00 | $17.00–$83.00 | — | 25% |
| H. pylori stool antigen test CPT 87338 IAAD IA HPYLORI STOOL | $101.25 | $135.00 | $14.00–$69.00 | at median | 25% |
| H. pylori stool antigen test inpatient CPT 87338 IAAD IA HPYLORI STOOL | $101.25 | $135.00 | $14.00–$69.00 | — | 25% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION | $562.50 | $750.00 | $85.00–$414.00 | 9% below | 25% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION | $562.50 | $750.00 | $85.00–$414.00 | — | 25% |
| HIV-1 and HIV-2 antibody test CPT 86703 ANTIBODY HIV-1&HIV-2 SINGLE RESULT | $83.25 | $111.00 | $14.00–$66.00 | 31% above | 25% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 ANTIBODY HIV-1&HIV-2 SINGLE RESULT | $83.25 | $111.00 | $14.00–$66.00 | — | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE | $229.50 | $306.00 | $24.00–$117.00 | 18% above | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE | $229.50 | $306.00 | $24.00–$117.00 | — | 25% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 IADNA HUMAN PAPILLOMAVIRUS HI-RSK TYP POOLD RSLT | $197.25 | $263.00 | $35.00–$172.00 | at median | 25% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 IADNA HUMAN PAPILLOMAVIRUS HI-RSK TYP POOLD RSLT | $197.25 | $263.00 | $35.00–$172.00 | — | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $67.50 | $90.00 | $10.00–$48.00 | 26% below | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $67.50 | $90.00 | $10.00–$48.00 | — | 25% |
| Hemoglobin blood test CPT 85018 BLOOD COUNT HEMOGLOBIN | $28.50 | $38.00 | $2.00–$12.00 | 10% above | 25% |
| Hemoglobin blood test inpatient CPT 85018 BLOOD COUNT HEMOGLOBIN | $28.50 | $38.00 | $2.00–$12.00 | — | 25% |
| Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL | $147.00 | $196.00 | $12.00–$59.00 | 38% above | 25% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL | $147.00 | $196.00 | $12.00–$59.00 | — | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURF ANTIBODY HBSAB | $105.75 | $141.00 | $11.00–$53.00 | 7% above | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURF ANTIBODY HBSAB | $105.75 | $141.00 | $11.00–$53.00 | — | 25% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 IAAD IA HEPATITIS B SURFACE ANTIGEN | $130.50 | $174.00 | $10.00–$50.00 | 27% above | 25% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 IAAD IA HEPATITIS B SURFACE ANTIGEN | $130.50 | $174.00 | $10.00–$50.00 | — | 25% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY | $156.00 | $208.00 | $14.00–$69.00 | 19% above | 25% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY | $156.00 | $208.00 | $14.00–$69.00 | — | 25% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION | $345.00 | $460.00 | $43.00–$208.00 | 3% above | 25% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION | $345.00 | $460.00 | $43.00–$208.00 | — | 25% |
| Herpes blood test, HSV-1 antibody CPT 86695 ANTIBODY HERPES SMPLX TYPE 1 | $88.50 | $118.00 | $13.00–$64.00 | 6% below | 25% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 ANTIBODY HERPES SMPLX TYPE 1 | $88.50 | $118.00 | $13.00–$64.00 | — | 25% |
| Herpes blood test, HSV-2 antibody CPT 86696 ANTIBODY HERPES SMPLX TYPE 2 | $129.00 | $172.00 | $19.00–$94.00 | 5% above | 25% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 ANTIBODY HERPES SMPLX TYPE 2 | $129.00 | $172.00 | $19.00–$94.00 | — | 25% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HIGH SENSITIVITY | $102.00 | $136.00 | $13.00–$63.00 | at median | 25% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HIGH SENSITIVITY | $102.00 | $136.00 | $13.00–$63.00 | — | 25% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE | $133.50 | $178.00 | $18.00–$87.00 | 14% below | 25% |
| Homocysteine blood test inpatient CPT 83090 ASSAY OF HOMOCYSTEINE | $133.50 | $178.00 | $18.00–$87.00 | — | 25% |
| Insulin blood test CPT 83525 ASSAY OF INSULIN TOTAL | $72.00 | $96.00 | $11.00–$56.00 | 17% below | 25% |
| Insulin blood test inpatient CPT 83525 ASSAY OF INSULIN TOTAL | $72.00 | $96.00 | $11.00–$56.00 | — | 25% |
| Iron blood test (serum iron) CPT 83540 ASSAY OF IRON | $43.50 | $58.00 | $6.00–$31.00 | 11% above | 25% |
| Iron blood test (serum iron) inpatient CPT 83540 ASSAY OF IRON | $43.50 | $58.00 | $6.00–$31.00 | — | 25% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY | $73.50 | $98.00 | $9.00–$43.00 | 19% below | 25% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY | $73.50 | $98.00 | $9.00–$43.00 | — | 25% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $73.50 | $98.00 | $9.00–$43.00 | 6% above | 25% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $73.50 | $98.00 | $9.00–$43.00 | — | 25% |
| LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LUTEINIZING HORMONE | $116.25 | $155.00 | $19.00–$91.00 | 18% below | 25% |
| LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN LUTEINIZING HORMONE | $116.25 | $155.00 | $19.00–$91.00 | — | 25% |
| Lactate (lactic acid) blood test CPT 83605 ASSAY OF LACTATE | $103.50 | $138.00 | $11.00–$56.00 | 5% above | 25% |
| Lactate (lactic acid) blood test inpatient CPT 83605 ASSAY OF LACTATE | $103.50 | $138.00 | $11.00–$56.00 | — | 25% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE DEHYDROGENASE LDH | $52.50 | $70.00 | $6.00–$30.00 | 10% below | 25% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE DEHYDROGENASE LDH | $52.50 | $70.00 | $6.00–$30.00 | — | 25% |
| Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE | $71.25 | $95.00 | $7.00–$33.00 | 2% below | 25% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 ASSAY OF LIPASE | $71.25 | $95.00 | $7.00–$33.00 | — | 25% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $72.75 | $97.00 | $8.00–$40.00 | 8% above | 25% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $72.75 | $97.00 | $8.00–$40.00 | — | 25% |
| Lyme disease antibody test CPT 86618 ANTIBODY BORRELIA BURGDORFERI LYME DISEASE | $106.50 | $142.00 | $17.00–$83.00 | 24% below | 25% |
| Lyme disease antibody test inpatient CPT 86618 ANTIBODY BORRELIA BURGDORFERI LYME DISEASE | $106.50 | $142.00 | $17.00–$83.00 | — | 25% |
| Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM | $60.00 | $80.00 | $7.00–$33.00 | 4% below | 25% |
| Magnesium blood test inpatient CPT 83735 ASSAY OF MAGNESIUM | $60.00 | $80.00 | $7.00–$33.00 | — | 25% |
| Measles (rubeola) antibody test CPT 86765 ANTIBODY RUBEOLA | $81.00 | $108.00 | $13.00–$63.00 | at median | 25% |
| Measles (rubeola) antibody test inpatient CPT 86765 ANTIBODY RUBEOLA | $81.00 | $108.00 | $13.00–$63.00 | — | 25% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODIES SCREEN | $24.00 | $32.00 | $5.00–$25.00 | 57% below | 25% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODIES SCREEN | $24.00 | $32.00 | $5.00–$25.00 | — | 25% |
| Mumps immunity blood test CPT 86735 ANTIBODY MUMPS | $113.25 | $151.00 | $13.00–$63.00 | 48% above | 25% |
| Mumps immunity blood test inpatient CPT 86735 ANTIBODY MUMPS | $113.25 | $151.00 | $13.00–$63.00 | — | 25% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $148.50 | $198.00 | $48.00–$233.00 | 49% below | 25% |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL | $148.50 | $198.00 | $48.00–$233.00 | — | 25% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $132.00 | $176.00 | $18.00–$89.00 | 4% above | 25% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $132.00 | $176.00 | $18.00–$89.00 | — | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $85.50 | $114.00 | $18.00–$89.00 | 25% below | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $85.50 | $114.00 | $18.00–$89.00 | — | 25% |
| Pap test (liquid-based, automated screening with review) CPT 88175 CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS | $81.75 | $109.00 | $26.00–$129.00 | 58% below | 25% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS | $81.75 | $109.00 | $26.00–$129.00 | — | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN | $78.75 | $105.00 | $20.00–$99.00 | at median | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 "CYTOPATHOLOGY CERVICAL, VAGINAL AUTO THIN LAYER PREP MANUAL SCREEN PHYS SUPERVISION (HC) BKR" | $79.50 | $106.00 | $20.00–$99.00 | 1% above | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN | $78.75 | $105.00 | $20.00–$99.00 | — | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 "CYTOPATHOLOGY CERVICAL, VAGINAL AUTO THIN LAYER PREP MANUAL SCREEN PHYS SUPERVISION (HC) BKR" | $79.50 | $106.00 | $20.00–$99.00 | — | 25% |
| Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE | $297.00 | $396.00 | $41.00–$201.00 | 21% below | 25% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 ASSAY OF PARATHORMONE | $297.00 | $396.00 | $41.00–$201.00 | — | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD | $51.00 | $68.00 | $6.00–$30.00 | 7% above | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD | $51.00 | $68.00 | $6.00–$30.00 | — | 25% |
| Phosphorus (phosphate) blood test CPT 84100 ASSAY OF PHOSPHORUS INORGANIC | $50.25 | $67.00 | $5.00–$23.00 | 13% above | 25% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 ASSAY OF PHOSPHORUS INORGANIC | $50.25 | $67.00 | $5.00–$23.00 | — | 25% |
| Potassium blood test CPT 84132 POTASSIUM SERUM PLASMA/WHOLE BLOOD | $50.25 | $67.00 | $5.00–$23.00 | 6% above | 25% |
| Potassium blood test inpatient CPT 84132 POTASSIUM SERUM PLASMA/WHOLE BLOOD | $50.25 | $67.00 | $5.00–$23.00 | — | 25% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS | $2,110.50 | $2,814.00 | $757.00–$3,694.00 | — | 25% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS | $2,110.50 | $2,814.00 | $757.00–$3,694.00 | — | 25% |
| Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE | $130.50 | $174.00 | $21.00–$102.00 | 18% below | 25% |
| Progesterone blood test inpatient CPT 84144 ASSAY OF PROGESTERONE | $130.50 | $174.00 | $21.00–$102.00 | — | 25% |
| Prolactin blood test CPT 84146 ASSAY OF PROLACTIN | $132.75 | $177.00 | $19.00–$94.00 | 27% below | 25% |
| Prolactin blood test inpatient CPT 84146 ASSAY OF PROLACTIN | $132.75 | $177.00 | $19.00–$94.00 | — | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $41.25 | $55.00 | $4.00–$21.00 | 13% above | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $41.25 | $55.00 | $4.00–$21.00 | — | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE | $60.00 | $80.00 | $13.00–$61.00 | 33% below | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE | $60.00 | $80.00 | $13.00–$61.00 | — | 25% |
| Rapid flu test (influenza antigen) CPT 87804 IAADIADOO INFLUENZA | $105.00 | $140.00 | $17.00–$81.00 | 13% above | 25% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 IAADIADOO INFLUENZA | $105.00 | $140.00 | $17.00–$81.00 | — | 25% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 IAADIADOO STREPTOCOCCUS GROUP A | $55.50 | $74.00 | $17.00–$81.00 | at median | 25% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 IAADIADOO STREPTOCOCCUS GROUP A | $55.50 | $74.00 | $17.00–$81.00 | — | 25% |
| Renin blood test CPT 84244 ASSAY OF RENIN | $138.00 | $184.00 | $22.00–$107.00 | 2% below | 25% |
| Renin blood test inpatient CPT 84244 ASSAY OF RENIN | $138.00 | $184.00 | $22.00–$107.00 | — | 25% |
| Rh blood typing CPT 86901 BLOOD TYPING SEROLOGIC RH (D) | $54.00 | $72.00 | $3.00–$15.00 | 10% above | 25% |
| Rh blood typing inpatient CPT 86901 BLOOD TYPING SEROLOGIC RH (D) | $54.00 | $72.00 | $3.00–$15.00 | — | 25% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIVE | $37.50 | $50.00 | $6.00–$28.00 | 38% below | 25% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTITATIVE | $37.50 | $50.00 | $6.00–$28.00 | — | 25% |
| Rubella antibody test (immunity check) CPT 86762 ANTIBODY RUBELLA | $96.00 | $128.00 | $14.00–$69.00 | 25% above | 25% |
| Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY RUBELLA | $96.00 | $128.00 | $14.00–$69.00 | — | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE RBC AUTOMATED | $25.50 | $34.00 | $3.00–$13.00 | 51% below | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE RBC AUTOMATED | $25.50 | $34.00 | $3.00–$13.00 | — | 25% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT | $45.00 | $60.00 | $12.00–$59.00 | — | 25% |
| Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT | $45.00 | $60.00 | $12.00–$59.00 | — | 25% |
| Sodium blood test CPT 84295 SODIUM SERUM PLASMA OR WHOLE BLOOD | $48.75 | $65.00 | $5.00–$23.00 | 8% above | 25% |
| Sodium blood test inpatient CPT 84295 SODIUM SERUM PLASMA OR WHOLE BLOOD | $48.75 | $65.00 | $5.00–$23.00 | — | 25% |
| Stool ova and parasites exam CPT 87177 OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID | $68.25 | $91.00 | $9.00–$43.00 | 26% below | 25% |
| Stool ova and parasites exam inpatient CPT 87177 OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID | $68.25 | $91.00 | $9.00–$43.00 | — | 25% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER | $18.00 | $24.00 | $4.00–$21.00 | 42% below | 25% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER | $18.00 | $24.00 | $4.00–$21.00 | — | 25% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 | $85.50 | $114.00 | $16.00–$78.00 | 10% below | 25% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 | $85.50 | $114.00 | $16.00–$78.00 | — | 25% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 ANTIBODY TREPONEMA PALLIDUM | $82.50 | $110.00 | $13.00–$64.00 | 23% below | 25% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 ANTIBODY TREPONEMA PALLIDUM | $82.50 | $110.00 | $13.00–$64.00 | — | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL | $49.50 | $66.00 | $4.00–$21.00 | 33% above | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL | $49.50 | $66.00 | $4.00–$21.00 | — | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON | $422.25 | $563.00 | $62.00–$302.00 | 52% above | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON | $422.25 | $563.00 | $62.00–$302.00 | — | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TESTOSTERONE TOTAL | $96.75 | $129.00 | $26.00–$125.00 | 51% below | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TESTOSTERONE TOTAL | $96.75 | $129.00 | $26.00–$125.00 | — | 25% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES EACH | $49.50 | $66.00 | $15.00–$71.00 | 55% below | 25% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODIES EACH | $49.50 | $66.00 | $15.00–$71.00 | — | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY OF THYROID STIMULATING HORMONE TSH | $111.75 | $149.00 | $17.00–$83.00 | 12% below | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY OF THYROID STIMULATING HORMONE TSH | $111.75 | $149.00 | $17.00–$83.00 | — | 25% |
| Total IgE blood test CPT 82785 ASSAY OF GAMMAGLOBULIN IGE | $57.75 | $77.00 | $17.00–$81.00 | 62% below | 25% |
| Total IgE blood test inpatient CPT 82785 ASSAY OF GAMMAGLOBULIN IGE | $57.75 | $77.00 | $17.00–$81.00 | — | 25% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL SERUM/WHOLE BLOOD TOTAL | $27.00 | $36.00 | $4.00–$21.00 | 29% below | 25% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL SERUM/WHOLE BLOOD TOTAL | $27.00 | $36.00 | $4.00–$21.00 | — | 25% |
| Total thyroxine (T4) blood test CPT 84436 ASSAY OF THYROXINE TOTAL | $42.75 | $57.00 | $7.00–$33.00 | 29% below | 25% |
| Total thyroxine (T4) blood test inpatient CPT 84436 ASSAY OF THYROXINE TOTAL | $42.75 | $57.00 | $7.00–$33.00 | — | 25% |
| Total triiodothyronine (T3) blood test CPT 84480 ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 | $94.50 | $126.00 | $14.00–$69.00 | 28% below | 25% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 | $94.50 | $126.00 | $14.00–$69.00 | — | 25% |
| Transferrin blood test CPT 84466 ASSAY OF TRANSFERRIN | $83.25 | $111.00 | $13.00–$63.00 | at median | 25% |
| Transferrin blood test inpatient CPT 84466 ASSAY OF TRANSFERRIN | $83.25 | $111.00 | $13.00–$63.00 | — | 25% |
| Trichomonas test (NAAT) CPT 87661 IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH | $153.00 | $204.00 | $35.00–$172.00 | 1% above | 25% |
| Trichomonas test (NAAT) inpatient CPT 87661 IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH | $153.00 | $204.00 | $35.00–$172.00 | — | 25% |
| Triglycerides blood test CPT 84478 ASSAY OF TRIGLYCERIDES | $39.75 | $53.00 | $6.00–$28.00 | 16% below | 25% |
| Triglycerides blood test inpatient CPT 84478 ASSAY OF TRIGLYCERIDES | $39.75 | $53.00 | $6.00–$28.00 | — | 25% |
| Troponin test, quantitative CPT 84484 ASSAY OF TROPONIN QUANTITATIVE | $145.50 | $194.00 | $13.00–$61.00 | 58% above | 25% |
| Troponin test, quantitative inpatient CPT 84484 ASSAY OF TROPONIN QUANTITATIVE | $145.50 | $194.00 | $13.00–$61.00 | — | 25% |
| Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID | $37.50 | $50.00 | $4.00–$21.00 | 21% below | 25% |
| Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID | $37.50 | $50.00 | $4.00–$21.00 | — | 25% |
| Urinalysis with microscope exam, automated CPT 81001 URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $33.75 | $45.00 | $3.00–$15.00 | 2% below | 25% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $33.75 | $45.00 | $3.00–$15.00 | — | 25% |
| Urinalysis with microscope exam, manual CPT 81000 URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY | $12.75 | $17.00 | $4.00–$20.00 | 34% below | 25% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY | $12.75 | $17.00 | $4.00–$20.00 | — | 25% |
| Urinalysis without microscope exam, automated CPT 81003 URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $15.75 | $21.00 | $2.00–$12.00 | 35% below | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $15.75 | $21.00 | $2.00–$12.00 | — | 25% |
| Urinalysis without microscope exam, manual CPT 81002 URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $15.75 | $21.00 | $3.00–$17.00 | 13% below | 25% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $15.75 | $21.00 | $3.00–$17.00 | — | 25% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE | $60.75 | $81.00 | $8.00–$40.00 | 18% below | 25% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE | $60.75 | $81.00 | $8.00–$40.00 | — | 25% |
| Urine microalbumin (albumin) test CPT 82043 URINE ALBUMIN QUANTITATIVE | $54.00 | $72.00 | $6.00–$28.00 | at median | 25% |
| Urine microalbumin (albumin) test inpatient CPT 82043 URINE ALBUMIN QUANTITATIVE | $54.00 | $72.00 | $6.00–$28.00 | — | 25% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS | $49.50 | $66.00 | $8.00–$41.00 | 25% above | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS | $49.50 | $66.00 | $8.00–$41.00 | — | 25% |
| Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN VITAMIN B-12 | $102.75 | $137.00 | $15.00–$73.00 | 26% below | 25% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBALAMIN VITAMIN B-12 | $102.75 | $137.00 | $15.00–$73.00 | — | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED | $231.00 | $308.00 | $29.00–$144.00 | at median | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED | $231.00 | $308.00 | $29.00–$144.00 | — | 25% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED | $186.00 | $248.00 | $39.00–$188.00 | 42% below | 25% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED | $186.00 | $248.00 | $39.00–$188.00 | — | 25% |
| Zinc blood test CPT 84630 ASSAY OF ZINC | $72.00 | $96.00 | $11.00–$56.00 | 17% below | 25% |
| Zinc blood test inpatient CPT 84630 ASSAY OF ZINC | $72.00 | $96.00 | $11.00–$56.00 | — | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN CHORIONIC QUANTITATIVE | $77.25 | $103.00 | $15.00–$73.00 | 89% above | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN CHORIONIC QUANTITATIVE | $77.25 | $103.00 | $15.00–$73.00 | — | 25% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Hawaii | Off list |
|---|---|---|---|---|---|
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR | $5,430.00 | $7,240.00 | $5,802.00–$18,641.00 | 77% below | 25% |
| Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR | $5,430.00 | $7,240.00 | $5,802.00–$18,641.00 | — | 25% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID | $2,789.25 | $3,719.00 | $1,316.00–$4,228.00 | at median | 25% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID | $2,789.25 | $3,719.00 | $1,316.00–$4,228.00 | — | 25% |
| Cardiac catheterization with coronary angiogram CPT 93458 CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I | $7,725.00 | $10,300.00 | $2,612.00–$8,393.00 | 21% above | 25% |
| Cardiac catheterization with coronary angiogram inpatient CPT 93458 CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I | $7,725.00 | $10,300.00 | $2,612.00–$8,393.00 | — | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL | $1,800.00 | $2,400.00 | $532.00–$1,708.00 | 52% above | 25% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL | $1,800.00 | $2,400.00 | $532.00–$1,708.00 | — | 25% |
| Carpal tunnel release, open surgery CPT 64721 NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE | $1,370.25 | $1,827.00 | $1,586.00–$5,096.00 | 71% below | 25% |
| Carpal tunnel release, open surgery inpatient CPT 64721 NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE | $1,370.25 | $1,827.00 | $1,586.00–$5,096.00 | — | 25% |
| Cataract surgery with lens implant CPT 66984 XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP | $2,753.25 | $3,671.00 | $1,853.00–$5,952.00 | 33% below | 25% |
| Cataract surgery with lens implant inpatient CPT 66984 XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP | $2,753.25 | $3,671.00 | $1,853.00–$5,952.00 | — | 25% |
| Catheter ablation for atrial fibrillation CPT 93656 COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION | $22,800.00 | $30,400.00 | — | at median | 25% |
| Catheter ablation for atrial fibrillation inpatient CPT 93656 COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION | $22,800.00 | $30,400.00 | — | — | 25% |
| Cervical biopsy CPT 57500 BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX | $2,135.25 | $2,847.00 | $707.00–$2,272.00 | 1% above | 25% |
| Cervical biopsy inpatient CPT 57500 BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX | $2,135.25 | $2,847.00 | $707.00–$2,272.00 | — | 25% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMCISION AGE >28 DAYS | $1,353.00 | $1,804.00 | $1,664.00–$5,346.00 | 81% below | 25% |
| Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUMCISION AGE >28 DAYS | $1,353.00 | $1,804.00 | $1,664.00–$5,346.00 | — | 25% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK | $4,726.50 | $6,302.00 | $1,664.00–$5,346.00 | 32% above | 25% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK | $4,726.50 | $6,302.00 | $1,664.00–$5,346.00 | — | 25% |
| Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION NEONATE | $4,726.50 | $6,302.00 | $542.00–$1,742.00 | — | 25% |
| Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUMCISION NEONATE | $4,726.50 | $6,302.00 | $542.00–$1,742.00 | — | 25% |
| Colonoscopy with polyp removal CPT 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $1,944.75 | $2,593.00 | $957.00–$3,076.00 | 51% below | 25% |
| Colonoscopy with polyp removal inpatient CPT 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $1,944.75 | $2,593.00 | $957.00–$3,076.00 | — | 25% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $2,466.00 | $3,288.00 | $957.00–$3,076.00 | 62% below | 25% |
| Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $2,466.00 | $3,288.00 | $957.00–$3,076.00 | — | 25% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $1,482.00 | $1,976.00 | $740.00–$2,379.00 | at median | 25% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $1,482.00 | $1,976.00 | $740.00–$2,379.00 | — | 25% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE | $798.00 | $1,064.00 | $247.00–$794.00 | 34% above | 25% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE | $798.00 | $1,064.00 | $247.00–$794.00 | — | 25% |
| Coronary stent placement, one artery CPT 92928 PERQ TCAT PLMT NTRAC ST 1 LES 1+C SEGMENTS | $18,000.00 | $24,000.00 | — | at median | 25% |
| Coronary stent placement, one artery inpatient CPT 92928 PERQ TCAT PLMT NTRAC ST 1 LES 1+C SEGMENTS | $18,000.00 | $24,000.00 | — | — | 25% |
| Cystoscopy with ureteral stent placement CPT 52332 CYSTO W/INSERT URETERAL STENT | $2,675.25 | $3,567.00 | $2,801.00–$9,000.00 | 36% below | 25% |
| Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTO W/INSERT URETERAL STENT | $2,675.25 | $3,567.00 | $2,801.00–$9,000.00 | — | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY | $695.25 | $927.00 | $542.00–$1,742.00 | 77% below | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY | $695.25 | $927.00 | $542.00–$1,742.00 | — | 25% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION & CURETTAGE DX&/THER NONOBSTETRIC | $2,076.00 | $2,768.00 | $2,582.00–$8,297.00 | 4% above | 25% |
| D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DILATION & CURETTAGE DX&/THER NONOBSTETRIC | $2,076.00 | $2,768.00 | $2,582.00–$8,297.00 | — | 25% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT | $42.75 | $57.00 | $48.00–$155.00 | 81% below | 25% |
| Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT | $42.75 | $57.00 | $48.00–$155.00 | — | 25% |
| Earwax removal with instruments, one ear one side CPT 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT | $68.25 | $91.00 | $48.00–$155.00 | 66% below | 25% |
| Earwax removal with instruments, one ear inpatient one side CPT 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT | $68.25 | $91.00 | $48.00–$155.00 | — | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX | $354.00 | $472.00 | $163.00–$525.00 | 37% below | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX | $354.00 | $472.00 | $163.00–$525.00 | — | 25% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS | $4,545.00 | $6,060.00 | $5,623.00–$18,064.00 | 67% below | 25% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS | $4,545.00 | $6,060.00 | $5,623.00–$18,064.00 | — | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN | $1,023.75 | $1,365.00 | $562.00–$1,807.00 | 45% below | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN | $1,023.75 | $1,365.00 | $562.00–$1,807.00 | — | 25% |
| Eye injection into the vitreous (intravitreal injection) CPT 67028 INTRAVITREAL NJX PHARMACOLOGIC AGT SPX | $900.00 | $1,200.00 | $270.00–$866.00 | 62% below | 25% |
| Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 INTRAVITREAL NJX PHARMACOLOGIC AGT SPX | $900.00 | $1,200.00 | $270.00–$866.00 | — | 25% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL | $1,835.25 | $2,447.00 | $723.00–$2,323.00 | 19% above | 25% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL | $1,835.25 | $2,447.00 | $723.00–$2,323.00 | — | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD | $2,172.00 | $2,896.00 | $740.00–$2,379.00 | 72% above | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD | $2,172.00 | $2,896.00 | $740.00–$2,379.00 | — | 25% |
| Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPY SURG CHOLECYSTECTOMY | $3,831.75 | $5,109.00 | $4,739.00–$15,225.00 | 78% below | 25% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPY SURG CHOLECYSTECTOMY | $3,831.75 | $5,109.00 | $4,739.00–$15,225.00 | — | 25% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY | $3,831.75 | $5,109.00 | $4,739.00–$15,225.00 | 64% below | 25% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY | $3,831.75 | $5,109.00 | $4,739.00–$15,225.00 | — | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI | $422.25 | $563.00 | — | 45% above | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI | $422.25 | $563.00 | — | — | 25% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C | $5,556.00 | $7,408.00 | $2,582.00–$8,297.00 | 70% above | 25% |
| Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C | $5,556.00 | $7,408.00 | $2,582.00–$8,297.00 | — | 25% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERTION INTRAUTERINE DEVICE IUD | $225.00 | $300.00 | — | 37% above | 25% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERTION INTRAUTERINE DEVICE IUD | $225.00 | $300.00 | — | — | 25% |
| Incision and drainage of a simple or single skin abscess CPT 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | $428.25 | $571.00 | $162.00–$519.00 | 25% above | 25% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | $428.25 | $571.00 | $162.00–$519.00 | — | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS | $346.50 | $462.00 | $240.00–$770.00 | 47% below | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS | $346.50 | $462.00 | $240.00–$770.00 | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $599.25 | $799.00 | $240.00–$770.00 | at median | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $599.25 | $799.00 | $240.00–$770.00 | — | 25% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION DRUG DELIVERY IMPLANT | $279.75 | $373.00 | $105.00–$336.00 | 17% above | 25% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERTION DRUG DELIVERY IMPLANT | $279.75 | $373.00 | $105.00–$336.00 | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US | $580.50 | $774.00 | $240.00–$770.00 | 16% below | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US | $580.50 | $774.00 | $240.00–$770.00 | — | 25% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US | $510.75 | $681.00 | $240.00–$770.00 | 27% below | 25% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US | $510.75 | $681.00 | $240.00–$770.00 | — | 25% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPIC APPENDECTOMY | $9,310.50 | $12,414.00 | $4,739.00–$15,225.00 | 6% above | 25% |
| Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAPAROSCOPIC APPENDECTOMY | $9,310.50 | $12,414.00 | $4,739.00–$15,225.00 | — | 25% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES | $3,831.75 | $5,109.00 | $4,739.00–$15,225.00 | 20% below | 25% |
| Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES | $3,831.75 | $5,109.00 | $4,739.00–$15,225.00 | — | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< | $1,059.00 | $1,412.00 | $325.00–$1,043.00 | 20% above | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< | $1,059.00 | $1,412.00 | $325.00–$1,043.00 | — | 25% |
| Left heart catheterization, diagnostic CPT 93452 L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I | $5,250.00 | $7,000.00 | — | 9% above | 25% |
| Left heart catheterization, diagnostic inpatient CPT 93452 L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I | $5,250.00 | $7,000.00 | — | — | 25% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN | $1,023.75 | $1,365.00 | $562.00–$1,807.00 | 56% above | 25% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN | $1,023.75 | $1,365.00 | $562.00–$1,807.00 | — | 25% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $1,082.25 | $1,443.00 | $723.00–$2,323.00 | 9% below | 25% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $1,082.25 | $1,443.00 | $723.00–$2,323.00 | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $1,341.00 | $1,788.00 | $723.00–$2,323.00 | 11% above | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $1,341.00 | $1,788.00 | $723.00–$2,323.00 | — | 25% |
| Mastectomy (total removal of the breast) CPT 19303 MASTECTOMY SIMPLE COMPLETE | $4,449.75 | $5,933.00 | $5,297.00–$17,018.00 | 75% below | 25% |
| Mastectomy (total removal of the breast) inpatient CPT 19303 MASTECTOMY SIMPLE COMPLETE | $4,449.75 | $5,933.00 | $5,297.00–$17,018.00 | — | 25% |
| Miscarriage treatment with D&C, first trimester CPT 59820 TX MISSED ABORTION FIRST TRIMESTER SURGICAL | $4,056.00 | $5,408.00 | $2,582.00–$8,297.00 | 32% below | 25% |
| Miscarriage treatment with D&C, first trimester inpatient CPT 59820 TX MISSED ABORTION FIRST TRIMESTER SURGICAL | $4,056.00 | $5,408.00 | $2,582.00–$8,297.00 | — | 25% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< | $1,869.00 | $2,492.00 | $571.00–$1,836.00 | 29% above | 25% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< | $1,869.00 | $2,492.00 | $571.00–$1,836.00 | — | 25% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 | $606.75 | $809.00 | $162.00–$519.00 | at median | 25% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 | $606.75 | $809.00 | $162.00–$519.00 | — | 25% |
| Occipital nerve block (injection for headaches) CPT 64405 INJECTION AA&/STRD GREATER OCCIPITAL NERVE | $879.75 | $1,173.00 | $240.00–$770.00 | 40% below | 25% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 INJECTION AA&/STRD GREATER OCCIPITAL NERVE | $879.75 | $1,173.00 | $240.00–$770.00 | — | 25% |
| Pacemaker implant (dual chamber) CPT 33208 INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT | $8,202.00 | $10,936.00 | $8,500.00–$27,309.00 | 23% above | 25% |
| Pacemaker implant (dual chamber) inpatient CPT 33208 INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT | $8,202.00 | $10,936.00 | $8,500.00–$27,309.00 | — | 25% |
| Paracentesis with imaging guidance CPT 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE | $1,318.50 | $1,758.00 | $761.00–$2,446.00 | 6% above | 25% |
| Paracentesis with imaging guidance inpatient CPT 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE | $1,318.50 | $1,758.00 | $761.00–$2,446.00 | — | 25% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL | $597.75 | $797.00 | $325.00–$1,043.00 | 38% below | 25% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL | $597.75 | $797.00 | $325.00–$1,043.00 | — | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL | $1,525.50 | $2,034.00 | $1,586.00–$5,096.00 | 23% above | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL | $1,525.50 | $2,034.00 | $1,586.00–$5,096.00 | — | 25% |
| Removal of a breast lump, open surgery CPT 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $4,867.50 | $6,490.00 | $3,110.00–$9,992.00 | 49% below | 25% |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $4,867.50 | $6,490.00 | $3,110.00–$9,992.00 | — | 25% |
| Removal of a foreign object under the skin, simple CPT 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE | $592.50 | $790.00 | $325.00–$1,043.00 | 33% below | 25% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE | $592.50 | $790.00 | $325.00–$1,043.00 | — | 25% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CA SCRN NOT HI RSK IND | $3,452.25 | $4,603.00 | $740.00–$2,379.00 | 47% below | 25% |
| Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLON CA SCRN NOT HI RSK IND | $3,452.25 | $4,603.00 | $740.00–$2,379.00 | — | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL SCRN; HI RISK IND | $4,625.25 | $6,167.00 | $740.00–$2,379.00 | 11% below | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLORECTAL SCRN; HI RISK IND | $4,625.25 | $6,167.00 | $740.00–$2,379.00 | — | 25% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 LITHOTRIPSY XTRCORP SHOCK WAVE | $2,696.25 | $3,595.00 | $2,801.00–$9,000.00 | 35% below | 25% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 LITHOTRIPSY XTRCORP SHOCK WAVE | $2,696.25 | $3,595.00 | $2,801.00–$9,000.00 | — | 25% |
| Short arm splint (forearm and hand) CPT 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC | $210.00 | $280.00 | $105.00–$336.00 | at median | 25% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC | $210.00 | $280.00 | $105.00–$336.00 | — | 25% |
| Short leg cast (below the knee) CPT 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE | $713.25 | $951.00 | $216.00–$693.00 | 9% below | 25% |
| Short leg cast (below the knee) inpatient CPT 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE | $713.25 | $951.00 | $216.00–$693.00 | — | 25% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT CALF FOOT | $378.00 | $504.00 | $128.00–$412.00 | 26% below | 25% |
| Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION SHORT LEG SPLINT CALF FOOT | $378.00 | $504.00 | $128.00–$412.00 | — | 25% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS | $372.00 | $496.00 | — | 93% below | 25% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS | $372.00 | $496.00 | — | — | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< | $263.25 | $351.00 | $162.00–$519.00 | 28% below | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< | $263.25 | $351.00 | $162.00–$519.00 | — | 25% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY SKIN SINGLE LESION | $632.25 | $843.00 | $325.00–$1,043.00 | 6% above | 25% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY SKIN SINGLE LESION | $632.25 | $843.00 | $325.00–$1,043.00 | — | 25% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 | $528.00 | $704.00 | $162.00–$519.00 | 44% above | 25% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 | $528.00 | $704.00 | $162.00–$519.00 | — | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DIAGNOSTIC LUMBAR SPINAL PUNCTURE | $1,928.25 | $2,571.00 | $562.00–$1,807.00 | 50% above | 25% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 DIAGNOSTIC LUMBAR SPINAL PUNCTURE | $1,928.25 | $2,571.00 | $562.00–$1,807.00 | — | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM | $367.50 | $490.00 | $162.00–$519.00 | at median | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM | $367.50 | $490.00 | $162.00–$519.00 | — | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< | $359.25 | $479.00 | $162.00–$519.00 | at median | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< | $359.25 | $479.00 | $162.00–$519.00 | — | 25% |
| TURP (transurethral resection of the prostate) CPT 52601 TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE | $3,875.25 | $5,167.00 | $4,129.00–$13,266.00 | 51% below | 25% |
| TURP (transurethral resection of the prostate) inpatient CPT 52601 TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE | $3,875.25 | $5,167.00 | $4,129.00–$13,266.00 | — | 25% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION | $314.25 | $419.00 | $162.00–$519.00 | 38% below | 25% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION | $314.25 | $419.00 | $162.00–$519.00 | — | 25% |
| Thoracentesis with imaging guidance CPT 32555 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING | $1,434.00 | $1,912.00 | $502.00–$1,613.00 | at median | 25% |
| Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING | $1,434.00 | $1,912.00 | $502.00–$1,613.00 | — | 25% |
| Total hip replacement CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $8,739.00 | $11,652.00 | $10,451.00–$33,576.00 | 43% below | 25% |
| Total hip replacement inpatient CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $8,739.00 | $11,652.00 | $10,451.00–$33,576.00 | — | 25% |
| Total knee replacement CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS | $8,739.00 | $11,652.00 | $10,451.00–$33,576.00 | 65% below | 25% |
| Total knee replacement inpatient CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS | $8,739.00 | $11,652.00 | $10,451.00–$33,576.00 | — | 25% |
| Trigger finger release surgery CPT 26055 TENDON SHEATH INCISION | $4,028.25 | $5,371.00 | $1,300.00–$4,176.00 | 23% above | 25% |
| Trigger finger release surgery inpatient CPT 26055 TENDON SHEATH INCISION | $4,028.25 | $5,371.00 | $1,300.00–$4,176.00 | — | 25% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES | $614.25 | $819.00 | $240.00–$770.00 | 34% below | 25% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES | $614.25 | $819.00 | $240.00–$770.00 | — | 25% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID | $2,202.00 | $2,936.00 | $1,316.00–$4,228.00 | at median | 25% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID | $2,202.00 | $2,936.00 | $1,316.00–$4,228.00 | — | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM | $3,070.50 | $4,094.00 | $1,541.00–$4,950.00 | 11% above | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM | $3,070.50 | $4,094.00 | $1,541.00–$4,950.00 | — | 25% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $1,476.00 | $1,968.00 | $761.00–$2,446.00 | 21% below | 25% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $1,476.00 | $1,968.00 | $761.00–$2,446.00 | — | 25% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION | $1,462.50 | $1,950.00 | $761.00–$2,446.00 | 5% above | 25% |
| Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION | $1,462.50 | $1,950.00 | $761.00–$2,446.00 | — | 25% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH | $3,039.75 | $4,053.00 | $1,541.00–$4,950.00 | 10% above | 25% |
| Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH | $3,039.75 | $4,053.00 | $1,541.00–$4,950.00 | — | 25% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS | $2,283.00 | $3,044.00 | $761.00–$2,446.00 | 64% above | 25% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS | $2,283.00 | $3,044.00 | $761.00–$2,446.00 | — | 25% |
| Upper endoscopy (EGD), diagnostic CPT 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $1,983.75 | $2,645.00 | $761.00–$2,446.00 | 8% above | 25% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $1,983.75 | $2,645.00 | $761.00–$2,446.00 | — | 25% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTO W/URETEROSCOPY W/LITHOTRIPSY | $3,435.75 | $4,581.00 | $4,129.00–$13,266.00 | 40% below | 25% |
| Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 CYSTO W/URETEROSCOPY W/LITHOTRIPSY | $3,435.75 | $4,581.00 | $4,129.00–$13,266.00 | — | 25% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT | $3,435.75 | $4,581.00 | $4,129.00–$13,266.00 | 29% below | 25% |
| Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT | $3,435.75 | $4,581.00 | $4,129.00–$13,266.00 | — | 25% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM | $6,060.00 | $8,080.00 | — | — | 25% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM | $6,060.00 | $8,080.00 | — | — | 25% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LESIONS UP TO 14 | $528.00 | $704.00 | $162.00–$519.00 | 39% above | 25% |
| Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION BENIGN LESIONS UP TO 14 | $528.00 | $704.00 | $162.00–$519.00 | — | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< | $917.25 | $1,223.00 | $325.00–$1,043.00 | 18% above | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< | $917.25 | $1,223.00 | $325.00–$1,043.00 | — | 25% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Hawaii | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD/BLOOD COMPONENTS | $906.00 | $1,208.00 | $355.00–$1,141.00 | 4% below | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD/BLOOD COMPONENTS | $906.00 | $1,208.00 | $355.00–$1,141.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT | $230.25 | $307.00 | — | 27% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT | $230.25 | $307.00 | — | — | 25% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG | $858.75 | $1,145.00 | — | 14% above | 25% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG | $858.75 | $1,145.00 | — | — | 25% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ | $104.25 | $139.00 | — | 62% below | 25% |
| Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ | $104.25 | $139.00 | — | — | 25% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN | $5,140.50 | $6,854.00 | $1,415.00–$4,550.00 | 17% above | 25% |
| Critical care, first 30 to 74 minutes CPT 99291 "FACILITY USE-EMERGENCY ROOM, LEVEL 6" | $5,140.50 | $6,854.00 | $1,415.00–$4,550.00 | 17% above | 25% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN | $5,140.50 | $6,854.00 | $1,415.00–$4,550.00 | — | 25% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 "FACILITY USE-EMERGENCY ROOM, LEVEL 6" | $5,140.50 | $6,854.00 | $1,415.00–$4,550.00 | — | 25% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY | $956.25 | $1,275.00 | — | 14% above | 25% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY | $956.25 | $1,275.00 | — | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R | $292.50 | $390.00 | — | 17% above | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R | $292.50 | $390.00 | — | — | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP | $360.00 | $480.00 | $150.00–$475.00 | 4% below | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 "FACILITY USE-EMERGENCY ROOM, LEVEL 1" | $360.00 | $480.00 | $150.00–$475.00 | 4% below | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP | $360.00 | $480.00 | $150.00–$475.00 | — | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 "FACILITY USE-EMERGENCY ROOM, LEVEL 1" | $360.00 | $480.00 | $150.00–$475.00 | — | 25% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 "FACILITY USE-EMERGENCY ROOM, LEVEL 2" | $641.25 | $855.00 | $265.00–$855.00 | 3% below | 25% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM | $641.25 | $855.00 | $265.00–$855.00 | 3% below | 25% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM | $641.25 | $855.00 | $265.00–$855.00 | — | 25% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 "FACILITY USE-EMERGENCY ROOM, LEVEL 2" | $641.25 | $855.00 | $265.00–$855.00 | — | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPARTMENT VISIT LOW MDM | $1,387.50 | $1,850.00 | $465.00–$1,495.00 | 6% above | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 "FACILITY USE-EMERGENCY ROOM, LEVEL 3" | $1,387.50 | $1,850.00 | $465.00–$1,495.00 | 6% above | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 "FACILITY USE-EMERGENCY ROOM, LEVEL 3" | $1,387.50 | $1,850.00 | $465.00–$1,495.00 | — | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY DEPARTMENT VISIT LOW MDM | $1,387.50 | $1,850.00 | $465.00–$1,495.00 | — | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPARTMENT VISIT MODERATE MDM | $2,025.00 | $2,700.00 | $715.00–$2,300.00 | 1% below | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 "FACILITY USE-EMERGENCY ROOM, LEVEL 4" | $2,025.00 | $2,700.00 | $715.00–$2,300.00 | 1% below | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPARTMENT VISIT MODERATE MDM | $2,025.00 | $2,700.00 | $715.00–$2,300.00 | — | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 "FACILITY USE-EMERGENCY ROOM, LEVEL 4" | $2,025.00 | $2,700.00 | $715.00–$2,300.00 | — | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPARTMENT VISIT HIGH MDM | $2,895.00 | $3,860.00 | $1,030.00–$3,310.00 | 7% above | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 "FACILITY USE-EMERGENCY ROOM, LEVEL 5" | $2,895.00 | $3,860.00 | $1,030.00–$3,310.00 | 7% above | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 "FACILITY USE-EMERGENCY ROOM, LEVEL 5" | $2,895.00 | $3,860.00 | $1,030.00–$3,310.00 | — | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY DEPARTMENT VISIT HIGH MDM | $2,895.00 | $3,860.00 | $1,030.00–$3,310.00 | — | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY | $517.50 | $690.00 | — | 36% below | 25% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY | $517.50 | $690.00 | — | — | 25% |
| Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I | $296.25 | $395.00 | — | — | 25% |
| Holter monitor, heart rhythm recording up to 48 hours, with report inpatient CPT 93224 XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I | $296.25 | $395.00 | — | — | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR | $438.75 | $585.00 | — | 5% below | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR | $438.75 | $585.00 | — | — | 25% |
| IV infusion of a medicine, first hour CPT 96365 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR | $441.75 | $589.00 | $171.00–$549.00 | 4% below | 25% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR | $441.75 | $589.00 | $171.00–$549.00 | — | 25% |
| IV push of a medicine, first drug CPT 96374 THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG | $217.50 | $290.00 | — | 42% below | 25% |
| IV push of a medicine, first drug inpatient CPT 96374 THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG | $217.50 | $290.00 | — | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM | $151.50 | $202.00 | $58.00–$186.00 | at median | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM | $151.50 | $202.00 | $58.00–$186.00 | — | 25% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | $408.00 | $544.00 | — | — | 25% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | $408.00 | $544.00 | — | — | 25% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE CONDUCTION STUDIES 7-8 STUDIES | $699.75 | $933.00 | — | 36% above | 25% |
| Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NERVE CONDUCTION STUDIES 7-8 STUDIES | $699.75 | $933.00 | — | — | 25% |
| Neuromuscular re-education, 15 minutes CPT 97112 THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA | $110.25 | $147.00 | — | 11% above | 25% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA | $110.25 | $147.00 | — | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES | $140.25 | $187.00 | — | 30% below | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES | $140.25 | $187.00 | — | — | 25% |
| Occupational therapy evaluation, low complexity CPT 97165 OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS | $241.50 | $322.00 | — | 38% above | 25% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS | $241.50 | $322.00 | — | — | 25% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS | $318.75 | $425.00 | — | 9% below | 25% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS | $318.75 | $425.00 | — | — | 25% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS | $236.25 | $315.00 | — | 15% above | 25% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS | $236.25 | $315.00 | — | — | 25% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS | $322.50 | $430.00 | — | 8% below | 25% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS | $322.50 | $430.00 | — | — | 25% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES | $156.00 | $208.00 | — | 1% below | 25% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES | $156.00 | $208.00 | — | — | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $114.75 | $153.00 | — | 13% above | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $114.75 | $153.00 | — | — | 25% |
| Psychiatric evaluation with medical services CPT 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES | $408.00 | $544.00 | — | — | 25% |
| Psychiatric evaluation with medical services inpatient CPT 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES | $408.00 | $544.00 | — | — | 25% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN | $351.00 | $468.00 | — | 8% above | 25% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN | $351.00 | $468.00 | — | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN | $162.75 | $217.00 | — | 36% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN | $162.75 | $217.00 | — | — | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN | $239.25 | $319.00 | — | 4% below | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN | $239.25 | $319.00 | — | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN | $91.50 | $122.00 | — | 55% below | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN | $91.50 | $122.00 | — | — | 25% |
| Speech and language evaluation CPT 92523 EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION | $534.00 | $712.00 | — | 71% above | 25% |
| Speech and language evaluation inpatient CPT 92523 EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION | $534.00 | $712.00 | — | — | 25% |
| Speech therapy session, individual CPT 92507 TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND | $192.00 | $256.00 | — | 6% above | 25% |
| Speech therapy session, individual inpatient CPT 92507 TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND | $192.00 | $256.00 | — | — | 25% |
| Spirometry (breathing test) CPT 94010 SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ | $290.25 | $387.00 | — | 2% below | 25% |
| Spirometry (breathing test) inpatient CPT 94010 SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ | $290.25 | $387.00 | — | — | 25% |
| Spirometry before and after a bronchodilator CPT 94060 BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN | $830.25 | $1,107.00 | — | 129% above | 25% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN | $830.25 | $1,107.00 | — | — | 25% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN | $110.25 | $147.00 | — | 11% above | 25% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN | $110.25 | $147.00 | — | — | 25% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE | $356.25 | $475.00 | — | at median | 25% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE | $356.25 | $475.00 | — | — | 25% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 CV STRS TST XERS&/OR RX CONT ECG W/SI&R | $235.50 | $314.00 | — | — | 25% |
| Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 CV STRS TST XERS&/OR RX CONT ECG W/SI&R | $235.50 | $314.00 | — | — | 25% |
| Visual field test, extended both sides CPT 92083 VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM | $134.25 | $179.00 | — | — | 25% |
| Visual field test, extended inpatient both sides CPT 92083 VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM | $134.25 | $179.00 | — | — | 25% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Hawaii | Off list |
|---|---|---|---|---|---|
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 flu vaccine 2025-26 (65 yrs up) PF 45 mcg (15 mcg x 3)/0.5 mL Syringe 0.5 mL SYRINGE | $203.78 | $271.70 | — | — | 25% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 flu vaccine 2025-26 (65 yrs up) PF 45 mcg (15 mcg x 3)/0.5 mL Syringe 0.5 mL SYRINGE | $203.78 | $271.70 | — | — | 25% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 "COVID vacc, 2025-2026 (12y up) PF 50 mcg/0.5 mL Syringe 0.5 mL SYRINGE" | $335.57 | $447.42 | — | 54% above | 25% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 "COVID vacc, 2025-2026 (12y up) PF 50 mcg/0.5 mL Syringe 0.5 mL SYRINGE" | $335.57 | $447.42 | — | — | 25% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE | $270.00 | $360.00 | — | 34% above | 25% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 "COVID vacc, 2025-2026 (12y up) PF 30 mcg/0.3 mL Syringe 0.3 mL SYRINGE" | $401.19 | $534.91 | — | 99% above | 25% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE | $270.00 | $360.00 | — | — | 25% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 "COVID vacc, 2025-2026 (12y up) PF 30 mcg/0.3 mL Syringe 0.3 mL SYRINGE" | $401.19 | $534.91 | — | — | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 "varicella virus live (PF) vaccine 1,350 unit/0.5 mL Recon susp 1 Each VIAL" | $451.55 | $602.06 | — | 55% above | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 "varicella virus live (PF) vaccine 1,350 unit/0.5 mL Recon susp 1 Each VIAL" | $451.55 | $602.06 | — | — | 25% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 hepatitis B-diphtheria-pertussis (acell)-tetanus-polio (PF) vaccine 10 mcg-25Lf-25 mcg-10Lf/0.5 mL Syringe 0.5 mL SYRINGE | $237.45 | $316.59 | — | 39% above | 25% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 hepatitis B-diphtheria-pertussis (acell)-tetanus-polio (PF) vaccine 10 mcg-25Lf-25 mcg-10Lf/0.5 mL Syringe 0.5 mL SYRINGE | $237.45 | $316.59 | — | — | 25% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 PENTACEL vaccine ACTHIB component (2 of 2) 10 mcg/0.5 mL Recon soln 1 Each VIAL | $300.42 | $400.55 | — | 74% above | 25% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 dip-pert(a)-tet-polio-hib (PF) vaccine 15Lf-20mcg-5Lf- 62 DU/0.5 mL Kit 1 Each KIT | $300.42 | $400.55 | — | 74% above | 25% |
| DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 dip-pert(a)-tet-polio-hib (PF) vaccine 15Lf-20mcg-5Lf- 62 DU/0.5 mL Kit 1 Each KIT | $300.42 | $400.55 | — | — | 25% |
| DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 PENTACEL vaccine ACTHIB component (2 of 2) 10 mcg/0.5 mL Recon soln 1 Each VIAL | $300.42 | $400.55 | — | — | 25% |
| Flu shot, recombinant, egg-free (Flublok) CPT 90673 flu vaccine TV 2025-26 (9 yrs up) RCM (PF) 135 mcg (45 mcg x 3)/0.5 mL Syringe 0.5 mL SYRINGE | $203.78 | $271.70 | — | — | 25% |
| Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 flu vaccine TV 2025-26 (9 yrs up) RCM (PF) 135 mcg (45 mcg x 3)/0.5 mL Syringe 0.5 mL SYRINGE | $203.78 | $271.70 | — | — | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 flu vaccine TS 2025-26 (6 mos up) PF 45 mcg (15 mcg x 3)/0.5 mL Syringe 0.5 mL SYRINGE | $64.16 | $85.54 | — | 104% above | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 flu vaccine TS 2025-26 (36 mos up) PF 45 mcg (15 mcg x 3)/0.5 mL Syringe 0.5 mL SYRINGE | $70.09 | $93.45 | — | 123% above | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 flu vaccine TS 2025-26 (6 mos up) PF 45 mcg (15 mcg x 3)/0.5 mL Syringe 0.5 mL SYRINGE | $64.16 | $85.54 | — | — | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 flu vaccine TS 2025-26 (36 mos up) PF 45 mcg (15 mcg x 3)/0.5 mL Syringe 0.5 mL SYRINGE | $70.09 | $93.45 | — | — | 25% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 human papillomavirus 9-valent vaccine (PF) 0.5 mL Syringe 0.5 mL SYRINGE | $772.07 | $1,029.42 | — | 69% above | 25% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 human papillomavirus 9-valent vaccine (PF) 0.5 mL Susp 0.5 mL VIAL | $772.07 | $1,029.42 | — | 69% above | 25% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 human papillomavirus 9-valent vaccine (PF) 0.5 mL Susp 0.5 mL VIAL | $772.07 | $1,029.42 | — | — | 25% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 human papillomavirus 9-valent vaccine (PF) 0.5 mL Syringe 0.5 mL SYRINGE | $772.07 | $1,029.42 | — | — | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 hepatitis A-hepatitis B vaccine (PF) 720 ELISA unit- 20 mcg/mL Syringe 1 mL SYRINGE | $310.13 | $413.50 | — | — | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 hepatitis A-hepatitis B vaccine (PF) 720 ELISA unit- 20 mcg/mL Syringe 1 mL SYRINGE | $310.13 | $413.50 | — | — | 25% |
| Hepatitis A vaccine, adult dose CPT 90632 hepatitis A virus vaccine (PF) 50 unit/mL Susp 1 mL VIAL | $201.09 | $268.11 | — | 16% above | 25% |
| Hepatitis A vaccine, adult dose CPT 90632 "hepatitis A virus vaccine (PF) 1,440 ELISA unit/mL Syringe 1 mL SYRINGE" | $203.59 | $271.45 | — | 17% above | 25% |
| Hepatitis A vaccine, adult dose CPT 90632 hepatitis A virus vaccine (PF) 50 unit/mL Syringe 1 mL SYRINGE | $227.81 | $303.74 | — | 31% above | 25% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A virus vaccine (PF) 50 unit/mL Susp 1 mL VIAL | $201.09 | $268.11 | — | — | 25% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 "hepatitis A virus vaccine (PF) 1,440 ELISA unit/mL Syringe 1 mL SYRINGE" | $203.59 | $271.45 | — | — | 25% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A virus vaccine (PF) 50 unit/mL Syringe 1 mL SYRINGE | $227.81 | $303.74 | — | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B virus vaccine (PF) 20 mcg/mL Syringe 1 mL SYRINGE | $113.13 | $150.84 | — | 8% below | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B virus vaccine (PF) 20 mcg/mL Susp 1 mL VIAL | $113.13 | $150.84 | — | 8% below | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B virus vaccine (PF) 20 mcg/mL Susp 1 mL VIAL | $113.13 | $150.84 | — | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B virus vaccine (PF) 20 mcg/mL Syringe 1 mL SYRINGE | $113.13 | $150.84 | — | — | 25% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 hepatitis B vacc-CpG 1018 (PF) 20 mcg/0.5 mL Syringe 0.5 mL SYRINGE | $368.21 | $490.94 | — | — | 25% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 hepatitis B vacc-CpG 1018 (PF) 20 mcg/0.5 mL Syringe 0.5 mL SYRINGE | $368.21 | $490.94 | — | — | 25% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 haemophilus B polysac conj-mening (PF) vaccine 7.5 mcg/0.5 mL Soln 0.5 mL VIAL | $97.77 | $130.35 | — | — | 25% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 haemophilus B polysac conj-mening (PF) vaccine 7.5 mcg/0.5 mL Soln 0.5 mL VIAL | $97.77 | $130.35 | — | — | 25% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 haemophilus B poly conj-tet tox (PF) vaccine 10 mcg/0.5 mL Recon soln 1 Each VIAL | $44.03 | $58.70 | — | 50% above | 25% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 haemophilus B poly conj-tet tox (PF) vaccine 10 mcg/0.5 mL Recon soln 1 Each VIAL | $44.03 | $58.70 | — | — | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 flu vaccine TS 2025-26 (65 yrs up) PF 180 mcg/0.5 mL Syringe 0.5 mL SYRINGE | $203.78 | $271.70 | — | 67% above | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 flu vaccine TS 2025-26 (65 yrs up) PF 180 mcg/0.5 mL Syringe 0.5 mL SYRINGE | $203.78 | $271.70 | — | — | 25% |
| Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 Japanese encephalitis vaccine (PF) 6 mcg/0.5 mL Syringe 0.5 mL SYRINGE | $694.24 | $925.65 | — | — | 25% |
| Japanese encephalitis vaccine (Ixiaro), 2-dose schedule inpatient CPT 90738 Japanese encephalitis vaccine (PF) 6 mcg/0.5 mL Syringe 0.5 mL SYRINGE | $694.24 | $925.65 | — | — | 25% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 measles-mumps-rubella (PF) vaccine 10exp3.4-4.2- 3.3CCID50/0.5mL Recon susp 1 Each VIAL | $221.26 | $295.01 | — | 22% above | 25% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 "measles-mumps-rubella (PF) vaccine 1,000-12,500 TCID50/0.5 mL Recon soln 1 Each VIAL" | $227.79 | $303.71 | — | 26% above | 25% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles-mumps-rubella (PF) vaccine 10exp3.4-4.2- 3.3CCID50/0.5mL Recon susp 1 Each VIAL | $221.26 | $295.01 | — | — | 25% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 "measles-mumps-rubella (PF) vaccine 1,000-12,500 TCID50/0.5 mL Recon soln 1 Each VIAL" | $227.79 | $303.71 | — | — | 25% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 measles-mumps-rubella-varicella (PF) vaccine 10exp3-4.3-3- 3.99 TCID50/0.5 Recon susp 1 Each VIAL | $673.39 | $897.85 | — | 44% above | 25% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 measles-mumps-rubella-varicella (PF) vaccine 10exp3-4.3-3- 3.99 TCID50/0.5 Recon susp 1 Each VIAL | $673.39 | $897.85 | — | — | 25% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 "meningococcaL A,C,Y,W-135 dip (PF) vaccine 4 mcg/0.5 mL Soln 0.5 mL VIAL" | $350.07 | $466.75 | — | 12% above | 25% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 "meningococcaL A,C,Y,W-135 dip (PF) (10 yrs up) vaccine 10-5 mcg/0.5 mL Soln 0.5 mL VIAL" | $392.19 | $522.91 | — | 25% above | 25% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 "meningococcaL A,C,Y,W-135 dip (PF) vaccine 10-5 mcg/0.5 mL Kit 1 Each KIT" | $392.19 | $522.91 | — | 25% above | 25% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 "meningococcaL A,C,Y,W-135 dip (PF) vaccine 4 mcg/0.5 mL Soln 0.5 mL VIAL" | $350.07 | $466.75 | — | — | 25% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 "meningococcaL A,C,Y,W-135 dip (PF) (10 yrs up) vaccine 10-5 mcg/0.5 mL Soln 0.5 mL VIAL" | $392.19 | $522.91 | — | — | 25% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 "meningococcaL A,C,Y,W-135 dip (PF) vaccine 10-5 mcg/0.5 mL Kit 1 Each KIT" | $392.19 | $522.91 | — | — | 25% |
| Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 "meningococcaL A,C,Y,W-135 TET (PF) vaccine 10 mcg/0.5 mL Soln 0.5 mL VIAL" | $416.43 | $555.24 | — | 2% above | 25% |
| Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 "meningococcaL A,C,Y,W-135 TET (PF) vaccine 10 mcg/0.5 mL Soln 0.5 mL VIAL" | $416.43 | $555.24 | — | — | 25% |
| Mpox and smallpox vaccine (Jynneos), 2-dose schedule CPT 90611 smallpox-mpox (PF) live vaccine 0.5x to 3.95x 10exp8 unit/0.5 Susp 0.5 mL VIAL | $635.55 | $847.40 | — | — | 25% |
| Mpox and smallpox vaccine (Jynneos), 2-dose schedule inpatient CPT 90611 smallpox-mpox (PF) live vaccine 0.5x to 3.95x 10exp8 unit/0.5 Susp 0.5 mL VIAL | $635.55 | $847.40 | — | — | 25% |
| Nasal spray flu vaccine, live (FluMist) CPT 90660 flu vaccine TV live 2025-26 (2-49 yrs) 10exp6.5-7.5 FF unit/0.2 mL Spry syrg 1 Each SYRINGE | $81.60 | $108.80 | — | 109% above | 25% |
| Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 flu vaccine TV live 2025-26 (2-49 yrs) 10exp6.5-7.5 FF unit/0.2 mL Spry syrg 1 Each SYRINGE | $81.60 | $108.80 | — | — | 25% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 pneumococcaL 13-valent conj-dip cr (PF) vaccine 0.5 mL Syringe 0.5 mL SYRINGE | $531.84 | $709.12 | — | 40% above | 25% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 pneumococcaL 13-valent conj-dip cr (PF) vaccine 0.5 mL Syringe 0.5 mL SYRINGE | $531.84 | $709.12 | — | — | 25% |
| Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 pneumococcaL 15-valent conj-dip cr (PF) vaccine 0.5 mL Syringe 0.5 mL SYRINGE | $555.08 | $740.10 | — | — | 25% |
| Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 pneumococcaL 15-valent conj-dip cr (PF) vaccine 0.5 mL Syringe 0.5 mL SYRINGE | $555.08 | $740.10 | — | — | 25% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcaL 20-valent conj-dip cr (PF) vaccine 0.5 mL Syringe 0.5 mL SYRINGE | $724.20 | $965.59 | — | 3% above | 25% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcaL 20-valent conj-dip cr (PF) vaccine 0.5 mL Syringe 0.5 mL SYRINGE | $724.20 | $965.59 | — | — | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE | $97.50 | $130.00 | — | 50% below | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 pneumococcaL 23-val ps vaccine 25 mcg/0.5 mL Syringe 0.5 mL SYRINGE | $277.72 | $370.29 | — | 41% above | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 pneumococcaL 23-val ps vaccine 25 mcg/0.5 mL Soln 0.5 mL VIAL | $277.72 | $370.29 | — | 41% above | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE | $97.50 | $130.00 | — | — | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 pneumococcaL 23-val ps vaccine 25 mcg/0.5 mL Soln 0.5 mL VIAL | $277.72 | $370.29 | — | — | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 pneumococcaL 23-val ps vaccine 25 mcg/0.5 mL Syringe 0.5 mL SYRINGE | $277.72 | $370.29 | — | — | 25% |
| Polio vaccine, inactivated (IPV) CPT 90713 poliovirus vaccine 40-8-32 unit/0.5 mL Susp 5 mL VIAL | $130.82 | $174.42 | — | 84% above | 25% |
| Polio vaccine, inactivated (IPV) inpatient CPT 90713 poliovirus vaccine 40-8-32 unit/0.5 mL Susp 5 mL VIAL | $130.82 | $174.42 | — | — | 25% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 nirsevimab-alip 100 mg/mL Syringe 1 mL SYRINGE | $1,396.20 | $1,861.59 | — | 11% above | 25% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 nirsevimab-alip 100 mg/mL Syringe 1 mL SYRINGE | $1,396.20 | $1,861.59 | — | — | 25% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 nirsevimab-alip 50 mg/0.5 mL Syringe 0.5 mL SYRINGE | $1,396.20 | $1,861.59 | — | 46% above | 25% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 nirsevimab-alip 50 mg/0.5 mL Syringe 0.5 mL SYRINGE | $1,396.20 | $1,861.59 | — | — | 25% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 "RSV vac, preF A and preF B (PF) 120 mcg/0.5 mL Recon soln 1 Each VIAL" | $721.67 | $962.22 | — | 3% below | 25% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 "RSV vac, preF A and preF B (PF) 120 mcg/0.5 mL Recon soln 1 Each VIAL" | $721.67 | $962.22 | — | — | 25% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSVPreF3 antigen-AS01E (PF) 120 mcg/0.5 mL Recon susp 1 Each KIT | $720.61 | $960.81 | — | — | 25% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSVPref3 antigen AREXVY component (2 of 2) 120 mcg Recon susp 1 Each VIAL | $720.61 | $960.81 | — | — | 25% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 RSVPref3 antigen AREXVY component (2 of 2) 120 mcg Recon susp 1 Each VIAL | $720.61 | $960.81 | — | — | 25% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 RSVPreF3 antigen-AS01E (PF) 120 mcg/0.5 mL Recon susp 1 Each KIT | $720.61 | $960.81 | — | — | 25% |
| Rabies vaccine, one dose CPT 90675 rabies HDCV (PF) vaccine 2.5 unit Recon soln 1 Each VIAL | $1,018.87 | $1,358.49 | — | 4% above | 25% |
| Rabies vaccine, one dose CPT 90675 rabies vaccine PCEC (PF) 2.5 unit Recon susp 1 Each VIAL | $1,020.74 | $1,360.98 | — | 4% above | 25% |
| Rabies vaccine, one dose inpatient CPT 90675 rabies HDCV (PF) vaccine 2.5 unit Recon soln 1 Each VIAL | $1,018.87 | $1,358.49 | — | — | 25% |
| Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine PCEC (PF) 2.5 unit Recon susp 1 Each VIAL | $1,020.74 | $1,360.98 | — | — | 25% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 "Rotavirus Vaccine, Live, 89-12 10exp6 CCID50 /1.5 mL Susp 1.5 mL SYRINGE" | $343.77 | $458.36 | — | — | 25% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 "Rotavirus Vaccine, Live, 89-12 10exp6 CCID50/mL Recon susp 1 mL VIAL" | $343.77 | $458.36 | — | — | 25% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 "Rotavirus Vaccine, Live, 89-12 10exp6 CCID50/mL Recon susp 1 mL VIAL" | $343.77 | $458.36 | — | — | 25% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 "Rotavirus Vaccine, Live, 89-12 10exp6 CCID50 /1.5 mL Susp 1.5 mL SYRINGE" | $343.77 | $458.36 | — | — | 25% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 "rotavirus vaccine live, pentavalent 2 mL Soln 2 mL TUBE" | $240.16 | $320.21 | — | 44% above | 25% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 "rotavirus vaccine live, pentavalent 2 mL Soln 2 mL TUBE" | $240.16 | $320.21 | — | — | 25% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX | $144.00 | $192.00 | — | 9% below | 25% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 varicella-zoster gE (PF) vaccine 50 mcg/0.5 mL Recon susp 1 Each KIT | $508.05 | $677.39 | — | 221% above | 25% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX | $144.00 | $192.00 | — | — | 25% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 varicella-zoster gE (PF) vaccine 50 mcg/0.5 mL Recon susp 1 Each KIT | $508.05 | $677.39 | — | — | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE | $32.25 | $43.00 | — | 44% below | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE | $32.25 | $43.00 | — | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE 7 YRS/> IM | $69.00 | $92.00 | — | 27% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE 7 YRS/> IM | $69.00 | $92.00 | — | — | 25% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 typhoid VI polysaccharide vaccine 25 mcg/0.5 mL Soln 10 mL VIAL | $264.54 | $352.71 | — | — | 25% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 typhoid VI polysaccharide vaccine 25 mcg/0.5 mL Syringe 0.5 mL SYRINGE | $381.90 | $509.19 | — | — | 25% |
| Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 typhoid VI polysaccharide vaccine 25 mcg/0.5 mL Soln 10 mL VIAL | $264.54 | $352.71 | — | — | 25% |
| Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 typhoid VI polysaccharide vaccine 25 mcg/0.5 mL Syringe 0.5 mL SYRINGE | $381.90 | $509.19 | — | — | 25% |
| Typhoid vaccine, oral capsules (Vivotif) CPT 90690 Typhoid Vaccine Live 2 billion unit Cpdr sr cap 4 Each BLIST PACK | $83.10 | $110.80 | — | — | 25% |
| Typhoid vaccine, oral capsules (Vivotif) inpatient CPT 90690 Typhoid Vaccine Live 2 billion unit Cpdr sr cap 4 Each BLIST PACK | $83.10 | $110.80 | — | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE | $87.75 | $117.00 | — | 27% below | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE | $87.75 | $117.00 | — | — | 25% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE | $32.25 | $43.00 | — | 47% below | 25% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE | $32.25 | $43.00 | — | — | 25% |
| Yellow fever vaccine, live CPT 90717 "yellow fever vaccine live (PF) 1,000 unit/0.5 mL Recon susp 1 Each VIAL" | $332.90 | $443.86 | — | — | 25% |
| Yellow fever vaccine, live CPT 90717 yellow fever vaccine live (PF) 10 exp4.74 unit/0.5 mL Recon susp 1 Each VIAL | $603.56 | $804.74 | — | — | 25% |
| Yellow fever vaccine, live inpatient CPT 90717 "yellow fever vaccine live (PF) 1,000 unit/0.5 mL Recon susp 1 Each VIAL" | $332.90 | $443.86 | — | — | 25% |
| Yellow fever vaccine, live inpatient CPT 90717 yellow fever vaccine live (PF) 10 exp4.74 unit/0.5 mL Recon susp 1 Each VIAL | $603.56 | $804.74 | — | — | 25% |
Dental
| Procedure | Cash price | List price | Insurers pay | vs Hawaii | Off list |
|---|---|---|---|---|---|
| Dental implant, surgical placement CDT D6010 IMPLANT DENTAL 13MM 3.5MM NOBELREPLACE STRAIGHT GROOVY NARROW PLATFORM | $324.90 | $433.20 | — | — | 25% |
| Dental implant, surgical placement CDT D6010 IMPLANT DENTAL 11.5MM 3.5MM NOBELREPLACE STRAIGHT GROOVY NARROW PLATFORM | $324.90 | $433.20 | — | — | 25% |
| Dental implant, surgical placement inpatient CDT D6010 IMPLANT DENTAL 13MM 3.5MM NOBELREPLACE STRAIGHT GROOVY NARROW PLATFORM | $324.90 | $433.20 | — | — | 25% |
| Dental implant, surgical placement inpatient CDT D6010 IMPLANT DENTAL 11.5MM 3.5MM NOBELREPLACE STRAIGHT GROOVY NARROW PLATFORM | $324.90 | $433.20 | — | — | 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.