Hospital Tulsa, OK

Saint Francis Hospital Yale

Saint Francis Hospital Yale in Tulsa, OK publishes cash prices for 380 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 Oklahoma median for 173 of 377 procedures and below it for 152. By typical cash price it ranks #33 of 64 Oklahoma hospitals and #10 of 18 hospitals in the Tulsa, OK area, cheapest first. Select a procedure to compare it with other hospitals nearby.

6161 South Yale, Tulsa, OK 74136,6161 South Yale, Tulsa, OK 74136,6161 South Yale, Tulsa, OK 74136 Collected Sep 22, 2026 Source price file Check a bill from this hospital (918) 494-8467

Acute care hospital Nonprofit hospital Emergency department CMS star rating 5 of 5 CCN 370091 · CMS hospital register NPI 1144228487

Financial assistance

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

Saint Francis Hospital Yale 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 Oklahoma	Off list
Abdominal CT scan without and with contrast CPT 74170 Hc Ct Abdomen W/O & W/Contrast Material	$1,307.20	$3,268.00	—	2% below	60%
Abdominal CT scan without and with contrast inpatient CPT 74170 Hc Ct Abdomen W/O & W/Contrast Material	$1,307.20	$3,268.00	—	—	60%
Abdominal X-ray, 2 views CPT 74019 Hc Radiologic Examination, Abdomen - 2 Views	$253.46	$633.65	—	19% above	60%
Abdominal X-ray, 2 views inpatient CPT 74019 Hc Radiologic Examination, Abdomen - 2 Views	$253.46	$633.65	—	—	60%
Ankle X-ray, complete, 3 or more views CPT 73610 Hc X-Ray Exam Of Ankle	$174.80	$437.00	—	2% below	60%
Ankle X-ray, complete, 3 or more views CPT 73610 Hc X-Ray Ankle Complete Minimum 3 Views	$413.44	$1,033.60	—	132% above	60%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 Hc X-Ray Exam Of Ankle	$174.80	$437.00	—	—	60%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 Hc X-Ray Ankle Complete Minimum 3 Views	$413.44	$1,033.60	—	—	60%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Hc Non-Invas Physiologic Std Extremity Art 2 Level	$348.96	$872.40	—	37% above	60%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Hc Non-Invas Physiologic Std Extremity Art 2 Level	$348.96	$872.40	—	—	60%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 Hc Ct Upper Extremity W/O Contrast Material	$3,412.02	$8,530.05	—	280% above	60%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 Hc Ct Upper Extremity W/O Contrast Material	$3,412.02	$8,530.05	—	—	60%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Hc X-Ray Esophagus	$286.90	$717.25	—	2% below	60%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Hc X-Ray Esophagus	$286.90	$717.25	—	—	60%
Bone scan, whole body (nuclear medicine) CPT 78306 Hc Bone &/Joint Imaging Whole Body	$919.60	$2,299.00	—	4% below	60%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Hc Bone &/Joint Imaging Whole Body	$919.60	$2,299.00	—	—	60%
Breast ultrasound, complete, one breast CPT 76641 Hc Ultrasound Of Breast Complete	$259.54	$648.85	—	25% below	60%
Breast ultrasound, complete, one breast inpatient CPT 76641 Hc Ultrasound Of Breast Complete	$259.54	$648.85	—	—	60%
Breast ultrasound, limited (one breast or one area) CPT 76642 Hc Us Exam Breast(S)	$628.90	$1,572.25	—	89% above	60%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Hc Us Exam Breast(S)	$628.90	$1,572.25	—	—	60%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 Hc Ct Angio Abd&Plvis Cntrst Mtrl W/Wo Cntrst Img	$2,248.46	$5,621.15	—	at median	60%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 Hc Ct Angio Abd&Plvis Cntrst Mtrl W/Wo Cntrst Img	$2,248.46	$5,621.15	—	—	60%
CT angiography (CTA) of the head CPT 70496 Hc Ct Angiography Head W/Contrast/Noncontrast	$1,196.24	$2,990.60	—	10% below	60%
CT angiography (CTA) of the head CPT 70496 Hc Ct Angio Head Venogram W/Contrast	$1,196.24	$2,990.60	—	10% below	60%
CT angiography (CTA) of the head inpatient CPT 70496 Hc Ct Angio Head Venogram W/Contrast	$1,196.24	$2,990.60	—	—	60%
CT angiography (CTA) of the head inpatient CPT 70496 Hc Ct Angiography Head W/Contrast/Noncontrast	$1,196.24	$2,990.60	—	—	60%
CT angiography (CTA) of the neck CPT 70498 Hc Ct Angiography Neck W/Contrast/Noncontrast	$1,124.04	$2,810.10	—	15% below	60%
CT angiography (CTA) of the neck inpatient CPT 70498 Hc Ct Angiography Neck W/Contrast/Noncontrast	$1,124.04	$2,810.10	—	—	60%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Hc Ct Angiography Chest W/Contrast/Noncontrast	$1,478.20	$3,695.50	—	1% below	60%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Hc Ct Angiography Chest W/Contrast/Noncontrast	$1,478.20	$3,695.50	—	—	60%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Hc Cta Hrt Cornry Art/Bypass Grfts Contrst 3D Post	$1,264.26	$3,160.65	—	3% above	60%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 Hc Cta Hrt Cornry Art/Bypass Grfts Contrst 3D Post	$1,264.26	$3,160.65	—	—	60%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 Hc Ct Heart No Contrast Quant Eval Coronry Calcium	$74.48	$186.20	—	27% below	60%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 Hc Ct Heart No Contrast Quant Eval Coronry Calcium	$74.48	$186.20	—	—	60%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Hc Ct Abdomen & Pelvis W/O Contrast Material	$1,338.74	$3,346.85	—	at median	60%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Hc Ct Abdomen & Pelvis W/O Contrast Material	$1,338.74	$3,346.85	—	—	60%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 Hc Ct Abdomen & Pelvis W/Contrast Material	$1,610.82	$4,027.05	—	12% below	60%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Hc Ct Abdomen & Pelvis W/Contrast Material	$1,610.82	$4,027.05	—	—	60%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Hc Ct Abdomen & Pelvis W & W/O Contrst 1/> Body Re	$1,895.82	$4,739.55	—	11% below	60%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Hc Ct Abdomen & Pelvis W & W/O Contrst 1/> Body Re	$1,895.82	$4,739.55	—	—	60%
CT scan of the abdomen with contrast CPT 74160 Hc Ct Abdomen W/Contrast Material	$1,057.16	$2,642.90	—	4% below	60%
CT scan of the abdomen with contrast inpatient CPT 74160 Hc Ct Abdomen W/Contrast Material	$1,057.16	$2,642.90	—	—	60%
CT scan of the abdomen without contrast CPT 74150 Hc Ct Abdomen W/O Contrast Material	$954.18	$2,385.45	—	4% below	60%
CT scan of the abdomen without contrast inpatient CPT 74150 Hc Ct Abdomen W/O Contrast Material	$954.18	$2,385.45	—	—	60%
CT scan of the face and sinuses, no contrast dye CPT 70486 Hc Ct Maxillofacial W/O Contrast Material	$878.94	$2,197.35	—	9% below	60%
CT scan of the face and sinuses, no contrast dye CPT 70486 Hc Ct Maxillofacial W/O Dye	$878.94	$2,197.35	—	9% below	60%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Hc Ct Maxillofacial W/O Contrast Material	$878.94	$2,197.35	—	—	60%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Hc Ct Maxillofacial W/O Dye	$878.94	$2,197.35	—	—	60%
CT scan of the head or brain, no contrast dye CPT 70450 Hc Ct Head/Brain W/O Contrast Material	$924.16	$2,310.40	—	7% below	60%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 Hc Ct Head/Brain W/O Contrast Material	$924.16	$2,310.40	—	—	60%
CT scan of the head with contrast CPT 70460 Hc Ct Head/Brain W/Contrast Material	$1,210.30	$3,025.75	—	at median	60%
CT scan of the head with contrast inpatient CPT 70460 Hc Ct Head/Brain W/Contrast Material	$1,210.30	$3,025.75	—	—	60%
CT scan of the head without and with contrast CPT 70470 Hc Ct Head/Brain W/O & W/Contrast Material	$1,280.98	$3,202.45	—	at median	60%
CT scan of the head without and with contrast inpatient CPT 70470 Hc Ct Head/Brain W/O & W/Contrast Material	$1,280.98	$3,202.45	—	—	60%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Hc Ct Lumbar Spine W/O Contrast Material	$1,010.42	$2,526.05	—	3% below	60%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 Hc Ct Lumbar Spine W/O Contrast Material	$1,010.42	$2,526.05	—	—	60%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Hc Ct Cervical Spine W/O Contrast Material	$902.88	$2,257.20	—	16% below	60%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 Hc Ct Cervical Spine W/O Contrast Material	$902.88	$2,257.20	—	—	60%
CT scan of the pelvis, with contrast dye CPT 72193 Hc Ct Pelvis W/Contrast Material	$1,083.38	$2,708.45	—	at median	60%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 Hc Ct Pelvis W/Contrast Material	$1,083.38	$2,708.45	—	—	60%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Hc Duplex Scan Extracranial Art Compl Bi Study	$598.88	$1,497.20	—	—	60%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Hc Duplex Scan Extracranial Art Compl Bi Study	$598.88	$1,497.20	—	—	60%
Chest CT scan without and with contrast CPT 71270 Hc Ct Thorax W/O & W/Contrast Material	$1,237.66	$3,094.15	—	1% below	60%
Chest CT scan without and with contrast inpatient CPT 71270 Hc Ct Thorax W/O & W/Contrast Material	$1,237.66	$3,094.15	—	—	60%
Chest X-ray, 2 views CPT 71046 Hc Radiologic Examination, Chest - 2 Views	$328.32	$820.80	—	85% above	60%
Chest X-ray, 2 views inpatient CPT 71046 Hc Radiologic Examination, Chest - 2 Views	$328.32	$820.80	—	—	60%
Chest X-ray, single view CPT 71045 Hc Radiologic Examination, Chest- Single View	$218.40	$546.00	—	32% above	60%
Chest X-ray, single view inpatient CPT 71045 Hc Radiologic Examination, Chest- Single View	$218.40	$546.00	—	—	60%
Collarbone (clavicle) X-ray, complete CPT 73000 Hc X-Ray Clavicle Complete	$183.16	$457.90	—	3% above	60%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 Hc X-Ray Clavicle Complete	$183.16	$457.90	—	—	60%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Hc Us Retroperitoneal Real Time W/Image Complete	$472.72	$1,181.80	—	at median	60%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Hc Us Retroperitoneal Real Time W/Image Complete	$472.72	$1,181.80	—	—	60%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Hc Dxa Bone Density Axial	$68.78	$171.95	—	73% below	60%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Hc Dxa Bone Density Axial	$68.78	$171.95	—	—	60%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Hc Dxa Bone Density/Peripheral	$108.30	$270.75	—	at median	60%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 Hc Dxa Bone Density/Peripheral	$108.30	$270.75	—	—	60%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Hc Us Preg Uterus W/Detail Fetal Anat 1St Gestation	$552.14	$1,380.35	—	at median	60%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 Hc Us Preg Uterus W/Detail Fetal Anat 1St Gestation	$552.14	$1,380.35	—	—	60%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Hc Ct Thorax W/O Contrast Material	$927.58	$2,318.95	—	3% below	60%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Hc Ct Thorax W/O Contrast Material	$927.58	$2,318.95	—	—	60%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Hc Ct Thorax W/Dye	$1,123.66	$2,809.15	—	3% below	60%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Hc Ct Thorax W/Dye	$1,123.66	$2,809.15	—	—	60%
Diagnostic mammogram, both breasts both sides CPT 77066 Hc Diagnostic Mammo Digital Bilateral, Includes Cad When Performed	$260.64	$651.60	—	—	60%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Hc Diagnostic Mammo Digital Bilateral, Includes Cad When Performed	$260.64	$651.60	—	—	60%
Diagnostic mammogram, one breast one side CPT 77065 Hc Diagnostic Mammo Digital Unilateral, Includes Cad When Performed	$202.08	$505.20	—	at median	60%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Hc Diagnostic Mammo Digital Unilateral, Includes Cad When Performed	$202.08	$505.20	—	—	60%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Hc Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study	$612.94	$1,532.35	—	—	60%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 Hc Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study	$612.94	$1,532.35	—	—	60%
Duplex ultrasound of the leg veins, both legs CPT 93970 Hc Extremity Study	$711.36	$1,778.40	—	11% above	60%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Hc Extremity Study	$711.36	$1,778.40	—	—	60%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Hc Echo Tthrc R-T 2D W/Wom-Mode Compl Spec&Colr D	$1,087.18	$2,717.95	—	1% below	60%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Hc Echo Tthrc R-T 2D W/Wom-Mode Compl Spec&Colr D	$1,087.18	$2,717.95	—	—	60%
Elbow X-ray, 2 views CPT 73070 Hc X-Ray Elbow 2 Views	$173.66	$434.15	—	at median	60%
Elbow X-ray, 2 views inpatient CPT 73070 Hc X-Ray Elbow 2 Views	$173.66	$434.15	—	—	60%
Elbow X-ray, complete, 3 or more views CPT 73080 Hc X-Ray Elbow Complete Minimum 3 Views	$205.58	$513.95	—	15% above	60%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 Hc X-Ray Elbow Complete Minimum 3 Views	$205.58	$513.95	—	—	60%
Eye socket (orbit) CT scan without contrast CPT 70480 Hc Ct Orbit Sella/Post Fossa/Ear W/O Contrast Matrl	$949.24	$2,373.10	—	4% above	60%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Hc Ct Orbit Sella/Post Fossa/Ear W/O Contrast Matrl	$949.24	$2,373.10	—	—	60%
Facial bones X-ray, complete, 3 or more views CPT 70150 Hc X-Ray Facial Bones Complete Minimum 3 Views	$205.58	$513.95	—	7% below	60%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 Hc X-Ray Facial Bones Complete Minimum 3 Views	$205.58	$513.95	—	—	60%
Forearm X-ray (radius and ulna), 2 views CPT 73090 Hc X-Ray Forearm 2 Views	$380.76	$951.90	—	112% above	60%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 Hc X-Ray Forearm 2 Views	$380.76	$951.90	—	—	60%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hc Hepatobiliary Syst Imaging Including Gallbladder	$1,153.30	$2,883.25	—	at median	60%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hc Hepatobiliary Syst Imaging Including Gallbladder	$1,153.30	$2,883.25	—	—	60%
Hand X-ray, 2 views CPT 73120 Hc X-Ray Hand 2 Views	$390.26	$975.65	—	109% above	60%
Hand X-ray, 2 views inpatient CPT 73120 Hc X-Ray Hand 2 Views	$390.26	$975.65	—	—	60%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 Hc X-Ray Calcaneus Minimum 2 Views	$161.88	$404.70	—	at median	60%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 Hc X-Ray Calcaneus Minimum 2 Views	$161.88	$404.70	—	—	60%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Hc Sleep Study, Unattended & Resp Effort	$378.48	$946.20	—	11% below	60%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Hc Sleep Study, Unattended & Resp Effort	$378.48	$946.20	—	—	60%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Hc Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd	$3,130.06	$7,825.15	—	1% above	60%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Hc Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd	$3,130.06	$7,825.15	—	—	60%
Knee X-ray, 3 views CPT 73562 Hc X-Ray Knee 3 Views	$424.84	$1,062.10	—	119% above	60%
Knee X-ray, 3 views inpatient CPT 73562 Hc X-Ray Knee 3 Views	$424.84	$1,062.10	—	—	60%
Knee X-ray, complete, 4 or more views CPT 73564 Hc X-Ray Knee Complete 4/More Views	$508.44	$1,271.10	—	78% above	60%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 Hc X-Ray Knee Complete 4/More Views	$508.44	$1,271.10	—	—	60%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 Hc Ct Lower Extremity W/O Contrast Material	$883.12	$2,207.80	—	1% below	60%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 Hc Ct Lower Extremity W/O Contrast Material	$883.12	$2,207.80	—	—	60%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Hc Us Abdominal Real Time W/Image Limited	$415.72	$1,039.30	—	7% above	60%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Hc Ultrasound Abdominal Real Time W/Image Limited	$415.72	$1,039.30	—	7% above	60%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Hc Ultrasound Abdominal Real Time W/Image Limited	$415.72	$1,039.30	—	—	60%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Hc Us Abdominal Real Time W/Image Limited	$415.72	$1,039.30	—	—	60%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Hc Us Extremity Non-Vasc Real-Time Img Lmtd	$259.16	$647.90	—	at median	60%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Hc Us Xtr Non-Vasc Lmtd	$259.16	$647.90	—	at median	60%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 Hc Us Xtr Non-Vasc Lmtd	$259.16	$647.90	—	—	60%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 Hc Us Extremity Non-Vasc Real-Time Img Lmtd	$259.16	$647.90	—	—	60%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Hc Low Dose Ct Lung Screening	$40.66	$101.65	—	90% below	60%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Hc Low Dose Ct Lung Screening	$40.66	$101.65	—	—	60%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 Hc X-Ray Tibia & Fibula 2 Views	$369.36	$923.40	—	119% above	60%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 Hc X-Ray Tibia & Fibula 2 Views	$369.36	$923.40	—	—	60%
MR angiography (MRA) of the head without contrast CPT 70544 Hc Mra Head W/O Contrst Material	$796.86	$1,992.15	—	26% below	60%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 Hc Mra Head W/O Contrst Material	$796.86	$1,992.15	—	—	60%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Hc Mri Any Jt Lower Extrem W/O Contrast Matrl	$2,009.44	$5,023.60	—	49% above	60%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Hc Mri Any Jt Lower Extrem W/O Contrast Matrl	$2,009.44	$5,023.60	—	—	60%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Hc Mri Any Jt Lower Extrem W/O & W/Contrast Matrl	$2,825.30	$7,063.25	—	58% above	60%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Hc Mri Any Jt Lower Extrem W/O & W/Contrast Matrl	$2,825.30	$7,063.25	—	—	60%
MRI of the abdomen without contrast CPT 74181 Hc Mri Abdomen W/O Contrast Material	$986.48	$2,466.20	—	16% below	60%
MRI of the abdomen without contrast inpatient CPT 74181 Hc Mri Abdomen W/O Contrast Material	$986.48	$2,466.20	—	—	60%
MRI of the abdomen, without and then with contrast dye CPT 74183 Hc Mri Abdomen W/O & W/Contrast Material	$2,876.60	$7,191.50	—	50% above	60%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Hc Mri Abdomen W/O & W/Contrast Material	$2,876.60	$7,191.50	—	—	60%
MRI of the brain, no contrast dye CPT 70551 Hc Mri Brain Brain Stem W/O Contrast Material	$919.98	$2,299.95	—	21% below	60%
MRI of the brain, no contrast dye inpatient CPT 70551 Hc Mri Brain Brain Stem W/O Contrast Material	$919.98	$2,299.95	—	—	60%
MRI of the brain, with and without contrast dye CPT 70553 Hc Mri Brain Brain Stem W/O W/Contrast Material	$1,327.34	$3,318.35	—	11% below	60%
MRI of the brain, with and without contrast dye inpatient CPT 70553 Hc Mri Brain Brain Stem W/O W/Contrast Material	$1,327.34	$3,318.35	—	—	60%
MRI of the lower back, no contrast dye CPT 72148 Hc Mri Spinal Canal Lumbar W/O Contrast Material	$1,030.18	$2,575.45	—	16% below	60%
MRI of the lower back, no contrast dye inpatient CPT 72148 Hc Mri Spinal Canal Lumbar W/O Contrast Material	$1,030.18	$2,575.45	—	—	60%
MRI of the lower back, without and then with contrast dye CPT 72158 Hc Mri Spinal Canal Lumbar W/O & W/Contr Matrl	$1,537.48	$3,843.70	—	2% below	60%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 Hc Mri Spinal Canal Lumbar W/O & W/Contr Matrl	$1,537.48	$3,843.70	—	—	60%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Hc Mri Spinal Canal Thoracic W/O Contrast Matrl	$1,017.26	$2,543.15	—	8% below	60%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 Hc Mri Spinal Canal Thoracic W/O Contrast Matrl	$1,017.26	$2,543.15	—	—	60%
MRI of the neck (cervical spine) without and with contrast CPT 72156 Hc Mri Spinal Canal Cervical W/O & W/Contr Matrl	$1,460.34	$3,650.85	—	11% below	60%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 Hc Mri Spinal Canal Cervical W/O & W/Contr Matrl	$1,460.34	$3,650.85	—	—	60%
MRI of the neck (cervical spine), no contrast dye CPT 72141 Hc Mri Spinal Canal Cervical W/O Contrast Matrl	$1,018.02	$2,545.05	—	12% below	60%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 Hc Mri Spinal Canal Cervical W/O Contrast Matrl	$1,018.02	$2,545.05	—	—	60%
MRI of the pelvis without and with contrast CPT 72197 Hc Mri Pelvis W/O & W/Contrast Material	$1,252.48	$3,131.20	—	21% below	60%
MRI of the pelvis without and with contrast inpatient CPT 72197 Hc Mri Pelvis W/O & W/Contrast Material	$1,252.48	$3,131.20	—	—	60%
MRI of the pelvis, no contrast dye CPT 72195 Hc Mri Pelvis W/O Contrast Material	$931.76	$2,329.40	—	9% below	60%
MRI of the pelvis, no contrast dye inpatient CPT 72195 Hc Mri Pelvis W/O Contrast Material	$931.76	$2,329.40	—	—	60%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Hc Mri Any Jt Upper Extremity W/O Contrast Matrl	$2,257.96	$5,644.90	—	60% above	60%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 Hc Mri Any Jt Upper Extremity W/O Contrast Matrl	$2,257.96	$5,644.90	—	—	60%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Hc X-Ray Spine Cervical 4 Or 5 Views	$262.96	$657.40	—	6% below	60%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 Hc X-Ray Spine Cervical 4 Or 5 Views	$262.96	$657.40	—	—	60%
Neck soft tissue CT scan with contrast CPT 70491 Hc Ct Soft Tissue Neck W/Contrast Material	$1,011.18	$2,527.95	—	8% below	60%
Neck soft tissue CT scan with contrast inpatient CPT 70491 Hc Ct Soft Tissue Neck W/Contrast Material	$1,011.18	$2,527.95	—	—	60%
Neck soft tissue CT scan without contrast CPT 70490 Hc Ct Soft Tissue Neck W/O Contrast Material	$847.02	$2,117.55	—	1% below	60%
Neck soft tissue CT scan without contrast inpatient CPT 70490 Hc Ct Soft Tissue Neck W/O Contrast Material	$847.02	$2,117.55	—	—	60%
Neck soft tissue X-ray CPT 70360 Hc X-Ray Neck Soft Tissue	$161.50	$403.75	—	at median	60%
Neck soft tissue X-ray inpatient CPT 70360 Hc X-Ray Neck Soft Tissue	$161.50	$403.75	—	—	60%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Hc Ht Muscle Image Spect Mult	$2,672.54	$6,681.35	—	at median	60%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Hc Myocardial Spect Multiple Studies	$2,672.54	$6,681.35	—	at median	60%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Hc Myocardial Spect Multiple Studies	$2,672.54	$6,681.35	—	—	60%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Hc Ht Muscle Image Spect Mult	$2,672.54	$6,681.35	—	—	60%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 Hc Pet Imaging Ct Attenuation Skull Base Mid-Thigh	$3,981.64	$9,954.10	—	at median	60%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Hc Pet Imaging Ct Attenuation Skull Base Mid-Thigh	$3,981.64	$9,954.10	—	—	60%
Pelvic CT scan without contrast CPT 72192 Hc Ct Pelvis W/O Contrast Material	$964.44	$2,411.10	—	at median	60%
Pelvic CT scan without contrast inpatient CPT 72192 Hc Ct Pelvis W/O Contrast Material	$964.44	$2,411.10	—	—	60%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Hc Us Pelvic Nonobstetric Image Dcmtn Limited/F/U	$318.44	$796.10	—	6% above	60%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Hc Us Pelvic Nonobstetric Image Dcmtn Limited/F/U	$318.44	$796.10	—	—	60%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Hc Us Pelvic Nonobstetric Real-Time Image Complete	$504.26	$1,260.65	—	2% above	60%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Hc Us Pelvic Nonobstetric Real-Time Image Complete	$504.26	$1,260.65	—	—	60%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Noncdm Charge Record	$129.60	$324.00	—	72% below	60%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Hc Us Preg Uterus After 1St Trimest 1/1St Gestation	$520.22	$1,300.55	—	12% above	60%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Noncdm Charge Record	$129.60	$324.00	—	—	60%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Hc Us Preg Uterus After 1St Trimest 1/1St Gestation	$520.22	$1,300.55	—	—	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Noncdm Charge Record	$113.60	$284.00	—	70% below	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Hc Us Pregnant Uterus 14 Wk Transabdl 1/1St Gestat	$429.40	$1,073.50	—	12% above	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Noncdm Charge Record	$113.60	$284.00	—	—	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Hc Us Pregnant Uterus 14 Wk Transabdl 1/1St Gestat	$429.40	$1,073.50	—	—	60%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Hc Us Pregnant Uterus Limited 1/> Fetuses	$335.54	$838.85	—	at median	60%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Hc Ob Us Limited Fetus(S)	$335.54	$838.85	—	at median	60%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Hc Us Pregnant Uterus Limited 1/> Fetuses	$335.54	$838.85	—	—	60%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Hc Ob Us Limited Fetus(S)	$335.54	$838.85	—	—	60%
Rib X-ray, one side, 2 views one side CPT 71100 Hc X-Ray Ribs Unilateral 2 Views	$234.08	$585.20	—	17% above	60%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Hc X-Ray Ribs Unilateral 2 Views	$234.08	$585.20	—	—	60%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 Hc X-Ray Ribs Uni W/Posteroant Ch Minimum 3 Views	$292.22	$730.55	—	20% above	60%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 Hc X-Ray Ribs Uni W/Posteroant Ch Minimum 3 Views	$292.22	$730.55	—	—	60%
Screening mammogram, both breasts CPT 77067 Hc Screeningmammographydigital, Includes Cad When Performed	$211.20	$528.00	—	17% above	60%
Screening mammogram, both breasts inpatient CPT 77067 Hc Screeningmammographydigital, Includes Cad When Performed	$211.20	$528.00	—	—	60%
Shoulder X-ray, complete, 2 or more views CPT 73030 Hc X-Ray Shoulder Complete Minimum 2 Views	$394.06	$985.15	—	103% above	60%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 Hc X-Ray Shoulder Complete Minimum 2 Views	$394.06	$985.15	—	—	60%
Sinus X-ray, complete, 3 or more views CPT 70220 Hc X-Ray Sinuses Paranasal Compl Minimum 3 Views	$206.72	$516.80	—	at median	60%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Hc X-Ray Sinuses Paranasal Compl Minimum 3 Views	$206.72	$516.80	—	—	60%
Skull X-ray, fewer than 4 views CPT 70250 Hc X-Ray Skull 4/> Views	$178.98	$447.45	—	13% below	60%
Skull X-ray, fewer than 4 views inpatient CPT 70250 Hc X-Ray Skull 4/> Views	$178.98	$447.45	—	—	60%
Sleep study in a lab (polysomnography) CPT 95810 Hc Polysom 6/>Yrs Sleep 4/> Addl Param Attnd	$2,763.36	$6,908.40	—	at median	60%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Hc Polysom 6/>Yrs Sleep 4/> Addl Param Attnd	$2,763.36	$6,908.40	—	—	60%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Hc Echo Tthrc R-T 2D W/Wo M-Mode Rest&Strs Cont Ecg	$1,169.26	$2,923.15	—	at median	60%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Hc Echo Tthrc R-T 2D W/Wo M-Mode Rest&Strs Cont Ecg	$1,169.26	$2,923.15	—	—	60%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Hc Swallowing Funcj W/Cineradiograpy/Vidradiog	$327.18	$817.95	—	at median	60%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Hc Swallowing Funcj W/Cineradiograpy/Vidradiog	$327.18	$817.95	—	—	60%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 Hc X-Ray Femur 2 Views	$456.76	$1,141.90	—	137% above	60%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 Hc X-Ray Femur 2 Views	$456.76	$1,141.90	—	—	60%
Thoracic spine (mid back) CT scan without contrast CPT 72128 Hc Ct Thoracic Spine W/O Contrast Material	$1,013.08	$2,532.70	—	at median	60%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 Hc Ct Thoracic Spine W/O Contrast Material	$1,013.08	$2,532.70	—	—	60%
Toe X-ray, 2 or more views CPT 73660 Hc X-Ray Toe Minimum 2 Views	$149.34	$373.35	—	8% below	60%
Toe X-ray, 2 or more views inpatient CPT 73660 Hc X-Ray Toe Minimum 2 Views	$149.34	$373.35	—	—	60%
Transvaginal pelvic ultrasound CPT 76830 Hc Ultrasound Transvaginal	$416.86	$1,042.15	—	at median	60%
Transvaginal pelvic ultrasound inpatient CPT 76830 Hc Ultrasound Transvaginal	$416.86	$1,042.15	—	—	60%
Transvaginal ultrasound during pregnancy CPT 76817 Hc Us Preg Uterus Real Time W/Image Dcmtn Transvag	$337.06	$842.65	—	5% above	60%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 Hc Us Preg Uterus Real Time W/Image Dcmtn Transvag	$337.06	$842.65	—	—	60%
Ultrasound of the abdomen, complete CPT 76700 Hc Us Abdominal Real Time W/Image Documentation	$581.78	$1,454.45	—	10% above	60%
Ultrasound of the abdomen, complete inpatient CPT 76700 Hc Us Abdominal Real Time W/Image Documentation	$581.78	$1,454.45	—	—	60%
Ultrasound of the scrotum and testicles CPT 76870 Hc Ultrasound Scrotum & Contents	$355.30	$888.25	—	at median	60%
Ultrasound of the scrotum and testicles inpatient CPT 76870 Hc Ultrasound Scrotum & Contents	$355.30	$888.25	—	—	60%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Hc Us Soft Tissue Head & Neck Real Time Imge Docm	$415.72	$1,039.30	—	2% above	60%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Hc Us Soft Tissue Head & Neck Real Time Imge Docm	$415.72	$1,039.30	—	—	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Hc X-Ray Gi Tract Upper W/Wo Delayed Films W/Kub	$380.38	$950.95	—	at median	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Hc Radiologic Exam Upr Gi Trc Single Contrast Study	$380.38	$950.95	—	at median	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Hc X-Ray Gi Tract Upper W/Wo Delayed Films W/Kub	$380.38	$950.95	—	—	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Hc Radiologic Exam Upr Gi Trc Single Contrast Study	$380.38	$950.95	—	—	60%
Upper arm X-ray (humerus), 2 views CPT 73060 Hc X-Ray Humerus Minimum 2 Views	$380.76	$951.90	—	118% above	60%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 Hc X-Ray Humerus Minimum 2 Views	$380.76	$951.90	—	—	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Hc Extremity Study	$508.82	$1,272.05	—	10% above	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Hc Extremity Study	$508.82	$1,272.05	—	—	60%
Wrist X-ray, 2 views CPT 73100 Hc X-Ray Wrist 2 Views	$346.94	$867.35	—	112% above	60%
Wrist X-ray, 2 views inpatient CPT 73100 Hc X-Ray Wrist 2 Views	$346.94	$867.35	—	—	60%
Wrist X-ray, complete, 3 or more views CPT 73110 Hc X-Ray Wrist Complete Minimum 3 Views	$419.14	$1,047.85	—	133% above	60%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 Hc X-Ray Wrist Complete Minimum 3 Views	$419.14	$1,047.85	—	—	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hc X-Ray Hip Unilateral Complete Minimum 2 Views	$311.60	$779.00	—	64% above	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Hc X-Ray Hip Unilateral Complete Minimum 2 Views	$311.60	$779.00	—	—	60%
X-ray of the abdomen, 1 view CPT 74018 Hc Radiologic Examination, Abdomen - 1 View	$185.82	$464.55	—	7% above	60%
X-ray of the abdomen, 1 view inpatient CPT 74018 Hc Radiologic Examination, Abdomen - 1 View	$185.82	$464.55	—	—	60%
X-ray of the ankle, 2 views CPT 73600 Hc X-Ray Ankle 2 Views	$346.18	$865.45	—	93% above	60%
X-ray of the ankle, 2 views inpatient CPT 73600 Hc X-Ray Ankle 2 Views	$346.18	$865.45	—	—	60%
X-ray of the finger(s), 2 or more views CPT 73140 Hc X-Ray Fingr Minimum 2 Views	$160.74	$401.85	—	1% below	60%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 Hc X-Ray Fingr Minimum 2 Views	$160.74	$401.85	—	—	60%
X-ray of the foot, 2 views CPT 73620 Hc X-Ray Foot 2 Views	$367.08	$917.70	—	110% above	60%
X-ray of the foot, 2 views inpatient CPT 73620 Hc X-Ray Foot 2 Views	$367.08	$917.70	—	—	60%
X-ray of the foot, complete, 3 or more views CPT 73630 Hc X-Ray Foot Complete Minimum 3 Views	$427.88	$1,069.70	—	117% above	60%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 Hc X-Ray Foot Complete Minimum 3 Views	$427.88	$1,069.70	—	—	60%
X-ray of the hand, 3 or more views CPT 73130 Hc X-Ray Hand Minimum 3 Views	$430.54	$1,076.35	—	119% above	60%
X-ray of the hand, 3 or more views inpatient CPT 73130 Hc X-Ray Hand Minimum 3 Views	$430.54	$1,076.35	—	—	60%
X-ray of the knee, 1 or 2 views CPT 73560 Hc X-Ray Knee 1/2 Views	$362.52	$906.30	—	109% above	60%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 Hc X-Ray Knee 1/2 Views	$362.52	$906.30	—	—	60%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Hc X-Ray Spine Lumbosacral 2/3 Views	$211.66	$529.15	—	at median	60%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Hc X-Ray Spine Lumbosacral 2/3 Views	$211.66	$529.15	—	—	60%
X-ray of the lower back, 4 or more views CPT 72110 Hc X-Ray Spine Lumbosacral Minimum 4 Views	$313.88	$784.70	—	at median	60%
X-ray of the lower back, 4 or more views inpatient CPT 72110 Hc X-Ray Spine Lumbosacral Minimum 4 Views	$313.88	$784.70	—	—	60%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Hc X-Ray Spine Thoracic 2 Views	$133.00	$332.50	—	37% below	60%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Hc X-Ray Spine Thoracic 2 Views	$133.00	$332.50	—	—	60%
X-ray of the nasal bones, 3 or more views CPT 70160 Hc X-Ray Nasal Bones Complete Minimum 3 Views	$163.40	$408.50	—	at median	60%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Hc X-Ray Nasal Bones Complete Minimum 3 Views	$163.40	$408.50	—	—	60%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Hc X-Ray Spine Cervical 2 Or 3 Views	$204.44	$511.10	—	at median	60%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Hc X-Ray Spine Cervical 2 Or 3 Views	$204.44	$511.10	—	—	60%
X-ray of the pelvis, 1 or 2 views CPT 72170 Hc X-Ray Pelvis 1/2 Views	$192.28	$480.70	—	at median	60%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Hc X-Ray Pelvis 1/2 Views	$192.28	$480.70	—	—	60%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Hc X-Ray Sacrum & Coccyx Minimum 2 Views	$177.84	$444.60	—	at median	60%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Hc X-Ray Sacrum & Coccyx Minimum 2 Views	$177.84	$444.60	—	—	60%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
ACTH blood test CPT 82024 Hc Adrenocorticotropic Hormone Acth	$179.36	$448.40	—	38% above	60%
ACTH blood test inpatient CPT 82024 Hc Adrenocorticotropic Hormone Acth	$179.36	$448.40	—	—	60%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Hc Transferase Alanine Amino Alt Sgpt	$60.80	$152.00	—	87% above	60%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Hc Transferase Alanine Amino Alt Sgpt	$60.80	$152.00	—	—	60%
AST (aspartate aminotransferase) enzyme test CPT 84450 Hc Transferase Aspartate Amino Ast Sgot	$53.20	$133.00	—	42% above	60%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Hc Transferase Aspartate Amino Ast Sgot	$53.20	$133.00	—	—	60%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hc Acute Hepatitis Panel	$191.90	$479.75	—	3% above	60%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hc Acute Hepatitis Panel	$191.90	$479.75	—	—	60%
Albumin blood test CPT 82040 Hc Albumin Serum Plasma/Whole Blood	$40.28	$100.70	—	29% above	60%
Albumin blood test inpatient CPT 82040 Hc Albumin Serum Plasma/Whole Blood	$40.28	$100.70	—	—	60%
Aldosterone blood test CPT 82088 Hc Assay Of Aldosterone	$191.14	$477.85	—	37% above	60%
Aldosterone blood test inpatient CPT 82088 Hc Assay Of Aldosterone	$191.14	$477.85	—	—	60%
Alkaline phosphatase (ALP) blood test CPT 84075 Hc Assay Of Phosphatase Alkaline	$59.66	$149.15	—	99% above	60%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Hc Assay Of Phosphatase Alkaline	$59.66	$149.15	—	—	60%
Allergy blood test, specific IgE, per allergen CPT 86003 Hc Allergen Specific Ige Quan/Semiquan Ea Allergen	$44.64	$111.60	—	107% above	60%
Allergy blood test, specific IgE, per allergen CPT 86003 Hc Allergen Specific Ige Quant/Semiquant Ea Allergen	$44.64	$111.60	—	107% above	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hc Allergen Specific Ige Quant/Semiquant Ea Allergen	$44.64	$111.60	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hc Allergen Specific Ige Quan/Semiquan Ea Allergen	$44.64	$111.60	—	—	60%
Alpha-fetoprotein (AFP) blood test CPT 82105 Hc Alpha-Fetoprotein Serum	$94.62	$236.55	—	72% above	60%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Hc Alpha-Fetoprotein Serum	$94.62	$236.55	—	—	60%
Ammonia blood test CPT 82140 Hc Assay Of Ammonia	$85.12	$212.80	—	22% above	60%
Ammonia blood test inpatient CPT 82140 Hc Assay Of Ammonia	$85.12	$212.80	—	—	60%
Amylase blood test CPT 82150 Hc Assay Of Amylase	$67.26	$168.15	—	45% above	60%
Amylase blood test inpatient CPT 82150 Hc Assay Of Amylase	$67.26	$168.15	—	—	60%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Hc Cyclic Citrullinated Peptide Antibody	$86.40	$216.00	—	32% above	60%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Hc Cyclic Citrullinated Peptide Antibody	$86.40	$216.00	—	—	60%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Hc Antinuclear Antibodies Ana	$74.88	$187.20	—	23% above	60%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Hc Antinuclear Antibodies Ana	$74.88	$187.20	—	—	60%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Hc Natriuretic Peptide	$112.10	$280.25	—	5% below	60%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Hc Natriuretic Peptide	$112.10	$280.25	—	—	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Culture Othr Specimn Aerobic	$167.04	$417.60	—	279% above	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Culture Othr Specimn Aerobic	$167.04	$417.60	—	—	60%
Basic metabolic panel (blood test) CPT 80048 Hc Basic Metabolic Panel Calcium Total	$31.92	$79.80	—	37% below	60%
Basic metabolic panel (blood test) inpatient CPT 80048 Hc Basic Metabolic Panel Calcium Total	$31.92	$79.80	—	—	60%
Bilirubin blood test, total CPT 82247 Hc Bilirubin Total	$76.80	$192.00	—	97% above	60%
Bilirubin blood test, total inpatient CPT 82247 Hc Bilirubin Total	$76.80	$192.00	—	—	60%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Hc Level Iv Surg Pathology Gross&Microscopic Exam	$249.66	$624.15	—	78% above	60%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Hc Level Iv Surg Pathology Gross&Microscopic Exam	$249.66	$624.15	—	—	60%
Blood culture for bacteria CPT 87040 Hc Culture Bacterial Blood Aerobic W/Id Isolates	$164.16	$410.40	—	122% above	60%
Blood culture for bacteria inpatient CPT 87040 Hc Culture Bacterial Blood Aerobic W/Id Isolates	$164.16	$410.40	—	—	60%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Noncdm Charge Record	$4.00	$10.00	—	60% below	60%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Hc Routine Venipuncture	$20.52	$51.30	—	105% above	60%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Noncdm Charge Record	$4.00	$10.00	—	—	60%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Hc Routine Venipuncture	$20.52	$51.30	—	—	60%
Blood glucose (sugar) test CPT 82947 Hc Glucose Quantitative Blood Xcpt Reagent Strip	$34.96	$87.40	—	25% above	60%
Blood glucose (sugar) test inpatient CPT 82947 Hc Glucose Quantitative Blood Xcpt Reagent Strip	$34.96	$87.40	—	—	60%
Blood lead test CPT 83655 Hc Assay Of Lead	$62.70	$156.75	—	32% above	60%
Blood lead test inpatient CPT 83655 Hc Assay Of Lead	$62.70	$156.75	—	—	60%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hc Gonadotropin Chorionic Qualitative	$80.18	$200.45	—	76% above	60%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Hc Gonadotropin Chorionic Qualitative	$80.18	$200.45	—	—	60%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Hc Blood Typing Abo	$57.12	$142.80	—	6% below	60%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Hc Blood Typing Abo	$57.12	$142.80	—	—	60%
Blood urea nitrogen (BUN) test CPT 84520 Hc Assay Of Urea Nitrogen Quantitative	$33.06	$82.65	—	32% above	60%
Blood urea nitrogen (BUN) test CPT 84520 Hc Bun (Poc)	$33.06	$82.65	—	32% above	60%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Hc Bun (Poc)	$33.06	$82.65	—	—	60%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Hc Assay Of Urea Nitrogen Quantitative	$33.06	$82.65	—	—	60%
C-peptide blood test CPT 84681 Hc Assay Of C-Peptide	$94.62	$236.55	—	4% above	60%
C-peptide blood test inpatient CPT 84681 Hc Assay Of C-Peptide	$94.62	$236.55	—	—	60%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Hc C-Reactive Protein	$59.52	$148.80	—	56% above	60%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 Hc C-Reactive Protein	$59.52	$148.80	—	—	60%
C. difficile toxin gene test (stool PCR) CPT 87493 Hc Inf Agent Det Nucleic Acid Clostridium Amp Probe	$72.96	$182.40	—	24% below	60%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Hc Inf Agent Det Nucleic Acid Clostridium Amp Probe	$72.96	$182.40	—	—	60%
CA 19-9 blood test (tumor marker) CPT 86301 Hc Immunoassay Tumor Antigen Quantitative Ca 19-9	$91.20	$228.00	—	at median	60%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Hc Immunoassay Tumor Antigen Quantitative Ca 19-9	$91.20	$228.00	—	—	60%
CA-125 blood test (ovarian cancer marker) CPT 86304 Hc Immunoassay Tumor Antigen Quantitative Ca 125	$122.88	$307.20	—	33% above	60%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Hc Immunoassay Tumor Antigen Quantitative Ca 125	$122.88	$307.20	—	—	60%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Hc Novel Coronavirus Sars-Cov-2	$63.84	$159.60	—	21% below	60%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Hc Novel Coronavirus Sars-Cov-2	$63.84	$159.60	—	—	60%
Calcium blood test, total CPT 82310 Hc Calcium Total	$53.20	$133.00	—	46% above	60%
Calcium blood test, total inpatient CPT 82310 Hc Calcium Total	$53.20	$133.00	—	—	60%
Carcinoembryonic antigen (CEA) test CPT 82378 Hc Carcinoembryonic Antigen Cea	$118.94	$297.35	—	15% above	60%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Hc Carcinoembryonic Antigen Cea	$118.94	$297.35	—	—	60%
Chickenpox (varicella) immunity blood test CPT 86787 Hc Antibody Varicella-Zoster	$69.60	$174.00	—	20% above	60%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Hc Antibody Varicella-Zoster	$69.60	$174.00	—	—	60%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Hc Iadna Chlamydia Trachomatis Amplified Probe Tq	$180.96	$452.40	—	127% above	60%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Hc Iadna Chlamydia Trachomatis Amplified Probe Tq	$180.96	$452.40	—	—	60%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Hc Lipid Panel	$65.36	$163.40	—	6% below	60%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Hc Lipid Panel	$65.36	$163.40	—	—	60%
Complete blood count (CBC) with differential CPT 85025 Hc Blood Count Complete Auto&Auto Difrntl Wbc	$45.60	$114.00	—	1% above	60%
Complete blood count (CBC) with differential inpatient CPT 85025 Hc Blood Count Complete Auto&Auto Difrntl Wbc	$45.60	$114.00	—	—	60%
Complete blood count (CBC), no differential CPT 85027 Hc Blood Count Complete Automated	$46.56	$116.40	—	6% above	60%
Complete blood count (CBC), no differential inpatient CPT 85027 Hc Blood Count Complete Automated	$46.56	$116.40	—	—	60%
Comprehensive metabolic panel (blood test) CPT 80053 Hc Comprehensive Metabolic Panel	$41.04	$102.60	—	43% below	60%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Hc Comprehensive Metabolic Panel	$41.04	$102.60	—	—	60%
Cortisol blood test, total CPT 82533 Hc Cortisol Total	$117.42	$293.55	—	53% above	60%
Cortisol blood test, total inpatient CPT 82533 Hc Cortisol Total	$117.42	$293.55	—	—	60%
Creatine kinase (CK) blood test, total CPT 82550 Hc Creatine Kinase Total	$70.68	$176.70	—	85% above	60%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Hc Creatine Kinase Total	$70.68	$176.70	—	—	60%
Creatinine blood test CPT 82565 Hc Creatinine Blood	$43.32	$108.30	—	46% above	60%
Creatinine blood test inpatient CPT 82565 Hc Creatinine Blood	$43.32	$108.30	—	—	60%
Cytomegalovirus (CMV) antibody test CPT 86644 Hc Antibody Cytomegalovirus Cmv	$127.68	$319.20	—	69% above	60%
Cytomegalovirus (CMV) antibody test CPT 86644 Hc Cmv Antibody	$127.68	$319.20	—	69% above	60%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Hc Cmv Antibody	$127.68	$319.20	—	—	60%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Hc Antibody Cytomegalovirus Cmv	$127.68	$319.20	—	—	60%
D-dimer blood test (blood clot marker) CPT 85379 Hc Fibrin Dgradiation Products D-Dimer Quantitative	$141.12	$352.80	—	43% above	60%
D-dimer blood test (blood clot marker) inpatient CPT 85379 Hc Fibrin Dgradiation Products D-Dimer Quantitative	$141.12	$352.80	—	—	60%
DHEA sulfate (DHEA-S) blood test CPT 82627 Hc Dehydroepiandrosterone-Sulfate	$73.34	$183.35	—	3% below	60%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Hc Dehydroepiandrosterone-Sulfate	$73.34	$183.35	—	—	60%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Drug Screen Newborn	$229.92	$574.80	—	137% above	60%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Drug Test(S), Presumptive, By Instrumented Chemistry Analyzer	$229.92	$574.80	—	137% above	60%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Meconium Drugs Of Abuse	$229.92	$574.80	—	137% above	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Drug Test(S), Presumptive, By Instrumented Chemistry Analyzer	$229.92	$574.80	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Meconium Drugs Of Abuse	$229.92	$574.80	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Drug Screen Newborn	$229.92	$574.80	—	—	60%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Hc Electrolyte Panel	$111.34	$278.35	—	84% above	60%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Hc Electrolyte Panel	$111.34	$278.35	—	—	60%
Epstein-Barr virus (EBV) antibody test CPT 86665 Hc Antibody Epstein-Barr Eb Virus Viral Capsid Vca	$69.12	$172.80	—	at median	60%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Hc Antibody Epstein-Barr Eb Virus Viral Capsid Vca	$69.12	$172.80	—	—	60%
Estradiol blood test CPT 82670 Hc Assay Of Estradiol	$126.54	$316.35	—	39% above	60%
Estradiol blood test inpatient CPT 82670 Hc Assay Of Estradiol	$126.54	$316.35	—	—	60%
FSH (follicle-stimulating hormone) test CPT 83001 Hc Gonadotropin Follicle Stimulating Hormone	$106.02	$265.05	—	51% above	60%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Hc Gonadotropin Follicle Stimulating Hormone	$106.02	$265.05	—	—	60%
Fecal calprotectin (stool inflammation test) CPT 83993 Hc Assay Of Calprotectin Fecal	$113.62	$284.05	—	21% below	60%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Hc Assay Of Calprotectin Fecal	$113.62	$284.05	—	—	60%
Ferritin blood test (iron stores) CPT 82728 Hc Assay Of Ferritin	$84.36	$210.90	—	31% above	60%
Ferritin blood test (iron stores) inpatient CPT 82728 Hc Assay Of Ferritin	$84.36	$210.90	—	—	60%
Fibrinogen blood test CPT 85384 Hc Fibrinogen Activity	$86.88	$217.20	—	23% above	60%
Fibrinogen blood test inpatient CPT 85384 Hc Fibrinogen Activity	$86.88	$217.20	—	—	60%
Folate (folic acid) blood test CPT 82746 Hc Assay Of Folic Acid Serum	$83.60	$209.00	—	27% above	60%
Folate (folic acid) blood test inpatient CPT 82746 Hc Assay Of Folic Acid Serum	$83.60	$209.00	—	—	60%
Free T3 thyroid hormone test CPT 84481 Hc Assay Of Triiodothyronine T3 Free	$128.44	$321.10	—	43% above	60%
Free T3 thyroid hormone test inpatient CPT 84481 Hc Assay Of Triiodothyronine T3 Free	$128.44	$321.10	—	—	60%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Hc Assay Of Free Thyroxine	$87.78	$219.45	—	43% above	60%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Hc Assay Of Free Thyroxine	$87.78	$219.45	—	—	60%
Free testosterone test CPT 84402 Hc Assay Of Testosterone Free	$86.64	$216.60	—	at median	60%
Free testosterone test inpatient CPT 84402 Hc Assay Of Testosterone Free	$86.64	$216.60	—	—	60%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Hc Assay Of Glutamyltrase Gamma	$64.98	$162.45	—	33% above	60%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Hc Assay Of Glutamyltrase Gamma	$64.98	$162.45	—	—	60%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 Hc General Health Panel	$81.70	$204.25	—	58% below	60%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 Hc General Health Panel	$81.70	$204.25	—	—	60%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Hc Glucose Post Glucose Dose	$29.26	$73.15	—	4% below	60%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Hc Glucose Post Glucose Dose	$29.26	$73.15	—	—	60%
Glucose tolerance test, 3 samples CPT 82951 Hc Glucose Tolerance Test Gtt 3 Specimens	$86.64	$216.60	—	29% above	60%
Glucose tolerance test, 3 samples inpatient CPT 82951 Hc Glucose Tolerance Test Gtt 3 Specimens	$86.64	$216.60	—	—	60%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Hc Iadna Neisseria Gonorrhoeae Amplified Probe Tq	$190.08	$475.20	—	128% above	60%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Hc Iadna Neisseria Gonorrhoeae Amplified Probe Tq	$190.08	$475.20	—	—	60%
H. pylori antibody blood test CPT 86677 Hc Antibody Helicobacter Pylori	$104.64	$261.60	—	40% above	60%
H. pylori antibody blood test inpatient CPT 86677 Hc Antibody Helicobacter Pylori	$104.64	$261.60	—	—	60%
H. pylori stool antigen test CPT 87338 Hc Iaad Eia Hpylori Stool	$156.96	$392.40	—	39% above	60%
H. pylori stool antigen test inpatient CPT 87338 Hc Iaad Eia Hpylori Stool	$156.96	$392.40	—	—	60%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hc Hiv-1 Quant & Reverse Transcription	$262.08	$655.20	—	29% above	60%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hc Iadna Hiv-1 Quant & Reverse Transcription	$338.88	$847.20	—	67% above	60%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Hc Hiv-1 Quant & Reverse Transcription	$262.08	$655.20	—	—	60%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Hc Iadna Hiv-1 Quant & Reverse Transcription	$338.88	$847.20	—	—	60%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hc Iaad Eia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$12.00	$30.00	—	75% below	60%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Hc Iaad Eia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$12.00	$30.00	—	—	60%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Hc Hpv High-Risk Types	$242.40	$606.00	—	163% above	60%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Hc Hpv High-Risk Types	$242.40	$606.00	—	—	60%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hc Hemoglobin Glycosylated A1C	$55.86	$139.65	—	30% above	60%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hc Hemoglobin Glycosylated A1C	$55.86	$139.65	—	—	60%
Hemoglobin blood test CPT 85018 Hc Blood Count Hemoglobin	$38.40	$96.00	—	91% above	60%
Hemoglobin blood test inpatient CPT 85018 Hc Blood Count Hemoglobin	$38.40	$96.00	—	—	60%
Hepatitis B core antibody test (total) CPT 86704 Hc Hepatitis B Core Antibody Hbcab Total	$59.04	$147.60	—	20% above	60%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hc Hepatitis B Core Antibody Hbcab Total	$59.04	$147.60	—	—	60%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hc Hepatitis B Surf Antibody Hbsab	$76.32	$190.80	—	62% above	60%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hc Hepatitis B Surf Antibody Hbsab	$76.32	$190.80	—	—	60%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hc Iaad Eia Hepatitis B Surface Antigen	$81.60	$204.00	—	79% above	60%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hc Iaad Eia Hepatitis B Surface Antigen	$81.60	$204.00	—	—	60%
Hepatitis C antibody blood test (screening) CPT 86803 Hc Hepatitis C Antibody	$84.48	$211.20	—	51% above	60%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hc Hepatitis C Antibody	$84.48	$211.20	—	—	60%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hc Iadna Hepatitis C Quant & Reverse Transcription	$313.44	$783.60	—	41% above	60%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hc Iadna Hepatitis C Quant & Reverse Transcription	$313.44	$783.60	—	—	60%
Herpes blood test, HSV-1 antibody CPT 86695 Hc Antibody Herpes Smplx Type 1	$69.12	$172.80	—	8% above	60%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Hc Antibody Herpes Smplx Type 1	$69.12	$172.80	—	—	60%
Herpes blood test, HSV-2 antibody CPT 86696 Hc Antibody Herpes Smplx Type 2	$85.92	$214.80	—	45% above	60%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Hc Antibody Herpes Smplx Type 2	$85.92	$214.80	—	—	60%
High-sensitivity CRP (hs-CRP) test CPT 86141 Hc C-Reactive Protein High Sensitivity	$115.20	$288.00	—	109% above	60%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 Hc C-Reactive Protein High Sensitivity	$115.20	$288.00	—	—	60%
Homocysteine blood test CPT 83090 Hc Assay Of Homocysteine	$186.20	$465.50	—	59% above	60%
Homocysteine blood test inpatient CPT 83090 Hc Assay Of Homocysteine	$186.20	$465.50	—	—	60%
Insulin blood test CPT 83525 Hc Assay Of Insulin Total	$56.24	$140.60	—	10% above	60%
Insulin blood test inpatient CPT 83525 Hc Assay Of Insulin Total	$56.24	$140.60	—	—	60%
Iron blood test (serum iron) CPT 83540 Hc Assay Of Iron	$47.12	$117.80	—	28% above	60%
Iron blood test (serum iron) inpatient CPT 83540 Hc Assay Of Iron	$47.12	$117.80	—	—	60%
Kidney function blood test panel CPT 80069 Hc Renal Function Panel	$33.06	$82.65	—	56% below	60%
Kidney function blood test panel inpatient CPT 80069 Hc Renal Function Panel	$33.06	$82.65	—	—	60%
LH (luteinizing hormone) test CPT 83002 Hc Gonadotropin Luteinizing Hormone	$106.40	$266.00	—	46% above	60%
LH (luteinizing hormone) test inpatient CPT 83002 Hc Gonadotropin Luteinizing Hormone	$106.40	$266.00	—	—	60%
Lactate (lactic acid) blood test CPT 83605 Hc Assay Of Lactate	$88.16	$220.40	—	49% above	60%
Lactate (lactic acid) blood test inpatient CPT 83605 Hc Assay Of Lactate	$88.16	$220.40	—	—	60%
Lactate dehydrogenase (LDH) blood test CPT 83615 Hc Lactate Dehydrogenase Ldh	$57.00	$142.50	—	62% above	60%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Hc Lactate Dehydrogenase Ldh	$57.00	$142.50	—	—	60%
Lipase blood test (pancreas enzyme) CPT 83690 Hc Assay Of Lipase	$70.30	$175.75	—	31% above	60%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Hc Assay Of Lipase	$70.30	$175.75	—	—	60%
Liver function blood test panel CPT 80076 Hc Hepatic Function Panel	$44.08	$110.20	—	24% below	60%
Liver function blood test panel inpatient CPT 80076 Hc Hepatic Function Panel	$44.08	$110.20	—	—	60%
Lyme disease antibody test CPT 86618 Hc Antibody Borrelia Burgdorferi Lyme Disease	$120.48	$301.20	—	49% above	60%
Lyme disease antibody test inpatient CPT 86618 Hc Antibody Borrelia Burgdorferi Lyme Disease	$120.48	$301.20	—	—	60%
Magnesium blood test CPT 83735 Hc Assay Of Magnesium	$89.60	$224.00	—	141% above	60%
Magnesium blood test inpatient CPT 83735 Hc Assay Of Magnesium	$89.60	$224.00	—	—	60%
Measles (rubeola) antibody test CPT 86765 Hc Antibody Rubeola	$59.52	$148.80	—	36% above	60%
Measles (rubeola) antibody test inpatient CPT 86765 Hc Antibody Rubeola	$59.52	$148.80	—	—	60%
Mono test (heterophile antibody, Monospot) CPT 86308 Hc Heterophile Antibody Screen	$47.52	$118.80	—	15% above	60%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Hc Heterophile Antibody Screen	$47.52	$118.80	—	—	60%
Mumps immunity blood test CPT 86735 Hc Antibody Mumps	$63.36	$158.40	—	8% above	60%
Mumps immunity blood test inpatient CPT 86735 Hc Antibody Mumps	$63.36	$158.40	—	—	60%
PSA (prostate-specific antigen) blood test, free CPT 84154 Hc Assay Of Prostate Specific Antigen Free	$111.72	$279.30	—	24% above	60%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Hc Assay Of Prostate Specific Antigen Free	$111.72	$279.30	—	—	60%
PSA (prostate-specific antigen) blood test, total CPT 84153 Hc Assay Of Prostate Specific Antigen Total	$75.24	$188.10	—	2% below	60%
PSA (prostate-specific antigen) blood test, total CPT 84153 Hc Psa Total	$75.24	$188.10	—	2% below	60%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Hc Assay Of Prostate Specific Antigen Total	$75.24	$188.10	—	—	60%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Hc Psa Total	$75.24	$188.10	—	—	60%
Pap test (liquid-based, automated screening with review) CPT 88175 Hc Cytp C/V Auto Thin Lyr Prepj Scr Mnl Rescr Phys	$47.88	$119.70	—	29% below	60%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Hc Cytp C/V Auto Thin Lyr Prepj Scr Mnl Rescr Phys	$47.88	$119.70	—	—	60%
Parathyroid hormone (PTH) blood test CPT 83970 Hc Assay Of Parathormone	$155.80	$389.50	—	12% above	60%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Hc Assay Of Parathormone	$155.80	$389.50	—	—	60%
Partial thromboplastin time (PTT) clotting test CPT 85730 Hc Thromboplastin Time Partial Plasma/Whole Blood	$31.20	$78.00	—	4% below	60%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Hc Thromboplastin Time Partial Plasma/Whole Blood	$31.20	$78.00	—	—	60%
Phosphorus (phosphate) blood test CPT 84100 Hc Assay Of Phosphorus Inorganic	$45.60	$114.00	—	39% above	60%
Phosphorus (phosphate) blood test inpatient CPT 84100 Hc Assay Of Phosphorus Inorganic	$45.60	$114.00	—	—	60%
Potassium blood test CPT 84132 Hc Potassium Serum Plasma/Whole Blood	$39.14	$97.85	—	17% above	60%
Potassium blood test inpatient CPT 84132 Hc Potassium Serum Plasma/Whole Blood	$39.14	$97.85	—	—	60%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 Hc Fetal Chromosomal Aneuploidy Genomic Seq Analysis	$572.16	$1,430.40	—	51% below	60%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 Hc Fetal Chromosomal Aneuploidy Genomic Seq Analysis	$572.16	$1,430.40	—	—	60%
Progesterone blood test CPT 84144 Hc Assay Of Progesterone	$89.30	$223.25	—	16% above	60%
Progesterone blood test inpatient CPT 84144 Hc Assay Of Progesterone	$89.30	$223.25	—	—	60%
Prolactin blood test CPT 84146 Hc Assay Of Prolactin	$93.86	$234.65	—	at median	60%
Prolactin blood test inpatient CPT 84146 Hc Assay Of Prolactin	$93.86	$234.65	—	—	60%
Prothrombin time (PT/INR) clotting test CPT 85610 Hc Prothrombin Time	$41.76	$104.40	—	28% above	60%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Hc Prothrombin Time	$41.76	$104.40	—	—	60%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Hc Drug Test Presumptive, Optical	$28.80	$72.00	—	41% below	60%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Hc Drug Test Presumptive, Optical	$28.80	$72.00	—	—	60%
Rapid flu test (influenza antigen) CPT 87804 Noncdm Charge Record	$38.00	$95.00	—	31% below	60%
Rapid flu test (influenza antigen) CPT 87804 Hc Iaadiadoo Influenza	$90.72	$226.80	—	66% above	60%
Rapid flu test (influenza antigen) inpatient CPT 87804 Noncdm Charge Record	$38.00	$95.00	—	—	60%
Rapid flu test (influenza antigen) inpatient CPT 87804 Hc Iaadiadoo Influenza	$90.72	$226.80	—	—	60%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Noncdm Charge Record	$15.20	$38.00	—	69% below	60%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Hc Strep A Assay	$73.44	$183.60	—	51% above	60%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Noncdm Charge Record	$15.20	$38.00	—	—	60%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Hc Strep A Assay	$73.44	$183.60	—	—	60%
Renin blood test CPT 84244 Hc Assay Of Renin	$106.02	$265.05	—	1% above	60%
Renin blood test inpatient CPT 84244 Hc Assay Of Renin	$106.02	$265.05	—	—	60%
Rh blood typing CPT 86901 Hc Blood Typing Rh (D)	$60.00	$150.00	—	33% above	60%
Rh blood typing inpatient CPT 86901 Hc Blood Typing Rh (D)	$60.00	$150.00	—	—	60%
Rheumatoid factor (RF) test CPT 86431 Hc Rheumatoid Factor Quantitative	$48.96	$122.40	—	58% above	60%
Rheumatoid factor (RF) test inpatient CPT 86431 Hc Rheumatoid Factor Quantitative	$48.96	$122.40	—	—	60%
Rubella antibody test (immunity check) CPT 86762 Hc Antibody Rubella	$80.64	$201.60	—	53% above	60%
Rubella antibody test (immunity check) inpatient CPT 86762 Hc Antibody Rubella	$80.64	$201.60	—	—	60%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Hc Sedimentation Rate Rbc Automated	$52.32	$130.80	—	113% above	60%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Hc Sedimentation Rate Rbc Automated	$52.32	$130.80	—	—	60%
Sodium blood test CPT 84295 Hc Sodium Serum Plasma Or Whole Blood	$39.14	$97.85	—	20% above	60%
Sodium blood test inpatient CPT 84295 Hc Sodium Serum Plasma Or Whole Blood	$39.14	$97.85	—	—	60%
Stool ova and parasites exam CPT 87177 Hc Ova&Parasites Direct Smears Concentration & Id	$138.72	$346.80	—	120% above	60%
Stool ova and parasites exam inpatient CPT 87177 Hc Ova&Parasites Direct Smears Concentration & Id	$138.72	$346.80	—	—	60%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Noncdm Charge Record	$18.00	$45.00	—	21% below	60%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Hc Occult Blood Feces	$20.14	$50.35	—	11% below	60%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Noncdm Charge Record	$18.00	$45.00	—	—	60%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Hc Occult Blood Feces	$20.14	$50.35	—	—	60%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Hc Blood Occult Fecal Hgb Deter Ia Qual Feces 1-3	$63.08	$157.70	—	8% above	60%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Hc Blood Occult Fecal Hgb Deter Ia Qual Feces 1-3	$63.08	$157.70	—	—	60%
Syphilis antibody test (Treponema pallidum) CPT 86780 Hc Treponema Pallidum Antibody By Tp-Pa	$63.36	$158.40	—	53% above	60%
Syphilis antibody test (Treponema pallidum) CPT 86780 Hc Treponema Pallidum Antibody, Igg	$63.36	$158.40	—	53% above	60%
Syphilis antibody test (Treponema pallidum) CPT 86780 Hc Antibody Treponema Pallidum	$63.36	$158.40	—	53% above	60%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Hc Antibody Treponema Pallidum	$63.36	$158.40	—	—	60%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Hc Treponema Pallidum Antibody, Igg	$63.36	$158.40	—	—	60%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Hc Treponema Pallidum Antibody By Tp-Pa	$63.36	$158.40	—	—	60%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Hc Syphilis Test Non-Treponemal Antibody Qual	$52.80	$132.00	—	69% above	60%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Hc Syphilis Test, Quantitative	$52.80	$132.00	—	69% above	60%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Hc Syphilis Test Non-Treponemal Antibody Qual	$52.80	$132.00	—	—	60%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Hc Syphilis Test, Quantitative	$52.80	$132.00	—	—	60%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Hc Tb Cell Mediated Antign Respnse Gamma Interferon	$323.52	$808.80	—	84% above	60%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Hc Tb Cell Mediated Antign Respnse Gamma Interferon	$323.52	$808.80	—	—	60%
Testosterone blood test, total (not free testosterone) CPT 84403 Hc Assay Of Testosterone Total	$150.86	$377.15	—	63% above	60%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Hc Assay Of Testosterone Total	$150.86	$377.15	—	—	60%
Thyroid peroxidase (TPO) antibody test CPT 86376 Hc Microsomal Antibodies Each	$126.24	$315.60	—	107% above	60%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Hc Microsomal Antibodies Each	$126.24	$315.60	—	—	60%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Hc Assay Of Thyroid Stimulating Hormone Tsh	$81.70	$204.25	—	51% above	60%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Hc Tsh (State Health Dept)	$139.20	$348.00	—	158% above	60%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Hc Assay Of Thyroid Stimulating Hormone Tsh	$81.70	$204.25	—	—	60%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Hc Tsh (State Health Dept)	$139.20	$348.00	—	—	60%
Total IgE blood test CPT 82785 Hc Assay Of Ige	$63.84	$159.60	—	24% above	60%
Total IgE blood test inpatient CPT 82785 Hc Assay Of Ige	$63.84	$159.60	—	—	60%
Total cholesterol blood test CPT 82465 Hc Cholesterol Serum/Whole Blood Total	$41.42	$103.55	—	24% above	60%
Total cholesterol blood test inpatient CPT 82465 Hc Cholesterol Serum/Whole Blood Total	$41.42	$103.55	—	—	60%
Total thyroxine (T4) blood test CPT 84436 Hc Assay Of Thyroxine Total	$72.58	$181.45	—	67% above	60%
Total thyroxine (T4) blood test inpatient CPT 84436 Hc Assay Of Thyroxine Total	$72.58	$181.45	—	—	60%
Total triiodothyronine (T3) blood test CPT 84480 Hc Assay Of Triiodothyronine T3 Total Tt3	$92.72	$231.80	—	57% above	60%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Hc Assay Of Triiodothyronine T3 Total Tt3	$92.72	$231.80	—	—	60%
Transferrin blood test CPT 84466 Hc Assay Of L7383Transferrin	$57.38	$143.45	—	at median	60%
Transferrin blood test inpatient CPT 84466 Hc Assay Of L7383Transferrin	$57.38	$143.45	—	—	60%
Trichomonas test (NAAT) CPT 87661 Hc Trichomonas Vaginalis Amplification	$158.40	$396.00	—	80% above	60%
Trichomonas test (NAAT) CPT 87661 Hc Iadna Trichomonas Vaginalis Amplified Probe Tech	$278.40	$696.00	—	217% above	60%
Trichomonas test (NAAT) inpatient CPT 87661 Hc Trichomonas Vaginalis Amplification	$158.40	$396.00	—	—	60%
Trichomonas test (NAAT) inpatient CPT 87661 Hc Iadna Trichomonas Vaginalis Amplified Probe Tech	$278.40	$696.00	—	—	60%
Triglycerides blood test CPT 84478 Hc Assay Of Triglycerides	$49.02	$122.55	—	42% above	60%
Triglycerides blood test inpatient CPT 84478 Hc Assay Of Triglycerides	$49.02	$122.55	—	—	60%
Troponin test, quantitative CPT 84484 Hc Assay Of Troponin Quantitative	$100.32	$250.80	—	41% above	60%
Troponin test, quantitative inpatient CPT 84484 Hc Assay Of Troponin Quantitative	$100.32	$250.80	—	—	60%
Uric acid blood test CPT 84550 Hc Assay Of Blood/Uric Acid	$50.54	$126.35	—	87% above	60%
Uric acid blood test inpatient CPT 84550 Hc Assay Of Blood/Uric Acid	$50.54	$126.35	—	—	60%
Urinalysis with microscope exam, automated CPT 81001 Noncdm Charge Record	$12.80	$32.00	—	60% below	60%
Urinalysis with microscope exam, automated CPT 81001 Hc Urnls Dip Stick/Tablet Reagent Auto Microscopy	$63.36	$158.40	—	98% above	60%
Urinalysis with microscope exam, automated inpatient CPT 81001 Noncdm Charge Record	$12.80	$32.00	—	—	60%
Urinalysis with microscope exam, automated inpatient CPT 81001 Hc Urnls Dip Stick/Tablet Reagent Auto Microscopy	$63.36	$158.40	—	—	60%
Urinalysis without microscope exam, automated CPT 81003 Hc Urnls Dip Stick/Tablet Rgnt Auto W/O Microscopy	$49.44	$123.60	—	245% above	60%
Urinalysis without microscope exam, automated inpatient CPT 81003 Hc Urnls Dip Stick/Tablet Rgnt Auto W/O Microscopy	$49.44	$123.60	—	—	60%
Urinalysis without microscope exam, manual CPT 81002 Noncdm Charge Record	$3.60	$9.00	—	79% below	60%
Urinalysis without microscope exam, manual CPT 81002 Hc Urnls Dip Stick/Tablet Rgnt Non-Auto W/O Micrscp	$63.84	$159.60	—	279% above	60%
Urinalysis without microscope exam, manual inpatient CPT 81002 Noncdm Charge Record	$3.60	$9.00	—	—	60%
Urinalysis without microscope exam, manual inpatient CPT 81002 Hc Urnls Dip Stick/Tablet Rgnt Non-Auto W/O Micrscp	$63.84	$159.60	—	—	60%
Urine culture for bacteria, with colony count CPT 87086 Hc Culture Bacterial Quanttative Colony Count Urine	$104.64	$261.60	—	117% above	60%
Urine culture for bacteria, with colony count inpatient CPT 87086 Hc Culture Bacterial Quanttative Colony Count Urine	$104.64	$261.60	—	—	60%
Urine microalbumin (albumin) test CPT 82043 Hc Albumin Urine Microalbumin Quantiative	$57.38	$143.45	—	50% above	60%
Urine microalbumin (albumin) test inpatient CPT 82043 Hc Albumin Urine Microalbumin Quantiative	$57.38	$143.45	—	—	60%
Urine pregnancy test, read by color change CPT 81025 Noncdm Charge Record	$13.20	$33.00	—	52% below	60%
Urine pregnancy test, read by color change CPT 81025 Hc Urine Pregnancy Test Visual Color Cmprsn Meths	$106.56	$266.40	—	284% above	60%
Urine pregnancy test, read by color change inpatient CPT 81025 Noncdm Charge Record	$13.20	$33.00	—	—	60%
Urine pregnancy test, read by color change inpatient CPT 81025 Hc Urine Pregnancy Test Visual Color Cmprsn Meths	$106.56	$266.40	—	—	60%
Vitamin B12 (cobalamin) blood test CPT 82607 Hc Cyanocobalamin Vitamin B-12	$80.18	$200.45	—	23% above	60%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Hc Cyanocobalamin Vitamin B-12	$80.18	$200.45	—	—	60%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Hc 25 Hydroxy Includes Fractions If Performed	$160.36	$400.90	—	22% above	60%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Hc 25 Hydroxy Includes Fractions If Performed	$160.36	$400.90	—	—	60%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Hc 1 25 Dihydroxy Includes Fractions If Performed	$167.58	$418.95	—	9% above	60%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Hc 1 25 Dihydroxy Includes Fractions If Performed	$167.58	$418.95	—	—	60%
Zinc blood test CPT 84630 Hc Zinc	$71.06	$177.65	—	23% above	60%
Zinc blood test CPT 84630 Hc Assay Of Zinc	$71.06	$177.65	—	23% above	60%
Zinc blood test inpatient CPT 84630 Hc Zinc	$71.06	$177.65	—	—	60%
Zinc blood test inpatient CPT 84630 Hc Assay Of Zinc	$71.06	$177.65	—	—	60%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hc Chorionic Gonadotropin, Quant	$71.82	$179.55	—	16% above	60%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hc Gonadotropin Chorionic Quantitative	$105.26	$263.15	—	70% above	60%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hc Chorionic Gonadotropin, Quant	$71.82	$179.55	—	—	60%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hc Gonadotropin Chorionic Quantitative	$105.26	$263.15	—	—	60%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
Botox injections for chronic migraine CPT 64615 Hc Chemodenervation Of Face, Neck Muscles For Migraine	$252.70	$631.75	—	at median	60%
Botox injections for chronic migraine inpatient CPT 64615 Hc Chemodenervation Of Face, Neck Muscles For Migraine	$252.70	$631.75	—	—	60%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Hc Vein X-Ray Liver W/Hemodynam	$1,994.62	$4,986.55	—	at median	60%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Hc Biopsy Breast 1St Lesion Stereotactic Guidance	$1,994.62	$4,986.55	—	at median	60%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Hc Vein X-Ray Liver W/Hemodynam	$1,994.62	$4,986.55	—	—	60%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Hc Biopsy Breast 1St Lesion Stereotactic Guidance	$1,994.62	$4,986.55	—	—	60%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Hc Cltx Dstl Fibular Fx Lat Malls W/O Manj	$247.00	$617.50	—	3% below	60%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Hc Cltx Dstl Fibular Fx Lat Malls W/O Manj	$247.00	$617.50	—	—	60%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Hc Closed Tx Metatarsal Fracture W/O Manipulation	$201.78	$504.45	—	at median	60%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Hc Closed Tx Metatarsal Fracture W/O Manipulation	$201.78	$504.45	—	—	60%
Cardiac catheterization with coronary angiogram CPT 93458 Hc L Hrt Artery/Ventricle Angio	$5,505.82	$13,764.55	—	16% below	60%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 Hc L Hrt Artery/Ventricle Angio	$5,505.82	$13,764.55	—	—	60%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Hc Cardioversion Elective Arrhythmia External	$1,097.06	$2,742.65	—	13% above	60%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Hc Cardioversion Electric Ext	$1,097.06	$2,742.65	—	13% above	60%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Hc Cardioversion Elective Arrhythmia External	$1,097.06	$2,742.65	—	—	60%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Hc Cardioversion Electric Ext	$1,097.06	$2,742.65	—	—	60%
Catheter ablation for atrial fibrillation CPT 93656 Hc Ephys Evl Trnsptl Tx Atrial Fib Isolat Pulm Vein	$13,504.82	$33,762.05	—	12% below	60%
Catheter ablation for atrial fibrillation inpatient CPT 93656 Hc Ephys Evl Trnsptl Tx Atrial Fib Isolat Pulm Vein	$13,504.82	$33,762.05	—	—	60%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Hc Cltx Dstl Radial Fx/Epiphysl Sep W/O Manj	$175.18	$437.95	—	33% below	60%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Hc Cltx Dstl Radial Fx/Epiphysl Sep W/O Manj	$175.18	$437.95	—	—	60%
Coronary stent placement, one artery CPT 92928 Hc Prq Trluml Coronary Stent W/Angio One Art/Brnch	$6,708.52	$16,771.30	—	32% below	60%
Coronary stent placement, one artery inpatient CPT 92928 Hc Prq Trluml Coronary Stent W/Angio One Art/Brnch	$6,708.52	$16,771.30	—	—	60%
Cystoscopy with ureteral stent placement CPT 52332 Hc Cystourethorscopy W/Ureteral Stent	$3,702.34	$9,255.85	—	43% below	60%
Cystoscopy with ureteral stent placement inpatient CPT 52332 Hc Cystourethorscopy W/Ureteral Stent	$3,702.34	$9,255.85	—	—	60%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Hc Cystourethroscopy	$1,828.94	$4,572.35	—	174% above	60%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Hc Cystourethroscopy	$1,828.94	$4,572.35	—	—	60%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Hc Destruction Premalignant Lesion 1St	$16.72	$41.80	—	83% below	60%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Noncdm Charge Record	$61.20	$153.00	—	39% below	60%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Hc Destruction Premalignant Lesion 1St	$16.72	$41.80	—	—	60%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Noncdm Charge Record	$61.20	$153.00	—	—	60%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Hc Removal Impacted Cerumen Irrigation/Lvg Unilat	$206.34	$515.85	—	234% above	60%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 Hc Removal Impacted Cerumen Irrigation/Lvg Unilat	$206.34	$515.85	—	—	60%
Earwax removal with instruments, one ear CPT 69210 Noncdm Charge Record	$45.60	$114.00	—	39% below	60%
Earwax removal with instruments, one ear one side CPT 69210 Hc Removal Impacted Cerumen Instrumentation Unilat	$286.14	$715.35	—	282% above	60%
Earwax removal with instruments, one ear inpatient CPT 69210 Noncdm Charge Record	$45.60	$114.00	—	—	60%
Earwax removal with instruments, one ear inpatient one side CPT 69210 Hc Removal Impacted Cerumen Instrumentation Unilat	$286.14	$715.35	—	—	60%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Hc Injection Epidural (Not Neurolytic) - Cervical Or Thoracic All Inclusive	$380.38	$950.95	—	42% below	60%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Hc Injection Epidural (Not Neurolytic) - Cervical Or Thoracic All Inclusive	$380.38	$950.95	—	—	60%
Eye injection into the vitreous (intravitreal injection) CPT 67028 Hc Intravitreal Njx Pharmacologic Agt Spx	$579.84	$1,449.60	—	at median	60%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 Hc Intravitreal Njx Pharmacologic Agt Spx	$579.84	$1,449.60	—	—	60%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Hc Lower Or Sacral Spine Facet Joint W Imaging	$1,169.26	$2,923.15	—	4% above	60%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Hc Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 1 Level	$1,991.20	$4,978.00	—	76% above	60%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Hc Lower Or Sacral Spine Facet Joint W Imaging	$1,169.26	$2,923.15	—	—	60%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Hc Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 1 Level	$1,991.20	$4,978.00	—	—	60%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Hc Cath & Saline/Contrast Sonohyster/Hysterosalpi	$191.52	$478.80	—	at median	60%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Hc Cath & Saline/Contrast Sonohyster/Hysterosalpi	$191.52	$478.80	—	—	60%
Incision and drainage of a simple or single skin abscess CPT 10060 Noncdm Charge Record	$104.97	$262.43	—	60% below	60%
Incision and drainage of a simple or single skin abscess CPT 10060 Hc Incision & Drainage Abscess Simple/Single	$336.68	$841.70	—	28% above	60%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Noncdm Charge Record	$104.97	$262.43	—	—	60%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Hc Incision & Drainage Abscess Simple/Single	$336.68	$841.70	—	—	60%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Hc Inj Tendon Sheath/Ligament	$163.02	$407.55	—	31% below	60%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Hc Injection 1 Tendon Sheath/Ligament Aponeurosis	$163.02	$407.55	—	31% below	60%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Hc Injection 1 Tendon Sheath/Ligament Aponeurosis	$163.02	$407.55	—	—	60%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Hc Inj Tendon Sheath/Ligament	$163.02	$407.55	—	—	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 NDC Description Not Available	$58.56	$146.40	—	85% below	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Hc Arthrocentesis Aspir&/Injection Major Jt/Bursa	$634.22	$1,585.55	—	66% above	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O Us	$1,200.04	$3,000.10	—	214% above	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 NDC Description Not Available	$58.56	$146.40	—	—	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Hc Arthrocentesis Aspir&/Injection Major Jt/Bursa	$634.22	$1,585.55	—	—	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O Us	$1,200.04	$3,000.10	—	—	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 NDC Description Not Available	$45.47	$113.67	—	83% below	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Hc Arthrocentesis Aspir&/Injection Interm Jt/Burs	$409.64	$1,024.10	—	52% above	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/O Us	$409.64	$1,024.10	—	52% above	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 NDC Description Not Available	$45.47	$113.67	—	—	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Hc Arthrocentesis Aspir&/Injection Interm Jt/Burs	$409.64	$1,024.10	—	—	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/O Us	$409.64	$1,024.10	—	—	60%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Methylprednisolone Acetate: 1 Vial, Single-Dose In 1 Carton (60219-1574-1) / 1 Ml In 1 Vial, Single-Dose	$43.60	$109.00	—	82% below	60%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Hc Arthrocentesis Aspir&/Inj Small Jt/Bursa W/O Us	$114.76	$286.90	—	53% below	60%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Hc Arthrocentesis Aspir&/Injection Small Jt/Bursa	$114.76	$286.90	—	53% below	60%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Methylprednisolone Acetate: 1 Vial, Single-Dose In 1 Carton (60219-1574-1) / 1 Ml In 1 Vial, Single-Dose	$43.60	$109.00	—	—	60%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Hc Arthrocentesis Aspir&/Inj Small Jt/Bursa W/O Us	$114.76	$286.90	—	—	60%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Hc Arthrocentesis Aspir&/Injection Small Jt/Bursa	$114.76	$286.90	—	—	60%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Hc Laparoscopic Appendectomy	$1,503.28	$3,758.20	—	32% below	60%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 Hc Laparoscopic Appendectomy	$1,503.28	$3,758.20	—	—	60%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 NDC Description Not Available	$208.80	$522.00	—	38% below	60%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Hc Repair Intermediate S/A/T/E 2.5 Cm/<	$406.22	$1,015.55	—	21% above	60%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 NDC Description Not Available	$208.80	$522.00	—	—	60%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Hc Repair Intermediate S/A/T/E 2.5 Cm/<	$406.22	$1,015.55	—	—	60%
Left heart catheterization, diagnostic CPT 93452 Hc L Hrt Cath W/Njx L Ventriculography Img S&I	$4,675.14	$11,687.85	—	1% below	60%
Left heart catheterization, diagnostic inpatient CPT 93452 Hc L Hrt Cath W/Njx L Ventriculography Img S&I	$4,675.14	$11,687.85	—	—	60%
Lower-back epidural injection, with imaging guidance CPT 62323 Hc Injection Epidural (Not Neurolytic) - Lumbar Or Sacral All Inclusive	$443.08	$1,107.70	—	39% below	60%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Hc Injection Epidural (Not Neurolytic) - Lumbar Or Sacral All Inclusive	$443.08	$1,107.70	—	—	60%
Lower-back epidural injection, without imaging guidance CPT 62322 Hc Njx Interlaminar Lmbr/Sac W/O Imaging Guidance	$625.48	$1,563.70	—	at median	60%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Hc Njx Interlaminar Lmbr/Sac W/O Imaging Guidance	$625.48	$1,563.70	—	—	60%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Hc Njx Anes&/Strd W/Img Tfrml Edrl Lmbr/Sac 1 Lvl	$953.42	$2,383.55	—	1% below	60%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Hc Njx Anes&/Strd W/Img Tfrml Edrl Lmbr/Sac 1 Lvl	$953.42	$2,383.55	—	—	60%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Hc Exc Face-Mm B9+Marg 0.5 Cm/<	$447.64	$1,119.10	—	16% above	60%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Hc Exc Face-Mm B9+Marg 0.5 Cm/<	$447.64	$1,119.10	—	—	60%
Nail removal (partial or complete), one nail CPT 11730 Noncdm Charge Record	$94.67	$236.67	—	57% below	60%
Nail removal (partial or complete), one nail CPT 11730 Hc Removal Of Nail Plate	$139.84	$349.60	—	37% below	60%
Nail removal (partial or complete), one nail inpatient CPT 11730 Noncdm Charge Record	$94.67	$236.67	—	—	60%
Nail removal (partial or complete), one nail inpatient CPT 11730 Hc Removal Of Nail Plate	$139.84	$349.60	—	—	60%
Occipital nerve block (injection for headaches) CPT 64405 Hc Injection Anesthetic Agent Greater Occipital Nrv	$637.26	$1,593.15	—	67% above	60%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Hc Injection Anesthetic Agent Greater Occipital Nrv	$637.26	$1,593.15	—	—	60%
Pacemaker implant (dual chamber) CPT 33208 Hc Ins New/Rplcmt Prm Pm W/Transv Eltrd Atrial&Vent	$9,123.04	$22,807.60	—	at median	60%
Pacemaker implant (dual chamber) inpatient CPT 33208 Hc Ins New/Rplcmt Prm Pm W/Transv Eltrd Atrial&Vent	$9,123.04	$22,807.60	—	—	60%
Paracentesis with imaging guidance CPT 49083 Hc Abdominal Paracentesis Dx/Ther W/Imaging Guidance	$929.10	$2,322.75	—	at median	60%
Paracentesis with imaging guidance CPT 49083 Hc Abdom Paracentesis Dx/Ther W/Imaging Guidance	$929.10	$2,322.75	—	at median	60%
Paracentesis with imaging guidance inpatient CPT 49083 Hc Abdom Paracentesis Dx/Ther W/Imaging Guidance	$929.10	$2,322.75	—	—	60%
Paracentesis with imaging guidance inpatient CPT 49083 Hc Abdominal Paracentesis Dx/Ther W/Imaging Guidance	$929.10	$2,322.75	—	—	60%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Noncdm Charge Record	$173.20	$433.00	—	59% below	60%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Hc Excision Nail Matrix Permanent Removal	$595.08	$1,487.70	—	40% above	60%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Noncdm Charge Record	$173.20	$433.00	—	—	60%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Hc Excision Nail Matrix Permanent Removal	$595.08	$1,487.70	—	—	60%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Hc Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance	$1,681.50	$4,203.75	—	5% below	60%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Hc Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance	$1,681.50	$4,203.75	—	—	60%
Removal of a foreign object under the skin, simple CPT 10120 Noncdm Charge Record	$142.00	$355.00	—	61% below	60%
Removal of a foreign object under the skin, simple CPT 10120 Hc Incision & Removal Foreign Body Subq Tiss Simple	$674.12	$1,685.30	—	86% above	60%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Noncdm Charge Record	$142.00	$355.00	—	—	60%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Hc Incision & Removal Foreign Body Subq Tiss Simple	$674.12	$1,685.30	—	—	60%
Short arm cast (elbow to hand) CPT 29075 Hc Application Cast Elbow Finger Short Arm	$246.62	$616.55	—	at median	60%
Short arm cast (elbow to hand) inpatient CPT 29075 Hc Application Cast Elbow Finger Short Arm	$246.62	$616.55	—	—	60%
Short arm splint (forearm and hand) CPT 29125 Noncdm Charge Record	$60.13	$150.33	—	56% below	60%
Short arm splint (forearm and hand) CPT 29125 Hc Application Short Arm Splint Forearm-Hand Static	$527.06	$1,317.65	—	287% above	60%
Short arm splint (forearm and hand) inpatient CPT 29125 Noncdm Charge Record	$60.13	$150.33	—	—	60%
Short arm splint (forearm and hand) inpatient CPT 29125 Hc Application Short Arm Splint Forearm-Hand Static	$527.06	$1,317.65	—	—	60%
Short leg cast (below the knee) CPT 29405 Hc Application Short Leg Cast Below Knee-Toe	$155.04	$387.60	—	11% below	60%
Short leg cast (below the knee) inpatient CPT 29405 Hc Application Short Leg Cast Below Knee-Toe	$155.04	$387.60	—	—	60%
Short leg splint (calf to foot) CPT 29515 Hc Application Short Leg Splint Calf Foot	$556.70	$1,391.75	—	182% above	60%
Short leg splint (calf to foot) inpatient CPT 29515 Hc Application Short Leg Splint Calf Foot	$556.70	$1,391.75	—	—	60%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Noncdm Charge Record	$85.60	$214.00	—	57% below	60%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Hc Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5Cm/<	$285.76	$714.40	—	45% above	60%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Noncdm Charge Record	$85.60	$214.00	—	—	60%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Hc Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5Cm/<	$285.76	$714.40	—	—	60%
Skin biopsy, punch, one lesion CPT 11104 Noncdm Charge Record	$116.80	$292.00	—	67% below	60%
Skin biopsy, punch, one lesion CPT 11104 Hc Punch Bx Skin Single Lesion	$419.52	$1,048.80	—	20% above	60%
Skin biopsy, punch, one lesion inpatient CPT 11104 Noncdm Charge Record	$116.80	$292.00	—	—	60%
Skin biopsy, punch, one lesion inpatient CPT 11104 Hc Punch Bx Skin Single Lesion	$419.52	$1,048.80	—	—	60%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Noncdm Charge Record	$162.40	$406.00	—	49% below	60%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Noncdm Charge Record	$162.40	$406.00	—	—	60%
Skin tag removal, up to 15 tags CPT 11200 Hc Removal Skn Tags Mlt Fibrq Tags Any Area Upw/15	$65.74	$164.35	—	58% below	60%
Skin tag removal, up to 15 tags CPT 11200 Noncdm Charge Record	$83.20	$208.00	—	46% below	60%
Skin tag removal, up to 15 tags inpatient CPT 11200 Hc Removal Skn Tags Mlt Fibrq Tags Any Area Upw/15	$65.74	$164.35	—	—	60%
Skin tag removal, up to 15 tags inpatient CPT 11200 Noncdm Charge Record	$83.20	$208.00	—	—	60%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Hc Spinal Puncture, Lumbar, Diagnostic	$597.74	$1,494.35	—	4% below	60%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Hc Spinal Puncture Lumbar Diagnostic	$597.74	$1,494.35	—	4% below	60%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Hc Spinal Puncture Lumbar Diagnostic	$597.74	$1,494.35	—	—	60%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Hc Spinal Puncture, Lumbar, Diagnostic	$597.74	$1,494.35	—	—	60%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Noncdm Charge Record	$104.80	$262.00	—	51% below	60%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Hc Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5Cm	$279.68	$699.20	—	31% above	60%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Noncdm Charge Record	$104.80	$262.00	—	—	60%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Hc Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5Cm	$279.68	$699.20	—	—	60%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Noncdm Charge Record	$105.20	$263.00	—	43% below	60%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Hc Simple Repair F/E/E/N/L/M 2.5Cm/<	$260.68	$651.70	—	41% above	60%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Noncdm Charge Record	$105.20	$263.00	—	—	60%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Hc Simple Repair F/E/E/N/L/M 2.5Cm/<	$260.68	$651.70	—	—	60%
TURP (transurethral resection of the prostate) CPT 52601 Hc Transurethral Resection Prostate	$3,702.34	$9,255.85	—	21% below	60%
TURP (transurethral resection of the prostate) inpatient CPT 52601 Hc Transurethral Resection Prostate	$3,702.34	$9,255.85	—	—	60%
Thoracentesis with imaging guidance CPT 32555 Hc Thoracentesis Needle/Cath Pleura W/Imaging	$684.00	$1,710.00	—	at median	60%
Thoracentesis with imaging guidance inpatient CPT 32555 Hc Thoracentesis Needle/Cath Pleura W/Imaging	$684.00	$1,710.00	—	—	60%
Trigger point injections, 1 or 2 muscles CPT 20552 NDC Description Not Available	$46.80	$117.00	—	82% below	60%
Trigger point injections, 1 or 2 muscles CPT 20552 Hc Injection Single/Mlt Trigger Point 1/2 Muscles	$283.10	$707.75	—	7% above	60%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 NDC Description Not Available	$46.80	$117.00	—	—	60%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Hc Injection Single/Mlt Trigger Point 1/2 Muscles	$283.10	$707.75	—	—	60%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Hc Bx Breast W Device 1St Lesion Ultrasound Guide	$1,799.30	$4,498.25	—	at median	60%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Hc Bx Breast W Device 1St Lesion Ultrasound Guide	$1,799.30	$4,498.25	—	—	60%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Hc Edg Balloon Dilation Esophagus <30 Mm Diam	$324.52	$811.30	—	82% below	60%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 Hc Edg Balloon Dilation Esophagus <30 Mm Diam	$324.52	$811.30	—	—	60%
Upper endoscopy (EGD) with biopsy CPT 43239 Hc Edg Transoral Biopsy Single/Multiple	$320.34	$800.85	—	70% below	60%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Hc Edg Transoral Biopsy Single/Multiple	$320.34	$800.85	—	—	60%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Hc Edg Insert Guide Wire Dilator Passage Esophagus	$337.44	$843.60	—	76% below	60%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 Hc Edg Insert Guide Wire Dilator Passage Esophagus	$337.44	$843.60	—	—	60%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 Hc Cystourethroscopy W/Ureteroscopy W/Lithotripsy	$2,666.84	$6,667.10	—	55% below	60%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 Hc Cystourethroscopy W/Ureteroscopy W/Lithotripsy	$2,666.84	$6,667.10	—	—	60%
Vein ablation, radiofrequency, first vein CPT 36475 Hc Endovenous Rf Ablation 1St Vein	$6,565.64	$16,414.10	—	at median	60%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 Hc Endovenous Rf Ablation 1St Vein	$6,565.64	$16,414.10	—	—	60%
Wart removal, up to 14 warts CPT 17110 Noncdm Charge Record	$95.85	$239.63	—	41% below	60%
Wart removal, up to 14 warts CPT 17110 Hc Destruction Benign Lesions Up To 14	$281.58	$703.95	—	73% above	60%
Wart removal, up to 14 warts inpatient CPT 17110 Noncdm Charge Record	$95.85	$239.63	—	—	60%
Wart removal, up to 14 warts inpatient CPT 17110 Hc Destruction Benign Lesions Up To 14	$281.58	$703.95	—	—	60%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Hc Debridement Subcutaneous Tissue 20 Sq Cm/<	$945.44	$2,363.60	—	99% above	60%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Hc Debridement Subcutaneous Tissue 20 Sq Cm/<	$945.44	$2,363.60	—	—	60%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Hc Transfusion Blood/Blood Components	$799.20	$1,998.00	—	5% above	60%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Hc Transfusion Blood/Blood Components	$799.20	$1,998.00	—	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Pressurized/Nonpressurized Inhalation Treatment (Ped)	$75.24	$188.10	—	43% below	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Airway Inhalation Treatment	$95.20	$238.00	—	28% below	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Pressurized/Nonpressurized Inhalation Treatment (Ped)	$75.24	$188.10	—	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Airway Inhalation Treatment	$95.20	$238.00	—	—	60%
Chemotherapy IV infusion, first hour CPT 96413 Hc Chemo Iv Infusion Up To 1Hr 1St Drug	$516.96	$1,292.40	—	40% above	60%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Hc Chemo Iv Infusion Up To 1Hr 1St Drug	$516.96	$1,292.40	—	—	60%
Critical care, first 30 to 74 minutes CPT 99291 Hc Critical Care Ill/Injured Patient Init 30-74 Min	$2,311.50	$5,778.75	—	91% above	60%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Hc Critical Care Ill/Injured Patient Init 30-74 Min	$2,311.50	$5,778.75	—	—	60%
EEG (brain wave test), awake and drowsy, routine CPT 95816 Hc Electroencephalogram W/Rec Awake&Drowsy	$431.68	$1,079.20	—	19% below	60%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Hc Electroencephalogram W/Rec Awake&Drowsy	$431.68	$1,079.20	—	—	60%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Noncdm Charge Record	$20.80	$52.00	—	37% below	60%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Noncdm Charge Record	$20.80	$52.00	—	—	60%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Hc Electrocardiogram Tracing	$130.72	$326.80	—	3% above	60%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Hc Electrocardiogram Tracing	$130.72	$326.80	—	—	60%
Electroconvulsive therapy (ECT), one session CPT 90870 Hc Electroconvulsive Therapy	$730.74	$1,826.85	—	at median	60%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 Hc Electroconvulsive Therapy	$730.74	$1,826.85	—	—	60%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Hc Er Visit Limited/Minor Prob	$306.36	$765.90	—	88% above	60%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Hc Er Visit Limited/Minor Prob	$306.36	$765.90	—	—	60%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Hc Er Visit Low/Moder Severity	$496.34	$1,240.85	—	58% above	60%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Hc Er Visit Low/Moder Severity	$496.34	$1,240.85	—	—	60%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Hc Er Visit Moderate Severity	$793.50	$1,983.75	—	50% above	60%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Hc Er Visit Moderate Severity	$793.50	$1,983.75	—	—	60%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Hc Er Visit High/Urgent Severity	$1,202.90	$3,007.25	—	59% above	60%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Hc Er Visit High/Urgent Severity	$1,202.90	$3,007.25	—	—	60%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Hc Er Visit High Severity&Threat Funcj	$1,736.96	$4,342.40	—	51% above	60%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Hc Er Visit High Severity&Threat Funcj	$1,736.96	$4,342.40	—	—	60%
Exercise stress test, tracing only, the hospital charge CPT 93017 Hc Cardiovascular Stress Test	$386.84	$967.10	—	at median	60%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Hc Cardiovascular Stress Test	$386.84	$967.10	—	—	60%
Group psychotherapy session CPT 90853 Hc Group Psychotherapy	$126.92	$317.30	—	34% below	60%
Group psychotherapy session CPT 90853 Hc Iop Chemical Dependancy	$159.22	$398.05	—	18% below	60%
Group psychotherapy session CPT 90853 Hc Iop Psychiatric	$159.22	$398.05	—	18% below	60%
Group psychotherapy session inpatient CPT 90853 Hc Group Psychotherapy	$126.92	$317.30	—	—	60%
Group psychotherapy session inpatient CPT 90853 Hc Iop Chemical Dependancy	$159.22	$398.05	—	—	60%
Group psychotherapy session inpatient CPT 90853 Hc Iop Psychiatric	$159.22	$398.05	—	—	60%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hc Iv Infusion Hydration Initial 31 Min-1 Hour	$312.48	$781.20	—	72% above	60%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hc Iv Infusion Hydration Initial 31 Min-1 Hour	$312.48	$781.20	—	—	60%
IV infusion of a medicine, first hour CPT 96365 Hc Iv Infusion Medication Up To 1 Hr	$390.72	$976.80	—	67% above	60%
IV infusion of a medicine, first hour inpatient CPT 96365 Hc Iv Infusion Medication Up To 1 Hr	$390.72	$976.80	—	—	60%
IV push of a medicine, first drug CPT 96374 Hc Iv Push Medication,Initial	$186.24	$465.60	—	25% above	60%
IV push of a medicine, first drug inpatient CPT 96374 Hc Iv Push Medication,Initial	$186.24	$465.60	—	—	60%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Noncdm Charge Record	$20.80	$52.00	—	69% below	60%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Hc Injection Im Or Sq	$97.44	$243.60	—	47% above	60%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Hc Therapeutic Prophylactic/Dx Injection Subq/Im	$97.44	$243.60	—	47% above	60%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Noncdm Charge Record	$20.80	$52.00	—	—	60%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Hc Injection Im Or Sq	$97.44	$243.60	—	—	60%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Hc Therapeutic Prophylactic/Dx Injection Subq/Im	$97.44	$243.60	—	—	60%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 Hc Nerve Conduction Studies 7-8 Studies	$797.76	$1,994.40	—	67% above	60%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 Hc Nerve Conduction Studies 7-8 Studies	$797.76	$1,994.40	—	—	60%
New patient office visit, about 30 minutes CPT 99203 Noncdm Charge Record	$83.20	$208.00	—	50% below	60%
New patient office visit, about 30 minutes inpatient CPT 99203 Noncdm Charge Record	$83.20	$208.00	—	—	60%
New patient office visit, about 45 minutes CPT 99204 Noncdm Charge Record	$126.80	$317.00	—	44% below	60%
New patient office visit, about 45 minutes inpatient CPT 99204 Noncdm Charge Record	$126.80	$317.00	—	—	60%
New patient office visit, about 60 minutes CPT 99205 Noncdm Charge Record	$160.61	$401.53	—	42% below	60%
New patient office visit, about 60 minutes inpatient CPT 99205 Noncdm Charge Record	$160.61	$401.53	—	—	60%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Noncdm Charge Record	$58.40	$146.00	—	55% below	60%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Noncdm Charge Record	$58.40	$146.00	—	—	60%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Hc Medical Nutrition Indiv In	$13.30	$33.25	—	72% below	60%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Hc Medical Nutrition Indiv In	$13.30	$33.25	—	—	60%
Preventive checkup, new patient aged 18–39 CPT 99385 Hc Initial Preventive Medicine New Pt Age 18-39Yrs	$32.30	$80.75	—	68% below	60%
Preventive checkup, new patient aged 18–39 CPT 99385 Noncdm Charge Record	$100.40	$251.00	—	at median	60%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Hc Initial Preventive Medicine New Pt Age 18-39Yrs	$32.30	$80.75	—	—	60%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Noncdm Charge Record	$100.40	$251.00	—	—	60%
Preventive checkup, new patient aged 40–64 CPT 99386 Hc Initial Preventive Medicine New Patient 40-64Yrs	$32.30	$80.75	—	72% below	60%
Preventive checkup, new patient aged 40–64 CPT 99386 Noncdm Charge Record	$116.40	$291.00	—	1% above	60%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Hc Initial Preventive Medicine New Patient 40-64Yrs	$32.30	$80.75	—	—	60%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Noncdm Charge Record	$116.40	$291.00	—	—	60%
Preventive checkup, returning patient aged 18–39 CPT 99395 Hc Periodic Preventive Med Est Patient 18-39 Yrs	$32.30	$80.75	—	61% below	60%
Preventive checkup, returning patient aged 18–39 CPT 99395 Noncdm Charge Record	$90.40	$226.00	—	9% above	60%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 Hc Periodic Preventive Med Est Patient 18-39 Yrs	$32.30	$80.75	—	—	60%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 Noncdm Charge Record	$90.40	$226.00	—	—	60%
Preventive checkup, returning patient aged 40–64 CPT 99396 Noncdm Charge Record	$96.80	$242.00	—	at median	60%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 Noncdm Charge Record	$96.80	$242.00	—	—	60%
Preventive checkup, returning patient aged 65 or older CPT 99397 Noncdm Charge Record	$103.60	$259.00	—	at median	60%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 Noncdm Charge Record	$103.60	$259.00	—	—	60%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Noncdm Charge Record	$12.40	$31.00	—	67% below	60%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Hc Tobacco Use Cessation Intermediate 3-10 Minutes	$45.98	$114.95	—	22% above	60%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Noncdm Charge Record	$12.40	$31.00	—	—	60%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Hc Tobacco Use Cessation Intermediate 3-10 Minutes	$45.98	$114.95	—	—	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Noncdm Charge Record	$124.48	$311.20	—	45% below	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Noncdm Charge Record	$124.48	$311.20	—	—	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Noncdm Charge Record	$62.86	$157.15	—	53% below	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Noncdm Charge Record	$62.86	$157.15	—	—	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Noncdm Charge Record	$88.58	$221.46	—	49% below	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Noncdm Charge Record	$88.58	$221.46	—	—	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Noncdm Charge Record	$38.62	$96.55	—	68% below	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Noncdm Charge Record	$38.62	$96.55	—	—	60%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Hc Office/Op Consltj New/Est Pt Mod Mdm 40 Minutes	$45.60	$114.00	—	53% below	60%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Hc Office/Op Consltj New/Est Pt Mod Mdm 40 Minutes	$45.60	$114.00	—	—	60%
Speech and language evaluation CPT 92523 Hc Eval Speech Sound Product Language Comprehension	$173.66	$434.15	—	7% below	60%
Speech and language evaluation inpatient CPT 92523 Hc Eval Speech Sound Product Language Comprehension	$173.66	$434.15	—	—	60%
Speech therapy session, individual CPT 92507 Hc Tx Speech Lang Voice Commj &/Auditory Proc Ind	$110.96	$277.40	—	11% below	60%
Speech therapy session, individual inpatient CPT 92507 Hc Tx Speech Lang Voice Commj &/Auditory Proc Ind	$110.96	$277.40	—	—	60%
Spirometry (breathing test) CPT 94010 Hc Spmtry W/Vc Expiratory Flo W/Wo Mxml Vol Vntj	$215.52	$538.80	—	at median	60%
Spirometry (breathing test) inpatient CPT 94010 Hc Spmtry W/Vc Expiratory Flo W/Wo Mxml Vol Vntj	$215.52	$538.80	—	—	60%
Spirometry before and after a bronchodilator CPT 94060 Hc Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn	$393.12	$982.80	—	at median	60%
Spirometry before and after a bronchodilator inpatient CPT 94060 Hc Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn	$393.12	$982.80	—	—	60%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Hc Phlebotomy Therapeutic Separate Procedure	$93.10	$232.75	—	24% below	60%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Hc Phlebotomy Therapeutic Separate Procedure	$93.10	$232.75	—	—	60%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 Noncdm Charge Record	$62.00	$155.00	—	at median	60%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 Noncdm Charge Record	$62.00	$155.00	—	—	60%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 NDC Description Not Available	$36.94	$92.35	—	at median	60%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 NDC Description Not Available	$36.94	$92.35	—	—	60%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 Vaxelis: 10 Syringe In 1 Package (63361-243-15) / .5 Ml In 1 Syringe (63361-243-88)	$56.80	$142.00	—	20% below	60%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 Vaxelis: 10 Syringe In 1 Package (63361-243-15) / .5 Ml In 1 Syringe (63361-243-88)	$56.80	$142.00	—	—	60%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 Pentacel: 1 Kit In 1 Package (49281-511-05) * .5 Ml In 1 Vial, Single-Dose (49281-561-01) * .5 Ml In 1 Vial, Single-Dose (49281-544-58)	$50.00	$125.00	—	35% below	60%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 Pentacel: 1 Kit In 1 Package (49281-511-05) * .5 Ml In 1 Vial, Single-Dose (49281-561-01) * .5 Ml In 1 Vial, Single-Dose (49281-544-58)	$50.00	$125.00	—	—	60%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Fluarix 2024/2025: 10 Syringe In 1 Carton (58160-884-52) / .5 Ml In 1 Syringe (58160-884-41)	$22.00	$55.00	—	57% below	60%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Fluarix 2024/2025: 10 Syringe In 1 Carton (58160-884-52) / .5 Ml In 1 Syringe (58160-884-41)	$22.00	$55.00	—	—	60%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 NDC Description Not Available	$118.00	$295.00	—	51% below	60%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 NDC Description Not Available	$118.00	$295.00	—	—	60%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 NDC Description Not Available	$16.80	$42.00	—	64% below	60%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 NDC Description Not Available	$16.80	$42.00	—	—	60%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 NDC Description Not Available	$103.60	$259.00	—	44% below	60%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 NDC Description Not Available	$103.60	$259.00	—	—	60%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Menveo: 1 Kit In 1 Carton (58160-955-09) * .5 Ml In 1 Vial, Single-Dose (58160-958-01) * .5 Ml In 1 Vial, Single-Dose (58160-959-01)	$65.20	$163.00	—	59% below	60%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Menveo: 1 Kit In 1 Carton (58160-955-09) * .5 Ml In 1 Vial, Single-Dose (58160-958-01) * .5 Ml In 1 Vial, Single-Dose (58160-959-01)	$65.20	$163.00	—	—	60%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Bexsero: 10 Syringe In 1 Carton (58160-976-20) / .5 Ml In 1 Syringe (58160-976-02)	$197.20	$493.00	—	38% below	60%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Bexsero: 10 Syringe In 1 Carton (58160-976-20) / .5 Ml In 1 Syringe (58160-976-02)	$197.20	$493.00	—	—	60%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 Vaxneuvance: 10 Syringe, Glass In 1 Carton (0006-4329-03) / .5 Ml In 1 Syringe, Glass (0006-4329-01)	$153.20	$383.00	—	4% below	60%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 Vaxneuvance: 10 Syringe, Glass In 1 Carton (0006-4329-03) / .5 Ml In 1 Syringe, Glass (0006-4329-01)	$153.20	$383.00	—	—	60%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02) / .5 Ml In 1 Syringe (0005-2000-01)	$214.58	$536.44	—	72% below	60%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02) / .5 Ml In 1 Syringe (0005-2000-01)	$214.58	$536.44	—	—	60%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Rotateq: 10 Pouch In 1 Carton (0006-4047-41) / 1 Tube In 1 Pouch (0006-4047-02) / 2 Ml In 1 Tube (0006-4047-01)	$48.00	$120.00	—	55% below	60%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 Rotateq: 10 Pouch In 1 Carton (0006-4047-41) / 1 Tube In 1 Pouch (0006-4047-02) / 2 Ml In 1 Tube (0006-4047-01)	$48.00	$120.00	—	—	60%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 NDC Description Not Available	$25.87	$64.67	—	70% below	60%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 NDC Description Not Available	$25.87	$64.67	—	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Noncdm Charge Record	$15.94	$39.84	—	72% below	60%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Hc Admin Vaccine Sq Or Im	$94.08	$235.20	—	66% above	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Noncdm Charge Record	$15.94	$39.84	—	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Hc Admin Vaccine Sq Or Im	$94.08	$235.20	—	—	60%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Noncdm Charge Record	$12.92	$32.30	—	57% below	60%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Hc Imadm Prq Id Subq/Im Njxs Ea Vaccine	$61.92	$154.80	—	107% above	60%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Noncdm Charge Record	$12.92	$32.30	—	—	60%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Hc Imadm Prq Id Subq/Im Njxs Ea Vaccine	$61.92	$154.80	—	—	60%

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

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

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

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

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

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

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

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

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

Source file: https://saintfrancis.com/finance/sfh-cms-hpt