Hospital

Klickitat Valley Hospital

Listed in its price file as “Klickitat County Public Hospital District No 1”.

Klickitat Valley Hospital in Goldendale, WA publishes cash prices for 297 common procedures listed here, from its own machine-readable price file updated Dec 2, 2024. Compared with other hospitals in the state, its outpatient cash prices are below the Washington median for 151 of 287 procedures and above it for 132. By typical cash price it ranks #20 of 46 Washington hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

310 South Roosevelt, Goldendale, WA 98620 Collected Sep 27, 2026 Source price file (509) 773-4022

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 501316 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Washington	Off list
Ankle X-ray, complete, 3 or more views both sides CPT 73610 RD XR Ankle BI 3 Views	$104.00	$130.00	—	—	20%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 XR Ankle BI 3 Views	$768.00	$960.00	—	—	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 RD XR Ankle RT 3 Views	$52.00	$65.00	—	82% below	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 RD XR Ankle LT 3 Views	$52.00	$65.00	—	82% below	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle RT 3 Views	$384.00	$480.00	—	30% above	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle LT 3 Views	$384.00	$480.00	—	30% above	20%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 RD XR Ankle BI 3 Views	$104.00	$130.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 XR Ankle BI 3 Views	$768.00	$960.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 RD XR Ankle RT 3 Views	$52.00	$65.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 RD XR Ankle LT 3 Views	$52.00	$65.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle LT 3 Views	$384.00	$480.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle RT 3 Views	$384.00	$480.00	—	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 RD ABI Extremity Artery Ltd	$76.00	$95.00	—	79% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABI Extremity Artery Ltd	$588.00	$735.00	—	63% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 RD ABI Extremity Artery Ltd	$76.00	$95.00	—	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ABI Extremity Artery Ltd	$588.00	$735.00	—	—	20%
Breast ultrasound, complete, one breast both sides CPT 76641 RD US Breast BI Comp w Axilla	$104.00	$130.00	—	—	20%
Breast ultrasound, complete, one breast both sides CPT 76641 US Breast BI Complete W Axilla	$324.00	$405.00	—	—	20%
Breast ultrasound, complete, one breast both sides CPT 76641 US Axilla BI	$440.00	$550.00	—	—	20%
Breast ultrasound, complete, one breast both sides CPT 76641 US AXILLA BI	$720.00	$900.00	—	—	20%
Breast ultrasound, complete, one breast CPT 76641 RD US AXILLA ONLY UNI	$40.00	$50.00	—	90% below	20%
Breast ultrasound, complete, one breast CPT 76641 RD US Breast Uni Comp Axilla	$52.00	$65.00	—	87% below	20%
Breast ultrasound, complete, one breast one side CPT 76641 US AXILLA ONLY LT	$128.00	$160.00	—	67% below	20%
Breast ultrasound, complete, one breast one side CPT 76641 US AXILLA RT	$128.00	$160.00	—	67% below	20%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast RT Complete w Axilla	$164.00	$205.00	—	58% below	20%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast LT Complete w Axilla	$164.00	$205.00	—	58% below	20%
Breast ultrasound, complete, one breast one side CPT 76641 US Axilla RT	$220.00	$275.00	—	44% below	20%
Breast ultrasound, complete, one breast one side CPT 76641 US Axilla LT	$220.00	$275.00	—	44% below	20%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 RD US Breast BI Comp w Axilla	$104.00	$130.00	—	—	20%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 US Breast BI Complete W Axilla	$324.00	$405.00	—	—	20%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 US Axilla BI	$440.00	$550.00	—	—	20%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 US AXILLA BI	$720.00	$900.00	—	—	20%
Breast ultrasound, complete, one breast inpatient CPT 76641 RD US AXILLA ONLY UNI	$40.00	$50.00	—	—	20%
Breast ultrasound, complete, one breast inpatient CPT 76641 RD US Breast Uni Comp Axilla	$52.00	$65.00	—	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US AXILLA RT	$128.00	$160.00	—	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US AXILLA ONLY LT	$128.00	$160.00	—	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast RT Complete w Axilla	$164.00	$205.00	—	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast LT Complete w Axilla	$164.00	$205.00	—	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Axilla LT	$220.00	$275.00	—	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Axilla RT	$220.00	$275.00	—	—	20%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 RD US Breast BI Limited	$408.00	$510.00	—	—	20%
Breast ultrasound, limited (one breast or one area) CPT 76642 RD US Breast Uni Limited	$204.00	$255.00	—	37% below	20%
Breast ultrasound, limited (one breast or one area) CPT 76642 US Breast FU Limited	$720.00	$900.00	—	124% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast LT Limited	$360.00	$450.00	—	12% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Rt Limited	$360.00	$450.00	—	12% above	20%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 RD US Breast BI Limited	$408.00	$510.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 RD US Breast Uni Limited	$204.00	$255.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US Breast FU Limited	$720.00	$900.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast LT Limited	$360.00	$450.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Rt Limited	$360.00	$450.00	—	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 RD CT CHEST ANGIO WO/W	$444.00	$555.00	—	81% below	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest wo/w Contrast	$3,272.00	$4,090.00	—	41% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 RD CT CHEST ANGIO WO/W	$444.00	$555.00	—	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA Chest wo/w Contrast	$3,272.00	$4,090.00	—	—	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 Read CT Calcium Calculations	$36.00	$45.00	—	71% below	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Calcium Calculations	$160.00	$200.00	—	28% above	20%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 Read CT Calcium Calculations	$36.00	$45.00	—	—	20%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Calcium Calculations	$160.00	$200.00	—	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 RD CT ABDOMEN PEL ORAL ONLY	$524.00	$655.00	—	79% below	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN PEL WO CONTRAST	$3,084.00	$3,855.00	—	23% above	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 RD CT ABDOMEN PEL ORAL ONLY	$524.00	$655.00	—	—	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN PEL WO CONTRAST	$3,084.00	$3,855.00	—	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 RD CT ABD PEL IV ONLY	$548.00	$685.00	—	82% below	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN PEL IV ONLY	$4,368.00	$5,460.00	—	47% above	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 RD CT ABD PEL IV ONLY	$548.00	$685.00	—	—	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN PEL IV ONLY	$4,368.00	$5,460.00	—	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 RD CT ABDO PELVIS WOW CONTRAST	$604.00	$755.00	—	84% below	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN PEL WOW CONTRAST	$4,396.00	$5,495.00	—	19% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 RD CT ABDO PELVIS WOW CONTRAST	$604.00	$755.00	—	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN PEL WOW CONTRAST	$4,396.00	$5,495.00	—	—	20%
CT scan of the abdomen with contrast CPT 74160 RD CT ABDOMEN IV ONLY	$300.00	$375.00	—	83% below	20%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN IV ONLY	$1,800.00	$2,250.00	—	at median	20%
CT scan of the abdomen with contrast inpatient CPT 74160 RD CT ABDOMEN IV ONLY	$300.00	$375.00	—	—	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN IV ONLY	$1,800.00	$2,250.00	—	—	20%
CT scan of the abdomen without contrast CPT 74150 RD CT ABDOMEN ORAL ONLY	$400.00	$500.00	—	71% below	20%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO CONTRAST	$1,660.00	$2,075.00	—	19% above	20%
CT scan of the abdomen without contrast inpatient CPT 74150 RD CT ABDOMEN ORAL ONLY	$400.00	$500.00	—	—	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WO CONTRAST	$1,660.00	$2,075.00	—	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 RD CT FACIAL/SINUS WO	$240.00	$300.00	—	73% below	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL WO CONTRAST	$1,720.00	$2,150.00	—	97% above	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 RD CT FACIAL/SINUS WO	$240.00	$300.00	—	—	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL WO CONTRAST	$1,720.00	$2,150.00	—	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 RD CT HEAD CODE STROKE	$216.00	$270.00	—	82% below	20%
CT scan of the head or brain, no contrast dye CPT 70450 RD CT HEAD WO CONTRAST	$220.00	$275.00	—	82% below	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST	$1,680.00	$2,100.00	—	41% above	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CONTRAST	$1,680.00	$2,100.00	—	41% above	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 RD CT HEAD CODE STROKE	$216.00	$270.00	—	—	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 RD CT HEAD WO CONTRAST	$220.00	$275.00	—	—	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CONTRAST	$1,680.00	$2,100.00	—	—	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST	$1,680.00	$2,100.00	—	—	20%
CT scan of the head with contrast CPT 70460 RD CT HEAD W CONTRAST	$284.00	$355.00	—	78% below	20%
CT scan of the head with contrast CPT 70460 CT HEAD W/CONTRAST	$1,040.00	$1,300.00	—	18% below	20%
CT scan of the head with contrast inpatient CPT 70460 RD CT HEAD W CONTRAST	$284.00	$355.00	—	—	20%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/CONTRAST	$1,040.00	$1,300.00	—	—	20%
CT scan of the head without and with contrast CPT 70470 READ CT HEAD WOW CONTRAST	$316.00	$395.00	—	78% below	20%
CT scan of the head without and with contrast CPT 70470 CT HEAD WO/W CONTRAST	$2,160.00	$2,700.00	—	47% above	20%
CT scan of the head without and with contrast inpatient CPT 70470 READ CT HEAD WOW CONTRAST	$316.00	$395.00	—	—	20%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WO/W CONTRAST	$2,160.00	$2,700.00	—	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 RD CT LUMBAR SPINE WO CONTRAST	$248.00	$310.00	—	81% below	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SP WO CONTRAST	$2,080.00	$2,600.00	—	63% above	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 RD CT LUMBAR SPINE WO CONTRAST	$248.00	$310.00	—	—	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SP WO CONTRAST	$2,080.00	$2,600.00	—	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 RD CT CERVIC SPINE WO CONTRAST	$264.00	$330.00	—	81% below	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE WO CONTRAST	$2,160.00	$2,700.00	—	58% above	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 RD CT CERVIC SPINE WO CONTRAST	$264.00	$330.00	—	—	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE WO CONTRAST	$2,160.00	$2,700.00	—	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 RD CT Pelvis w Contrast	$448.00	$560.00	—	74% below	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/Contrast	$1,696.00	$2,120.00	—	2% below	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 RD CT Pelvis w Contrast	$448.00	$560.00	—	—	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/Contrast	$1,696.00	$2,120.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 RD US Carotid Duplex Scan BI	$240.00	$300.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Scan BI	$940.00	$1,175.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 RD US Carotid Duplex Scan BI	$240.00	$300.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Duplex Scan BI	$940.00	$1,175.00	—	—	20%
Chest X-ray, 2 views CPT 71046 RD XR Chest 2 Views	$68.00	$85.00	—	74% below	20%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$348.00	$435.00	—	31% above	20%
Chest X-ray, 2 views inpatient CPT 71046 RD XR Chest 2 Views	$68.00	$85.00	—	—	20%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$348.00	$435.00	—	—	20%
Chest X-ray, single view CPT 71045 RD XR Chest 1 View	$52.00	$65.00	—	78% below	20%
Chest X-ray, single view CPT 71045 XR Chest 1 View	$272.00	$340.00	—	17% above	20%
Chest X-ray, single view inpatient CPT 71045 RD XR Chest 1 View	$52.00	$65.00	—	—	20%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View	$272.00	$340.00	—	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 RD US RETRO RENAL OR NODE	$224.00	$280.00	—	59% below	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retro Renal or Node	$784.00	$980.00	—	43% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 RD US RETRO RENAL OR NODE	$224.00	$280.00	—	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retro Renal or Node	$784.00	$980.00	—	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 RD CT CHEST WO CONTRAST	$256.00	$320.00	—	82% below	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Sternoclavicular Jnt wo Con	$1,412.00	$1,765.00	—	at median	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO CONTRAST	$1,820.00	$2,275.00	—	29% above	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 RD CT CHEST WO CONTRAST	$256.00	$320.00	—	—	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Sternoclavicular Jnt wo Con	$1,412.00	$1,765.00	—	—	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST WO CONTRAST	$1,820.00	$2,275.00	—	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 RD CT CHEST WCONTRAST	$308.00	$385.00	—	83% below	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CONTRAST	$2,120.00	$2,650.00	—	19% above	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 RD CT CHEST WCONTRAST	$308.00	$385.00	—	—	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CONTRAST	$2,120.00	$2,650.00	—	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 RD Mammography Dx BI	$224.00	$280.00	—	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammography Dx BI	$504.00	$630.00	—	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 RD Mammography Dx BI	$224.00	$280.00	—	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mammography Dx BI	$504.00	$630.00	—	—	20%
Diagnostic mammogram, one breast CPT 77065 RD Mammography Dx UNI	$200.00	$250.00	—	49% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA Mammography Dx RT	$428.00	$535.00	—	10% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MA Mammography DX LT	$428.00	$535.00	—	10% above	20%
Diagnostic mammogram, one breast inpatient CPT 77065 RD Mammography Dx UNI	$200.00	$250.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammography DX LT	$428.00	$535.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammography Dx RT	$428.00	$535.00	—	—	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 RD Lower Extremity Arterial Bi	$236.00	$295.00	—	—	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US Lower Extremity Arterial Bi	$1,200.00	$1,500.00	—	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 RD Lower Extremity Arterial Bi	$236.00	$295.00	—	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US Lower Extremity Arterial Bi	$1,200.00	$1,500.00	—	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 RD Extrem Veins Bi w Compress	$208.00	$260.00	—	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Extrem Veins Bi w Compress	$1,284.00	$1,605.00	—	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 RD Extrem Veins Bi w Compress	$208.00	$260.00	—	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Extrem Veins Bi w Compress	$1,284.00	$1,605.00	—	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 READ ECHO TT W DOPPLER AND CLR	$436.00	$545.00	—	73% below	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO TT DOPPLER AND COLOR	$1,980.00	$2,475.00	—	24% above	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 READ ECHO TT W DOPPLER AND CLR	$436.00	$545.00	—	—	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO TT DOPPLER AND COLOR	$1,980.00	$2,475.00	—	—	20%
Knee X-ray, 3 views both sides CPT 73562 RD KNEE BILAT 3V	$120.00	$150.00	—	—	20%
Knee X-ray, 3 views both sides CPT 73562 XR Knee BI 3 Views	$880.00	$1,100.00	—	—	20%
Knee X-ray, 3 views one side CPT 73562 RD XR Knee LT 3 Views	$60.00	$75.00	—	81% below	20%
Knee X-ray, 3 views one side CPT 73562 RD XR Knee RT 3 Views	$60.00	$75.00	—	81% below	20%
Knee X-ray, 3 views one side CPT 73562 XR Knee RT 3 Views	$440.00	$550.00	—	42% above	20%
Knee X-ray, 3 views one side CPT 73562 XR Knee LT 3 Views	$440.00	$550.00	—	42% above	20%
Knee X-ray, 3 views inpatient both sides CPT 73562 RD KNEE BILAT 3V	$120.00	$150.00	—	—	20%
Knee X-ray, 3 views inpatient both sides CPT 73562 XR Knee BI 3 Views	$880.00	$1,100.00	—	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 RD XR Knee RT 3 Views	$60.00	$75.00	—	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 RD XR Knee LT 3 Views	$60.00	$75.00	—	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee RT 3 Views	$440.00	$550.00	—	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee LT 3 Views	$440.00	$550.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 RD US Abdomen Limited	$176.00	$220.00	—	63% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited	$652.00	$815.00	—	38% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 RD US Abdomen Limited	$176.00	$220.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Limited	$652.00	$815.00	—	—	20%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 RD MRI BREAST BI WOW CONTRAST	$680.00	$850.00	—	—	20%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MR BREAST BI WOW CONTRAST	$4,400.00	$5,500.00	—	—	20%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 RD MRI BREAST BI WOW CONTRAST	$680.00	$850.00	—	—	20%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MR BREAST BI WOW CONTRAST	$4,400.00	$5,500.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 RD MRI LOW EXT BILAT JT WO	$920.00	$1,150.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 RD MRI LE Joint LT wo Contrast	$460.00	$575.00	—	73% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 RD MRI LE JOINT RT WO CONTRAST	$460.00	$575.00	—	73% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR LE JOINT RT WO CONTRAST	$2,400.00	$3,000.00	—	41% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR LE Joint LT wo Contrast	$2,400.00	$3,000.00	—	41% above	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 RD MRI LOW EXT BILAT JT WO	$920.00	$1,150.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 RD MRI LE Joint LT wo Contrast	$460.00	$575.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 RD MRI LE JOINT RT WO CONTRAST	$460.00	$575.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR LE Joint LT wo Contrast	$2,400.00	$3,000.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR LE JOINT RT WO CONTRAST	$2,400.00	$3,000.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 RD MRI LE BI JOINT WOW CONTRAS	$1,136.00	$1,420.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MR LE BI JOINT WOW CONTRAST	$6,400.00	$8,000.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 RD MRI LE JOINT LT WOW CONTRAS	$568.00	$710.00	—	81% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 RD MRI LE JOINT RT WOW CONTR	$568.00	$710.00	—	81% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR LE JOINT LT WOW CONTRAST	$3,200.00	$4,000.00	—	8% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR LE JOINT RT WOW CONTRAST	$3,200.00	$4,000.00	—	8% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 RD MRI LE BI JOINT WOW CONTRAS	$1,136.00	$1,420.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 MR LE BI JOINT WOW CONTRAST	$6,400.00	$8,000.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 RD MRI LE JOINT LT WOW CONTRAS	$568.00	$710.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 RD MRI LE JOINT RT WOW CONTR	$568.00	$710.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR LE JOINT LT WOW CONTRAST	$3,200.00	$4,000.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR LE JOINT RT WOW CONTRAST	$3,200.00	$4,000.00	—	—	20%
MRI of the abdomen without contrast CPT 74181 RD MRI Abdomen wo Contrast	$496.00	$620.00	—	75% below	20%
MRI of the abdomen without contrast CPT 74181 MR Abdomen wo Contrast	$2,400.00	$3,000.00	—	22% above	20%
MRI of the abdomen without contrast inpatient CPT 74181 RD MRI Abdomen wo Contrast	$496.00	$620.00	—	—	20%
MRI of the abdomen without contrast inpatient CPT 74181 MR Abdomen wo Contrast	$2,400.00	$3,000.00	—	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 RD MRI Abdomen wo/w Contrast	$580.00	$725.00	—	81% below	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MR Abdomen wo/w Contrast	$3,200.00	$4,000.00	—	5% above	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 RD MRI Abdomen wo/w Contrast	$580.00	$725.00	—	—	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR Abdomen wo/w Contrast	$3,200.00	$4,000.00	—	—	20%
MRI of the brain, no contrast dye CPT 70551 RD MRI PITUITARY WO CONTRAST	$504.00	$630.00	—	72% below	20%
MRI of the brain, no contrast dye CPT 70551 RD MRI BRAIN WO CONTRAST	$504.00	$630.00	—	72% below	20%
MRI of the brain, no contrast dye CPT 70551 MR PITUITARY WO CONTRAST	$2,400.00	$3,000.00	—	33% above	20%
MRI of the brain, no contrast dye CPT 70551 MR Brain wo Contrast	$2,400.00	$3,000.00	—	33% above	20%
MRI of the brain, no contrast dye inpatient CPT 70551 RD MRI BRAIN WO CONTRAST	$504.00	$630.00	—	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 RD MRI PITUITARY WO CONTRAST	$504.00	$630.00	—	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MR PITUITARY WO CONTRAST	$2,400.00	$3,000.00	—	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MR Brain wo Contrast	$2,400.00	$3,000.00	—	—	20%
MRI of the brain, with and without contrast dye CPT 70553 RD MRI PITUITARY WO/W CONTRAST	$604.00	$755.00	—	77% below	20%
MRI of the brain, with and without contrast dye CPT 70553 RD MRI BRAIN WOW CONTRAST	$604.00	$755.00	—	77% below	20%
MRI of the brain, with and without contrast dye CPT 70553 MR Brain wo/w Contrast	$3,656.00	$4,570.00	—	38% above	20%
MRI of the brain, with and without contrast dye CPT 70553 MR PITUITARY WO/W CONTRAST	$3,656.00	$4,570.00	—	38% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 RD MRI BRAIN WOW CONTRAST	$604.00	$755.00	—	—	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 RD MRI PITUITARY WO/W CONTRAST	$604.00	$755.00	—	—	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Brain wo/w Contrast	$3,656.00	$4,570.00	—	—	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR PITUITARY WO/W CONTRAST	$3,656.00	$4,570.00	—	—	20%
MRI of the lower back, no contrast dye CPT 72148 RD MRI Lumbar Spine woContrast	$504.00	$630.00	—	76% below	20%
MRI of the lower back, no contrast dye CPT 72148 MR Lumbar Spine wo Contrast	$2,544.00	$3,180.00	—	22% above	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 RD MRI Lumbar Spine woContrast	$504.00	$630.00	—	—	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR Lumbar Spine wo Contrast	$2,544.00	$3,180.00	—	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 RD MRI Lumr Spine wow Contrast	$604.00	$755.00	—	80% below	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MR Lumbar Spine wow Contrast	$3,680.00	$4,600.00	—	21% above	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 RD MRI Lumr Spine wow Contrast	$604.00	$755.00	—	—	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR Lumbar Spine wow Contrast	$3,680.00	$4,600.00	—	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 RD MRI T Spine wo Contrast	$504.00	$630.00	—	76% below	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR Thoracic Spine wo Contrast	$2,096.00	$2,620.00	—	1% below	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 RD MRI T Spine wo Contrast	$504.00	$630.00	—	—	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR Thoracic Spine wo Contrast	$2,096.00	$2,620.00	—	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 RD MRI C Spine w/wo Contrast	$604.00	$755.00	—	80% below	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MR C Spine w/wo Contrast	$3,680.00	$4,600.00	—	21% above	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 RD MRI C Spine w/wo Contrast	$604.00	$755.00	—	—	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR C Spine w/wo Contrast	$3,680.00	$4,600.00	—	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 RD MRI C Spine wo Contrast	$504.00	$630.00	—	75% below	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MR C Spine wo Contrast	$2,544.00	$3,180.00	—	27% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 RD MRI C Spine wo Contrast	$504.00	$630.00	—	—	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR C Spine wo Contrast	$2,544.00	$3,180.00	—	—	20%
MRI of the pelvis without and with contrast CPT 72197 RD Pelvis wow Contrast	$580.00	$725.00	—	82% below	20%
MRI of the pelvis without and with contrast CPT 72197 MR Pelvis wow Contrast	$4,044.00	$5,055.00	—	29% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 RD Pelvis wow Contrast	$580.00	$725.00	—	—	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR Pelvis wow Contrast	$4,044.00	$5,055.00	—	—	20%
MRI of the pelvis, no contrast dye CPT 72195 RD Pelvis wo Contrast	$496.00	$620.00	—	74% below	20%
MRI of the pelvis, no contrast dye CPT 72195 MR Pelvis wo Contrast	$2,560.00	$3,200.00	—	35% above	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 RD Pelvis wo Contrast	$496.00	$620.00	—	—	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MR Pelvis wo Contrast	$2,560.00	$3,200.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 RD MRI UE Joint RT wo Contrast	$460.00	$575.00	—	74% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 RD MRI LE Joint LT wo Contrast	$460.00	$575.00	—	74% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MR UE Joint LT wo Contrast	$2,360.00	$2,950.00	—	31% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MR UE Joint RT wo Contrast	$2,360.00	$2,950.00	—	31% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 RD MRI LE Joint LT wo Contrast	$460.00	$575.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 RD MRI UE Joint RT wo Contrast	$460.00	$575.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR UE Joint RT wo Contrast	$2,360.00	$2,950.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR UE Joint LT wo Contrast	$2,360.00	$2,950.00	—	—	20%
OCT scan of the retina (optical coherence tomography) CPT 92134 SCANNING COMPUTERIZED OPHTH IMAGING, RETINA	$80.00	$100.00	—	9% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 RD Pelvic Non-Obstetrical Ltd	$148.00	$185.00	—	60% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic Non-Obstetrical Ltd	$540.00	$675.00	—	46% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LTD OR FU OR BLADDER	$540.00	$675.00	—	46% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 RD Pelvic Non-Obstetrical Ltd	$148.00	$185.00	—	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LTD OR FU OR BLADDER	$540.00	$675.00	—	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic Non-Obstetrical Ltd	$540.00	$675.00	—	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 RD US Pelvic Complete Non-OB	$208.00	$260.00	—	62% below	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Complete Non-OB	$720.00	$900.00	—	32% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 RD US Pelvic Complete Non-OB	$208.00	$260.00	—	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Complete Non-OB	$720.00	$900.00	—	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 RD Fetal/Maternal Eval >14 Wks	$300.00	$375.00	—	44% below	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Fetal/Maternal Eval >14 Wks	$740.00	$925.00	—	37% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 RD Fetal/Maternal Eval >14 Wks	$300.00	$375.00	—	—	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Fetal/Maternal Eval >14 Wks	$740.00	$925.00	—	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 RD US FetaL/Mater Eval <14 WKS	$300.00	$375.00	—	40% below	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Fetal/Maternal Eval <14 Wks	$564.00	$705.00	—	13% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 RD US FetaL/Mater Eval <14 WKS	$300.00	$375.00	—	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Fetal/Maternal Eval <14 Wks	$564.00	$705.00	—	—	20%
Screening mammogram, both breasts both sides CPT 77067 RD Mammography Screen BI	$200.00	$250.00	—	—	20%
Screening mammogram, both breasts both sides CPT 77067 MA Mammography Screen BI	$392.00	$490.00	—	—	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 RD Mammography Screen BI	$200.00	$250.00	—	—	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 MA Mammography Screen BI	$392.00	$490.00	—	—	20%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 RD XR Shoulder BI 2 Views	$104.00	$130.00	—	—	20%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 XR Shoulder BI 2 Views	$672.00	$840.00	—	—	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 RD XR Shoulder RT 2 Views	$60.00	$75.00	—	80% below	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 RD XR Shoulder LT 2 Views	$60.00	$75.00	—	80% below	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder LT 2 Views	$392.00	$490.00	—	33% above	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder RT 2 Views	$392.00	$490.00	—	33% above	20%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 RD XR Shoulder BI 2 Views	$104.00	$130.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 XR Shoulder BI 2 Views	$672.00	$840.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 RD XR Shoulder RT 2 Views	$60.00	$75.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 RD XR Shoulder LT 2 Views	$60.00	$75.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder LT 2 Views	$392.00	$490.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder RT 2 Views	$392.00	$490.00	—	—	20%
Transvaginal pelvic ultrasound CPT 76830 RD US Transvaginal Non-OB	$208.00	$260.00	—	55% below	20%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB	$720.00	$900.00	—	57% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 RD US Transvaginal Non-OB	$208.00	$260.00	—	—	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB	$720.00	$900.00	—	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 RD US Pregnant Uterus Transvag	$228.00	$285.00	—	48% below	20%
Transvaginal ultrasound during pregnancy CPT 76817 US Pregnant Uterus Transvagina	$600.00	$750.00	—	38% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 RD US Pregnant Uterus Transvag	$228.00	$285.00	—	—	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Pregnant Uterus Transvagina	$600.00	$750.00	—	—	20%
Ultrasound of the abdomen, complete CPT 76700 RD US Abdomen Complete	$244.00	$305.00	—	61% below	20%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$796.00	$995.00	—	26% above	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 RD US Abdomen Complete	$244.00	$305.00	—	—	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$796.00	$995.00	—	—	20%
Ultrasound of the scrotum and testicles CPT 76870 RD US Scrotum & Contents	$192.00	$240.00	—	60% below	20%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum & Contents	$640.00	$800.00	—	35% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 RD US Scrotum & Contents	$192.00	$240.00	—	—	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum & Contents	$640.00	$800.00	—	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 RD Soft Tissue Head and Neck	$168.00	$210.00	—	65% below	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Soft Tissue Head and Neck	$696.00	$870.00	—	46% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 RD Soft Tissue Head and Neck	$168.00	$210.00	—	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Soft Tissue Head and Neck	$696.00	$870.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 RD US EXTR VEINS RT W/COMPRESS	$132.00	$165.00	—	79% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 RD US Extr Veins LT w Compress	$132.00	$165.00	—	79% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Veins Uni w Compress LT	$872.00	$1,090.00	—	36% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US EXTR VEINS W/COMPRESS RT	$872.00	$1,090.00	—	36% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 RD US Extr Veins LT w Compress	$132.00	$165.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 RD US EXTR VEINS RT W/COMPRESS	$132.00	$165.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Veins Uni w Compress LT	$872.00	$1,090.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US EXTR VEINS W/COMPRESS RT	$872.00	$1,090.00	—	—	20%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 RD Wrist BI 3V Minimum	$104.00	$130.00	—	—	20%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 XR Wrist Bi 3V Minimum	$792.00	$990.00	—	—	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 RD WRIST LEFT 3V W/NAVICULAR	$44.00	$55.00	—	86% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 RD WRIST RT 3V W/NAVICULAR	$44.00	$55.00	—	86% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 RD XR Wrist LT 3V Minimum	$52.00	$65.00	—	83% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 RD XR Wrist RT 3V Minimum	$52.00	$65.00	—	83% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist RT 3V Minimum	$300.00	$375.00	—	3% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST RIGHT 3V W/NAVICULAR	$396.00	$495.00	—	28% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST LEFT 3V MIN	$396.00	$495.00	—	28% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist LT 3V Minimum	$396.00	$495.00	—	28% above	20%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 RD Wrist BI 3V Minimum	$104.00	$130.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 XR Wrist Bi 3V Minimum	$792.00	$990.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 RD WRIST LEFT 3V W/NAVICULAR	$44.00	$55.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 RD WRIST RT 3V W/NAVICULAR	$44.00	$55.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 RD XR Wrist RT 3V Minimum	$52.00	$65.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 RD XR Wrist LT 3V Minimum	$52.00	$65.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist RT 3V Minimum	$300.00	$375.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST RIGHT 3V W/NAVICULAR	$396.00	$495.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist LT 3V Minimum	$396.00	$495.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST LEFT 3V MIN	$396.00	$495.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 RD XR Hip/Pelvis RT 2-3 Views	$68.00	$85.00	—	77% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 RD XR Hip/Pelvis LT 2-3 Views	$68.00	$85.00	—	77% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip and Pelvis RT 2-3 Views	$440.00	$550.00	—	51% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip and Pelvis LT 2-3 Views	$440.00	$550.00	—	51% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 RD XR Hip/Pelvis LT 2-3 Views	$68.00	$85.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 RD XR Hip/Pelvis RT 2-3 Views	$68.00	$85.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip and Pelvis RT 2-3 Views	$440.00	$550.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip and Pelvis LT 2-3 Views	$440.00	$550.00	—	—	20%
X-ray of the abdomen, 1 view CPT 74018 RD XR Abdomen 1 View	$56.00	$70.00	—	76% below	20%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View	$352.00	$440.00	—	49% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 RD XR Abdomen 1 View	$56.00	$70.00	—	—	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View	$352.00	$440.00	—	—	20%
X-ray of the ankle, 2 views both sides CPT 73600 RD XR Ankle BI 2 Views	$96.00	$120.00	—	—	20%
X-ray of the ankle, 2 views both sides CPT 73600 XR Ankle BI 2 Views	$584.00	$730.00	—	—	20%
X-ray of the ankle, 2 views one side CPT 73600 RD XR Ankle RT 2 Views	$48.00	$60.00	—	82% below	20%
X-ray of the ankle, 2 views one side CPT 73600 RD XR Ankle LT 2 Views	$48.00	$60.00	—	82% below	20%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle LT 2 Views	$292.00	$365.00	—	11% above	20%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle RT 2 Views	$292.00	$365.00	—	11% above	20%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 RD XR Ankle BI 2 Views	$96.00	$120.00	—	—	20%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 XR Ankle BI 2 Views	$584.00	$730.00	—	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 RD XR Ankle LT 2 Views	$48.00	$60.00	—	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 RD XR Ankle RT 2 Views	$48.00	$60.00	—	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle LT 2 Views	$292.00	$365.00	—	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle RT 2 Views	$292.00	$365.00	—	—	20%
X-ray of the finger(s), 2 or more views both sides CPT 73140 RD XR Finger BI 2 View Minimum	$88.00	$110.00	—	—	20%
X-ray of the finger(s), 2 or more views both sides CPT 73140 XR Finger BI 2 Views Minimum	$800.00	$1,000.00	—	—	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 RD XR Finger LT 2 View Minimum	$44.00	$55.00	—	83% below	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 RD XR Finger RT 2 View Minimum	$44.00	$55.00	—	83% below	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger RT 2Views Minimum	$400.00	$500.00	—	55% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger LT 2 Views Minimum	$400.00	$500.00	—	55% above	20%
X-ray of the finger(s), 2 or more views inpatient both sides CPT 73140 RD XR Finger BI 2 View Minimum	$88.00	$110.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient both sides CPT 73140 XR Finger BI 2 Views Minimum	$800.00	$1,000.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 RD XR Finger RT 2 View Minimum	$44.00	$55.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 RD XR Finger LT 2 View Minimum	$44.00	$55.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger LT 2 Views Minimum	$400.00	$500.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger RT 2Views Minimum	$400.00	$500.00	—	—	20%
X-ray of the foot, 2 views both sides CPT 73620 RD FOOT BILATERAL 2V	$96.00	$120.00	—	—	20%
X-ray of the foot, 2 views both sides CPT 73620 XR FOOT BILATERAL 2V	$608.00	$760.00	—	—	20%
X-ray of the foot, 2 views one side CPT 73620 RD FOOT RIGHT 2V	$48.00	$60.00	—	81% below	20%
X-ray of the foot, 2 views one side CPT 73620 RD XR Foot LT 2 Views	$48.00	$60.00	—	81% below	20%
X-ray of the foot, 2 views one side CPT 73620 XR Foot LT 2 Views	$304.00	$380.00	—	23% above	20%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT RIGHT 2V	$304.00	$380.00	—	23% above	20%
X-ray of the foot, 2 views inpatient both sides CPT 73620 RD FOOT BILATERAL 2V	$96.00	$120.00	—	—	20%
X-ray of the foot, 2 views inpatient both sides CPT 73620 XR FOOT BILATERAL 2V	$608.00	$760.00	—	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 RD XR Foot LT 2 Views	$48.00	$60.00	—	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 RD FOOT RIGHT 2V	$48.00	$60.00	—	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot LT 2 Views	$304.00	$380.00	—	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT RIGHT 2V	$304.00	$380.00	—	—	20%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 RD XR Foot BI 3Views Minimum	$104.00	$130.00	—	—	20%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 XR Foot BI 3 Views Minimum	$752.00	$940.00	—	—	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 RD XR Foot LT 3 Views Minimum	$52.00	$65.00	—	81% below	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 RD XR Foot RT 3 View Minimum	$52.00	$65.00	—	81% below	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot LT 3 Views Minimum	$376.00	$470.00	—	40% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot RT 3 View Minimum	$376.00	$470.00	—	40% above	20%
X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 RD XR Foot BI 3Views Minimum	$104.00	$130.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 XR Foot BI 3 Views Minimum	$752.00	$940.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 RD XR Foot RT 3 View Minimum	$52.00	$65.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 RD XR Foot LT 3 Views Minimum	$52.00	$65.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot LT 3 Views Minimum	$376.00	$470.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot RT 3 View Minimum	$376.00	$470.00	—	—	20%
X-ray of the hand, 3 or more views both sides CPT 73130 RD HAND BILAT 3V MIN	$104.00	$130.00	—	—	20%
X-ray of the hand, 3 or more views both sides CPT 73130 XR HAND BILAT 3V MIN	$720.00	$900.00	—	—	20%
X-ray of the hand, 3 or more views one side CPT 73130 RD XR Hand LT 3 View Minimum	$52.00	$65.00	—	81% below	20%
X-ray of the hand, 3 or more views one side CPT 73130 RD XR Hand RT 3 View Minimum	$52.00	$65.00	—	81% below	20%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand LT 3 Views Minimum	$360.00	$450.00	—	32% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand RT 3 Views Minimum	$360.00	$450.00	—	32% above	20%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 RD HAND BILAT 3V MIN	$104.00	$130.00	—	—	20%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 XR HAND BILAT 3V MIN	$720.00	$900.00	—	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 RD XR Hand RT 3 View Minimum	$52.00	$65.00	—	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 RD XR Hand LT 3 View Minimum	$52.00	$65.00	—	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand RT 3 Views Minimum	$360.00	$450.00	—	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand LT 3 Views Minimum	$360.00	$450.00	—	—	20%
X-ray of the knee, 1 or 2 views both sides CPT 73560 RD KNEE BILAT 1-2V	$104.00	$130.00	—	—	20%
X-ray of the knee, 1 or 2 views both sides CPT 73560 XR KNEE BILAT 1-2V	$792.00	$990.00	—	—	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 RD Knee LT 1-2 View	$52.00	$65.00	—	80% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 RD KNEE RIGHT 1-2V	$52.00	$65.00	—	80% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE RIGHT 1-2V	$396.00	$495.00	—	52% above	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee LT 1-2 View	$396.00	$495.00	—	52% above	20%
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 RD KNEE BILAT 1-2V	$104.00	$130.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 XR KNEE BILAT 1-2V	$792.00	$990.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 RD KNEE RIGHT 1-2V	$52.00	$65.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 RD Knee LT 1-2 View	$52.00	$65.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE RIGHT 1-2V	$396.00	$495.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee LT 1-2 View	$396.00	$495.00	—	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RD LUMBAR SPINE 2-3 VIEWS	$68.00	$85.00	—	78% below	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Lumbar Spine 2-3 Views	$444.00	$555.00	—	45% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 RD LUMBAR SPINE 2-3 VIEWS	$68.00	$85.00	—	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Lumbar Spine 2-3 Views	$444.00	$555.00	—	—	20%
X-ray of the lower back, 4 or more views CPT 72110 RD XR L Spine 4 View wObliques	$80.00	$100.00	—	82% below	20%
X-ray of the lower back, 4 or more views CPT 72110 XR L Spine 4 View W Obliques	$560.00	$700.00	—	27% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 RD XR L Spine 4 View wObliques	$80.00	$100.00	—	—	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR L Spine 4 View W Obliques	$560.00	$700.00	—	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 RD XR Thoracic Spine 2 Views	$64.00	$80.00	—	77% below	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Thoracic Spine 2 Views	$400.00	$500.00	—	43% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 RD XR Thoracic Spine 2 Views	$64.00	$80.00	—	—	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Thoracic Spine 2 Views	$400.00	$500.00	—	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 RD Nasal Bones Min 3 Views	$52.00	$65.00	—	79% below	20%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Min 3 Views	$444.00	$555.00	—	78% above	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RD Nasal Bones Min 3 Views	$52.00	$65.00	—	—	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones Min 3 Views	$444.00	$555.00	—	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RD C-Spine 3 View or Less	$68.00	$85.00	—	78% below	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR C-Spine 2 or 3 views	$428.00	$535.00	—	37% above	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 RD C-Spine 3 View or Less	$68.00	$85.00	—	—	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR C-Spine 2 or 3 views	$428.00	$535.00	—	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 RD Pelvis 1-2 Views	$52.00	$65.00	—	81% below	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1-2 Views	$288.00	$360.00	—	5% above	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RD Pelvis 1-2 Views	$52.00	$65.00	—	—	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1-2 Views	$288.00	$360.00	—	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RD Sacrum and Coccyx 2V Min	$52.00	$65.00	—	77% below	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum and Coccyx 2V Min	$364.00	$455.00	—	62% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 RD Sacrum and Coccyx 2V Min	$52.00	$65.00	—	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum and Coccyx 2V Min	$364.00	$455.00	—	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Washington	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT	$68.00	$85.00	—	77% above	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT	$68.00	$85.00	—	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST	$56.00	$70.00	—	54% above	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST	$56.00	$70.00	—	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL (ACUTE)	$300.00	$375.00	—	25% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL (ACUTE)	$300.00	$375.00	—	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 IGE TYPE ALLERGEN, EA (Low)	$8.00	$10.00	—	70% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 IGE TYPE ALLERGEN, EA (mid)	$32.00	$40.00	—	20% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 IGE TYPE ALLERGEN, EA (High)	$80.00	$100.00	—	199% above	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 IGE TYPE ALLERGEN, EA (Low)	$8.00	$10.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 IGE TYPE ALLERGEN, EA (mid)	$32.00	$40.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 IGE TYPE ALLERGEN, EA (High)	$80.00	$100.00	—	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODIES, IGG/IGA	$92.00	$115.00	—	19% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODIES, IGG/IGA	$92.00	$115.00	—	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES	$96.00	$120.00	—	52% above	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES	$96.00	$120.00	—	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-TYPE NATRIURETIC PEPTIDE BNP	$260.00	$325.00	—	40% above	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 PROBNP	$260.00	$325.00	—	40% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 PROBNP	$260.00	$325.00	—	—	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-TYPE NATRIURETIC PEPTIDE BNP	$260.00	$325.00	—	—	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$92.00	$115.00	—	28% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$92.00	$115.00	—	—	20%
Blood culture for bacteria CPT 87040 CULTURE, BLOOD, ROUTINE	$192.00	$240.00	—	51% above	20%
Blood culture for bacteria inpatient CPT 87040 CULTURE, BLOOD, ROUTINE	$192.00	$240.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$32.80	$41.00	—	31% above	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$32.80	$41.00	—	—	20%
Blood glucose (sugar) test CPT 82947 Glucose, Blood, Quant FM	$48.00	$60.00	—	37% above	20%
Blood glucose (sugar) test inpatient CPT 82947 Glucose, Blood, Quant FM	$48.00	$60.00	—	—	20%
Blood lead test CPT 83655 LEAD	$56.00	$70.00	—	at median	20%
Blood lead test inpatient CPT 83655 LEAD	$56.00	$70.00	—	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG, QUALITATIVE	$120.00	$150.00	—	69% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG, QUALITATIVE	$120.00	$150.00	—	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Typing ABO	$64.00	$80.00	—	at median	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ARC Blood Typing ABO	$64.00	$80.00	—	at median	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood Typing ABO	$64.00	$80.00	—	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ARC Blood Typing ABO	$64.00	$80.00	—	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN, QUANT	$72.00	$90.00	—	30% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN, QUANT	$72.00	$90.00	—	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFFICILE TOXIN GENE NAA	$172.00	$215.00	—	1% below	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFFICILE TOXIN GENE NAA	$172.00	$215.00	—	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 ASSAY FOR TUMOR AG CA 19-9	$112.00	$140.00	—	2% above	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 ASSAY FOR TUMOR AG CA 19-9	$112.00	$140.00	—	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 ASSAY FOR TUMOR AG CA 125	$120.00	$150.00	—	2% above	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 ASSAY FOR TUMOR AG CA 125	$120.00	$150.00	—	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 PCR	$172.00	$215.00	—	100% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 PCR	$172.00	$215.00	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA AMP PROBE	$152.00	$190.00	—	13% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA AMP PROBE	$152.00	$190.00	—	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$112.80	$141.00	—	28% above	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$112.80	$141.00	—	—	20%
Complete blood count (CBC) with differential CPT 85025 CBC WITH AUTO DIFF	$96.00	$120.00	—	74% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH AUTO DIFF	$96.00	$120.00	—	—	20%
Complete blood count (CBC), no differential CPT 85027 CBC NO DIFF (HEMOGRAM)	$72.00	$90.00	—	61% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC NO DIFF (HEMOGRAM)	$72.00	$90.00	—	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$124.80	$156.00	—	49% above	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$124.80	$156.00	—	—	20%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER, QUANTITATIVE	$156.00	$195.00	—	36% above	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER, QUANTITATIVE	$156.00	$195.00	—	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-SULFATE	$80.00	$100.00	—	40% below	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-SULFATE	$80.00	$100.00	—	—	20%
Estradiol blood test CPT 82670 ESTRADIOL	$96.00	$120.00	—	31% below	20%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$96.00	$120.00	—	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE-STIM HORMONE	$104.00	$130.00	—	8% above	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE-STIM HORMONE	$104.00	$130.00	—	—	20%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, FECAL	$248.00	$310.00	—	40% above	20%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, FECAL	$248.00	$310.00	—	—	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$148.00	$185.00	—	55% above	20%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$148.00	$185.00	—	—	20%
Folate (folic acid) blood test CPT 82746 FOLATE	$124.00	$155.00	—	17% above	20%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE	$124.00	$155.00	—	—	20%
Free T3 thyroid hormone test CPT 84481 TRIIODOTHYRONINE (T3), FREE	$144.00	$180.00	—	66% above	20%
Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINE (T3), FREE	$144.00	$180.00	—	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4, FREE	$120.00	$150.00	—	88% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4, FREE	$120.00	$150.00	—	—	20%
Free testosterone test CPT 84402 TESTOSTERONE, FREE	$132.00	$165.00	—	5% above	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE	$132.00	$165.00	—	—	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PROFILE	$288.00	$360.00	—	29% above	20%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PROFILE	$288.00	$360.00	—	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE SCREEN, POST 50g GLUCO	$56.00	$70.00	—	57% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE SCREEN, POST 50g GLUCO	$56.00	$70.00	—	—	20%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLER TEST 3 SPECIMENS	$152.00	$190.00	—	133% above	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLER TEST 3 SPECIMENS	$152.00	$190.00	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONORRHOEAE AMP PROBE	$152.00	$190.00	—	13% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GONORRHOEAE AMP PROBE	$152.00	$190.00	—	—	20%
H. pylori antibody blood test CPT 86677 H PYLORI ABS	$76.00	$95.00	—	9% below	20%
H. pylori antibody blood test inpatient CPT 86677 H PYLORI ABS	$76.00	$95.00	—	—	20%
H. pylori stool antigen test CPT 87338 H PYLORI STOOL AG EIA	$148.00	$185.00	—	6% above	20%
H. pylori stool antigen test inpatient CPT 87338 H PYLORI STOOL AG EIA	$148.00	$185.00	—	—	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA, REAL TIME PCR QUANT	$360.00	$450.00	—	5% below	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA, REAL TIME PCR QUANT	$360.00	$450.00	—	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV SCREEN, 4TH GEN W/RFLX	$96.00	$120.00	—	1% below	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV SCREEN, 4TH GEN W/RFLX	$96.00	$120.00	—	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Glycosylated Hemoglobin FM	$80.00	$100.00	—	14% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOBIN LAB	$80.00	$100.00	—	14% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOHEMOGLOBIN (HbA1C-)	$106.40	$133.00	—	52% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HEMOGLOBIN LAB	$80.00	$100.00	—	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Glycosylated Hemoglobin FM	$80.00	$100.00	—	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOHEMOGLOBIN (HbA1C-)	$106.40	$133.00	—	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE AB,QUAL	$80.00	$100.00	—	16% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE AB,QUAL	$80.00	$100.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HBSAG SCREEN	$112.00	$140.00	—	69% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HBSAG SCREEN	$112.00	$140.00	—	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 HCV ANTIBODY REFLEX TO PCR QNT	$104.00	$130.00	—	25% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV ANTIBODY REFLEX TO PCR QNT	$104.00	$130.00	—	—	20%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 HCV RT-PCR, QUANT	$376.00	$470.00	—	17% above	20%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 HCV RT-PCR, QUANT	$376.00	$470.00	—	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IGG, TYPE SPEC	$96.00	$120.00	—	39% above	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IGG, TYPE SPEC	$96.00	$120.00	—	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IGG, TYPE SPEC	$96.00	$120.00	—	11% above	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IGG, TYPE SPEC	$96.00	$120.00	—	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN, CARDIAC	$100.00	$125.00	—	48% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN, CARDIAC	$100.00	$125.00	—	—	20%
Homocysteine blood test CPT 83090 HOMOCYSTEINE	$156.00	$195.00	—	33% above	20%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE	$156.00	$195.00	—	—	20%
Insulin blood test CPT 83525 INSULIN	$80.00	$100.00	—	1% above	20%
Insulin blood test inpatient CPT 83525 INSULIN	$80.00	$100.00	—	—	20%
Iron blood test (serum iron) CPT 83540 IRON	$72.00	$90.00	—	53% above	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$72.00	$90.00	—	—	20%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity	$68.00	$85.00	—	13% above	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity	$68.00	$85.00	—	—	20%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$108.00	$135.00	—	66% above	20%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$108.00	$135.00	—	—	20%
LH (luteinizing hormone) test CPT 83002 LUTEINIZING HORMONE	$104.00	$130.00	—	15% above	20%
LH (luteinizing hormone) test inpatient CPT 83002 LUTEINIZING HORMONE	$104.00	$130.00	—	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$116.00	$145.00	—	64% above	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$116.00	$145.00	—	—	20%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$100.00	$125.00	—	71% above	20%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$100.00	$125.00	—	—	20%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY	$232.00	$290.00	—	160% above	20%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY	$232.00	$290.00	—	—	20%
Magnesium blood test CPT 83735 MAGNESIUM, SERUM	$84.00	$105.00	—	67% above	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM, SERUM	$84.00	$105.00	—	—	20%
Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODIES, IGG	$80.00	$100.00	—	13% above	20%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ANTIBODIES, IGG	$80.00	$100.00	—	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO TEST	$56.80	$71.00	—	27% above	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO TEST	$56.80	$71.00	—	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 acPSA FREE	$104.00	$130.00	—	12% above	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 acPSA FREE	$104.00	$130.00	—	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total	$124.00	$155.00	—	21% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total	$124.00	$155.00	—	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH, INTACT	$244.00	$305.00	—	11% above	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, INTACT	$244.00	$305.00	—	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME	$88.00	$110.00	—	127% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLASTIN TIME	$88.00	$110.00	—	—	20%
Progesterone blood test CPT 84144 PROGESTERONE	$100.00	$125.00	—	2% above	20%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$100.00	$125.00	—	—	20%
Prolactin blood test CPT 84146 PROLACTIN	$124.00	$155.00	—	23% above	20%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$124.00	$155.00	—	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROBMIN TIME LAB FM	$40.00	$50.00	—	at median	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PT/INR)	$72.00	$90.00	—	80% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROBMIN TIME LAB FM	$40.00	$50.00	—	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (PT/INR)	$72.00	$90.00	—	—	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 UDS 12 PANEL	$168.00	$210.00	—	123% above	20%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 UDS 12 PANEL	$168.00	$210.00	—	—	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A&B TESTS FM	$24.00	$30.00	—	64% below	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A&B TESTS FM	$24.00	$30.00	—	—	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Rapid Strep Test Group A	$72.00	$90.00	—	6% below	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Rapid Strep Test Group A	$72.00	$90.00	—	—	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID ARTHRITIS FACTOR	$72.00	$90.00	—	100% above	20%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID ARTHRITIS FACTOR	$72.00	$90.00	—	—	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODIES, IGG	$80.00	$100.00	—	17% above	20%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODIES, IGG	$80.00	$100.00	—	—	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ERYTHROCYTE SEDIMENT RATE-ESR	$68.00	$85.00	—	145% above	20%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ERYTHROCYTE SEDIMENT RATE-ESR	$68.00	$85.00	—	—	20%
Stool ova and parasites exam CPT 87177 OVA + PARASITE EXAM	$112.00	$140.00	—	98% above	20%
Stool ova and parasites exam inpatient CPT 87177 OVA + PARASITE EXAM	$112.00	$140.00	—	—	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood 3 Cards FM	$24.00	$30.00	—	12% below	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Single FM	$32.00	$40.00	—	18% above	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood 3 Cards FM	$24.00	$30.00	—	—	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Single FM	$32.00	$40.00	—	—	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 FECAL OCCULT BLOOD, IA	$80.00	$100.00	—	6% above	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 BLOOD OCC FEC HEMOGL FITLAB FM	$104.00	$130.00	—	38% above	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 FECAL OCCULT BLOOD, IA	$80.00	$100.00	—	—	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 BLOOD OCC FEC HEMOGL FITLAB FM	$104.00	$130.00	—	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagent Qual	$40.00	$50.00	—	48% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagent Qual	$40.00	$50.00	—	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB Test Immunity Antigens	$224.00	$280.00	—	9% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB Test Immunity Antigens	$224.00	$280.00	—	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$144.00	$180.00	—	22% above	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL	$144.00	$180.00	—	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE (TPO) AB	$84.00	$105.00	—	9% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE (TPO) AB	$84.00	$105.00	—	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH W/REFLEX TO FT4	$152.00	$190.00	—	44% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH W/REFLEX TO FT4	$152.00	$190.00	—	—	20%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis PCR	$56.00	$70.00	—	49% below	20%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis PCR	$56.00	$70.00	—	—	20%
Uric acid blood test CPT 84550 URIC ACID, SERUM	$56.00	$70.00	—	54% above	20%
Uric acid blood test inpatient CPT 84550 URIC ACID, SERUM	$56.00	$70.00	—	—	20%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS WITH MICROSCOPIC	$64.00	$80.00	—	76% above	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS WITH MICROSCOPIC	$64.00	$80.00	—	—	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS WO MICROSCOPIC EXAM	$28.00	$35.00	—	2% above	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS WO MICROSCOPIC EXAM	$28.00	$35.00	—	—	20%
Urinalysis without microscope exam, manual CPT 81002 UA DIP FM	$24.00	$30.00	—	23% above	20%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA DIP FM	$24.00	$30.00	—	—	20%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE, ROUTINE	$96.00	$120.00	—	27% above	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE, ROUTINE	$96.00	$120.00	—	—	20%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST FM	$48.00	$60.00	—	at median	20%
Urine pregnancy test, read by color change CPT 81025 HCG, URINE, QUALITATIVE	$56.00	$70.00	—	17% above	20%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST FM	$48.00	$60.00	—	—	20%
Urine pregnancy test, read by color change inpatient CPT 81025 HCG, URINE, QUALITATIVE	$56.00	$70.00	—	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$128.00	$160.00	—	25% above	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$128.00	$160.00	—	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D, 25-HYDROXY	$152.00	$190.00	—	11% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25-HYDROXY	$152.00	$190.00	—	—	20%
Zinc blood test CPT 84630 ZINC	$80.00	$100.00	—	12% above	20%
Zinc blood test inpatient CPT 84630 ZINC	$80.00	$100.00	—	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG, QUANTITATIVE	$144.00	$180.00	—	33% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG, QUANTITATIVE	$144.00	$180.00	—	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Washington	Off list
Arthroscopic rotator cuff repair of the shoulder CPT 29827 Arthr Shld w Rotator Rep Surg	$2,000.00	$2,500.00	—	19% below	20%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 Arthr Shld w Rotator Rep OR	$10,584.00	$13,230.00	—	328% above	20%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 Arthr Shld w Rotator Rep Surg	$2,000.00	$2,500.00	—	—	20%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 Arthr Shld w Rotator Rep OR	$10,584.00	$13,230.00	—	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLO TX DISTL FIB FX WO MAN PHY	$720.00	$900.00	—	8% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLO TX FX FIBULA DIST W/O MANP	$720.00	$900.00	—	8% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLO TX FX FIBULA DIST W/O MAN	$800.00	$1,000.00	—	20% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLO TX DISTAL FIB FX WO MANIP	$800.00	$1,000.00	—	20% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLO TX DIST FIB FX WO MANIP SC	$1,520.00	$1,900.00	—	128% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLO TX FX FIBULA DIST W/O MANP	$720.00	$900.00	—	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLO TX DISTL FIB FX WO MAN PHY	$720.00	$900.00	—	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLO TX FX FIBULA DIST W/O MAN	$800.00	$1,000.00	—	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLO TX DISTAL FIB FX WO MANIP	$800.00	$1,000.00	—	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLO TX DIST FIB FX WO MANIP SC	$1,520.00	$1,900.00	—	—	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLO TX METTAR FX WO MAN CLNSUR	$720.00	$900.00	—	30% above	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Clo Tx Metatars Fx WO Man Phys	$720.00	$900.00	—	30% above	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLO TX METATARSAL FX WO MANIP	$800.00	$1,000.00	—	44% above	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLO TX METATARS FX WO MANIP SC	$1,520.00	$1,900.00	—	174% above	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Clo Tx Metatars Fx WO Man Phys	$720.00	$900.00	—	—	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLO TX METTAR FX WO MAN CLNSUR	$720.00	$900.00	—	—	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLO TX METATARSAL FX WO MANIP	$800.00	$1,000.00	—	—	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLO TX METATARS FX WO MANIP SC	$1,520.00	$1,900.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIO VERSION PHYS	$384.00	$480.00	—	62% below	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION Phys	$576.00	$720.00	—	43% below	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION	$1,248.00	$1,560.00	—	24% above	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIO VERSION PHYS	$384.00	$480.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION Phys	$576.00	$720.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION	$1,248.00	$1,560.00	—	—	20%
Carpal tunnel release, open surgery CPT 64721 RELEASE CARPAL TUNNEL	$900.00	$1,125.00	—	69% below	20%
Carpal tunnel release, open surgery inpatient CPT 64721 RELEASE CARPAL TUNNEL	$900.00	$1,125.00	—	—	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision w Clamp FPC	$224.00	$280.00	—	55% below	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision w Clamp FPC	$224.00	$280.00	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLO TX DIS RAD FX WO MANIP	$452.00	$565.00	—	24% below	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Clo Tx Dis Rad Fx wo Man Phys	$960.00	$1,200.00	—	62% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Clo Tx Dis Rad Fx wo Man Surg	$960.00	$1,200.00	—	62% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Clo Tx Dis Rad Fx wo Manip OR	$1,240.00	$1,550.00	—	109% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Clo Tx Dis Rad Fx wo Man ED	$1,240.00	$1,550.00	—	109% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLO TX DIS RAD FX WO MAN SC	$2,200.00	$2,750.00	—	271% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLO TX DIS RAD FX WO MANIP	$452.00	$565.00	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Clo Tx Dis Rad Fx wo Man Phys	$960.00	$1,200.00	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Clo Tx Dis Rad Fx wo Man Surg	$960.00	$1,200.00	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Clo Tx Dis Rad Fx wo Manip OR	$1,240.00	$1,550.00	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Clo Tx Dis Rad Fx wo Man ED	$1,240.00	$1,550.00	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLO TX DIS RAD FX WO MAN SC	$2,200.00	$2,750.00	—	—	20%
Colonoscopy with polyp removal CPT 45385 Colonoscopy w Snare Rem Surg	$876.00	$1,095.00	—	44% below	20%
Colonoscopy with polyp removal CPT 45385 Colonoscopy w Snare Rem OR	$2,864.00	$3,580.00	—	83% above	20%
Colonoscopy with polyp removal inpatient CPT 45385 Colonoscopy w Snare Rem Surg	$876.00	$1,095.00	—	—	20%
Colonoscopy with polyp removal inpatient CPT 45385 Colonoscopy w Snare Rem OR	$2,864.00	$3,580.00	—	—	20%
Colonoscopy with tissue sample CPT 45380 Colonoscopy w Bx Surg	$920.00	$1,150.00	—	47% below	20%
Colonoscopy with tissue sample CPT 45380 Colonoscopy W Bx OR	$2,716.00	$3,395.00	—	56% above	20%
Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy w Bx Surg	$920.00	$1,150.00	—	—	20%
Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy W Bx OR	$2,716.00	$3,395.00	—	—	20%
Colonoscopy, diagnostic CPT 45378 Colonoscopy Diagnostic Surg	$920.00	$1,150.00	—	44% below	20%
Colonoscopy, diagnostic CPT 45378 Colonoscopy Diagnostic OR	$2,716.00	$3,395.00	—	66% above	20%
Colonoscopy, diagnostic inpatient CPT 45378 Colonoscopy Diagnostic Surg	$920.00	$1,150.00	—	—	20%
Colonoscopy, diagnostic inpatient CPT 45378 Colonoscopy Diagnostic OR	$2,716.00	$3,395.00	—	—	20%
Complex cataract surgery with lens implant CPT 66982 CATARACT SURGERY, COMPLEX	$299.20	$374.00	—	94% below	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruction Single Lesion RHC	$172.00	$215.00	—	8% below	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT LESION 1ST/SINGLE FM	$172.00	$215.00	—	8% below	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT LESION 1ST/SINGLE FM	$172.00	$215.00	—	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Destruction Single Lesion RHC	$172.00	$215.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPCTD CERUMEN IRRIGATION	$48.00	$60.00	—	57% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Rem Impacted Wax Ear w Irrig	$48.00	$60.00	—	57% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPCTD CERUMEN W IRRIG PHY	$52.00	$65.00	—	54% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPCTD CERUMEN EAR W IRRIG	$168.00	$210.00	—	50% above	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REM IMPCTD CERUMEN IRRIGATION	$48.00	$60.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Rem Impacted Wax Ear w Irrig	$48.00	$60.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REM IMPCTD CERUMEN W IRRIG PHY	$52.00	$65.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REM IMPCTD CERUMEN EAR W IRRIG	$168.00	$210.00	—	—	20%
Earwax removal with instruments, one ear CPT 69210 Rem Impacted Wax Ear w Instr	$92.00	$115.00	—	46% below	20%
Earwax removal with instruments, one ear CPT 69210 REM IMPCTD CERUMEN INSTRUMENT	$92.00	$115.00	—	46% below	20%
Earwax removal with instruments, one ear CPT 69210 REM IMPACT CERUMEN EAR PHYS	$156.00	$195.00	—	8% below	20%
Earwax removal with instruments, one ear CPT 69210 REM IMPACTED CERUMEN EAR	$240.00	$300.00	—	41% above	20%
Earwax removal with instruments, one ear inpatient CPT 69210 Rem Impacted Wax Ear w Instr	$92.00	$115.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMPCTD CERUMEN INSTRUMENT	$92.00	$115.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMPACT CERUMEN EAR PHYS	$156.00	$195.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMPACTED CERUMEN EAR	$240.00	$300.00	—	—	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Rep Ant Abd Hernia <3CM Surg	$1,328.00	$1,660.00	—	78% below	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Rep Ant Abd Hernia 1ST <3CM	$6,600.00	$8,250.00	—	8% above	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 Rep Ant Abd Hernia <3CM Surg	$1,328.00	$1,660.00	—	—	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 Rep Ant Abd Hernia 1ST <3CM	$6,600.00	$8,250.00	—	—	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy Diagnostic Surg	$380.00	$475.00	—	62% below	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy Diagnostic OR	$1,680.00	$2,100.00	—	69% above	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Sigmoidoscopy Diagnostic Surg	$380.00	$475.00	—	—	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Sigmoidoscopy Diagnostic OR	$1,680.00	$2,100.00	—	—	20%
Gallbladder removal, laparoscopic CPT 47562 CHOLECYSTECTOMY LAP OR SURG	$1,744.00	$2,180.00	—	84% below	20%
Gallbladder removal, laparoscopic CPT 47562 CHOLECYSTECTOMY LAP	$12,800.00	$16,000.00	—	17% above	20%
Gallbladder removal, laparoscopic inpatient CPT 47562 CHOLECYSTECTOMY LAP OR SURG	$1,744.00	$2,180.00	—	—	20%
Gallbladder removal, laparoscopic inpatient CPT 47562 CHOLECYSTECTOMY LAP	$12,800.00	$16,000.00	—	—	20%
Hammertoe correction surgery CPT 28285 HAMMER TOE CORRECTION	$1,200.00	$1,500.00	—	39% below	20%
Hammertoe correction surgery inpatient CPT 28285 HAMMER TOE CORRECTION	$1,200.00	$1,500.00	—	—	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 HEMORRHOID BAND LIG	$744.00	$930.00	—	40% below	20%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HEMORRHOID BAND LIG	$744.00	$930.00	—	—	20%
IUD insertion (the device itself billed separately) CPT 58300 Insertion of IUD FM	$248.00	$310.00	—	22% below	20%
IUD insertion (the device itself billed separately) inpatient CPT 58300 Insertion of IUD FM	$248.00	$310.00	—	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Abscess Simple/Single SC	$200.00	$250.00	—	46% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE Bedside	$216.00	$270.00	—	41% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE PHYS	$216.00	$270.00	—	41% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Abscess Simple or Single	$328.00	$410.00	—	11% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE FM	$328.00	$410.00	—	11% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$352.00	$440.00	—	5% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Abscess Simple/Single Surg	$356.00	$445.00	—	4% below	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Abscess Simple/Single SC	$200.00	$250.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE Bedside	$216.00	$270.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE/SINGLE PHYS	$216.00	$270.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Abscess Simple or Single	$328.00	$410.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE FM	$328.00	$410.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$352.00	$440.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Abscess Simple/Single Surg	$356.00	$445.00	—	—	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Rep Hernia Inguinal >5Yrs Surg	$1,200.00	$1,500.00	—	85% below	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Rep Hernia Inguinal >5 Yrs OR	$7,200.00	$9,000.00	—	8% below	20%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Rep Hernia Inguinal >5Yrs Surg	$1,200.00	$1,500.00	—	—	20%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Rep Hernia Inguinal >5 Yrs OR	$7,200.00	$9,000.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Tendon Sheath or Ligament	$128.00	$160.00	—	51% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Tendon Sheath/Ligament RHC	$240.00	$300.00	—	8% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Tendon Sheath/Ligament FM	$240.00	$300.00	—	8% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Tendon Sheath/Ligament SC	$528.00	$660.00	—	101% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj Tendon Sheath or Ligament	$128.00	$160.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj Tendon Sheath/Ligament FM	$240.00	$300.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj Tendon Sheath/Ligament RHC	$240.00	$300.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj Tendon Sheath/Ligament SC	$528.00	$660.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS MAJOR JOINT	$80.00	$100.00	—	84% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Major Joint Sur	$84.00	$105.00	—	83% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS LARGE JOINT FM	$148.00	$185.00	—	69% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Large Joint RHC	$148.00	$185.00	—	69% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS LRG JOINT PHYS	$180.00	$225.00	—	63% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Major Joint OR	$435.20	$544.00	—	10% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS LARGE JOINT	$532.00	$665.00	—	10% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Large Joint SC	$712.00	$890.00	—	47% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS MAJOR JOINT	$80.00	$100.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis Major Joint Sur	$84.00	$105.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS LARGE JOINT FM	$148.00	$185.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis Large Joint RHC	$148.00	$185.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS LRG JOINT PHYS	$180.00	$225.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis Major Joint OR	$435.20	$544.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS LARGE JOINT	$532.00	$665.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis Large Joint SC	$712.00	$890.00	—	—	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insert Drug Delive Implant RHC	$292.00	$365.00	—	9% above	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insert Drug Delivery Implant	$292.00	$365.00	—	9% above	20%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Insert Drug Delivery Implant	$292.00	$365.00	—	—	20%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Insert Drug Delive Implant RHC	$292.00	$365.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS INTERMED FM	$120.00	$150.00	—	74% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis Med Joint RHC	$120.00	$150.00	—	74% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS MED JOINT PHY	$144.00	$180.00	—	69% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS MEDIUM JOINT	$144.00	$180.00	—	69% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis Medium Joint SC	$544.00	$680.00	—	17% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS INTERMED FM	$120.00	$150.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis Med Joint RHC	$120.00	$150.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS MEDIUM JOINT	$144.00	$180.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS MED JOINT PHY	$144.00	$180.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis Medium Joint SC	$544.00	$680.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHRO SMALL FM	$128.00	$160.00	—	67% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis Small Joint RHC	$128.00	$160.00	—	67% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis Sm Joint Phys	$144.00	$180.00	—	62% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 INJ SMALL JOINT CLINIC SURG	$144.00	$180.00	—	62% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS SMALL JOINT ER	$284.00	$355.00	—	26% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS SMALL JOINT	$284.00	$355.00	—	26% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis Small Joint SC	$428.00	$535.00	—	12% above	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHRO SMALL FM	$128.00	$160.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis Small Joint RHC	$128.00	$160.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis Sm Joint Phys	$144.00	$180.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 INJ SMALL JOINT CLINIC SURG	$144.00	$180.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS SMALL JOINT ER	$284.00	$355.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS SMALL JOINT	$284.00	$355.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis Small Joint SC	$428.00	$535.00	—	—	20%
Knee arthroscopy with meniscus trim CPT 29881 ARTHRO KNEE W MENISCUS REP	$1,200.00	$1,500.00	—	47% below	20%
Knee arthroscopy with meniscus trim CPT 29881 ARTHRO KNEE W 1 MENISCUS REP	$6,400.00	$8,000.00	—	184% above	20%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHRO KNEE W MENISCUS REP	$1,200.00	$1,500.00	—	—	20%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHRO KNEE W 1 MENISCUS REP	$6,400.00	$8,000.00	—	—	20%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAP APPENDECTOMY OR SURG	$800.00	$1,000.00	—	84% below	20%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAP APPENDECTOMY OR SURG	$800.00	$1,000.00	—	—	20%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 AFTER CATARACT LASER SURGERY	$136.00	$170.00	—	78% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REPAIR SCLP/TRNK/EXT <2.5CM	$312.00	$390.00	—	51% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Rep Scalp/Trunk/Ext <2.5CM SC	$580.00	$725.00	—	8% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Rep Scalp/Trunk/Ext <2.6CM SC	$900.00	$1,125.00	—	42% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REPAIR SCLP/TRNK/EXT <2.5CM	$312.00	$390.00	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Rep Scalp/Trunk/Ext <2.5CM SC	$580.00	$725.00	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Rep Scalp/Trunk/Ext <2.6CM SC	$900.00	$1,125.00	—	—	20%
Nail removal (partial or complete), one nail CPT 11730 EXC NAIL/MAT PT/CMPT PERM PHY	$216.00	$270.00	—	23% below	20%
Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate Single RHC	$216.00	$270.00	—	23% below	20%
Nail removal (partial or complete), one nail CPT 11730 Avulsion One Nail Plate Surg	$216.00	$270.00	—	23% below	20%
Nail removal (partial or complete), one nail CPT 11730 AVULSION OF NAIL PLATE FM	$216.00	$270.00	—	23% below	20%
Nail removal (partial or complete), one nail CPT 11730 AVULSN NAIL PLATE SINGLE	$216.00	$270.00	—	23% below	20%
Nail removal (partial or complete), one nail CPT 11730 AVULSN NAIL PLATE SINGLE ER	$428.00	$535.00	—	53% above	20%
Nail removal (partial or complete), one nail CPT 11730 Avulsion One Nail Plate OR	$428.00	$535.00	—	53% above	20%
Nail removal (partial or complete), one nail CPT 11730 AVULSN NAIL PLATE SINGLE SC	$644.00	$805.00	—	130% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion Nail Plate Single RHC	$216.00	$270.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSN NAIL PLATE SINGLE	$216.00	$270.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion One Nail Plate Surg	$216.00	$270.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION OF NAIL PLATE FM	$216.00	$270.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 EXC NAIL/MAT PT/CMPT PERM PHY	$216.00	$270.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion One Nail Plate OR	$428.00	$535.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSN NAIL PLATE SINGLE ER	$428.00	$535.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSN NAIL PLATE SINGLE SC	$644.00	$805.00	—	—	20%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS W IMGING GUIDANC	$376.00	$470.00	—	67% below	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W GUID Hosp	$376.00	$470.00	—	67% below	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS/IMG GUID PHYS	$528.00	$660.00	—	53% below	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W GUIDANCE ER	$1,912.00	$2,390.00	—	70% above	20%
Paracentesis with imaging guidance CPT 49083 PARACENTES W IMAGIN GUIDANCE	$1,912.00	$2,390.00	—	70% above	20%
Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS W IMGING GUIDANC	$376.00	$470.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W GUID Hosp	$376.00	$470.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS/IMG GUID PHYS	$528.00	$660.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W GUIDANCE ER	$1,912.00	$2,390.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 PARACENTES W IMAGIN GUIDANCE	$1,912.00	$2,390.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Exc Nail & Nail Bed Phys	$412.00	$515.00	—	43% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excise Nail & Nail Bed RHC	$412.00	$515.00	—	43% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL TOENAIL AND BED	$412.00	$515.00	—	43% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF TOENAIL FM	$460.00	$575.00	—	36% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL & NAIL BED	$824.00	$1,030.00	—	14% above	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL & NAIL BED SC	$1,236.00	$1,545.00	—	72% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL TOENAIL AND BED	$412.00	$515.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Exc Nail & Nail Bed Phys	$412.00	$515.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excise Nail & Nail Bed RHC	$412.00	$515.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF TOENAIL FM	$460.00	$575.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL & NAIL BED	$824.00	$1,030.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL & NAIL BED SC	$1,236.00	$1,545.00	—	—	20%
Removal of a foreign object under the skin, simple CPT 10120 REMOVE FB SUBQ	$248.00	$310.00	—	55% below	20%
Removal of a foreign object under the skin, simple CPT 10120 INCISION & REMOVAL FB FM	$312.00	$390.00	—	43% below	20%
Removal of a foreign object under the skin, simple CPT 10120 Incision & Removal FB Subq RHC	$312.00	$390.00	—	43% below	20%
Removal of a foreign object under the skin, simple CPT 10120 INCS/REMOVE FB SQ SIMPLE PHYS	$432.00	$540.00	—	21% below	20%
Removal of a foreign object under the skin, simple CPT 10120 Incision & Removal FB SC	$1,144.00	$1,430.00	—	110% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVE FB SUBQ	$248.00	$310.00	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision & Removal FB Subq RHC	$312.00	$390.00	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION & REMOVAL FB FM	$312.00	$390.00	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCS/REMOVE FB SQ SIMPLE PHYS	$432.00	$540.00	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision & Removal FB SC	$1,144.00	$1,430.00	—	—	20%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colonoscopy Screening OR	$1,960.00	$2,450.00	—	41% above	20%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 Colonoscopy Screening OR	$1,960.00	$2,450.00	—	—	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colonoscopy Screen HighRisk OR	$1,680.00	$2,100.00	—	12% above	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 Colonoscopy Screen HighRisk OR	$1,680.00	$2,100.00	—	—	20%
Short arm cast (elbow to hand) CPT 29075 Applcation Cast Short Arm Surg	$92.00	$115.00	—	79% below	20%
Short arm cast (elbow to hand) CPT 29075 APPLICTION CAST SHORTARM FM	$160.00	$200.00	—	64% below	20%
Short arm cast (elbow to hand) CPT 29075 Appy Cast Shortarm FAC SC	$328.00	$410.00	—	26% below	20%
Short arm cast (elbow to hand) inpatient CPT 29075 Applcation Cast Short Arm Surg	$92.00	$115.00	—	—	20%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICTION CAST SHORTARM FM	$160.00	$200.00	—	—	20%
Short arm cast (elbow to hand) inpatient CPT 29075 Appy Cast Shortarm FAC SC	$328.00	$410.00	—	—	20%
Short arm splint (forearm and hand) CPT 29125 APPLCATION SPLINT SHORTARM SUR	$117.60	$147.00	—	50% below	20%
Short arm splint (forearm and hand) CPT 29125 Apply Splint Shortarm RHC	$148.00	$185.00	—	37% below	20%
Short arm splint (forearm and hand) CPT 29125 SPLINT SHORT ARM FM	$148.00	$185.00	—	37% below	20%
Short arm splint (forearm and hand) CPT 29125 Apply Short Arm Splint Phys	$184.00	$230.00	—	21% below	20%
Short arm splint (forearm and hand) CPT 29125 APPLICATION SPLINT SHORTARM	$420.00	$525.00	—	80% above	20%
Short arm splint (forearm and hand) CPT 29125 APP SHORT ARM SPLINT STATIC	$420.00	$525.00	—	80% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLCATION SPLINT SHORTARM SUR	$117.60	$147.00	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 Apply Splint Shortarm RHC	$148.00	$185.00	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT SHORT ARM FM	$148.00	$185.00	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 Apply Short Arm Splint Phys	$184.00	$230.00	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APP SHORT ARM SPLINT STATIC	$420.00	$525.00	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION SPLINT SHORTARM	$420.00	$525.00	—	—	20%
Short leg splint (calf to foot) CPT 29515 APPLY SHORT LEG SPLINT PHYS	$208.00	$260.00	—	41% below	20%
Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT	$416.00	$520.00	—	18% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 APPLY SHORT LEG SPLINT PHYS	$208.00	$260.00	—	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION SHORT LEG SPLINT	$416.00	$520.00	—	—	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Arthr Shld DistClavlectomy Sur	$824.00	$1,030.00	—	44% below	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Arthr Shld Dist Clavlectomy OR	$4,762.40	$5,953.00	—	222% above	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 Arthr Shld DistClavlectomy Sur	$824.00	$1,030.00	—	—	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 Arthr Shld Dist Clavlectomy OR	$4,762.40	$5,953.00	—	—	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Arthr decom subacrom space Sur	$1,008.00	$1,260.00	—	37% below	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Arthro decom subacrom space OR	$4,000.00	$5,000.00	—	151% above	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Arthr decom subacrom space Sur	$1,008.00	$1,260.00	—	—	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Arthro decom subacrom space OR	$4,000.00	$5,000.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR SIMP SCLP/TRNK <2.5CM PHYS	$176.00	$220.00	—	48% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple Rep Trunnk <2.6 CM RHC	$308.00	$385.00	—	9% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR TRUNK 2.5CM OR LESS FM	$348.00	$435.00	—	3% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR SIMP SCLP/TRK <2.5CM	$444.00	$555.00	—	31% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR SIMP SCLP/TRNK <2.5CM PHYS	$176.00	$220.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple Rep Trunnk <2.6 CM RHC	$308.00	$385.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPAIR TRUNK 2.5CM OR LESS FM	$348.00	$435.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR SIMP SCLP/TRK <2.5CM	$444.00	$555.00	—	—	20%
Skin biopsy, punch, one lesion CPT 11104 Bx Skin Punch 1st Lesion RHC	$264.00	$330.00	—	23% below	20%
Skin biopsy, punch, one lesion CPT 11104 BX SKIN PUNCH 1ST LSN FM	$264.00	$330.00	—	23% below	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 Bx Skin Punch 1st Lesion RHC	$264.00	$330.00	—	—	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 BX SKIN PUNCH 1ST LSN FM	$264.00	$330.00	—	—	20%
Skin tag removal, up to 15 tags CPT 11200 Remove 1-15 Skin Tags RHC	$164.00	$205.00	—	10% below	20%
Skin tag removal, up to 15 tags CPT 11200 Rem Skin Tags To 15 Tags FM	$164.00	$205.00	—	10% below	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 Rem Skin Tags To 15 Tags FM	$164.00	$205.00	—	—	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 Remove 1-15 Skin Tags RHC	$164.00	$205.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE Anes	$648.00	$810.00	—	15% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE PHYS	$648.00	$810.00	—	15% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE	$992.00	$1,240.00	—	30% above	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE PHYS	$648.00	$810.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE Anes	$648.00	$810.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE	$992.00	$1,240.00	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR SIMP SC/TRK 2.6-7.5CM PHYS	$232.00	$290.00	—	41% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR SIMP SCLP/TRK 2.6-7.5CM	$472.00	$590.00	—	20% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR SIMP SC/TRK 2.6-7.5CM PHYS	$232.00	$290.00	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR SIMP SCLP/TRK 2.6-7.5CM	$472.00	$590.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR SIMP FACE/MUCOUS <2.5 PHYS	$220.00	$275.00	—	40% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR SIMPLE FACE 2.5CM	$320.00	$400.00	—	13% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple Rep Face <2.6 CM RHC	$320.00	$400.00	—	13% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR SIMPLE FACE/MUCOUS <2.5	$560.00	$700.00	—	52% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR SIMP FACE/MUCOUS <2.5 PHYS	$220.00	$275.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Simple Rep Face <2.6 CM RHC	$320.00	$400.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REPAIR SIMPLE FACE 2.5CM	$320.00	$400.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR SIMPLE FACE/MUCOUS <2.5	$560.00	$700.00	—	—	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Bx Skin Tangential 1st Lesion	$264.00	$330.00	—	2% below	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 BX SKIN TANGENTIAL 1ST LSN FM	$264.00	$330.00	—	2% below	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 BX SKIN TANGENTIAL 1ST LSN FM	$264.00	$330.00	—	—	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Bx Skin Tangential 1st Lesion	$264.00	$330.00	—	—	20%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis w Guidance PHYS	$720.00	$900.00	—	47% below	20%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS PLEUR ASP W GUID	$720.00	$900.00	—	47% below	20%
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis w Guidance PHYS	$720.00	$900.00	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS PLEUR ASP W GUID	$720.00	$900.00	—	—	20%
Trigger finger release surgery CPT 26055 TENDON SHEATH INCISION	$880.00	$1,100.00	—	67% below	20%
Trigger finger release surgery inpatient CPT 26055 TENDON SHEATH INCISION	$880.00	$1,100.00	—	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Pt 1-2 Muscles Sur	$76.00	$95.00	—	77% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Pt 1-2 Muscles Phy	$148.00	$185.00	—	56% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Pt 1-2 Muscles RHC	$160.00	$200.00	—	52% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Pt 1-2 Muscles FM	$164.00	$205.00	—	51% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Pts 1-2 Musc FAC	$496.00	$620.00	—	48% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Pt 1-2 Muscles ED	$496.00	$620.00	—	48% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger PT 1-2 Muscles OR	$496.00	$620.00	—	48% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Pt 1-2 Muscles SC	$644.00	$805.00	—	92% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Trigger Pt 1-2 Muscles Sur	$76.00	$95.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Trigger Pt 1-2 Muscles Phy	$148.00	$185.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Trigger Pt 1-2 Muscles RHC	$160.00	$200.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Trigger Pt 1-2 Muscles FM	$164.00	$205.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Trigger Pt 1-2 Muscles ED	$496.00	$620.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Trigger PT 1-2 Muscles OR	$496.00	$620.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Trigger Pts 1-2 Musc FAC	$496.00	$620.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Trigger Pt 1-2 Muscles SC	$644.00	$805.00	—	—	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD W Dilation <30MM Surg	$1,600.00	$2,000.00	—	18% below	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD W Esoph Dilation <30MM OR	$3,484.00	$4,355.00	—	79% above	20%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 EGD W Dilation <30MM Surg	$1,600.00	$2,000.00	—	—	20%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 EGD W Esoph Dilation <30MM OR	$3,484.00	$4,355.00	—	—	20%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD W Bx Surg	$896.00	$1,120.00	—	48% below	20%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD W Bx OR	$2,560.00	$3,200.00	—	48% above	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD W Bx Surg	$896.00	$1,120.00	—	—	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD W Bx OR	$2,560.00	$3,200.00	—	—	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD w Snare Removal Surg	$616.00	$770.00	—	53% below	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD W Snare Removal OR	$1,008.00	$1,260.00	—	23% below	20%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD w Snare Removal Surg	$616.00	$770.00	—	—	20%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD W Snare Removal OR	$1,008.00	$1,260.00	—	—	20%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD Diagnostic Surg	$740.00	$925.00	—	28% below	20%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD Diagnostic OR	$2,472.00	$3,090.00	—	142% above	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD Diagnostic Surg	$740.00	$925.00	—	—	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD Diagnostic OR	$2,472.00	$3,090.00	—	—	20%
Wart removal, up to 14 warts CPT 17110 DEST B9 LES ANY METHOD PHYS	$136.00	$170.00	—	43% below	20%
Wart removal, up to 14 warts CPT 17110 Destruct up to 14 Lesions RHC	$224.00	$280.00	—	6% below	20%
Wart removal, up to 14 warts CPT 17110 Destruction Benign Lesion FM	$224.00	$280.00	—	6% below	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION LESIONS UP TO 14	$248.00	$310.00	—	4% above	20%
Wart removal, up to 14 warts CPT 17110 Destruction Benign Lesion SC	$384.00	$480.00	—	62% above	20%
Wart removal, up to 14 warts inpatient CPT 17110 DEST B9 LES ANY METHOD PHYS	$136.00	$170.00	—	—	20%
Wart removal, up to 14 warts inpatient CPT 17110 Destruction Benign Lesion FM	$224.00	$280.00	—	—	20%
Wart removal, up to 14 warts inpatient CPT 17110 Destruct up to 14 Lesions RHC	$224.00	$280.00	—	—	20%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION LESIONS UP TO 14	$248.00	$310.00	—	—	20%
Wart removal, up to 14 warts inpatient CPT 17110 Destruction Benign Lesion SC	$384.00	$480.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN/SUBQ <21SQ CM	$244.00	$305.00	—	60% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRID SKIN & SUBQ TISSUE PHYS	$244.00	$305.00	—	60% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Skin/Subq <21sqcm SC	$1,288.00	$1,610.00	—	109% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRID SKIN & SUBQ TISSUE PHYS	$244.00	$305.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SKIN/SUBQ <21SQ CM	$244.00	$305.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride Skin/Subq <21sqcm SC	$1,288.00	$1,610.00	—	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Washington	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Transf Blood/Component 1 Unit	$1,520.00	$1,900.00	—	60% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 Transf Blood/Component 2 Units	$1,760.00	$2,200.00	—	85% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 Transf Blood/Component 3 Units	$2,000.00	$2,500.00	—	110% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transf Blood/Component 1 Unit	$1,520.00	$1,900.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transf Blood/Component 2 Units	$1,760.00	$2,200.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transf Blood/Component 3 Units	$2,000.00	$2,500.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Tx <1 Hr RHC	$212.00	$265.00	—	7% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Tx <1 Hr Add Tx ER	$220.00	$275.00	—	11% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER TREATMENT ER	$224.00	$280.00	—	13% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Tx Less Than 1 Hr FM	$224.00	$280.00	—	13% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 Nebulizer Tx <1 Hour RT	$356.00	$445.00	—	80% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Nebulizer Tx <1 Hr RHC	$212.00	$265.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Nebulizer Tx <1 Hr Add Tx ER	$220.00	$275.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER TREATMENT ER	$224.00	$280.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Nebulizer Tx Less Than 1 Hr FM	$224.00	$280.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient one side CPT 94640 Nebulizer Tx <1 Hour RT	$356.00	$445.00	—	—	20%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 COMP. OPHTH. SERVICE, NEW PT	$304.00	$380.00	—	93% above	20%
Comprehensive eye exam, returning patient CPT 92014 COMP. OPHTH. SERVICE, EST PT	$256.00	$320.00	—	79% above	20%
Critical care, first 30 to 74 minutes CPT 99291 Critical Care 1st Hour ER Phys	$424.00	$530.00	—	86% below	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITCAL CARE 30-74 MIN Anes	$2,000.00	$2,500.00	—	34% below	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 1ST HR HOSP	$2,000.00	$2,500.00	—	34% below	20%
Critical care, first 30 to 74 minutes CPT 99291 Critical Care 30-74 Min ED	$3,020.00	$3,775.00	—	at median	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care 1st Hour ER Phys	$424.00	$530.00	—	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE 1ST HR HOSP	$2,000.00	$2,500.00	—	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITCAL CARE 30-74 MIN Anes	$2,000.00	$2,500.00	—	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care 30-74 Min ED	$3,020.00	$3,775.00	—	—	20%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG GLOBAL	$332.00	$415.00	—	360% above	20%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG GLOBAL	$332.00	$415.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING ONLY	$248.00	$310.00	—	37% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING ONLY	$248.00	$310.00	—	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 E/M ER LEVEL 1	$240.00	$300.00	—	6% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 E/M ER LEVEL 1	$240.00	$300.00	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER Visit Level 2 Physician	$328.00	$410.00	—	15% below	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 E/M ER Level 2 ER	$492.00	$615.00	—	27% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER Visit Level 2 Physician	$328.00	$410.00	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 E/M ER Level 2 ER	$492.00	$615.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 E/M ED MODERATE SURG	$520.00	$650.00	—	31% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER Visit Level 3 Physician	$560.00	$700.00	—	26% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 E/M ER Level 3 Fac	$840.00	$1,050.00	—	11% above	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 E/M ED MODERATE SURG	$520.00	$650.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER Visit Level 3 Physician	$560.00	$700.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 E/M ER Level 3 Fac	$840.00	$1,050.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 E/M ER Level 4 Anesthesia	$784.00	$980.00	—	35% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER Visit Level 4 Physician	$904.00	$1,130.00	—	26% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 E/M ED MOD HIGH SURG	$952.00	$1,190.00	—	22% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 E/M ER Level 4 Fac	$1,428.00	$1,785.00	—	18% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 E/M ER Level 4 Anesthesia	$784.00	$980.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER Visit Level 4 Physician	$904.00	$1,130.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 E/M ED MOD HIGH SURG	$952.00	$1,190.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 E/M ER Level 4 Fac	$1,428.00	$1,785.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER Visit Level 5 Physician	$1,440.00	$1,800.00	—	28% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 E/M ER Level 5 ER	$2,068.00	$2,585.00	—	4% above	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER Visit Level 5 Physician	$1,440.00	$1,800.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 E/M ER Level 5 ER	$2,068.00	$2,585.00	—	—	20%
Eye exam, returning patient, intermediate CPT 92012 INTERM. OPHTH. SERVICE, EST PT	$176.00	$220.00	—	24% above	20%
Family therapy with the patient, 50 minutes CPT 90847 PSYCHOTHERAPY FAM PT PRESENT	$436.00	$545.00	—	111% above	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 PSYCHOTHERAPY FAM PT PRESENT	$436.00	$545.00	—	—	20%
Family therapy without the patient, 50 minutes CPT 90846 PSYCHOTHERAPY FAM NO PT PRESNT	$240.00	$300.00	—	28% above	20%
Family therapy without the patient, 50 minutes inpatient CPT 90846 PSYCHOTHERAPY FAM NO PT PRESNT	$240.00	$300.00	—	—	20%
Group psychotherapy session CPT 90853 PSYCHOTHERAPY GROUP	$152.00	$190.00	—	16% above	20%
Group psychotherapy session inpatient CPT 90853 PSYCHOTHERAPY GROUP	$152.00	$190.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION 1ST 31-60 MINS OP	$488.00	$610.00	—	48% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION 1ST 31-60 MINS OP	$488.00	$610.00	—	—	20%
IV infusion of a medicine, first hour CPT 96365 IV INIT DRG 1ST 16-60MIN ER	$544.00	$680.00	—	42% above	20%
IV infusion of a medicine, first hour CPT 96365 IV INIT DRG 1ST 16-60MIN Hosp	$544.00	$680.00	—	42% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INIT DRG 1ST 16-60MIN ER	$544.00	$680.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INIT DRG 1ST 16-60MIN Hosp	$544.00	$680.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM/SQ EA INJ FPC	$120.00	$150.00	—	18% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection IM/SQ Ea RHC	$120.00	$150.00	—	18% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM/SQ EA ER	$212.00	$265.00	—	108% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM/SQ EA INPT	$212.00	$265.00	—	108% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM/SQ EA Outpt	$212.00	$265.00	—	108% above	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM/SQ EA INJ FPC	$120.00	$150.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection IM/SQ Ea RHC	$120.00	$150.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM/SQ EA Outpt	$212.00	$265.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM/SQ EA ER	$212.00	$265.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM/SQ EA INPT	$212.00	$265.00	—	—	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PYSCH DIAGNOS EVAL	$240.00	$300.00	—	at median	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PYSCH DIAGNOS EVAL	$240.00	$300.00	—	—	20%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular	$104.00	$130.00	—	7% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular	$104.00	$130.00	—	7% above	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular	$104.00	$130.00	—	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT Neuromuscular	$104.00	$130.00	—	—	20%
New patient office visit, about 30 minutes CPT 99203 E/M NEW PT LEVEL 3 PHYS	$200.00	$250.00	—	13% above	20%
New patient office visit, about 30 minutes CPT 99203 E/M New Pt Level 3 RHC	$220.00	$275.00	—	24% above	20%
New patient office visit, about 30 minutes CPT 99203 E/M NEW PT LEVEL 3 FM	$220.00	$275.00	—	24% above	20%
New patient office visit, about 30 minutes CPT 99203 E/M NEW PT LEVEL 3 BH	$220.00	$275.00	—	24% above	20%
New patient office visit, about 30 minutes CPT 99203 E&M LEVEL 3, NEW PT	$224.00	$280.00	—	26% above	20%
New patient office visit, about 30 minutes CPT 99203 E/M NEW PT LVL 3 FAC	$276.00	$345.00	—	55% above	20%
New patient office visit, about 30 minutes CPT 99203 E/M NEW PT LEVEL 3 SC	$476.00	$595.00	—	168% above	20%
New patient office visit, about 30 minutes inpatient CPT 99203 E/M NEW PT LEVEL 3 PHYS	$200.00	$250.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 E/M NEW PT LEVEL 3 FM	$220.00	$275.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 E/M New Pt Level 3 RHC	$220.00	$275.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 E/M NEW PT LEVEL 3 BH	$220.00	$275.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 E/M NEW PT LVL 3 FAC	$276.00	$345.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 E/M NEW PT LEVEL 3 SC	$476.00	$595.00	—	—	20%
New patient office visit, about 45 minutes CPT 99204 E/M NEW PT LVL 4 FAC	$312.00	$390.00	—	24% above	20%
New patient office visit, about 45 minutes CPT 99204 E/M NEW PT LEVEL 4 BH	$324.00	$405.00	—	28% above	20%
New patient office visit, about 45 minutes CPT 99204 E/M New Pt Level 4 RHC	$324.00	$405.00	—	28% above	20%
New patient office visit, about 45 minutes CPT 99204 E/M NEW PT LEVEL 4 FM	$324.00	$405.00	—	28% above	20%
New patient office visit, about 45 minutes CPT 99204 E&M LEVEL 4, NEW PT	$336.00	$420.00	—	33% above	20%
New patient office visit, about 45 minutes CPT 99204 E/M NEW PT LEVEL 4 PHYS	$340.00	$425.00	—	35% above	20%
New patient office visit, about 45 minutes CPT 99204 E/M NEW PT LEVEL 4 SC	$652.00	$815.00	—	159% above	20%
New patient office visit, about 45 minutes inpatient CPT 99204 E/M NEW PT LVL 4 FAC	$312.00	$390.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 E/M New Pt Level 4 RHC	$324.00	$405.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 E/M NEW PT LEVEL 4 FM	$324.00	$405.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 E/M NEW PT LEVEL 4 BH	$324.00	$405.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 E/M NEW PT LEVEL 4 PHYS	$340.00	$425.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 E/M NEW PT LEVEL 4 SC	$652.00	$815.00	—	—	20%
New patient office visit, about 60 minutes CPT 99205 E/M NEW PT LEVEL 5 SC	$360.00	$450.00	—	6% above	20%
New patient office visit, about 60 minutes CPT 99205 E/M NEW PT LVL 5 FAC	$404.00	$505.00	—	19% above	20%
New patient office visit, about 60 minutes CPT 99205 E/M New Pt Level 5 RHC	$412.00	$515.00	—	21% above	20%
New patient office visit, about 60 minutes CPT 99205 E/M NEW PT LEVEL 5 FM	$412.00	$515.00	—	21% above	20%
New patient office visit, about 60 minutes CPT 99205 E/M NEW PT LEVEL 5 BH	$420.00	$525.00	—	23% above	20%
New patient office visit, about 60 minutes CPT 99205 E/M NEW PT LEVEL 5 PHYS	$444.00	$555.00	—	31% above	20%
New patient office visit, about 60 minutes inpatient CPT 99205 E/M NEW PT LEVEL 5 SC	$360.00	$450.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 E/M NEW PT LVL 5 FAC	$404.00	$505.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 E/M New Pt Level 5 RHC	$412.00	$515.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 E/M NEW PT LEVEL 5 FM	$412.00	$515.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 E/M NEW PT LEVEL 5 BH	$420.00	$525.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 E/M NEW PT LEVEL 5 PHYS	$444.00	$555.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 E/M NEW PT LEVEL 2 FPC	$128.00	$160.00	—	16% below	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 E/M NEW PT LEVEL 2 PHYS	$136.00	$170.00	—	10% below	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 ANES E/M New Pt Level 2 SC	$136.00	$170.00	—	10% below	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 E&M LEVEL 2, NEW PT	$144.00	$180.00	—	5% below	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 E/M New Pt Level 2 RHC	$152.00	$190.00	—	at median	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 E/M NEW PT LEVEL 2 BH	$152.00	$190.00	—	at median	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 E/M NEW PT LEVEL 2 SC	$188.00	$235.00	—	24% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 E/M NEW PT LVL 2 FAC	$244.00	$305.00	—	61% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 E/M Anesthesia New Pt Lev 2	$380.00	$475.00	—	150% above	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 E/M NEW PT LEVEL 2 FPC	$128.00	$160.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 E/M NEW PT LEVEL 2 PHYS	$136.00	$170.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 ANES E/M New Pt Level 2 SC	$136.00	$170.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 E/M NEW PT LEVEL 2 BH	$152.00	$190.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 E/M New Pt Level 2 RHC	$152.00	$190.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 E/M NEW PT LEVEL 2 SC	$188.00	$235.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 E/M NEW PT LVL 2 FAC	$244.00	$305.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 E/M Anesthesia New Pt Lev 2	$380.00	$475.00	—	—	20%
Occupational therapy evaluation, low complexity CPT 97165 OT Eval Low Complexity	$260.00	$325.00	—	20% above	20%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT Eval Low Complexity	$260.00	$325.00	—	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT Eval High Complexity	$344.00	$430.00	—	24% above	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT Eval High Complexity	$344.00	$430.00	—	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Eval Low Complexity	$252.00	$315.00	—	15% above	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT Eval Low Complexity	$252.00	$315.00	—	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Eval Moderate Complexity	$296.00	$370.00	—	23% above	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT Eval Moderate Complexity	$296.00	$370.00	—	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Ea 15 Mins	$116.00	$145.00	—	65% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Ea 15 Mins	$116.00	$145.00	—	65% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Ea 15 Mins	$116.00	$145.00	—	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Ea 15 Mins	$116.00	$145.00	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeut Exer Ea 15 Min	$84.00	$105.00	—	10% below	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Proc Ea 15 Mins	$84.00	$105.00	—	10% below	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeut Exer Ea 15 Min	$84.00	$105.00	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Proc Ea 15 Mins	$84.00	$105.00	—	—	20%
Preventive checkup, new patient aged 18–39 CPT 99385 New Prevent Visit Pt 18-39 Yrs	$268.00	$335.00	—	149% above	20%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 New Prevent Visit Pt 18-39 Yrs	$268.00	$335.00	—	—	20%
Preventive checkup, new patient aged 40–64 CPT 99386 E/M PREVNT EXM NW PT AGE 40-64	$280.00	$350.00	—	161% above	20%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 E/M PREVNT EXM NW PT AGE 40-64	$280.00	$350.00	—	—	20%
Preventive checkup, new patient aged 65 or older CPT 99387 E/M PREVNT EXM NW PT AGE >64	$292.00	$365.00	—	142% above	20%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 E/M PREVNT EXM NW PT AGE >64	$292.00	$365.00	—	—	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 SPORTS PHYSICAL PT 18-39	$124.00	$155.00	—	53% above	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 EXAM ADULT 18-39 YEARS	$212.00	$265.00	—	161% above	20%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 SPORTS PHYSICAL PT 18-39	$124.00	$155.00	—	—	20%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 EXAM ADULT 18-39 YEARS	$212.00	$265.00	—	—	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 EXAM ADULT 40-64 YEARS	$212.00	$265.00	—	97% above	20%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 EXAM ADULT 40-64 YEARS	$212.00	$265.00	—	—	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 PREVENTIVE CARE 65 YEARS FM	$240.00	$300.00	—	99% above	20%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PREVENTIVE CARE 65 YEARS FM	$240.00	$300.00	—	—	20%
Psychiatric evaluation with medical services CPT 90792 PYSCH DIAGNOS EVAL W/MED SERV	$240.00	$300.00	—	13% below	20%
Psychiatric evaluation with medical services inpatient CPT 90792 PYSCH DIAGNOS EVAL W/MED SERV	$240.00	$300.00	—	—	20%
Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY 30 MINUTES	$212.00	$265.00	—	48% above	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY 30 MINUTES	$212.00	$265.00	—	—	20%
Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY 45 MINUTES	$244.00	$305.00	—	15% above	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY 45 MINUTES	$244.00	$305.00	—	—	20%
Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHERAPY 60 MINUTES	$284.00	$355.00	—	1% above	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY 60 MINUTES	$284.00	$355.00	—	—	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking Counseling 3-10min RHC	$36.00	$45.00	—	10% above	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking Counseling 3-10mins FP	$36.00	$45.00	—	10% above	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Smoking Counseling 3-10mins FP	$36.00	$45.00	—	—	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Smoking Counseling 3-10min RHC	$36.00	$45.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E/M EST PT LEVEL 5 PHYS	$288.00	$360.00	—	19% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E/M Established Pt Level 5 RHC	$332.00	$415.00	—	38% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E/M EST PT LEVEL 5 FM	$332.00	$415.00	—	38% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E/M EST PT LEVEL 5 BH	$332.00	$415.00	—	38% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E/M EST PT LVL 5 FAC	$352.00	$440.00	—	46% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E/M EST PT LEVEL 5 SC	$640.00	$800.00	—	165% above	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E/M EST PT LEVEL 5 PHYS	$288.00	$360.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E/M Established Pt Level 5 RHC	$332.00	$415.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E/M EST PT LEVEL 5 FM	$332.00	$415.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E/M EST PT LEVEL 5 BH	$332.00	$415.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E/M EST PT LVL 5 FAC	$352.00	$440.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E/M EST PT LEVEL 5 SC	$640.00	$800.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E/M Established Pt Level 3 RHC	$172.00	$215.00	—	18% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E/M EST PT LEVEL 3 FM	$172.00	$215.00	—	18% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E/M EST PT LEVEL 3 BH	$180.00	$225.00	—	23% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M LEVEL 3, EST PT	$184.00	$230.00	—	26% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E/M EST PT LEVEL 3 Surg	$212.00	$265.00	—	45% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E/M EST PT LVL 3 FAC	$244.00	$305.00	—	67% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E/M EST PT LEVEL 3 SC	$456.00	$570.00	—	212% above	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E/M EST PT LEVEL 3 FM	$172.00	$215.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E/M Established Pt Level 3 RHC	$172.00	$215.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E/M EST PT LEVEL 3 BH	$180.00	$225.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E/M EST PT LEVEL 3 Surg	$212.00	$265.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E/M EST PT LVL 3 FAC	$244.00	$305.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E/M EST PT LEVEL 3 SC	$456.00	$570.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E/M EST PT LEVEL 4 PHYS	$248.00	$310.00	—	38% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E&M LEVEL 4, EST PT	$256.00	$320.00	—	42% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E/M EST PT LEVEL 4 FM	$260.00	$325.00	—	45% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E/M EST PT LVL 4 FAC	$260.00	$325.00	—	45% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E/M EST PT LEVEL 4 BH	$260.00	$325.00	—	45% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E/M Established Pt Level 4 RHC	$260.00	$325.00	—	45% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E/M EST PT LEVEL 4 SC	$508.00	$635.00	—	183% above	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E/M EST PT LEVEL 4 PHYS	$248.00	$310.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E/M EST PT LVL 4 FAC	$260.00	$325.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E/M Established Pt Level 4 RHC	$260.00	$325.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E/M EST PT LEVEL 4 BH	$260.00	$325.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E/M EST PT LEVEL 4 FM	$260.00	$325.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E/M EST PT LEVEL 4 SC	$508.00	$635.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E/M EST PT LEVEL 2 PHYS	$88.00	$110.00	—	20% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E/M NEW PT LEVEL 2 BH	$112.00	$140.00	—	2% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E/M LEVEL 2 FM	$112.00	$140.00	—	2% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E/M Established Pt Level 2 RHC	$112.00	$140.00	—	2% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M LEVEL 2, EST PT	$112.00	$140.00	—	2% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E/M EST PT LVL 2 FAC	$200.00	$250.00	—	82% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E/M Established LEVEL 2 SC	$288.00	$360.00	—	161% above	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E/M EST PT LEVEL 2 PHYS	$88.00	$110.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E/M LEVEL 2 FM	$112.00	$140.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E/M Established Pt Level 2 RHC	$112.00	$140.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E/M NEW PT LEVEL 2 BH	$112.00	$140.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E/M EST PT LVL 2 FAC	$200.00	$250.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E/M Established LEVEL 2 SC	$288.00	$360.00	—	—	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 E/M ER Consult Level Phys	$560.00	$700.00	—	164% above	20%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 E/M ER Consult Level Phys	$560.00	$700.00	—	—	20%
Spirometry (breathing test) one side CPT 94010 Spirometry W Graphic Rec RT	$280.00	$350.00	—	38% above	20%
Spirometry (breathing test) inpatient one side CPT 94010 Spirometry W Graphic Rec RT	$280.00	$350.00	—	—	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Act/Body 15Min	$104.00	$130.00	—	1% below	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapy to Imp Funct 15 min	$104.00	$130.00	—	1% below	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Act/Body 15Min	$104.00	$130.00	—	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapy to Imp Funct 15 min	$104.00	$130.00	—	—	20%
Visual field test, extended both sides CPT 92083 VISUAL FIELD, EXTENSIVE, UNILAT OR BILAT	$128.00	$160.00	—	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Washington	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VACCINE (Varivax)	$227.95	$284.94	—	13% above	20%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VACCINE (Varivax)	$227.95	$284.94	—	—	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV NONAVALENT VAC (Gardasil)	$382.86	$478.58	—	41% above	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV NONAVALENT VAC (Gardasil)	$382.86	$478.58	—	—	20%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITS A VACCINE	$55.76	$69.70	—	24% below	20%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITS A VACCINE	$55.76	$69.70	—	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VAC 20 & OVER	$120.00	$150.00	—	46% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VAC 20 & OVER	$120.00	$150.00	—	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles,Mumps,Rubella (M-M-R)	$132.00	$165.00	—	23% below	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Measles,Mumps,Rubella (M-M-R)	$132.00	$165.00	—	—	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL VACCINE	$215.63	$269.54	—	12% above	20%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL VACCINE	$215.63	$269.54	—	—	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MenB-4C (Bexsero) SL	$306.80	$383.50	—	13% below	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MenB-4C (Bexsero) SL	$306.80	$383.50	—	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV23 (Pneumovax23)	$104.00	$130.00	—	34% below	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal 23 Vaccine RHC	$332.00	$415.00	—	110% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PPSV23 (Pneumovax23)	$104.00	$130.00	—	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal 23 Vaccine RHC	$332.00	$415.00	—	—	20%
Rabies vaccine, one dose CPT 90675 RABIES IMMGLOB IM SOL150 IU/mL	$1,431.58	$1,789.48	—	126% above	20%
Rabies vaccine, one dose inpatient CPT 90675 RABIES IMMGLOB IM SOL150 IU/mL	$1,431.58	$1,789.48	—	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus/Diptheria (Tenivac)	$57.82	$72.28	—	11% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus/Diptheria (Tenivac)	$57.82	$72.28	—	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap 7 Years and Up (Boostrix)	$166.40	$208.00	—	101% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tdap 7 Years and Up (Boostrix)	$166.40	$208.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin pneumococcal Vaccine	$36.00	$45.00	—	24% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Influenza Virus Vaccine	$36.00	$45.00	—	24% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Administration of Vaccine	$84.00	$105.00	—	77% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Administration RHC	$84.00	$105.00	—	77% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION	$104.00	$130.00	—	120% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Admin pneumococcal Vaccine	$36.00	$45.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Admin Influenza Virus Vaccine	$36.00	$45.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Administration RHC	$84.00	$105.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Administration of Vaccine	$84.00	$105.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION	$104.00	$130.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMINS OF VACCINE ADDL	$32.00	$40.00	—	21% below	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADMINS OF VACCINE ADDL	$32.00	$40.00	—	—	20%

Dental

Procedure	Cash price	List price	Insurers pay	vs Washington	Off list
Deep cleaning (scaling and root planing), 4 or more teeth in one quadrant CDT D4341 periodontal scaling and root planing - four or more teeth per quadrant	$135.20	$169.00	—	at median	20%
Dental implant, surgical placement CDT D6010 surgical placement of implant body: endosteal implant	$1,299.20	$1,624.00	—	—	20%
Porcelain crown CDT D2740 crown - porcelain/ceramic	$717.60	$897.00	—	23% above	20%
Removal of an impacted tooth fully covered by bone, often a wisdom tooth CDT D7240 removal of impacted tooth - completely bony	$278.40	$348.00	—	95% below	20%
Root canal treatment on a molar (back tooth), not including the final crown CDT D3330 endodontic therapy, molar tooth (excluding final restoration)	$676.80	$846.00	—	—	20%
Routine teeth cleaning (prophylaxis), adult or teen CDT D1110 prophylaxis - adult	$68.00	$85.00	—	—	20%
Simple extraction of a tooth or exposed root that is above the gum CDT D7140 extraction, erupted tooth or exposed root (elevation and/or forceps removal)	$80.80	$101.00	—	90% below	20%

Source file: https://kvhealth.net/files/916001738_klickitat_county_public_hospital_district_no_1_standardcharges.json